(From the ISHN Member information service) ISHN has started two international discussion groups focused on new approaches to school health promotion and development. (www.schools-for-all.org - Select Discussion Groups) Our Implementation/Capacity group has included the concepts of senior leadership and shared vision as part of the capacities need to implement and sustain comprehensive SH approaches. The Integration within Education group has started a global dialogue with global educator organizations to emphasize that health programs need to work within the core mandates, constraints and concerns of school systems. It is heartening to see research that confirms such topics that are included in the knowledge development agendas of these two ISHN initiatives. An article in Issue #2, 2015 of Health Education Journal reports on a small study in Nova Scotia that examined the variance of implementation in nine schools. "The results revealed that schools assembled into three sequential categories based on the functioning of theoretical components. Higher level visioning and school-level leadership were critical in sustaining the adoption and implementation of HPS across schools and appeared to enable and integrate organisational processes, such as distributed leadership and a collaborative school culture, to enhance HPS implementation at school level. This study confirmed other reports that it is imperative to integrate HPS work with educational values so as to enable partnerships in both the health and education sectors, thereby promoting both health and prosperity among students." Read more>>
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(From the ISHN Member information service) An article in the March 2015 Issue of Preventing Chronic Disease reports on a detailed study. "We quantified the moderate-to-vigorous physical activity (MVPA, heart rate ≥140 bpm) of urban public elementary school children on school days with and schooldays without physical education (PE) class by using continuous heart rate monitoring. The heart rate of 81 students (93.8% black) in grades 3 and 5 was recorded in 15-second intervals. On the basis of 575 school-day observations (mean 7.1 days/student), students accumulated 44.4 minutes of MVPA on days with PE and 30.6 MVPA minutes on days without PE (P < .001)" On average, students accumulated 17.1 MVPA minutes during a 50-minute PE class. Recess contributed an average 5.5 MVPA minutes each school day, with no difference between days with and days without PE." These results are similar to other studies we have noted in our SH blog. The authors argue that PE should be mandatory every day based on these results. We suggest that other, less costly alternatives might be considered such as PA breaks in regular classes, more actual activity within PE classes and an expanded range of activity during recess. We also need to examine the actual health gains from these squeezed out minutes. Read more>>
(From the ISHN Member information service) ISHN has recent published several Commentaries on the value of Random Controlled Trials (RCT's) in health promotion/social development. Two articles in Issue #1, 2015 of Global Health: Science & Practice continues this discussion. The first article "takes issue with Shelton's (The Editor of the Journal) previous article that “randomized controlled trials (RCTs) have limited utility for public health” They argue that "setting RCTs in opposition to other systematic approaches for generating knowledge creates a false dichotomy, and it distracts from the more important question that Shelton addresses—namely, which research method is best suited for the question at hand?" They conclude with the traditional defence of RCT's that "It is imperative for public health practitioners to answer definitively, “Does it work?” before asking, “How can it be made to work practicably at scale?” In the rebuttal article, the author states that "“Does it work” is always affected by context. The paradigm Hatt et al. put forward asserts that one strength of randomized trials is to answer definitively, “Does it work?” But for the kinds of complex programs public health must muster, there is generally no absolute answer to that question" This article states that "RCTs are only one piece of the picture in triangulating evidence for public health programming." but, he also goes on to say that "While I really do appreciate randomized studies, perhaps my biggest concern is the “hierarchy” whereby some colleagues place controlled trials at the top of a pyramid as manifestly the best evidence. For understanding public health programming, I see that as quite misguided. Randomized studies help us to understand some things, but they are only one piece of the picture in “triangulating” evidence for programming. And evidence from real-world programming is especially key." Read more>>
(From the ISHN Member information service) Teachers' perspectives of supporting pupils with long-term health conditions in mainstream schools are reported in an articles in Issue #2, 2015 of Health & Social Care in the Community. The narrative review of the literature found that " teachers receive little formal training relevant to long-term condition management and are fearful of the risks involved in teaching children and young people with long-term conditions. Communication between families, school and health and social care services appears to be poor. Educational programmes developed in conjunction with and/or delivered by healthcare professionals seem to have the potential to increase teachers' knowledge and confidence. This review suggests that healthcare professionals have an important role to play in supporting teachers in identifying and meeting the needs of pupils with long-term conditions. It is vital that pupils with long-term conditions receive appropriate care and support in schools to ensure their safety and help them to integrate with their peers and achieve their academic potential. Limitations in the current evidence are highlighted and implications for future research are identified." Read more>>
(From the ISHN Member information service) A study examining the correlates of Portuguesechildren reaching the recommended 60 minutes per day of moderate or vigorous activity reveals that several factors may be beyond the reach of the school. As well, the goal of 60 minutes per day appears to be aspirational in nature. The authors report that " Physical activity (PA) was objectively assessed by accelerometry throughout seven days on 777 children. A count model using Poisson regression was used to identify the best set of correlates that predicts the variability in meeting the guidelines. Only 3.1% of children met the recommended daily 60 min of MVPA for all seven days of the week. Further, the Cochrane–Armitage chi-square test indicated a linear and negative trend (p < 0.001) from none to all seven days of children complying with the guidelines. The count model explained 22% of the variance in meeting MVPA guidelines daily. Being a girl, having a higher BMI, belonging to families with higher income, sleeping more and taking greater time walking from home to a sporting venue significantly reduced the probability of meeting daily recommended MVPA across the seven days. Furthermore, compared to girls, increasing sleep time in boys increased their chances of compliance with the MVPA recommendations. These results reinforce the relevance of considering different covariates’ roles on PA compliance when designing efficient intervention strategies to promote healthy and active lifestyles in children." Read More>>
(From the ISHN Member information service) With Spring finally here in the northern hemisphere, this item about flowers might be of interest. Two articles in March 2015 Issue of International Journal of Environmental Research and Public Health report on studies examining the impact of plants and flowers on children and youth. The first study was " implemented with Portuguese students and consisted of several activities, exploring pre-existent Scientific Gardens at the School, aiming to investigate the antibacterial, antitumor and anti-inflammatory properties of plant extracts. This project increased the knowledge about autochthonous plants and the potential medical properties of the corresponding plant extracts and increased the awareness about the correct design of scientific experiments and the importance of the use of experimental models of disease. The students regarded their experiences as exciting and valuable and believed that the project helped to improve their understanding and increase their interest in these subjects". The second "study aimed to clarify the physiological and psychological effects on high school students of viewing real and artificial pansies. Forty high school students (male: 19, female: 21) at Chiba Prefectural Kashiwanoha Senior High School, Japan, participated in this experiment. The subjects were presented with a visual stimulation of fresh yellow pansies in a planter for 3 min. Artificial yellow pansies in a planter were used as the control. Compared with artificial pansies, visual stimulation with real flowers resulted in a significant decrease in the ratio of low- to high-frequency heart rate variability component, which reflects sympathetic nerve activity. In contrast, high frequency, which reflects parasympathetic nerve activity, showed no significant difference. With regard to the psychological indices, viewing real flowers resulted in “comfortable”, “relaxed”, and “natural” feelings." Read more>>
(From the ISHN Member information service) An excellent illustration of a procedure to select evidence-based interventions to promote health is described in Issue #1, 2015 of Environmental Health Review. ISHN recommends the use of this type of planning tool but also suggests that, despite the rigour within this procedure used to select relevant research on better practices, other steps need to be taken to test our underlying assumptions before we begin as well as use our common sense in assessing the fit between the planned intervention and our local context, especially in regards to likely barriers that may be prevalent in our local communities, states or countries.
The illustration used in the journal article is focused on an urban setting, wherein the public health practitioners are looking for urban planning interventions to increase physical activity among children and adults in the community in response to rising obesity rates. The article takes the reader through several planning steps to identify such urban planning tools, eventually pointing to a credible research review published by the CDC in the United States that suggest that "Community-scale urban design and land-use regulations, policies, and practices" such as zoning regulations and building codes, and environmental changes brought about by government policies or builders’ practices. The latter include policies encouraging transit-oriented development, and policies addressing street layouts, the density of development, the location of more stores, jobs and schools within walking distance of where people live as well as "street-scale urban design and land use approaches" in small geographic areas, generally limited to a few blocks, such as improved street lighting or infrastructure projects that increase the ease and safety of street crossing, ensure sidewalk continuity, introduce or enhance traffic calming such as center islands or raised crosswalks, or enhance the aesthetics of the street area, such as landscaping can improve levels of physical activity. Once these two types of interventions are identified in the procedure, the remaining steps suggest the involvement of stakeholders, program development and building in evaluation and feedback mechanisms. One section of the procedure suggests "Assessing Applicability and Transferability of Evidence" but the focus in that section is on how the knowledge about the intervention can be transferred successfully to policy-makers and practitioners and mentions real-barriers related to feasibility such as costs, resources and other practical factors only briefly. We suggest here that this excellent illustration of a procedure to select an intervention to address a problem needs to be accompanied by at least three other processes. The first of these is to test our assumptions about the type of outcome we are seeking. The illustration in this article, where the fictional planners decide in advance that increased physical activity can prevent or reduce obesity and overweight is actually reflective of many real-life planners, who have done the same. The trouble is that there is increasing evidence, including from sources such as the CDC and the centre which has published this guide to selecting interventions, that increased physical activity alone, will have little impact on body weight unless it is very intense, well beyond the scope of the average person. The second process we suggest is a real hard look at the resources available in the community or organization. The research reviews identified in the article did note these barriers in their study. The barriers to community scale interventions include "1) changing how cities are built given that the urban landscape changes relatively slowly, 2) zoning regulations that preclude mixed-use neighborhoods, 3) cost of remodeling/retrofitting existing communities, 4) lack of effective communication between different professional groups (i.e., urban planners, architects, transportation engineers, public health professionals, etc.), and 5) changing behavioral norms directed towards urban design, lifestyle, and physical activity patterns" The real world barriers to street scale changes include: "the expense of changing existing streetscapes. In addition, street-scale urban design an land use policies require careful planning and coordination between urban planners, architects, engineers, developers, and public health professionals. Success is greatly enhanced by community buy-in, which can take time and effort to achieve. Inadequate resources and lack of incentives for improving pedestrian-friendliness may affect how completely and appropriately interventions are implemented and evaluated". The article suggests that the local context is an established urban setting. In most established cities, it is very difficult to make major changes in existing neighbourhoods, especially in these days where priority concerns might very well be crime, traffic and aging infrastructure. This real world observation leads us to the third major consideration that should be used in conjunction with this procedure to select evidence-based interventions. The third consideration needs to be an in-depth understanding of the core mandates, constraints and current concerns of the system that will carry the major part of the burden in implementing the intervention. In this case, it is the municipality. There are lots of examples of how such systems analysis can be done, but we close this ISHN Commentary with an appropriate example, also found by the same centre that has created this procedure for identifying evidence-based interventions. This systems planning guide that they suggest is from the province of Alberta, which suggests that program planners consider the characterisitcs of the system that will will host the intervention. These include the leadership, organization "slack" in committed vs available resources, staffing, time for implementation and more. In school health promotion, ISHN is pleased to be pat of a global dialogue being led by educators in regards to how health and social programs can be better integrated within education systems. We suggest that before we select an intervention from the research, we seek to truly understand the system that will carry the intervention over the long term. We also suggest we look closely ar practical barriers and that we check our assumptions. Read more>> (From the ISHN Member information service) Recently we have been discussing the value and limits of Random Control Trials (RCT) and subsequent systematic reviews based on those trials. Although it does not discuss school-related programs directly, an article the February 2015 issue of Children and Youth Services Review continues this discussion, noting the need to control or at least accurately describe the control groups used in comparison with the intervention being tested. The authors ask if "Does allocation to a control condition in a Randomized Controlled Trial affect the routine care foster parents receive? And, of course, the answer is yes. "Strengthening Foster parents in Parenting’ (SFP) is a support program for foster parents who care for foster children with externalizing problem behavior. Its effectiveness was examined with a Randomized Controlled Trial (RCT). In this paper, we examine the treatment as usual (TAU) that was offered in the control condition of this RCT. For this purpose, the TAU from the SFP control group was compared with TAU provided to a similar group of foster parents outside any RCT. Our results show that TAU is diverse and varies widely. Furthermore, being part of the control condition was positively associated with both the counseling frequency from the foster care services and with external help-seeking behavior (finding and using additional support). In order to prevent condition contamination in future trials, TAU should be clearly described and standardized, and treatment fidelity should be carefully monitored." We suspect that this natural inclination to improve performance while being part of a research study will also affect school-based studies. Further, as the authors note (and as we have commented before, the Treatment As Usual" condition, even as is, may actually be quite close to the intervention being tested. Read more>>
(From the ISHN Member information service) An article in Issue #3, 2015 of the Journal of Sex research reports on a study in the Netherlands that examined the impact of parent-teen communications on sexual health behaviours. The researchers found that more frequent communications affected some but not all adolescent behaviours. "A nationally representative sample of parent–adolescent dyads (N = 2,965; mean adolescent age = 13.8 years) in the Netherlands was employed to examine the frequency of parent–adolescent sexual communication and its association with adolescent sexual behaviors (defined as sexual initiation, condom use, and contraceptive pill use). Nine communication topics in the areas of anatomy, relationships and rights, and protection and contraception were examined. In all, 75%of parents reported having discussed at least one topic multiple times with their adolescents. Romantic relationships were discussed most frequently. Hierarchical logistic regression analyses indicated that parent–adolescent sexual communication on protection and contraception was positively associated with adolescent sexual initiation and contraceptive pill use but not condom use. This may reflect that adolescents, when they become sexually active, are more likely to discuss sexuality with their parents. Findings are interpreted within the context of Dutch culture, which is generally accepting of adolescent sexuality and characterized by open sexual communication." Read more>>
(From the ISHN Member information service) A systematic review and meta-analyses of parent-based adolescent sexual health interventions reports that they have an effect on communication outcomes. The article appears in Issue #1, 2015 of Perspectives on Sexual and Reproductive Health. "A systematic search of databases for the period 1998–2013 identified 28 published trials of U.S. parent-based interventions to examine theory use, setting, reach, delivery mode, dose and effects on parent–child communication. Established coding schemes were used to assess use of theory and describe methods employed to achieve behavioral change; intervention effects were explored in meta-analyses. Most interventions were conducted with minority parents in group sessions or via self-paced activities; interventions averaged seven hours, and most used theory extensively. Meta-analyses found improvements in sexual health communication: Analysis of 11 controlled trials indicated a medium effect on increasing communication (Cohen's d, 0.5), and analysis of nine trials found a large effect on increasing parental comfort with communication (0.7); effects were positive regardless of delivery mode or intervention dose. Intervention participants were 68% more likely than controls to report increased communication and 75% more likely to report increased comfort. These findings point to gaps in the range of programs examined in published trials—for example, interventions for parents of sexual minority youth, programs for custodial grandparents and faith-based services. Yet they provide support for the effectiveness of parent-based interventions in improving communication. Innovative delivery approaches could extend programs’ reach, and further research on sexual health outcomes would facilitate the meta-analysis of intervention effectiveness in improving adolescent sexual health behaviors." Read more>>
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