(An item from the ISHN Member information service)  School-focused research on the impact of normative beliefs on youth tobacco, alcohol and drug use has led to extensive discussions about "normative education" which focuses on transmitting beliefs about normative behaviours (eg most people do not smoke). Two articles in Issue #5, 2015 of Environment & Behavior report that even manipulated information about normative behaviours can have a positive impact on behaviours. Although both articles refer to studies of adult behaviours (use of cars for commuting and the use of bottled water), the results were the same. The participants in the two intervention groups did choose the healthier option. Read more>>

(An item from the ISHN Member information service)  An article in Issue #6, 2015 of Journal of Health Psychology reports on a small study of tThe impact of a school-based gardening intervention on intentions and behaviour related to fruit and vegetable consumption in children. The results of this singke school study are positive but the explanation of the result is equally interesting. The Theory of Planned Behaviour was used to explain the results. "Measures of the Theory of Planned Behaviour and fruit and vegetable consumption were taken pre- and post-intervention. Repeated measures analysis of variance and hierarchical regression analysis indicated that the intervention group increased daily consumption of fruits and vegetables and increased intentions, attitudes, norms, and perceived behavioural control related to fruit and vegetable consumption. Attitudes, norms and perceived behavioural control significantly predicted changes in fruit and vegetable consumption." It is this combination knowledge, practical experience, changes in attitudes, intentions, percveptions of control/health beliefs and the other aspects listed in the article that we need to consider more often. Read more>>

(From the ISHN Member information service) Regular readers of this blog will know that we have lamented the confusing presentations and ensuing studies about resilience that have emerged over recent years. Finally, an article and commentary in in the January 2015 Issue of Journal of Child Psychology and Psychiatry present a definition that does not lose the necessary, direct connection with adversity and presents both individual and environmental factors as well as their complex interactions. " This article presents diagnostic criteria for assessing childhood resilience in a way that is sensitive to the systemic factors that influence a child's wellbeing.A multidimensional assessment of resilience is presented that examines, first, the severity, chronicity, ecological level, children's attributions of causality, and cultural and contextual relevance of experiences of adversity. Second, promotive and protective factors related to resilience are assessed with sensitivity to the differential impact these have on outcomes depending on a child's level of exposure to adversity. These factors include individual qualities like temperament, personality, and cognitions, as well as contextual dimensions of positive functioning related to the available and accessibility of resources, their strategic use, positive reinforcement by a child's significant others, and the adaptive capacity of the environment itself. Third, an assessment of resilience includes temporal and cultural factors that increase or decrease the influence of protective factors. A decision tree for the diagnosis of resilience is presented, followed by a case study and diagnosis of a 15-year-old boy who required treatment for a number of mental health challenges." The commentary in the same issue notes: "Yet resilience approaches have been limited by a lack of conceptual clarity and ongoing questions about how to assess and measure it. In this context, Michael Ungar's Practitioner Review is an important contribution to practice". Read more>> 

(From the ISHN Member information service)  In our extensive monitoring of the research, we find that the now-popular "ecological approach" is more often actually applied in the "analysis" stage, identifying the complex, multiple and multi-level influences on behaviour and practice, rather than being actually used in the "action" stage, where the approach is used to organize and deliver a planned variety of interventions to affect the multiple influences. We are pleased to read the article in the August 2014 issue of International Journal of Behavioral Nutrition & Physical Activity, which reports on a superb application of the ecological approach in 15 elementary schools in Mexico. The authors report that "Thirty-two distinct intervention strategies were implemented in one setting (i.e., school) to engage four different target-groups (students, parents, school representatives, government) across two domains (Nutrition and Physical Activity). Overall, 47.5% of the strategies targeted the school infrastructure and/or personnel; 37.5% of strategies targeted a key political actor, the Public Education Secretariat while fewer strategies targeted parents (12.5%) and children (3%). More strategies were implemented in the Nutrition domain (69%) than Physical Activity (31%). The most frequently used SCT construct within both intervention domains was Reciprocal Determinism (e.g., where changes to the environment influence changes in behavior and these behavioral changes influence further changes to the environment); no significant differences were observed in the use of SCT constructs across domains. Findings provide insight into a promising combination of strategies and theoretical constructs that can be used to implement a school-based obesity prevention program. Strategies emphasized school-level infrastructure/personnel change and strong political engagement." The complete text of the article is available. A full report on the project is also available here.  

A detailed description of the impact of intervention during its two year implementation is provided here. (Note: the results after two years are modest, with small changes in eating habits and some types of physical activity reported. In our view, this reflects the reality that complex, multi-intervention programs need several years in order to be embedded in the school culture as well as to interact with the local neighbourhood and parents/families. Larger, community, media and societal influences are also important. The study did not report any changes to obesity levels. This is consistent with other studies, not only of school programs, that obesity is a problem that is far more challenging than what can be affected by a single setting within the community.  For schools, we should adjust our expectations of the impact of even well-delivered multiple interventions such that students are truly supported by healthy factors while in school and that they graduate with the knowledge, skills, selected attitudes, beliefs and intentions that can be reasonably expected. If an entire society is obsengenic, then we should recognize the limits of the school's influence.  

The authors capture our above assessment of current efforts to implement ecological approaches as follows: " The premise underlying ecological programming is that a multilevel program is likely to be more effective than an individually focused program because it affords the opportunity to encounter the same behavioral prompts (e.g., to be more physically active) from a variety of sources (parents, teachers, coaches) in a variety of settings (home, school, community) [13]-[16]. Therefore, an intervention program that contains diverse strategies to engage several different stakeholders across a range of settings might address the health behavior in a more comprehensive way and thus yield better results than a simpler program (i.e., fewer targets, less settings). Despite its intuitive appeal and an increase in the use of ecological principles for programming to prevent childhood obesity in developed countries [17], optimal (i.e., effective, easy to implement at low cost) combinations of intervention activities to promote healthy lifestyles have yet to be identified. In addition to determining optimal combinations of intervention activities, health promotion practitioners striving to integrate ecological principles into their programs must also strive to develop programs that are theoretically informed. Challenges to theoretical integration include practitioner difficulties in operationalizing and assessing theoretical constructs [18]. The purpose of this study was to assess the integration of ecological principles and theoretical constructs in a school-based obesity prevention program that was successful in creating a supportive environment for healthy behaviors." 

The conclusion to the paper notes that "The aim of this paper was to assess the integration of ecological principles and theoretical constructs involved in a successful school-based obesity prevention program in Mexico City. We sought to unpack the intervention program along intervention domains in order to develop a map of the successful intervention program. If we compare our ecological map with recommendations in the literature [15],[17],[20], we can ascertain that this intervention program was a genuine ecological effort within a single setting since it delivered a diversity of intervention strategies involving multiple targets (POL, ORG, INT, IND), across both intervention domains. The ecological mapping showed that several different targets (PE teachers, school teachers, food vendors, parents, children and the school environment) were engaged, and that these efforts are consistent with those recommended to promote behavior change and to prevent obesity in children [7],[9],[23],[37]-[39]. Overall, our findings are consistent with existing evidence that policy intervention strategies can impact different ecological levels of influence [42]. This may be especially the case for hierarchical institutions such as school systems, where decisions are made at more than one level."


The reflections offered by the researchers are also interesting. "To our knowledge, this is the first research to document the integration of ecological principles and theoretical constructs in a school-based obesity prevention program in Mexico. The deconstruction of a successful intervention program that has documented environmental and student behavior improvements provides novel information for the implementation of multifactorial interventions in school-based health promotion programs. Although there may be a variety of successful combinations of ecological strategies and theoretical constructs, our findings provide one version that can be used as a starting point to develop even more effective combinations. Within the school setting, this ecological combination of strategies emphasizes school and political targets. Moreover, the strategies in both the Nutrition and Physical Activity domains are most commonly underpinned by the theoretical construct of Reciprocal Determinism. In a context where the school environment is considered “obesogenic” and there is compelling evidence that this environment can shape children's eating and PA patterns, the current findings provide valuable insight about the types of strategies that can be leveraged to optimal effects. It is expected that these findings will be especially meaningful to inform obesity prevention programs in Mexico and in low-middle income countries where childhood obesity is an emerging problem."  Read more>>  

(From the ISHN Member information service)  An article in Issue #12, 2014 of the Journal of Interpersonal Violence uses "General Strain" theory to explain and understand interpersonal aggression at school. "Using data from a sample of 296 middle school students in a southwestern state of the United States, this article examined whether different types of strain and negative emotions are positively associated with psychological, physical, and general bullying. Overall findings of negative binomial regression analyses tended to be consistent with our expectations, while some aspects of GST received more empirical support than others. Strains and negative emotions were mostly related positively either to psychological or physical bullying, with negative emotions, anger and depression, partly mediating the strain-bullying relationship." This being the first encounter with strain theories for us, our quick look on the Internet found an excellent Canadian government report examining the roots of violence in response to a school shooting in Ontario. The Appendix on Literature reviews in that report has discussed several such strain theories in relation to school violence. Other sections of that report review school-based and school-linked violence prevention. Read more>>

(From Prevention Plus Wellness) Helping children, adolescents and young adults understand how health risk behaviors and health enhancing behaviors influence each other is critical to them making effective decisions for enhancing their whole health. In particular, youth need to know how substance abuse and health promoting habits affect each other to either enhance or interfere with their physical and mental health, perceived self-image, and achieving important life goals. In the past, health behaviors were viewed as being largely independent of each other. We now know that it is more common for youth to experience a number of co-existing unhealthy behaviors rather than a single behavior problem. These co-occurring behaviors influence each other both directly, as well as indirectly through common underlying risk and protective factors such as self-image and self-regulation skills. Effective prevention programs should therefore help young people identify how multiple areas of their lives interconnect to influence their future health, well-being and happiness. Below we provide some tips for teachers and parents on how to communicate with youth to help them make the connection between substance abuse and healthy behaviors. Read more>>

(An item from ISHN Member information service)  Several articles in the January 2013 issue of the International Journal of Behavioral Nutrition & Physical Activity explain the influence that parents and familiy patterns have on childhood weight and eating. Another article notes that walking to school is correlated with better health. All of these artlcles are good science but rarely extend our knowledge beyond our own common sense. The challenge for researchers is to explain how, when and what can be done to support families with low cost, sustainable interventions. Read more. 

(An item from ISHN Member information service) We have been following articles that discuss behavioural intentions and this latest one indicates that the transparency of BI research may need improvement. An article in the November 2012 issue of Addictions reports on an analysis of BI research studies and " used the Transparent Reporting of Evaluations with Nonrandomized Designs (TREND) Statement to develop the 59-question Adapted TREND Questionnaire (ATQ). Each ATQ question corresponds to a transparency guideline and asks how clearly a study reports its objectives, research design, analytical methods and conclusions". The authors noted that "The average report adhered to 38.4 (65.1%) of the 59 ATQ transparency guidelines. Each of the 59 ATQ questions received positive responses from an average of 16.9 (63.8%) of the reports." They conclude that " Gambling intervention reports need to improve their transparency by adhering to currently neglected and particularly relevant guidelines. Among them are recommendations for comparing study participants who are lost to follow-up and those who are retained, comparing study participants with the target population, describing methods used to minimize potential bias due to group assignment, and reporting adverse events or unintended effects." Given the potential challenges associated with BI and its importance as a tool for school health studies, where behavioural outcomes are expensive to track for more than a few months after the intervention, this article appears very relevant. Read more. 

(An item taken from the daily/weekly/monthly ISHN Member information service) As with many other behaviours, healthy eating is a social construction that is built differently by different people. As we design education and information campaigns, we need to address those different understandings and perceptions. An article in Issue #4, 2012 of the Journal of Nutrition Education and Behavior draws from several qualittative research sources to describe how people perceive and act upon the idea of healthy eating.  The researchers found studies emphasized a social constructionist approach, and most used focus groups and/or individual, in-depth interviews to collect data. Study participants explained healthy eating in terms of food, food components, food production methods, physical outcomes, psychosocial outcomes, standards, personal goals, and as requiring restriction. Researchers described meanings as specific to life stages and different life experiences, such as parenting and disease onset. Identity (self-concept), social settings, resources, food availability, and conflicting considerations were themes in participants’ explanations for not eating according to their ideals for healthy eating. The researchers noted that the implications of these findings are that people interpret healthy eating in complex and diverse ways that reflect their personal, social, and cultural experiences, as well as their environments. Their meanings include but are broader than the food composition and health outcomes considered by scientists. The rich descriptions and concepts generated by qualitative research can help practitioners and researchers think beyond their own experiences and be open to audience members’ perspectives as they seek to promote healthy ways of eating. Read more..