(From the ISHN Member information service)  The WHO fact sheet describing the response of health ministries to prevent and control NCDs indicates the collective, global intentions and strategies. The ideas and actions not mentioned on the page and in the action plan are as important as the ones that are highlighted. WHO summarizes the actions needed as follows:
" To lessen the impact of NCDs on individuals and society, a comprehensive approach is needed that requires all sectors, including health, finance, foreign affairs, education, agriculture, planning and others, to work together to reduce the risks associated with NCDs, as well as promote the interventions to prevent and control them. An important way to reduce NCDs is to focus on lessening the risk factors associated with these diseases. Low-cost solutions exist to reduce the common modifiable risk factors (mainly tobacco use, unhealthy diet and physical inactivity, and the harmful use of alcohol) and map the epidemic of NCDs and their risk factors. Other ways to reduce NCDs are high impact essential NCD interventions that can be delivered through a primary health-care approach to strengthen early detection and timely treatment. Evidence shows that such interventions are excellent economic investments because. The greatest impact can be achieved by creating healthy public policies that promote NCD prevention and control and reorienting health systems. Lower-income countries generally have lower capacity for prevention and control. Countries with inadequate health insurance coverage are unlikely to provide universal access to essential NCD interventions". Our initial comments: (1) The WHO is clearly medical, focused on health services rather than health promotion. (2) The absence of disease is the goal rather than overall health. (3) Other sectors are expected to be partners but a settings-based approach, essential to these partnerships, is neglected and forgotten. Read more>>

(From the ISHN Member information service)  The release of the WHO status report/global action plan this week represents the efforts of health ministries to address a cluster of physical health diseases. The key facts are not new: "(1) NCD's kill 38 million people each year. (2) Almost 3/4 of deaths (28 million) occur in low- and middle-income countries.(3) Sixteen million deaths occur before the age of 70; 82% of these "premature" deaths occur in low/middle-income countries. (4) Cardiovascular diseases account for most deaths, (17.5 million), followed by cancers (8.2 million), respiratory diseases (4 million), and diabetes (1.5 million). These 4 groups of diseases account for 82% of all NCD deaths. Tobacco use, physical inactivity, unhealthy diet and the harmful use of alcohol increase the risk of NCDs. Tobacco accounts for around 6 million deaths every year and is projected to increase to 8 million by 2030. About 3.2 million deaths annually can be attributed to insufficient physical activity. More than half of the 3.3 million annual deaths from harmful drinking are from NCDs In 2010, 1.7 million annual deaths from cardiovascular causes have been attributed to excess salt/s. To lessen the impact of NCDs on individuals and society, a comprehensive approach is needed that requires all sectors, including health, finance, foreign affairs, education, agriculture, planning and others, to work together to reduce the risks associated with NCDs, as well as promote the interventions to prevent and control them.odium intake.More than 190 countries agreed in 2011 to reduce the avoidable NCD burden in a Global action plan. This plan aims to reduce the number of premature deaths from NCDs by 25% by 2025. In 2015, countries will begin to set national targets and measure progress on the 2010 baselines. The UN General Assembly will convene a third high-level meeting on NCDs in 2018 to take stock of national progress. Read more>>

 (From the ISHN Member information service)  An article in the January 2015 issue of Substance Use, Misuse examines the correlation between study sport involvement and the use of drugs and alcohol. The authors report "The empirical research examining the impact of sports participation on alcohol and other drug use has produced mixed results. Part of this problem may be the result of how different types of sports participation create different experiences that shape certain types of behaviors that either facilitate or deter substance use. Objectives. We examined the association between different types of competitive sports participation and substance use among a nationally representative sample of adolescents. Methods: Two recent cross-sections from the Monitoring the Future were merged to capture a large subsection of adolescents who participate in either high-contact sports (football, wrestling, hockey, and lacrosse), semicontact sports (baseball, basketball, field hockey, and soccer), and noncontact sports (cross-country, gymnastics, swimming, tennis, track, and volleyball). Results: Multivariate analyses revealed that adolescents who participated in high-contact sports had higher odds of using substances during the past 30 days and initiating substance use at early ages. Further, adolescents who participated in noncontact sports had lower odds to indicate smoking cigarettes and marijuana during the past 30 days. Read more>>

(From the ISHN Member information service)   Using odds ratio calculations from data from the Canadian HBSC survey, a researcher shows (Vol 66, 2014, Preventive Medicine) that both the perception of safety in a neighbourhood, as well as the actual crime rate, will affect the levels of physical activity among adolescents. However, the article suggests that these are independent variables (with actual crime rates having more impact than perceived safety). Consequently, the author suggests that the reach of PA programs can be improved if we address the perceptions of safety alone. "After controlling for crime and relevant confounders, the relative odds of being physically active outside of school was 0.52 (95% CI: 0.44–0.62) in youth whose perceptions of neighborhood safety were in the lowest quintile. After controlling for perceptions of safety and relevant confounders, the relative odds of being physically active outside of school was 0.75 (0.60–0.95) in youth from neighborhoods with crimes against persons scores in the highest quintile. Within this large sample of 11–15 year olds, perceptions and objective measures of neighborhood safety and crime were independently associated with physical activity in free-time outside of school. 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)  A study reported in Volume 107, 2014 of Social Science & Medicine examined whether "Mothers' work hours are likely to affect their time allocation towards activities related to children's diet, activity and well-being. The researchers examined the suggestion that mothers who work more may be more reliant on processed foods, foods prepared away from home and school meal programs for their children's meals. A greater number of work hours may also lead to more unsupervised time for children that may, in turn, allow for an increase in unhealthy behaviors among their children such as snacking and sedentary activities such as TV watching. the study confirmed that hypothesis, even more so for higher income families. "Using data on a national cohort of children, we examine the relationship between mothers' average weekly work hours during their children's school years on children's dietary and activity behaviors, BMI and obesity in 5th and 8th grade. Our results are consistent with findings from the literature that maternal work hours are positively associated with children's BMI and obesity especially among children with higher socioeconomic status. Unlike previous papers, our detailed data on children's behaviors allow us to speak directly to affected behaviors that may contribute to the increased BMI. We show that children whose mothers work more consume more unhealthy foods (e.g. soda, fast food) and less healthy foods (e.g. fruits, vegetables, milk) and watch more television. Although they report being slightly more physically active, likely due to organized physical activities, the BMI and obesity results suggest that the deterioration in diet and increase in sedentary behaviors dominate." Read more>>

(From the ISHN Member information service)   The recent international conference on physical activity in Toronto in May 2014 had several national surveys reporting sub-standard levels of physical activity in children. Walking and biking to school is potentially the best way to increase school-related PA but studies also shpw that parents are reluctant to allow their children to walk/bike to school or to play outside after school in unsupervised activities. A blog post from an unlikely source (The Microsoft Mobility Lab) helps us to understand how underlying social factors are driving parent concerns and decisions. The Communications Director for the Microsoft Lab asks the question: " Are Fearful, Lurking Parents a Reason for Uninspired Transportation Choice?  He quotes from a book on the social lives of networked teens and points out that this parental concern is larger than just the trip to school. Parents are also reluctant to allow their children to go online, ride public transit, or even have much unstructured free time. The article notes how little time is now available for young people to mix socially without monitoring from their parents. He concludes that "  We have to remember that when you’re younger, you always want to be older. Kids see adults in places like bars, clubs, restaurants, and even public transit where they are not allowed. Somehow within that mix, we, as a society, have to do a better job of helping our children go through the coming-of-age process in ways that will create the local and global communities for them that we once had as kids ourselves." Read more>>  

(From the ISHN Member information service)  An article in the May 2014 issue of the Journal of School Health reports on the factors that contribute to program sustainability in a school after a research project (with additional funding for the school) is completed. The researchers report that " This study examined the sustainability of New Moves, a school-based program aimed at decreasing weight-related problems in adolescent girls. Ten schools participated in the sustainability study. Teachers completed a survey and interview, and research staff observed 1 physical education (PE) class within 2 years of the study's completion. All schools continued all-girls PE classes using New Moves components following the study period. Fewer schools continued the nutrition and social support classroom modules and individual coaching sessions while no schools continued lunch get-togethers. Program components were sustained in both New Moves intervention schools and control schools. Programs are most likely to be sustained if they (1) fit into the current school structure, (2) receive buy-in by teachers, and (3) require minimal additional funds or staff time. Providing control schools with minimal training and intervention resources was sufficient to continue program components if staff perceived the program was important. Read more>>

From the ISHN Member information service) An article in Issue #1, 2014 of Physical and Health Education Academic journal review the socialization of PE teachers. The authors note that "Teacher socialization is a term used to describe the socializing processes that influence a teacher’s beliefs, assumptions, and values regarding teaching. The nature, quality and effectiveness of teaching is greatly influenced by a teacher’s early socializing experiences. Using Lortie’s (1975) theoretical framework, Lawson (1983a) identified three main kinds of socialization that teachers face: (a) Acculturation: this includes actions, beliefs, and value systems that are learned from birth and foster ideologies about, in this case, professional conduct. (b) Professional socialization: this is the process through which prospective and practicing teachers learn and maintain the values deemed ideal for teaching physical education. Professional socialization is strongly influenced by recruits’ experiences as a K-12 school student (the period of time described by Lortie 
(1975) as the apprenticeship of observation). These experiences inform recruits’ subjective warrant, which consists of their beliefs about the requirements for being a physical education teacher. (c) Organizational socialization: this process serves to maintain the “traditional skills” valued by institutions and organizations. Organizational socialization may work against change in order to uphold traditions and routines." 

The review (full text available free) concludes that "there have been several patterns to emerge in socialization research since 2000, most notably in the increasingly progressive, “teaching-oriented” views that many physical education recruits now hold. In particular, the findings suggest that teaching orientations are now more prevalent in recruits than they were prior to 2000. Attached to this finding is a general pattern that physical education teachers today are more likely now than in the past to develop a student-centered holistic approach to teaching physical education that develops the “whole-student”, one who is socially responsible and aware. While there appears to be less evidence supporting the presence of coaching orientations in recruits which is likely due to a change in the modern recruit’s acculturation, we feel that this finding should be treated with caution, as it does not suggest that coaching orientations are “things of the past” or are no longer present in physical education. There are still many recruits who do come to physical education with the aim of becoming coaches and the sport-centred philosophies to physical education content and pedagogy that tend to come with this mindset. 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 the ASCD Whole Child Blog) Thomas Armstrong, education expert, author, and Whole Child Podcast guest, just can't say enough about the importance of play. The chapter "Early Childhood Education Programs: Play" is excerpted from Armstrong's ASCD book Best Schools, which looks at not just best schools, but also best practices for teaching and learning. In this chapter, Armstrong points to early education practices that actually hinder young learners rather than helping them to get ahead. Cutting out play is one such practice that thwarts child development, says Armstrong. A young child, particularly, needs to be in a safe environment where he can touch, sense, and move in order to learn.  Read more>>