Does School Health Promotion Have Additional Value for Educational Performance? A Repeated Cross-Sectional Multilevel Study.

Little information is available regarding the influence of the interplay between the school context and school health promotion on educational performance. Therefore, we examined whether the variation between primary and secondary schools regarding the educational performance of students could be explained by general school characteristics, school population characteristics, and school health promotion and to what extent these factors interact. We performed multilevel analyses using existing data on 7021 primary schools and 1315 secondary schools in the Netherlands from the school years 2010-2011 till 2018-2019. Our outcomes were the final test score from primary education and the average grade of standardized final exams from secondary education. School health promotion was operationalized as having obtained Healthy School (HS) certification. For the test score, 7.17% of the total variation was accounted for by differences at the school level and 4.02% for the average grade. For both outcomes, the percentage of disadvantaged students in a school explained most variation. HS certification did not explain variation, but moderated some associations. We found small to moderate differences between schools regarding educational performance. Compositional differences of school populations, especially socioeconomic status, seemed more important in explaining variation in educational performance than general school characteristics and HS certification. Some associations were moderated by HS certification, but differences remained small in most cases.

RISKY BEHAVIORS AMONG SCHOOL-AGED ADOLESCENTS AND SOCIAL DETERMINANTS OF HEALTH / CONDUCTAS DE RIESGO ENTRE ADOLESCENTES EN EDAD ESCOLAR Y DETERMINANTES SOCIALES DE LA SALUD / COMPORTAMENTOS DE RISCO ENTRE ADOLESCENTES ESCOLARES E DETERMINANTES SOCIAIS DA SAÚDE

This study aimed to identify the association between the occurrence of risk behaviors among school adolescents and the Social Determinants of Health of both the students and their families. This is a descriptive, correlational, cross-sectional study, with a quantitative approach, carried out with adolescents enrolled in elementary school (final years) and high school, in public schools in the metropolitan region and the agrestic region of Pernambuco, between June and August 2023. Two instruments were used: a sociodemographic questionnaire prepared by the researchers and the Risk Behavior Index. The data was analyzed using Epi info and SPSS software. The results revealed that aspects such as age, gender, religion, marital status, physical activity and family structure were related to the behaviors assessed and could act as risk or protective factors. When considering ways of conducting actions to protect, prevent and mitigate risk behaviors among school adolescents, it is imperative to include the involvement of health and education professionals in the development of strategies that facilitate the development of dialogical spaces. It is also important to encourage responsible protagonism and active participation by adolescents in making decisions about their lives and health.

Este estudio tuvo como objetivo identificar la asociación entre la ocurrencia de comportamientos de riesgo entre adolescentes escolares y los Determinantes Sociales de la Salud tanto de los alumnos como de sus familias. Se trata de un estudio descriptivo, correlacional, transversal, con abordaje cuantitativo, realizado entre adolescentes matriculados en la enseñanza fundamental (años finales) y secundaria en escuelas públicas de las regiones metropolitana y agreste de Pernambuco, entre junio y agosto de 2023. Se utilizaron dos instrumentos: un cuestionario sociodemográfico elaborado por los investigadores y el Índice de Comportamiento de Riesgo. Los datos fueron analizados utilizando los softwares Epi info y SPSS. Los resultados mostraron que aspectos como la edad, el sexo, la religión, el estado civil, la actividad física y la estructura familiar estaban relacionados con los comportamientos evaluados y podían actuar como factores de riesgo o de protección. Al pensar en formas de conducir acciones para proteger, prevenir y mitigar las conductas de riesgo entre los adolescentes escolarizados, es fundamental considerar la participación de los profesionales de la salud y de la educación en el desarrollo de estrategias que faciliten la construcción de espacios dialógicos. También es importante fomentar el protagonismo responsable y la participación activa de los adolescentes en la toma de decisiones sobre sus vidas y su salud.

Este estudo objetivou identificar a associação entre a ocorrência de comportamentos de risco entre adolescentes escolares e os Determinantes Sociais de Saúde tanto dos estudantes quanto de suas famílias. Trata-se de um uma pesquisa descritiva, correlacional, de delineamento transversal, com abordagem quantitativa, realizada ao público de adolescentes matriculados no Ensino Fundamental II e Médio, em escolas públicas da região metropolitana e do agreste de Pernambuco, durante o período de junho a agosto de 2023. Foram aplicados 2 instrumentos: um questionário sociodemográfico elaborado pelos pesquisadores e o Índice de Comportamentos de Risco. Os dados foram analisados com suporte dos softwares Epi info e SPSS. Os resultados evidenciaram que aspectos como idade, gênero, religião, estado civil dos adolescentes, prática de atividades físicas e estrutura familiar obtiveram relações com os comportamentos avaliados, podendo agir como fatores de risco ou protetivos. Ao pensar formas de conduzir ações de proteção, prevenção e mitigação de comportamentos de risco entre adolescentes escolares, é crucial considerar o envolvimento de profissionais da saúde e da educação no desenvolvimento de estratégias que facilitem a criação de espaços dialógicos. Ademais, o estímulo ao protagonismo responsável e participação ativa dos adolescentes na tomada de decisões relacionadas às suas vidas e saúde.

School health promotion and fruit and vegetable consumption in secondary schools: a repeated cross-sectional multilevel study.

BACKGROUND: Worldwide, recommendations for fruit and vegetable consumption are not met, which can cause chronic diseases. Especially adolescence is an important phase for the development of health behaviours. Therefore, in the Netherlands, the Healthy School program was established to aid schools in promoting healthy lifestyles among their students. We examined to what extent the variation between secondary schools regarding students' fruit and vegetable consumption could be explained by differences between schools regarding Healthy School certification, general school characteristics, and the school population. Additionally, we examined whether Healthy School certification was related to the outcomes, and whether the association differed for subgroups. METHODS: We performed a repeated cross-sectional multilevel study. We used data from multiple school years from the national Youth Health Monitor on secondary schools (grades 2 and 4, age ranged from approximately 12 to 18 years) of seven Public Health Services, and added data with regard to Healthy School certification, general school characteristics and school population characteristics. We included two outcomes: the number of days a student consumed fruit and vegetables per week. In total, we analysed data on 168,127 students from 256 secondary schools in the Netherlands. RESULTS: Results indicated that 2.87% of the variation in fruit consumption and 5.57% of the variation in vegetable consumption could be attributed to differences at the school-level. Characteristics related to high parental educational attainment, household income, and educational track of the students explained most of the variance between schools. Additionally, we found a small favourable association between Healthy School certification and the number of days secondary school students consumed fruit and vegetables. CONCLUSIONS: School population characteristics explained more variation between schools than Healthy School certification and general school characteristics, especially indicators of parental socioeconomic status. Nevertheless, Healthy School certification seemed to be slightly related to fruit and vegetable consumption, and might contribute to healthier dietary intake. We found small differences for some subgroups, but future research should focus on the impact in different school contexts, since we were restricted in the characteristics that could be included in this study.

Staff perspectives on poor mental health in secondary school students: an increasing problem handled with insufficient resources.

Introduction: An increasing number of schools are recognizing the importance of addressing students' mental health based on the association with educational outcomes and long-term health. The school organization and the members of the school staff play important but, in several ways, challenging roles in this work. The purpose of this study was to explore views of staff from schools and school health services on mental ill health among students and their own role in detecting and managing it. Methods: A qualitative study was conducted in a sparsely populated municipality in northern Sweden. In total, 40 participants from three secondary schools and the school health services participated either in focus groups or individual interviews. Participants were teachers, assistants, school nurses, school counselors and psychologists. Data were analyzed using thematic analysis. Results: The analysis revealed the main theme Student mental ill health: an increasing problem handled with insufficient resources and two subthemes, i.e., Uncertainty in interpreting students' signs of mental ill health and the need to clarify roles and establish a supportive organization. Conclusions: It was concluded that school staff were uncertain regarding how to interpret signs of mental ill health among students and required better knowledge and more resources to help students with mental ill health. A clearer organization and consensus regarding support for students with mental ill health were also necessary in light of the division of responsibilities between school staff and the school health services.

Sedentary Behavior and Physical Inactivity Among Secondary School Students in the 2017 Sierra Leone Global School-Based Student Health Survey.

BACKGROUND: The 2020 World Health Organization Guidelines on Physical Activity and Sedentary Behavior are the first to provide evidence-based recommendations for reducing both dimensions of languorous behavior. The relationship between sitting time and exercise remains understudied among diverse adolescent populations worldwide. METHODS: The 2017 Sierra Leone Global School-based Student Health Survey was a nationally representative cross-sectional study of secondary school students. RESULTS: Of the 2798 participants, 82% did not engage in moderate or vigorous physical activity for at least an hour every day, 25% sat for 3 or more hours each day outside of school and homework, and 87% were physically inactive and/or sedentary based on those thresholds. Girls who never or rarely exercised tended to maintain light physical activity outside of school rather than sitting, while boys who exercised daily tended to be sedentary when they were not playing sports. IMPLICATIONS FOR SCHOOL HEALTH POLICY, PRACTICE, AND EQUITY: Students spend their waking hours doing a mix of sitting, light physical activity, and moderate or vigorous physical activity. Schools can help reduce sedentarism and increase movement among students. CONCLUSIONS: Home, school, and community health interventions may be useful for increasing energy expenditure among adolescents in low- and middle-income countries.

Cost-effectiveness of dental caries prevention strategies in South African schools.

BACKGROUND: In South Africa, an estimated 85% of the population relies on the public sector for oral health services. With poor infrastructure and inadequate personnel, over 80% of children with dental caries remain untreated. To reduce this burden of disease, one key goal is to promote good oral health and address oral diseases through prevention, screening, and treatment among children. While all policies have been proven to be effective in the control and prevention of dental caries, it is unclear which of those strategies provide value for money. This study evaluated five caries preventative strategies in terms of the cost and benefits among South African school children. METHODS: The study uses a hypothetical South African population of school aged learners aged 5-15. The context and insights of the strategies utilized at the schools were informed by data from both grey and published literature. Using Markov modeling techniques, we conducted a cost-effectiveness analysis of Acidulated Phosphate Fluoride (APF) application, atraumatic restorative treatment (ART), sugar-reduction and fissure sealants. Markov model was used to depict the movement of a hypothetical patient cohort between different health states over time. We assessed both health outcomes and costs of various interventions. The health outcome metric was measured as the number of Decayed, Missing, Filled Tooth (DMFT). The net monetary benefit was then used to determine which intervention was most cost-effective. RESULTS: The results showed that school-based caries prevention strategies are cost-effective compared to the status quo of doing nothing. The average cost per learner over the 10-year period ranged from ZAR4380 to approx. ZAR7300 for the interventions considered. The total costs (including screening) associated with the interventions and health outcome (DMFT averted) were: sugar reduction (ZAR91,380, DFMT: 63,762), APF-Gel (ZAR54 million, DMFT: 42,010), tooth brushing (ZAR72.8 million, DMFT: 74,018), fissure sealant (ZAR44.63 million, DMFT: 100,024), and ART (ZAR45 million, DMFT: 144,035). The net monetary benefits achieved for APF-Gel, sugar reduction, tooth brushing, fissure sealant and ART programs were ZAR1.56, ZAR2.45, ZAR2.78, ZAR3.81, and ZAR5.55 billion, respectively. CONCLUSION: Based on the net monetary benefit, ART, fissure sealant and sugar-reduction appear to be the most cost-effective strategies for preventing caries in South Africa. In a resource-scarce setting such as South Africa, where there is no fluoridation of drinking water, this analysis can inform decisions about service packages for oral health.

School health promotion and the consumption of water and sugar-sweetened beverages in secondary schools: a cross-sectional multilevel study.

BACKGROUND: Overweight among adolescents remains a serious concern worldwide and can have major health consequences in later life, such as cardiovascular diseases and cancer. Still, 33% of secondary school adolescents in the Netherlands consume sugar-sweetened beverages daily and over 26% do not consume water every day. The Dutch Healthy School program was developed to support schools in stimulating healthier lifestyles by focusing on health education, school environments, identifying students' health problems, and school policy. We examined the variation between secondary schools regarding the daily consumption of water and sugar-sweetened beverages and whether this variation can be explained by differences between schools regarding Healthy School certification, general school characteristics, and the school population. METHODS: We performed a cross-sectional multilevel study. We used data from the national Youth Health Monitor of 2019 on secondary schools (grades 8 and 10, age range about 12 to 18 years) of seven Public Health Services and combined these with information regarding Healthy School certification and general school- and school population characteristics. Our outcomes were daily consumption of water and sugar-sweetened beverages. In total, data from 51,901 adolescents from 191 schools were analysed. We calculated the intraclass correlation to examine the variation between schools regarding our outcomes. Thereafter, we examined whether we could explain this variation by the included characteristics. RESULTS: The school-level explained 4.53% of the variation in the consumption of water and 2.33% of the variation in the consumption of sugar-sweetened beverages. This small variation in water and sugar-sweetened consumption could not be explained by Healthy School certification, yet some general school- and school population characteristics did: the proportion of the school population with at least one parent with high educational attainment, the educational track of the adolescents, urbanicity (only for water consumption) and school type (only for sugar-sweetened beverages consumption). CONCLUSIONS: The low percentages of explained variation indicate that school-level characteristics in general (including Healthy School certification) do not matter substantially for the daily consumption of water and sugar-sweetened beverages. Future research should examine whether school health promotion can contribute to healthier lifestyles, and if so, under which level of implementation and school conditions.

The Role of Wellness Teams in Promoting Health and Wellness Implementation Strategies in Elementary Schools in Chicago.

BACKGROUND: Strategies used by wellness teams (WTs) to foster local wellness policy (LWP) implementation have been documented, yet there remains a need to better understand how WTs respond to district-level LWP requirements, particularly when bundled with additional health-related policies. This study's goal was to explore how WTs implement Healthy Chicago Public School (CPS), a district-led initiative focused on both LWP and other health policy implementation in the CPS district, one of the most diverse in the nation. METHODS: Eleven discussion groups were conducted with WTs in CPS. Discussions were recorded, transcribed, and thematically coded. RESULTS: Six overarching strategies used by WTs in working to achieve Healthy CPS include: (1) using district guides and resources to support planning, progress monitoring, and reporting; (2) under the leadership of wellness champions, as required by the district, facilitating engagement among staff, students, and/or families; (3) taking district guidance and adapting and integrating it into their schools' existing structures, curricula, and practices, often taking a holistic approach; (4) fostering linkages in the communities surrounding their schools to supplement internal school capacities; and (5) stewarding resources, time, and staff for sustainability. IMPLICATIONS: Strategies for LWP implementation by WTs in urban and diverse schools include planning for staff turnover, integrating health and wellness into existing curricula and structures, and leveraging relationships with the local community. CONCLUSION: WTs can play a critical role in supporting schools in diverse, urban districts to implement district-level LWP and the plethora of related policies that schools are subject to at the federal, state, and district levels.

Feasibility, acceptability and potential efficacy of a virtual physical activity program in primary and secondary schools in New South Wales, Australia: A quasi-experimental study.

ISSUE ADDRESSED: Child and youth participation in physical activity (PA) is fundamental for healthy development and obesity prevention. Government policy requires schools to offer 150 minutes of PA each week, however compliance is low. Race around Australia (RAA) is a New South Wales (NSW) Department of Education, virtual PA program aimed at assisting schools in meeting the PA guidelines. METHODS: A pre- and post-intervention, quasi-experimental study was conducted using a mixed-methods approach comprising teacher interviews, a student questionnaire and a 1.6 kilometre (km) timed run. Data were collected from April to September 2021 among students and teachers in Grades 5 to 8, from 10 schools in NSW, Australia. RESULTS: The analytical sample included data from 918 students and 17 teachers. The RAA program was deemed feasible and acceptable in primary schools, whereas there were several systemic and intrapersonal barriers to implementation success for secondary schools. In primary schools, RAA increased PA opportunities and the 1.6 km timed runs revealed a statistically significant treatment by time effect in favour of the intervention group for cardiorespiratory fitness (-36.91 seconds, 95% CI [-63.14, -10.68], P = .006). CONCLUSIONS: RAA has demonstrated feasibility and potential efficacy in improving cardiorespiratory fitness. We recommend that program refinement be made to deliver an intervention that addresses the unique barriers of the secondary school setting through a multi-level ecological approach. SO WHAT?: Despite evident benefits, implementation of PA initiatives in the school setting reveals many challenges. Stronger consideration of the Health Promotion with Schools Framework is evidently needed.

Analysis of the implementation of Food and Nutrition Education actions in public schools in a capital city in southern Brazil / Análise da implementação de ações de Educação Alimentar e Nutricional em escolas públicas municipais de uma capital da região do Sul do Brasil

ABSTRACT Objective To analyze the insertion of Food and Nutrition Education actions in Early Childhood and Elementary Education units of the municipal public school system of Florianópolis, Santa Catarina, Brazil, in 2019. Methods This analytical study applied an online questionnaire directed to the 125 Early Childhood and Elementary Education schools in Florianópolis. Results Ninety-four schools (75.2%) participated in the study, among which 94.7% developed Nutritional Food Education actions in 2019. It was made evident that the insertion of Nutritional Food Education in the Pedagogical Political Project (p<0.001) and the planning of such actions (p<0.001) in schools has a significant association with their implementation. The participation of the professionals in training in food and nutrition showed no association with the implementation of the Nutritional Food Education actions. The actions developed most frequently were the pedagogical activities in the school curriculum (95.5%), the school garden (71.9%), and the hands-on cooking classes (46.1%). Conclusion The study identified a positive panorama in the capital of Santa Catarina, with actions included transversally in the school curriculum with a multiprofessional focus standing out. However, the need for studies that monitor and evaluate the actions is emphasized.

RESUMO Objetivo Analisar a inserção de ações de Educação Alimentar e Nutricional em unidades de Educação Infantil e Ensino Fundamental da rede pública municipal de Florianópolis, no ano de 2019. Métodos Ratos Wistar machos foram divididos em dois grupos experimentais de acordo com a dieta da mãe durante a gestação e lactação: grupo controle (NP: 17% caseína n=6) e grupo desnutrido (LP: 8% caseína n=6). Aos 60 dias de vida, os ratos foram sacrificados para coleta do hipotálamo para posterior análise bioquímica. Resultados Participaram do estudo 94 das 125 escolas de Educação Infantil e Ensino Fundamental de Florianópolis (75,2%). Dessas, 94,7% desenvolveram ações de Educação Alimentar Nutricional no ano de 2019. Evidenciou-se que a inserção da Educação Alimentar Nutricional no Projeto Político Pedagógico (p<0,001) e o planejamento dessas ações (p<0,001) nas escolas têm associação significativa com a sua realização. A participação dos profissionais em formação sobre alimentação e nutrição não mostrou associação com a realização das ações de Educação Alimentar Nutricional. As ações desenvolvidas com mais frequência foram a inclusão de atividades pedagógicas no currículo escolar (95,5%), a horta pedagógica (71,9%) e as oficinas culinárias (46,1%). Conclusão O estudo identificou um panorama positivo na capital catarinense, com destaque para ações incluídas transversalmente no currículo escolar, com enfoque multiprofissional. Ressalta-se, no entanto, a necessidade de desenvolvimento de estudos de monitoramento e avaliação das ações.

Programa Saúde na Escola: desafios e possibilidades para promover saúde na perspectiva da alimentação saudável / School Health Program: challenges and possibilities for health promotion from the perspective of healthy eating

RESUMO O Programa Saúde na Escola elege a promoção da saúde como diretriz para o desenvolvimento de ações de saúde na escola. O objetivo foi identificar e analisar fortalezas, oportunidades, fragilidades e ameaças ao programa para implementar ações de promoção da saúde que promovem hábitos alimentares saudáveis. Esta revisão, de abordagem qualitativa, selecionou 29 artigos de avaliação do programa, publicados entre 2015 e 2021. Pela Matriz Fofa, a análise agrupou os resultados em: Fortalezas, Oportunidades, Fraquezas e Ameaças. Entre as fortalezas, destacaram-se a proximidade dos setores de saúde e educação e a integração entre escola, unidade de saúde e família. Como oportunidades, observou-se a possibilidade de planejamento intersetorial para promoção da saúde. As fragilidades referem-se à desarticulação intersetorial, à falta de formação e à predominância de ações biomédicas. As ameaças encontradas demonstram a centralização do poder na saúde e a aproximação dos escolares ao serviço de saúde sem uma compreensão ampliada da promoção da saúde, oportunizando a medicalização. Conclui-se que é possível desenvolver ações educativas intersetoriais para promoção da alimentação saudável nos serviços básicos envolvendo os escolares e suas famílias. Essas ações devem ser priorizadas nas agendas públicas a fim de viabilizar sua prática cotidiana nos serviços.

ABSTRACT The School Health Program (PSE) elects health promotion as a guideline for developing health actions at school. The aim is to identify and analyze the program's strengths, opportunities, weaknesses, and threats to implement health-promoting actions that promote healthy eating habits. This review, of qualitative approach, comprises 29 articles of evaluation of the program published between 2015 and 2021. By the SWOT matrix, the analysis grouped the results into Strengths, Opportunities, Weaknesses, and Threats. Among the strengths, the proximity of the health and education sectors and the integration between the school, health unit, and family stood out; as opportunities, the possibility of intersectoral planning for health promotion was observed. The weaknesses refer to the intersectoral disarticulation, the lack of training, and the predominance of biomedical actions. The threats found demonstrate the centralization of power in health and the schoolchildren's approach to the health service without a broader understanding of health promotion, providing opportunities for medicalization. It is concluded that it is possible to develop intersectoral educational actions to promote healthy eating in basic services involving schoolchildren and their families. This practice should be prioritized in public agendas in order to enable its daily practice in services.

Menstrual hygiene management and its determinants among adolescent girls in low-income urban areas of Delhi, India: a community-based study.

OBJECTIVES: Menstrual hygiene management (MHM) in developing countries is linked to human rights, social justice, and the education and empowerment of young girls. The objective of this study was to assess menstrual hygiene practices and their determinants among adolescent girls, including school dropouts, and the effects of pad distribution programs in urban resettlement areas of Delhi, India. METHODS: A cross-sectional study was conducted from March 2019 to February 2020 in urban resettlement colonies and 2 villages of Delhi among 1,130 adolescent girls aged 10 to 19 years, who were interviewed face to face. RESULTS: In total, 954 participants (84.4%) used only disposable sanitary pads, 150 (13.3%) used both sanitary pads and cloths, and 26 (2.3%) used only cloths (n=1,130). Most school-going girls utilized the scheme for pad distribution, but only two-thirds of the girls who were out of school utilized the scheme. In the adjusted analysis, girls with lower educational status, those who had dropped out of school, and those from the Muslim religious community were more likely to use cloths for MHM. CONCLUSION: More than 4 out of 5 adolescent girls in Delhi in low-income neighborhoods preferred sanitary pads for MHM. The government free pad scheme reached near-universal utilization among school-going girls (97%), but the subsidized pad scheme for girls who did not attend school was insufficiently utilized (75%).

Bad for Girls and Boys: Gender Does Not Modify the Negative Effect of Physical Inactivity on Life Satisfaction in Adolescents.

Objectives: Physical activity (PA) has a positive effect on life satisfaction (LS) among adolescents, but the moderating effect of gender and level of PA intensity have been equivocal. Our aim was to examine the pattern of physical activity by grade in high school students, and the role of gender and grade on the association between physical activity and life satisfaction. Methods: Four repeated cross-sectional online questionnaire surveys between 2011 and 2013 were carried out among all students in one Hungarian high school (N = 3,450). Health status and behavior was assessed by the Hungarian online version of the health behavior of school-aged children (HBSC) questionnaire. Regression with robust variance estimator was used to identify determinants of life satisfaction. Results: Good self-reported health as opposed to bad increased life satisfaction by 0.30 standard deviation; having very well or well-off family as opposed to not well-off increased LS by 0.16 standard deviation; and being inactive compared to being vigorously active decreased LS by 0.1 standard deviation. Conclusions: Physical inactivity has a negative effect on life satisfaction in boys and girls regardless of grade but compounded by low perceived family wealth.

A School Intervention's Impact on Adolescents' Health-Related Knowledge and Behavior.

Background: Many factors can influence health behavior during adolescence, and the lifestyle of adolescents is associated with health behavior during adulthood. Therefore, their behavior can determine not only present, but also later health status. Objective: We aimed to develop an intervention program to improve high school students' health behavior and to evaluate its effectiveness. Methods: We performed our study at a secondary school in a rural town in East Hungary between 2016 and 2020. Sessions about healthy lifestyles were organized regularly for the intervention group to improve students' knowledge, to help them acquire the right skills and attitudes, and to shape their behavior accordingly. Data collection was carried out via self-administered, anonymous questionnaires (n = 192; boys = 49.5%; girls = 50.5%; age range: 14-16). To determine the intervention-specific effect, we took into account the differences between baseline and post-intervention status, and between the intervention and control groups using individual follow-up data. We used generalized estimating equations to assess the effectiveness of our health promotion program. Results: Our health promotion program had a positive effect on the students' health-related knowledge and health behavior in the case of unhealthy eating, moderate to vigorous physical activity, and alcohol consumption. Conclusion: Our findings suggest that school health promotion can be effective in knowledge transfer and lifestyle modification. To achieve a more positive impact on health behavior, preventive actions must use a complex approach during implementation.

Teacher Training and Engagement in Health Promotion Mediates Health Behavior Outcomes.

School-based health promotion interventions have been shown to lead to measurable changes in the nutrition and physical activity behaviors. This study examines whether the impact of an intervention program on students' healthy eating and physical activity was mediated by teacher training and engagement in health promotion. The trial was conducted in three phases: needs assessment of the baseline survey of teachers, mothers' and children; intervention among seven randomly selected schools that included teacher training in healthy eating and physical activity; and a post-intervention evaluation survey. The SPSS PROCESS for Hayes (Model8) was used to determine moderation and mediation effects. The difference in difference (DID) was calculated for the three main outcomes of the study: eating breakfast daily (DID = 17.5%, p < 0.001); consuming the recommended servings of F&V (DID = 29.4%, p < 0.001); and being physically active for at least 5 days/week (DID = 45.2%, p < 0.001). Schoolchildren's eating breakfast daily was mediated by their teachers' training in nutrition (ß = 0.424, p = 0.002), teachers' engagement (ß = 0.167, p = 0.036), and mothers preparing breakfast (ß = 1.309, p < 0.001). Schoolchildren's consumption of F&V was mediated by teachers' engagement (ß = 0.427, p = 0.001) and knowing the recommended F&V servings (ß = 0.485, p < 0.001). Schoolchildren's physical activity was mediated by their teachers' training in physical activity (ß = 0.420, p = 0.020) and teachers' engagement (ß = 0.655, p < 0.001). Health behavior changes in the school setting including improvements in eating breakfast, consuming the recommended F&V and physical activity was mediated by teacher training and engagement. Effective teacher training leading to teacher engagement is warranted in the design of health-promotion interventions in the school setting.

Concepções de professores de Educação Física do município de Lábrea/AM acerca do tema da saúde / The conceptions of physical education teachers in the city of lábrea/am on health / Concepciones de profesores de educación física del municipio de lábrea/am sobre el tema de salud

O estudo teve por objetivo investigar as concepções de alguns professores de Educação Física (EF) acerca do conceito e do tema saúde nas aulas de EF escolar. A pesquisa qualitativa e de campo foi desenvolvida no Município de Lábrea/AM com utilização de entrevista remota semiestruturada com sete professores. O conceito de saúde mencionado é o da Organização Mundial da Saúde. Porém, ambiguamente, as narrativas operam com uma visão restrita/negativa e comportamental da relação entre práticas corporais, atividade física e saúde. Conclui-se que há a necessidade de fortalecer a formação inicial e continuada dos professores de EF para tratarem de perspectivas mais amplas do tema da saúde, a fim de fomentar práticas pedagógicas coerentes e inovadoras que promovam saúde para a comunidade escolar (AU).

This study aimed to investigate the conceptions of some Physical Education (P.E.) teachers on the concept and the theme of health in PE classes at school. We developed a qualitative field research in the city Lábrea/AM. We collected data through se-mi-structured interviews conducted online with seven teachers. The concept of health mentioned is the one of the World Health Organization. However, ambiguously, the narrative operates with a behavioral and restricted/negative view regarding corporal prac-tices, physical activity, and health. We conclude that there is a need to strengthen pre- and in-service training of P.E. teachers to deve-lop broader perspectives of health, so as to promote coherent and innovative pedagogical practices that can promote health in the school community (AU).

nvestiga las concepciones de algunos profesores de Educación Física (EF) sobre el concepto y el tema de la salud en las clases de EF. Se realizó una investigación cualitativa y de campo en el Municipio de Lábrea/AM, con entrevistas semiestructuradas a distancia con siete docentes. El concepto de salud mencionado es el de la Organización Mundial de la Salud. Sin embargo, las narra-tivas operan con una visión restringida/negativa y conductual de la relación entre prácticas corporales, actividad física y salud. Se concluye que existe la necesidad de fortalecer la formación inicial y continua de los docentes para tratar con perspectivas ampliadasel tema de la salud, a fin de propiciar prácticas pedagógicas cohe-rentes e innovadoras que promuevan la salud de la comunidad escolar (AU).

Concepções de professores de Educação Física do município de Lábrea/AM acerca do tema da saúde / The conceptions of physical education teachers in the city of lábrea/am on health / Concepciones de profesores de educación física del municipio de lábrea/am sobre el tema de salud

O estudo teve por objetivo investigar as concepções de alguns professores de Educação Física (EF) acerca do conceito e do tema saúde nas aulas de EF escolar. A pesquisa qualitativa e de campo foi desenvolvida no Município de Lábrea/AM com utilização de entrevista remota semiestruturada com sete professores. O conceito de saúde mencionado é o da Organização Mundial da Saúde. Porém, ambiguamente, as narrativas operam com uma visão restrita/negativa e comportamental da relação entre práticas corporais, atividade física e saúde. Conclui-se que há a necessidade de fortalecer a formação inicial e continuada dos professores de EF para tratarem de perspectivas mais amplas do tema da saúde, a fim de fomentar práticas pedagógicas coerentes e inovadoras que promovam saúde para a comunidade escolar.

This study aimed to investigate the conceptions of some Physical Education (P.E.) teachers on the concept and the theme of health in PE classes at school. We developed a qualitative field research in the city Lábrea/AM. We collected data through semi-structured interviews conducted online with seven teachers. The concept of health mentioned is the one of the World Health Organization. However, ambiguously, the narrative operates with a behavioral and restricted/negative view regarding corporal prac-tices, physical activity, and health. We conclude that there is a need to strengthen pre- and in-service training of P.E. teachers to develop broader perspectives of health, so as to promote coherent and innovative pedagogical practices that can promote health in the school community.

Investiga las concepciones de algunos profesores de Educación Física (EF) sobre el concepto y el tema de la salud en las clases de EF. Se realizó una investigación cualitativa y de campo en el Municipio de Lábrea/AM, con entrevistas semiestructuradas a distancia con siete docentes. El concepto de salud mencionado es el de la Organización Mundial de la Salud. Sin embargo, las narrativas operan con una visión restringida/negativa y conductual de la relación entre prácticas corporales, actividad física y salud. Se concluye que existe la necesidad de fortalecer la formación inicial y continua de los docentes para tratar con perspectivas ampliadas el tema de la salud, a fin de propiciar prácticas pedagógicas coherentes e innovadoras que promuevan la salud de la comunidad escolar.

Understanding key implementation determinants for a school-based universal prevention intervention: a qualitative study.

This study examined how teachers discuss various factors as impacting their ability to execute with fidelity the Michigan Model for Health (MMH), an evidence-based health universal prevention curriculum widely adopted throughout Michigan. Researchers have found a robust relationship between fidelity and participant outcomes, including in schools. While previous studies have identified barriers that inhibit fidelity, few have focused on identifying key barriers and deepening our understanding of how these factors influence intervention fidelity. We conducted a thematic analysis using the reflexive thematic approach to identify key barriers and facilitators and deepen our understanding of how these factors influence MMH implementation. Guided by the Consolidated Framework for Implementation Research (CFIR) and the Implementation Outcomes Framework, we conducted semistructured interviews with 23 high school health teachers across Michigan. Teachers identified intervention characteristics (e.g., design quality, packaging, and program adaptability), student needs (e.g., trauma exposure, substances), and the fit between the intervention and the context as factors that contributed to acceptability. They also discussed the curriculum and its alignment with their teaching style and/or experiences as contributing to fidelity. Teachers shared how they would often go "off protocol" to improve intervention-context fit and meet students' needs. Our results identified acceptability, a perceptual implementation outcome, as demonstrating an important role in shaping the relationship between CFIR factors and fidelity. Results provide guidance for systematically designing implementation strategies that address key barriers to improve acceptability, enhance fidelity, and ultimately achieve desired public health objectives.

Evaluation of the 'H2NOE Water Schools' programme to promote water consumption in elementary schoolchildren: a non-randomised controlled cluster trial.

OBJECTIVE: This study evaluated a simple environmental intervention called 'Water Schools' in Lower Austria providing free refillable water bottles and educational material. DESIGN: Non-randomised controlled cluster trial with three measurements: at baseline (T0), after the intervention at 9 months (T1) and after 1-year follow-up (T2). SETTING: Half-day elementary schools in Lower Austria (Austria). PARTICIPANTS: Third-grade pupils from twenty-two schools in the intervention group (IG) and thirty-two schools in the control group (CG) participated in the study. Data were analysed for 569 to 598 pupils in the IG and for 545 to 613 in the CG, depending on the time of measurement. RESULTS: The consumption of tap water increased in the IG from baseline to T1 and then decreased again at T2, but this was similar in the CG (no statistically significant difference in the time trend between the IG and CG). Similar results were seen for tap water consumption in the mornings. The proportion of children who only drank tap water on school mornings increased significantly from baseline to T1 in the IG compared to the CG (P = 0·020). No difference in the changes over time occurred between the groups for the proportion of pupils drinking approximately one bottle of tap water during school mornings. CONCLUSIONS: Not only the children in the IG but also those in the CG drank more tap water after 1 school year than at the beginning. The measurement of drinking habits in the CG may have been intervention enough to bring about changes or to initiate projects.

Early identification of depressive symptoms in school-aged children: Psychometric properties and validation of a new short version of Short Mood & Feelings Questionnaire.

BACKGROUND: Depressive mood is a common problem among children in Western countries. Professionals in school and other health services have an important role in identifying children at increased risk for depression. The Short Mood and Feelings Questionnaire (SMFQ) is a widely used screening tool, but its 13 items still make it quite time-consuming to complete. There is an urgent need for a quick and easy-to-complete self-report depressive mood scale for use in school health examinations. AIM: This paper aims to describe and validate a revised version of SMFQ: FsMFQ-6 is intended as a short screening tool for the early identification of depressive symptoms in children. METHODS: Nationally representative data (n = 95,725) were drawn from the 2017 School Health Promotion Study. The respondents were fourth- and fifth-grade pupils (aged 10-12) in Finnish primary schools. The data were analysed separately by gender. The construct validity of the scale was studied by principal component analysis and confirmatory factor analysis (CFA), convergent validity by both receiver operating characteristic (ROC) analysis and Spearman's correlation coefficient. Reliability was tested by Cronbach's alpha coefficient. RESULTS: Principal component analysis yielded a one-component model: the Finnish Short Mood and Feelings Questionnaire 6 (FsMFQ-6). CFA confirmed the validity of FsMFQ-6. Compared with mood at home (AUC = 0.80) and mood at school (AUC = 0.85), overall sensitivity and specificity were optimal at cut-off point 0. Cronbach's alpha coefficient was 0.73, indicating good internal consistency. The results for girls and boys were almost identical. CONCLUSION: The results confirmed the validity and reliability of FsMFQ-6. FsMFQ-6 recognises depressive mood in children and is suitable for screening depressive symptoms in fourth- and fifth-grade pupils in Finland. However, it is important to pay close attention to children who choose the 'Sometimes' response option more than once, for that can be a sign of depressive symptoms.