Rural young people and physical activity: understanding participation through social theory

Studies from around the world point to the inadequate participation of young people in physical activity and sport, and the consequences of this on their health. However, very few interventions to increase the levels of physical activity amongst young people have been sustainable. The aim of this paper is to use Bourdieu's notions of the logic of practice along with habitus and capital to theorise young people's participation in physical activities to add to the wealth of empirical material. Data are drawn from a cohort of rural participants in an Australian longitudinal, qualitative research project with young people from diverse social, cultural and geographical backgrounds. It was found that traditional rural gender roles impact on young women's perceptions of legitimate physical activity options and practices. The role of the family in the reproduction of the social order which sustains gendered understandings of physical activity is also explored. This paper demonstrates how Bourdieu's theories can be applied to explain gender distinctions in health behaviours. It is proposed that building bridges between epidemiological and sociological understandings of participation in physical activities will lead to the generation of more equitable and sustainable physical activity and health promotion initiatives.     

Exploring health behaviours: understanding drinking practice using the lens of practice theory

Research suggests that there is no safe amount of alcohol but despite this alcohol consumption remains an important part of many [young] people's lives. Viewed as an inherently social activity, drinking alcohol provides an opportunity for socialising and connecting with friends. This study is one of the first to draw on practice theory to explore one type of intoxicated drinking occasion engaged in by young people; framed in this article as a ‘proper night out’. This article argues that this hybrid entity is made up of a series of interconnected social practices that have come and now hang together to serve to normalise and routinise intoxicated drinking occasions. The operationalisation of practice theory has enabled an in-depth exploration of intoxicated drinking and provides the potential for new ways of intervening in harmful drinking practices by refocusing attention away from individual level decision-making to drinking practices.     

Subjective social status and health in young people

Health inequalities according to objective socioeconomic position (SEP), have been well-documented. Yet, in young people the associations are negligible. Recently, research on the association of subjective social status (SSS), and adult health has begun to accumulate. Studies on young people are rare and describe societies with large income inequalities. Here, we investigated the association between SSS and health, while controlling for own and familial SEP. The study population consisted of 15-year-olds (N = 2369) who have grown up in a context of low social inequalities. Data were derived from surveys carried out in 2004 in 29 secondary schools in Helsinki. The SSS was measured with an indicator specific to and validated for adolescents (a societal ladder). Outcome measures were self-rated health, health complaints, presence of limiting longstanding illness (LLI) and GHQ-12 caseness (indicating psychiatric morbidity). The SSS associated strongly with all health measures. Adjusting for objective socioeconomic measures attenuated the associations; although they all remained statistically significant apart from LLI among girls. The subjective assessment contributes to health inequalities in young people largely independent of objective SEP. Subjective ratings most probably capture aspects of social hierarchy that are more subtle and less well represented than in conventional measures.     

Designing sexual health services for young people: a methodology for capturing the user voice

The aim of the study was to assess the suitability of the Thurstone paired comparison method for capturing the user voice, through a survey of young people's views on the most salient priorities for a sexual health service. A convenience sample of 161 12–24 year olds was used. A psychometrically robust questionnaire was developed from a review of the relevant literature and from the information provided by three focus groups. The data derived from both stages were distilled into seven themes, and adapted to a Thurstone paired comparison format, in which each theme was paired with every other theme, with an 8-point scale between each pairing (21 pairings in total). Respondents were required to indicate their preference for one theme over the other in each pairing. The questionnaire was completed by 161 young people between April and July 2007, and the results were analysed using the Kendall coefficient of concordance to establish the degree of within-group agreement. The results suggested that there was significant agreement as to the essential desirable features of a sexual health service, both within the whole sample as well as within sub-samples (i.e. gender, age group and previous sexual health service use). The priorities were privacy, and a dedicated service close to home, with a drop-in facility and male and female staff being next most important, and an informal service and young staff being lowest priorities. The feedback from the pilot study, the 40% return and absence of spoiled questionnaires together indicated that the respondents found the method acceptable, while the actual findings corroborated those from other studies. Taken together, these results suggest that the Thurstone method offers a quick and simple method of capturing the user voice, with the results having sufficient validity to inform the planning of a local sexual health service.     

A qualitative study exploring the benefits of involving young people in mental health research

Introduction

It is increasingly accepted that young people need to be centrally involved in research on issues that affect them. The aim of this study was to explore young people's perceptions of the benefits for them of being involved in mental health research and the processes that enabled these benefits.

Methods

Qualitative interviews were conducted by co-researchers (young people with lived experience and/or interest in mental health) with 13 young people (aged 13–24 years) who had experience of being involved in mental health research when they were between 11 and 16 years of age. Reflective thematic analysis was used to identify important aspects of young people's experiences.

Results

Four main themes were identified: (1) opportunity to have a meaningful impact, (2) opportunity to be part of a supportive community, (3) opportunity to learn and grow and (4) increasing opportunities for young people.

Conclusion

This study highlights young people's experiences of being involved in mental health research and identifies ways in which researchers can ensure that involvement opportunities bring benefits to both the young people and the research.

Patient or Public Contribution

This research was a response to issues raised by young people involved in research. The project was supported by co-researchers throughout, including design, data collection, analysis and write-up.     

Nae job,nae future: young people and health in a context of unemployment*

There is increasing concern about the health, particularly mental health, of young people and the factors that affect it. Drawing on data from the West of Scotland Twenty-07 Study: Health in the Community, this paper describes the pattern of health in a cohort of about 1000 young people between the ages of 15 and 21, within a context of their experience and expectations of unemployment. Contrary to assumptions of healthiness, high levels of poor physical and mental health were found, with a third of males and two-fifths of females exhibiting evidence of psychological morbidity at age 18. Poorer mental health was strongly linked to the experience of unemployment and being at home, the latter predominantly involving females. This effect was confirmed in multivariate analysis, which controlled for prior health. In addition, an expectation of being unemployed in the future was associated with poorer mental health. For many young people entering the labour market, the prospects of limited employment opportunities and associated risks to health are a major public health concern. In setting their needs firmly on the policy agenda, and planning appropriate services, these broader social issues should not be forgotten.     

Risk,resistance and the neoliberal agenda: young people,health and well-being in the UK,Canada and Australia

In this article we describe how concepts of risk are both generated by and used to reinforce a neoliberal agenda in relation to the health and well-being of young people. We examine how risk may be used as a tool to advance ideals such as rational choice and individual responsibility, and how this can further disadvantage young people living within the contexts of structural disadvantage (such as geographic areas of long-term unemployment; communities that experience racial discrimination). We also identify the ways in which risk is applied in uneven ways within structurally disadvantaged contexts. To suggest a way forward, we articulate a set of principles and strategies that offer up a means of resisting neoliberal imperatives and suggest how these might play out at the micro-, meso- and macro-levels. To do this, we discuss examples from the UK, Canadian and Australian contexts to illustrate how young people resist being labelled as risky, and how it is possible to engage in health equity-enhancing actions, despite seemingly deterministic forces. The cases we describe reveal some of the vulnerabilities (and hence opportunities) within the seemingly impenetrable world view and powers of neoliberals, and point towards the potential to formulate an agenda of resistance and new directions for young people's health promotion.     

Engagement with health and social care services: perceptions of homeless young people with mental health problems

The present qualitative study describes and discusses the perspectives and experiences of young homeless people with mental health problems in relation to their interactions with health and social care services. Working in partnership with Streetlink, a supported accommodation assistance programme in Adelaide, Australia, the authors interviewed 10 homeless young people, aged from 16 to 24 years of age, who had experienced mental health problems. In-depth interviews elicited accounts of the best and worst of the participants' experiences of health and social care services. Access to services was not identified as being a significant problem in comparison with the participants' concerns regarding the quality of the services encountered. The central findings stress the importance of a respectful and supportive climate in relation to the qualities of service provision that the young people identified as valuable for their continuing treatment or consultation.     

Setting an ethical agenda for health promotion

The Bangkok Charter for Health Promotion in a Globalized Worldhas sparked lively dialogue. Welcomed by some as a Charter currentto the times, there are others who see it as an unneeded andtherefore unwelcome challenger to the Ottawa Charter for HealthPromotion. Intended or not, the Bangkok Charter seems to signala shift in discourse, from a social-ecological approach andan emphasis on individual and community capacity-building andempowerment, to an investment approach and an emphasis on globalization,macro-level factors and policy. Positively, the Bangkok Charterproclaims to build on Ottawa, and no one suggests it is meantto replace the Ottawa Charter outright. In concert with that,the dialogue today is not so much about the ascendancy of theone Charter over the other, but about the degree to which theBangkok Charter remains true to the ethic of the Ottawa Charter.It is welcome that the Ottawa and Bangkok Charters are the subjectof brisk dialogue about strategy and tactics in a rapidly changingworld, and about the foundational values of health promotion.Regarding the latter, we have unfinished work in constructingan ethic for health promotion, and the present dialogue mayinspire us to progress. Though we have the cornerstone of anethic for health promotion, in the Ottawa Charter and in otherprincipled documents that have followed, we have yet to buildsufficiently on the cornerstone; an ethic for practice has yetto be codified, and the same is true for research. Health promotionjournals, conferences and organizations can and should do moreto facilitate dialogue on ethics in health promotion, and theInternet provides the means for all to participate actively.     

The health and well‐being of children and young people who are looked after: Findings from a face‐to‐face survey in Glasgow

Evidence suggests children and young people who are looked after (LACYP) may have poorer health outcomes than children and young people in the general population, particularly in relation to mental health. This paper discusses findings from a survey of the health and well‐being of LACYP in Glasgow. A structured questionnaire used in the 2010 Glasgow Schools Survey (GSS) was adapted and administered in face‐to‐face interviews with 130 young people aged 11–18 in 2014–2015 to investigate various aspects of health and well‐being including physical activity, diet and sleep, smoking, alcohol and drugs, health feelings and worries, behaviours, attitudes and expectations. LACYP were more likely to report that they had tried drugs, slightly more likely to have scores indicating a high level of difficulties on the Strengths and Difficulties Questionnaire (SDQ) and less likely to report that they ate fruit and vegetables, used active transport methods to get to school and expected to go on to further or higher education; however, reported rates of physical activity, smoking and drinking were similar. LACYP were less likely to report that they had engaged in antisocial behaviour, truancy or bullying or been exposed to environmental tobacco smoke, less likely to worry or have low self‐esteem, and more likely to rate their health positively. There were some variations according to placement type. The findings of this study present a more positive picture of the health and well‐being of LACYP in Glasgow than might have been expected but should be treated with caution due to small sample size. Further research is needed to identify differences in relation to placement type and to determine whether being looked after might be associated with improved health and well‐being outcomes for some children and young people.     

Promoting and protecting the health of children and young people

BACKGROUND: The health-related behaviours adopted by children and young people can have both immediate and long-term health effects. Health promotion interventions that target children and young people can lay the foundations of a healthy lifestyle that may be sustained into adulthood. This paper is based on a selective review of evidence relating to health promotion in childhood, carried out to support the external working group on the 'Healthy Child' module of the Children's National Service Framework. METHODS: This is a selective review of mainly secondary research. It focuses on injury prevention, support for parenting and the promotion of good mental health, and promoting a healthy diet and physical activity amongst children and young people. FINDINGS: In many areas, the quality of primary research into health promotion interventions aimed at children and young people is poor. Interventions are heterogeneous and not described in sufficient detail. Sample sizes tend to be small, and there are commonly problems of bias. Despite these difficulties, there is good evidence for a range of interventions, including (1) area road safety schemes; (2) combining a variety of approaches to the promotion of the use of safety equipment, including legislation and enforcement, loan/assisted purchase/giveaway schemes, education, fitting and maintenance of safety equipment; (3) school-based mental health promotion; (4) parenting support; (5) interventions that promote and facilitate 'lifestyle' activity for children, such as walking and cycling to school, and those that aim to reduce sedentary behaviours such as parent education to reduce the time children spend watching TV and using computers; and (6) controlling advertising of unhealthy food that is aimed at children. CONCLUSIONS: There are effective interventions to promote and protect the health of children and young people that require action across the five areas described in the Ottawa Charter. Health, social care and education services have a direct role in the delivery of many of these interventions and, in other areas, a role in collaborative work with other agencies, in lobbying for policy change and in raising the profile of child health promotion. Further research is needed using larger study populations, and closely defined interventions, both targeted and universal, in order to fill some of the current gaps in the evidence base for health promotion in children and young people.     

Resource use and service costs for ventilator-dependent children and young people in the UK

This paper describes the resource use and costs involved in supporting ventilator-dependent children and young people at home compared with those in hospital. Accommodation arrangements, patterns of service and resource use in the year prior to interview were recorded for 35 index cases aged 1-18 years using a piloted variant of the Client Services Receipt Inventory. Costs to the National Health Service (NHS), social services (excluding local authority housing costs), education (excluding basic statutory education costs), and voluntary and independent sectors were included. For each of the resources and supports used, a unit cost was calculated at 2002 prices, which was a close approximation to the long-run marginal opportunity cost. Of the 35 cases, 24 lived at home, seven were in hospital and four had transferred from hospital to home during the previous 12 months. Twelve used ventilation 24-h per day. The children and young people made intensive use of NHS services and resources. In total, the 35 cases cost just over pound 6.2 million to support during the year prior to interview; 92% of the costs were borne by the NHS. It was mostly, but not always, cheaper for children to live at home. A care package including qualified nurses and 24-h care (mean=pound 239,855 per year) was more expensive than a children's ward (mean=pound 155,158 per year), but less expensive than a long-term ventilation unit (mean=pound 301,888 per year) or an intensive care unit (mean=pound 630,388 per year), where most cases live whilst awaiting discharge. Support costs for children with complex ventilator dependency were seven times higher than those with simple ventilator dependency. These estimates provide commissioners and managers with good-quality data to inform the implementation of recently published national guidance on care for these children and young people.     

The experiences of young people with obesity in secondary school: some implications for the healthy school agenda

In 1995, the World Health Organisation launched a Global School Health Initiative to reduce health risks among young people. In the UK, the National Healthy School Programme (HSP) developed as part of a wider government commitment to promoting social inclusion. One of the key issues to be tackled by the programme is childhood obesity, for obesity is widely argued to be a public health problem for which a solution needs to be found. However, the assumption that obesity is necessarily problematic and that a higher body weight leads to health problems and social exclusion, is not without challenge. Critics of anti-obesity campaigns question the significance of weight per se and highlight the potential implications of discrediting not only fatness, but also the people who are seen as fat. This paper therefore explores the experiences of young people with obesity within the secondary school environment in relation to areas of concern prioritised by the HSP. The paper draws upon data from a qualitative research study involving 18 children and young people, between the ages of 10 and 17. Data were generated in focus group discussions and individual interview with participants of a community-based obesity intervention programme in South Yorkshire, UK. Data collection took place in 2005, and thematic analysis of the data was undertaken. Findings suggest that the issues prioritised in the HSP, particularly physical exercise and healthy eating, present challenges to young people with obesity and can reinforce their vulnerability to bullying in schools and contribute to their social exclusion. It concludes that social exclusion is a process experienced by, and pertinent to, children and young people, which has meaning for their experiences of, and during, childhood and youth. The whole-school approach of the HSP may fail to adequately address the experiences of marginalised and vulnerable groups of young people within schools, challenging and undermining the social inclusion agenda in which the programme is grounded and contributing to the construction of undesirable, fat, young bodies.