What do we know about promoting mental health through schools?

There is a growing evidence base on what schools need to do to promote mental health effectively. There is strong evidence that they need first and foremost to use a whole school approach. This shapes the social contexts which promote mental health and which provide a backdrop of measures to prevent mental health disorders. In this context the targeting of those with particular needs and the work of the specialist services can be much more effective. Schools need to use positive models of mental health, which emphasise well being and competence not just illness--this will help overcome problems of stigma and denial and promote the idea of mental health as 'everyone's business'. The most effective programmes in schools which address mental health have the following characteristics: They provide a backdrop of universal provision to promote the mental health of all and then target those with special needs effectively. They are multi-dimensional and coherent. They create supportive climates that promote warmth, empathy, positive expectations and clear boundaries. They tackle mental health problems early when they first manifest themselves and then take a long term, developmental approach which does not expect immediate answers. They identify and target vulnerable and at risk groups and help people to acquire the skills and competences that underlie mental health. They involve end users and their families in ways that encourage a feeling of ownership and participation, and provide effective training for those who run the programmes, including helping them to promote their own mental health. Using these starting points, we need to develop a rigorous evidence-based approach on this issue. We also require the facilitation of the dissemination of such research findings while encouraging new and innovative approaches.     

Hunting happiness or promoting health? Why positive psychology deserves a place in health promotion

This commentary asks the question of whether positive psychology represents an egoistic pursuit of happiness, which is in conflict with basic values within health promotion. A look at key concepts and research findings within positive psychology reveals common ground with health promotion. Similarities are evident in conceptualization of health, resource focus, value focus and consequences for policy. Some influences of happiness on health and functioning are described.     

Are schools of public health needed to address public health workforce development in Canada for the 21st century?

In addition to establishing Canadian federal institutions for public health to work in cooperation with provincial and local health authorities, the infrastructure of public health for the future depends on a multi-disciplinary and well-prepared workforce. Traditionally, Canada trained its public health workforce in schools of public health (or hygiene), but in recent decades this has been carried out in departments and centres primarily within medical faculties. Recent public health crises in Canada have led to some new federal institutions and reorganization of public health activities as well as other reforms. This commentary proposes re-examination of the context of public health workforce training and especially for schools of public health as independent faculties within universities as in the United States or, as developed more recently in Europe, semi-independent schools within medical faculties. The multi-disciplinary nature of public health professionals and the complex challenges of the "New Public Health" call for a new debate on this vital issue of public health workforce development. Public health needs a new image and higher profile of training, research and service to meet provincial and national needs, based on international standards of accreditation and recognition.     

Should we change the focus of health promotion in sexual health clinics?

The effectiveness of sexual behaviour change interventions in sexual health clinics is unknown. Risk factors for poor sexual and reproductive health such as depression, violence, alcohol and smoking in sexual health clinics are all common and can be identified easily in sexual health services. Targeting these risk factors could be as effective as traditional sexual health promotion and could have additional benefits. The authors propose a pilot to assess the cost-effectiveness and acceptability of incorporating screening and interventions for these risk factors.     

Should we change the focus of health promotion in sexual health clinics?

In a response to the recent article by Rudiger Pitroff and Elizabeth Goodburn on changing the focus of health promotion in sexual health clinics, Crouch and Fagan draw attention to the confusion among practitioners between brief interventions in clinics (health education) and the actual nature and scope of sexual health promotion. The response refocuses attention on the Ottawa Charter for Health Promotion and on the social determinants of sexual health inequity as appropriate design drivers of a pilot initiative proposed by Pitroff and Goodburn to re-orient sexual health service provision around the real needs of its clients.     

Can schools promote the health of children with asthma?

This report describes the evaluation of a whole-school intervention to improve morbidity and psychosocial well-being in pupils with asthma. In all, 193 children with asthma (7-9 years) from 23 primary/junior schools in the south of England participated. Schools (n = 12) randomly assigned to the intervention group (IV) received a staff asthma training session, advice on asthma policy and practice and an emergency beta(2)-agonist inhaler with spacer. Pupils participated in an asthma lesson. Staff and pupils in non-intervention (NI) schools (n = 11) received no asthma-oriented input. While wheeze reports improved for all children with asthma, only the IV group showed lower requirement for medication (P = 0.01), clinically significant improvement (P < 0.05) in activity related quality of life (QOL) and increased self-esteem (SE: social P = 0.01; athletic P = 0.05; behaviour P = 0.001) in girls. SE decreased for NI girls but there was no change for non-asthmatic peers in NI or IV schools which had similar baseline levels of SE and QOL. There was a marginal improvement in the establishment of asthma policies/practices and no change in school absence or staff knowledge. The significantly increased peer group understanding of asthma seen in the intervention schools may have mediated increased well-being in the IV group. Primary schools are a potentially important context for improving asthma morbidity and psychosocial well-being of children with asthma.     

What's the future for health promotion in England? The views of practitioners

Specialized health promotion is an internationally recognized occupation and field of activity which has had a chequered history in England. After flourishing briefly in some areas in the early years of the New Labour government it has been in decline in most parts of the country. The last survey of practice conducted in 2005 found that the specialized health promotion workforce was unevenly distributed and much in need of advocacy and development. Since then there has been another major reorganization of primary care trusts (PCTs) and a split between commissioning and provider functions. Practitioners' views on the impact of this on health promotion were gathered in a survey in 2008-2009. Participants comprised 36 people attending a Shaping the Future workshop in the North of England and 40 practitioners studying a masters course in health promotion. The findings reveal that organizational structure has a major impact on the nature of health promotion activity: the split between commissioning and provider functions of PCTs has presented huge challenges to practitioners irrespective of the arm in which they are placed, as one of the strengths of health promotion has always been its ability to straddle both strategic and operational levels and offer a joined-up approach to tackling the causes of ill health. For the specialized health promotion workforce, there has been a loss of identity and critical mass as the discipline is increasingly reduced and fragmented, a trend that looks set to worsen following further reorganization and reductions in public sector spending introduced by the new coalition government.     

The District: the place of management of community health services or the place of governance of primary health care? The epidemiologic context

This is a review of epidemiologic requirements for the governance of District health services. The governance concern both the health system (organization, management and assessment of health services) and the population's health (health needs, health services needs, determinants of health).     

HPV vaccination: Are we initiating too late?

Background

Human papillomavirus (HPV) vaccination is recommended in early adolescence. While limited data suggest that patients frequently delay initiation of the three-dose series, age-based variability in initiation of HPV vaccination and its clinical relevance are not well described. Thus, this study aims to characterize HPV vaccination delay among adolescent and young adult females.

Methods

This retrospective cohort study examined age at HPV vaccination initiation and missed opportunities for receipt of the first vaccine dose (HPV1) among 11–26 year-old females (n = 22,900) receiving care at 16 urban academically-affiliated ambulatory care clinics between 2007 and 2011. Predictors of timely vaccination and post-licensure trends in age at HPV1 receipt were assessed using multivariable logistic regression and a generalized linear mixed model, respectively. Chlamydia trachomatis and Papanicolaou screening before HPV vaccination initiation, as markers of prior sexual experience and associated morbidity, were examined in a subcohort of subjects (n = 15,049).

Results

The proportion of 11–12 year-olds who initiated HPV vaccination increased over time (44.4% [2007] vs. 74.5% [2011], p < 0.01). Initiation rates also improved among 13–26 year-olds. Thus, the mean age at HPV1 receipt remained unchanged between 2007 and 2011 (16.0 ± 2.7 vs. 15.9 ± 4.0 years, p = 0.45). Spanish language was a positive predictor (AOR 1.62, 95% CI 1.05–2.48) of HPV vaccination initiation among 11–12 year-olds in 2011. The majority (70.8–76.4%) of unvaccinated subjects experienced missed vaccination opportunities. Of the subcohort, 36.9% underwent Chlamydia screening before HPV1 receipt (19.1% with ≥1 positive result). Of those with prior Papanicolaou screening (16.6%), 32.1% had ≥1 abnormal result.

Conclusions

These low-income, minority females frequently delayed initiation of HPV vaccination. Many had evidence of prior sexual experience and associated morbidity, placing them at risk of HPV-related complications. Promoting timely HPV vaccination and reducing missed vaccination opportunities are crucial.     

Small area inequalities in health: Are we underestimating them?

Spatially aggregated data are frequently used for official statistics and by researchers investigating the contextual determinants of health. Results of reporting and analysis vary according to the choice of areal unit. This is the well-known Modifiable Areal Unit Problem or MAUP. Its implication for the monitoring and understanding of area inequalities in health has received little empirical attention in the public health literature. Health differences will likely be smallest across arbitrarily chosen areas whereas boundaries acknowledging the physical and social geography should indicate greater differences between areas. Here we use three methods to define area boundaries and compare the extent of health inequalities across each drawing on data from the London boroughs of Camden and Islington. Irrespective of the boundary definition used, between-area inequalities in obesity, alcohol intake, smoking, walking and self-rated health were small compared with inequalities between individuals. There was a tendency for slightly larger estimated inequalities across areas defined by socioeconomic homogeneity compared with other definitions, but differences between methods were very small in magnitude. Existing studies predominantly use area boundaries that are based on administrative boundaries. Although these have little theoretical basis for the study of neighbourhood inequalities in health, our findings indicate that alternative definitions of the neighbourhood boundaries have no substantive effect on the estimates of those inequalities. Based on these findings, we can have greater confidence in the results of numerous studies which have used administrative boundaries to define the neighbourhood.     

Are we ignoring population density in health planning? The issues of availability and accessibility

Availability of health facilities is commonly expressed in terms of the number of persons dependent on one unit. Whether that unit is actually accessible to those persons depends, however, on the population density. Some examples illustrate the precise relationship. A measure of accessibility is obtained by expressing the availability of facilities as 'one unit within x km distance' (for the average--or, preferably, the median--person). This measure is therefore to be preferred.     

Are reproductive health NGOs in Uganda able to engage in the health SWAp?

This paper explores the ability for reproductive health (RH) non-governmental organizations (NGO) in Uganda to survive in the context of SWAp and decentralization. The authors argue that, contrary to the perceptions that this context may increase NGO's financial vulnerability, a SWAp and a decentralized system may provide an opportunity that should be embraced by NGOs to enhance their sustainability and effectiveness by reducing their current dependency on donor funding. The paper discusses the systemic weaknesses of many NGOs that currently make them vulnerable, and observes that unless these weaknesses are addressed, such NGOs will lose their space in the SWAp and decentralization arena. The authors suggest that NGOs need to recognize the opportunities that participating in public-private partnerships through a SWAp can offer them for long-term and significant funding. They need also to develop their capacity to pro-actively participate in a SWAp and decentralized context by becoming more entrepreneurial in nature, through re-orienting their organizational philosophies and strategic planning and budgeting so as to be able to partner effectively with the public sector in accessing funds made available through health sector reform.