Exploring the limitations of an adult-led agenda for understanding the health behaviours of young people

Public health and health promotion agendas are usually determined by adults, even when the 'target' population is children and young people. Adult-centred frameworks for health maintenance and the promotion of well-being risk ignoring young people's conceptualizations and experiences of health and health-relevant behaviours. However, the current policy emphasis in the UK and elsewhere apparently seeks to position young people at the centre of their own health-related decisions. Building on the United Nations Convention on the Rights of the Child, this paper examines and critiques policies relating to young people in UK, European and worldwide contexts. This paper then introduces data from two qualitative studies conducted in the UK. These studies illustrate that young people's definitions of health often run counter to prevailing public health and health promotion discourses. Young people do, however, often exhibit strategies for managing their health, even though they are frequently restricted by the perceptions that adults have about their lives and behaviour. This paper argues that the new policy discourse is not yet being systematically turned into action to give all young people a voice. This is important to begin to understand young people's perspectives about what matters to them and what really influences their health behaviours.     

Coordinated school health programs and academic achievement: a systematic review of the literature

BACKGROUND: Few evaluations of school health programs measure academic outcomes. K-12 education needs evidence for academic achievement to implement school programs. This article presents a systematic review of the literature to examine evidence that school health programs aligned with the Coordinated School Health Program (CSHP) model improve academic success. METHODS: A multidisciplinary panel of health researchers searched the literature related to academic achievement and elements of the CSHP model (health services, counseling/social services, nutrition services, health promotion for staff, parent/family/community involvement, healthy school environment, physical education, and health education) to identify scientifically rigorous studies of interventions. Study designs were classified according to the analytic framework provided in the Guide developed by the Community Preventive Services Task Force. RESULTS: The strongest evidence from scientifically rigorous evaluations exists for a positive effect on some academic outcomes from school health programs for asthmatic children that incorporate health education and parental involvement. Strong evidence also exists for a lack of negative effects of physical education programs on academic outcomes. Limited evidence from scientifically rigorous evaluations support the effect of nutrition services, health services, and mental health programs, but no such evidence is found in the literature to support the effect of staff health promotion programs or school environment interventions on academic outcomes. CONCLUSIONS: Scientifically rigorous evaluation of school health programs is challenging to conduct due to issues related to sample size, recruitment, random assignment to condition, implementation fidelity, costs, and adequate follow-up time. However, school health programs hold promise for improving academic outcomes for children.     

The lifestyle concept and health education with young people. Results from a WHO international survey

This article draws upon data from a unique, 11-country study of young people's health behaviour, facilitated by the WHO Regional Office for Europe. Analyses of the data available on individual health behaviours cluster into two groups: (i) health enhancing behaviours; and (ii) health-compromising behaviours. The results were analysed to identify the strength and consistency of these lifestyles across countries. A relatively modest proportion of the variance of the original variables was explained by these two lifestyle factors, but a consistent pattern emerged between countries. This consistency indicates that the health-related lifestyles of young people may not vary greatly between the countries in the study, a finding which might be used as an encouragement for greater international cooperation in the development and use of health education materials for young people, which may be easily transferable between countries. The data also support a more integrated approach to health education based on the promotion of healthy lifestyles, rather than a focus on individual health behaviours.     

Investing in mental health and well-being: findings from the DataPrev project

A systematic review was conducted to determine the extent to which an economic case has been made in high-income countries for investment in interventions to promote mental health and well-being. We focused on areas of interest to the DataPrev project: early years and parenting interventions, actions set in schools and workplaces and measures targeted at older people. Economic evaluations had to have some focus on promotion of mental health and well-being and/or primary prevention of poor mental health through health-related means. Studies preventing exacerbations in existing mental health problems were excluded, with the exception of support for parents with mental health problems, which might indirectly affect the mental health of their children. Overall 47 studies were identified. There was considerable variability in their quality, with a variety of outcome measures and different perspectives: societal, public purse, employer or health system used, making policy comparisons difficult. Caution must therefore be exercised in interpreting results, but the case for investment in parenting and health visitor-related programmes appears most strong, especially when impacts beyond the health sector are taken into account. In the workplace an economic return on investment in a number of comprehensive workplace health promotion programmes and stress management projects (largely in the USA) was reported, while group-based exercise and psychosocial interventions are of potential benefit to older people. Many gaps remain; a key first step would be to make more use of the existence evidence base on effectiveness and model mid- to long-term costs and benefits of action in different contexts and settings.     

Effectiveness of peer education interventions for HIV prevention, adolescent pregnancy prevention and sexual health promotion for young people: a systematic review of European studies

Peer education remains a popular strategy for health promotion and prevention, but evidence of its effectiveness is still limited. This article presents a systematic review of peer education interventions in the European Union that were published between January 1999 and May 2010. The objective of the review is to determine the effectiveness of peer education programs for human immunodeficiency virus (HIV) prevention, adolescent pregnancy prevention and promotion of sexual health among young people. Standardized methods of searching and data extraction were utilized and five studies were identified. Although a few statistically significant and non-significant changes were observed in the studies, it is concluded that, overall, when compared to standard practice or no intervention, there is no clear evidence of the effectiveness of peer education concerning HIV prevention, adolescent pregnancy prevention and sexual health promotion for young people in the member countries of the European Union. Further research is needed to determine factors that contribute to program effectiveness.     

The structural influence of family and parenting on young people's sexual and reproductive health in rural northern Tanzania

This paper explores the structural role of the family and parenting in young people's sexual and reproductive health. The study involved eight weeks of participant observation, 26 in-depth interviews, and 11 group discussions with young people aged 14–24 years, and 20 in-depth interviews and 6 group discussions with parents/carers of children in this age group. At an individual level, parenting and family structure were found to affect young people's sexual behaviour by influencing children's self-confidence and interactional competence, limiting discussion of sexual health and shaping economic provision for children, which in turn affected parental authority and daughters' engagement in risky sexual behaviour. Sexual norms are reproduced both through parents' explicit prohibitions and their own behaviours. Girls are socialised to accept men's superiority, which shapes their negotiation of sexual relationships. Interventions to improve young people's sexual and reproductive health should recognise the structural effects of parenting, both in terms of direct influences on children and the dynamics by which structural barriers such as gendered power relations and cultural norms around sexuality are transmitted across generations.     

Australian parents’ use of universal child and family health services: A consumer survey

This study aimed to explore Australian parents’ use of universally available well‐child health services. It used an online survey of 719 parents of children aged from birth to 5 years in all states and territories to examine patterns of service use and consumer preferences. In Australia, several health professional groups provide advice to pregnant women, infants, children, and parents, offering health promotion, developmental screening, parenting support, and referral to specialist health services if required. The survey examined parents’ use of different child and family health providers, and their preferences for support with several common parenting issues. The study indicated that families with young children obtain primary healthcare from a range of service providers, often more than one, depending on children's ages and needs. Parents frequently visit general practitioners for immunisation and medical concerns. They attend dedicated child and family health nurses for parenting advice and well‐child checks and prefer them as an information source for many health issues. However, a substantial proportion of parents (44.1%) do not currently visit a child and family health nurse, often because they not only do not perceive a need but also sometimes because these services are unknown, inaccessible, or considered unsuitable. They may seek advice from less qualified sources. There is potential for increased collaboration between child and family health providers to ensure effective resource use and consistency of parenting information and advice. Nursing services may need to address accessibility and appropriateness of care.     

Healthy urban environments for children and young people: A systematic review of intervention studies

This systematic review collates, and presents as a narrative synthesis, evidence from interventions which included changes to the urban environment and reported at least one health behaviour or outcome for children and young people. Following a comprehensive search of six databases, 33 primary studies relating to 27 urban environment interventions were included. The majority of interventions related to active travel. Others included park and playground renovations, road traffic safety, and multi-component community-based initiatives. Public health evidence for effectiveness of such interventions is often weak because study designs tend to be opportunistic, non-randomised, use subjective outcome measures, and do not incorporate follow-up of study participants. However, there is some evidence of potential health benefits to children and young people from urban environment interventions relating to road safety and active travel, with evidence of promise for a multi-component obesity prevention initiative. Future research requires more robust study designs incorporating objective outcome measures.     

Parenting for mental health: what does the evidence say we need to do? Report of Workpackage 2 of the DataPrev project

The last decade has witnessed increasing interest in the promotion of mental health and well-being because of its importance for health and social functioning at individual level and for the social and economic well-being of societies. Recent research from a range of disciplines (including neurodevelopment, developmental psychology and genetics) has highlighted the importance of childhood, and particularly the first few years of life, for future mental, social and emotional development. The quality of the parent-child relationship and parenting more generally is one of the factors in determining outcomes. The objective of this review was to identify effective interventions to support parents, parenting and the parent-child relationship from the ante-natal period to adolescence. A systematic search of key electronic databases was undertaken to identify systematic reviews evaluating approaches to parenting support; 52 systematic reviews were identified. Results were synthesized qualitatively and reported under the following headings: (i) perinatal programmes; (ii) parenting support programmes in infancy and early years focused on enhancing caregiver sensitivity and attunement; (iii) formal parenting programmes focused on children's behaviour; (iv) parenting support for highest risk groups. The review provides a robust international evidence base of programmes which have been demonstrated to improve parenting and the mental health and well-being of children. Policies and programmes to support parenting offer much scope for improving mental health. Effective provision requires a skilled workforce and careful application of approaches that have been found to work. More research is needed to develop and identify interventions for some of the highest risk groups.     

Family influences on children's physical activity and fruit and vegetable consumption

Background  

There is evidence of a clustering of healthy dietary patterns and physical activity among young people and also of unhealthy behaviours. The identification of influences on children's health behaviors, particularly clustered health behaviors, at the time at which they develop is imperative for the design of interventions. This study examines associations between parental modelling and support and children's physical activity (PA) and consumption of fruit and vegetables (FV), and combinations of these behaviours.     

Australian Middle Eastern parents’ perceptions and practices of children's weight‐related behaviours: Talking with Parents’ Study

The home environment is associated with obesity‐related behaviours among children, and research in Australia has shown that some of these behaviours are more prevalent among children from particular cultural backgrounds including Middle Eastern. This study presents findings from face‐to‐face, semi‐structured interviews conducted in April 2013 with a convenience sample of Middle Eastern parents of primary school‐age children at an Islamic private school in Sydney, Australia. The interviews explored parental perceptions and practices regarding state government health messages addressing children's eating, physical activity and screen time. The purpose of the study was to investigate whether the content of these generic public health messages is relevant and acceptable to Middle Eastern parents of young children, and to identify any enablers and barriers to adopting these healthy practices at home. Thematic analysis identified predominant themes. In total, 21 interviews were conducted (reference children: 12 boys/9 girls, aged 5–12 years). The content of current health messages regarding children's weight‐related behaviours was familiar to respondents, and accepted as relevant for guiding their parenting practices. Parents perceived that they typically encouraged healthy behaviours, although they also reported making regular exemptions, in response to various circumstances. Overall, the perceptions and reported practices of the parents were consistent with other studies with Australian parents. There were no apparent culturally specific barriers or enablers to children's weight‐related behaviours. There is however scope for health promoters to provide more precise information on health recommendations, health risks and benefits, and to provide more specific ideas for ways in which parents can act on these health messages within the home and family environment, to encourage and support healthy behaviours in their children.     

Vulnerable children in families affected by parental mental illness: The role of theory in programme development

Abstract

People who experience mental illness frequently undertake parenting duties. While this group of parents can parent well, they often experience challenges that are associated with adverse impacts upon their children's mental health. A robust body of evidence does not currently exist to indicate interventions for this group that are most effective in promoting positive outcomes. We argue that, in this context, theory and the use of theoretical models are advantageous for practitioners to increase the effectiveness of interventions. This paper presents an analysis of the explicitly stated theoretical models used to guide published evaluations targeting this vulnerable group of children and young people. Almost half (46%) of the published evaluations examined failed to state explicitly or describe a theoretical underpinning for the intervention programme. Of those programmes that did use theory there was an emphasis on individual-focused theories drawn from psychology, psychiatry and social work rather than mainstream health promotion theories.     

NHS health trainers: a review of emerging evaluation evidence

Recent years have seen a change in focus in UK public health policies towards an emphasis on individual lifestyle choices. As part of this shift, NHS health trainers were introduced in disadvantaged communities in England, to provide peer support to people ‘at risk’ of developing lifestyle-related health problems and to help them to self manage their behaviour. Concerns have been expressed, however, about the strength of the evidence supporting the initiative. This article outlines a number of gaps between the theory and rhetoric underpinning the NHS health trainer initiative, and the reality in practice. This article critiques the evaluation evidence, questions the assumption that engaging lay people in health promotion activities in place of health professionals is necessarily a preferable option, identifies inconsistencies in the evidence supporting individually based health improvement initiatives, and suggests that interventions which target deprived areas but neglect the social determinants of health may be limited in their effectiveness.     

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.     

新疆精河县社区健康教育工作中存在问题及对策分析

健康教育是医学模式转变和现代医学发展的必然趋势.随着新医改的进一步深化,基本公共卫生服务逐步均等化工作已经在城乡逐渐铺开.社区已经成为推行健康教育与健康促进的重要场所.社区健康教育是利用社区资源针对不同人群开展的健康教育活动与过程.对社区居民、患者及其家属开展健康教育与健康促进,通过健康教育和环境支持改变人们的行为、生活方式和社会的影响,提高人民群众健康意识和自我保健能力、防治疾病能力.养成积极向上的健康行为,消除患者及其家属的不良心理反应,帮助他们树立战胜疾病的信心,实现对患者的心理保健,促使人们采纳有益于健康行为的生活方式.社区健康教育对于提高居民的健康水平和文明素质具有重要的作用.     

Family correlates of breakfast consumption among children and adolescents. A systematic review

Regular breakfast consumption can have a multitude of positive health benefits, yet young people are more likely to skip breakfast than any other meal. Given the evidence that dietary behaviours established in childhood and adolescence track into adulthood along with evidence that breakfast skipping increases with age, identifying correlates of children's and adolescent's breakfast behaviours is imperative. The family environment is an important influence on the dietary behaviours of young people, and therefore we systematically reviewed the literature on family correlates of children and adolescent's breakfast consumption. From the 24 papers reviewed, 6 studied children and 19 studied adolescents. Few studies have examined the same specific family correlates of breakfast consumption, limiting the possibilities of drawing strong or consistent conclusions. Research in this area is relatively new and this review has identified areas for further investigation. Parental breakfast eating and living in two-parent families were the correlates supported by the greatest amount of evidence in association with adolescent's breakfast consumption. The results suggest that parents should be encouraged to be positive role models to their children by targeting their own dietary behaviours and that family structure should be considered when designing programmes to promote healthy breakfast behaviours.     

Health behaviours of young, rural residents: A case study

Objective:  To analyse self-reported health behaviours of young people from a rural community and the factors influencing their behaviours.
Methods:  Interviews were conducted with 19 young people, 11 parents and 10 key informants from a small rural Victorian community, asking about teenage health behaviours and the factors influencing these behaviours.
Results:  Young people ate both healthy and unhealthy foods, most participated in physical activity, few smoked and most drank alcohol. The study found that community level factors, including community norms, peers, access issues and geographic isolation, were particularly powerful in shaping health behaviours, especially alcohol consumption. Smoking was influenced by social participation in the community and national media health campaigns. Diet and exercise behaviour were influenced by access and availability, convenience, family, peers and local and non-local cultural influences.
Conclusion and implications:  The rural context, including less access to and choice of facilities and services, lower incomes, lack of transport and local social patterns (including community norms and acceptance), impact significantly on young people's health behaviours. Although national health promotion campaigns are useful aspects of behaviour modification, much greater focus on the role and importance of the local contexts in shaping health decisions of young rural people is required.     

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.