School- and intervention-related factors associated with institutionalization of health promotion interventions in elementary schools. / Facteurs liés aux écoles et facteurs liés aux interventions dans le contexte de l'institutionnalisation des interventions de promotion de la santé dans les écoles primaires.

INTRODUCTION: Long-term availability of health-promoting interventions (HPIs) in school settings can translate into health benefits for children. However, little is known about factors associated with HPI institutionalization in schools. In this study, we identified correlates of the institutionalization of HPIs offered in elementary schools in Quebec, Canada. METHODS: In two-part, structured telephone interviews over three academic years (2016-2019), elementary school principals (or their designees) throughout Quebec identified an index HPI offered at least once in their school during the previous three years, and were asked whether it was institutionalized (i.e. explicitly written in the school's educational project, e.g. in the form of educational objectives and means of achieving them). We examined associations between institutionalization and 10 school-related and 16 HPI-related characteristics in univariable and multivariable logistic regression analyses. RESULTS: School key informants (n = 163) reported on 147 different HPIs that had been available in their schools in the past three years, 56% of which were institutionalized. Three aspects of school culture-parent/community engagement with the school, school/teacher commitment to student health and school physical environment-were positively associated with HPI institutionalization. HPI-related characteristics positively associated with HPI institutionalization included number of competencies addressed by the HPI, number of teaching strategies employed, modifications made to the HPI prior to or during implementation and perceived success of the HPI. Inviting families or community groups to participate in the HPI was inversely associated with institutionalization. CONCLUSION: Better understanding of factors associated with HPI institutionalization may inform the development of school-based HPIs that have the potential for sustainability.

Lack of consistency in measurement methods and semantics used for network measures in adolescent health behaviour studies using social network analysis: a systematic review.

BACKGROUND: Social network analysis (SNA) is often used to examine how social relationships influence adolescent health behaviours, but no study has documented the range of network measures used to do so. We aimed to identify network measures used in studies on adolescent health behaviours. METHODS: We conducted a systematic review to identify network measures in studies investigating adolescent health behaviours with SNA. Measures were grouped into eight categories based on network concepts commonly described in the literature: popularity, position within the network, network density, similarity, nature of relationships, peer behaviours, social norms, and selection and influence mechanisms. Different subcategories were further identified. We detailed all distinct measures and the labels used to name them in included articles. RESULTS: Out of 6686 articles screened, 201 were included. The categories most frequently investigated were peer behaviours (n=201, 100%), position within the network (n=144, 71.6%) and popularity (n=110, 54.7%). The number of measurement methods varied from 1 for 'similarity on popularity' (within the 'similarity' category) to 28 for the 'characterisation of the relationship between the respondent and nominated peers' (within the 'nature of the relationships' category). Using the examples of 'social isolation', 'group membership', 'individuals in a central position' (within the 'position within the network' category) and 'nominations of influential peers' (sub within the 'popularity' category), we illustrated the inconsistent reporting and heterogeneity in measurement methods and semantics. CONCLUSION: Robust methodological recommendations are needed to harmonise network measures in order to facilitate comparison across studies and optimise public health intervention based on SNA.

Availability of health-promoting interventions in high schools in Quebec, Canada, by school deprivation level. / Disponibilité des interventions de promotion de la santé dans des écoles secondaires du Québec (Canada) selon le niveau de défavorisation scolaire.

INTRODUCTION: School-based health-promoting interventions (HPIs) foster adolescent health and well-being. Access to HPIs may differ by the socioeconomic advantage of students at each school (school deprivation). We assessed the importance of health issues and availability of HPIs and extracurricular activities by school deprivation in high schools in Quebec, Canada. METHODS: In 2016/17, 2017/18 and 2018/19, we interviewed school principals or a designee in 48 public high schools classified as disadvantaged (33%) or advantaged (67%). Schools rated whether 13 common health-related issues were important (i.e. warranted intervention) in their student population and reported whether HPIs to address these or other health issues and/or sports or special interest extracurricular activities had been available in the past year. RESULTS: 84% of disadvantaged schools offered one or more HPIs in the past year compared to 73% of advantaged schools. Higher proportions of disadvantaged schools perceived most of 13 health-related issues as important. HPIs for bullying/exclusion, sex education and physical activity (issues subject to government mandates) were available in most schools. Higher proportions of disadvantaged schools offered non-mandated HPIs (i.e. for healthy eating, mental health/well-being and substance use). Higher proportions of advantaged schools offered extracurricular activities in all areas other than non-competitive sports, which was offered by equal proportions of advantaged and disadvantaged schools. CONCLUSION: Government mandates appear to facilitate universal availability of HPIs in schools, possibly boosting equity in school-based health promotion. Further investigation of possible differences in the content, implementation and/or effects of HPIs based on school deprivation is warranted.

Health-Promoting School Culture: How Do We Measure it and Does it Vary by School Neighborhood Deprivation?

BACKGROUND: The context in which school-based health-promoting interventions are implemented is key for the delivery and success of these interventions. However, little is known about whether school culture differs by school deprivation. METHODS: Using data from PromeSS, a cross-sectional study of 161 elementary schools in Québec, Canada, we drew from the Health Promoting Schools theoretical framework to develop four measures of health-promoting school culture (i.e., school physical environment, school/teacher commitment to student health, parent/community engagement with the school, ease of principal leadership) using exploratory factor analysis. One-way ANOVA with post-hoc Tukey-Kramer analyses was used to examine associations between each measure and social and material deprivation in the school neighborhood. RESULTS: Factor loadings supported the content of the school culture measures and Cronbach's alpha indicated good reliability (range: 0.68-0.77). As social deprivation in the school neighborhood increased, scores for both school/teacher commitment to student health and parent/community engagement with the school decreased. IMPLICATIONS FOR SCHOOL HEALTH POLICY, PRACTICE, AND EQUITY: Implementation of health-promoting interventions in schools located in socially deprived neighborhoods may require adapted strategies to address challenges related to staff commitment and parental and community involvement. CONCLUSION: The measures developed herein can be used to investigate school culture and interventions for health equity.

Social network analysis to study health behaviours in adolescents: A systematic review of methods.

PURPOSE: Our objectives were (i) to systematically review how SNA is used in studies investigating adolescent health behaviours (i.e., the purpose of using SNA, methods used for network data collection and analysis), and (ii) to develop methodological guidelines to help researchers use SNA in studies on adolescent health behaviours. METHODS: Five databases were searched using keywords related to "social network analysis" and "adolescents". We extracted data from included articles pertaining to the choice of methods for network data collection and analysis. We used these data to develop a 5-step decision tree to help researchers make methodological decisions most appropriate to their research objectives. RESULTS: A total of 201 articles were included. Most investigated tobacco (50%) or alcohol use (48%). SNA was used most often to examine processes related to peer selection or influence (37%) and/or to examine the effect of sociometric position on health behaviours (34%). 181 studies (90%) used a sociocentric approach for SNA, 16 studies (8%) used an egocentric approach, and 4 studies (2%) used both. We identified five decision-making steps in SNA including the choice of: (i) network boundary, (ii) SNA approach, (iii) methods for name generators, (iv) methods for name interpreters, and (iv) SNA indicators. CONCLUSION: This study provides insights and guidance in a 5-step decision tree on practical and methodological considerations in using SNA to explore adolescent health behaviours.

Correlates of perceived success of health-promoting interventions in elementary school. / Corrélats du succès perçu des interventions de promotion de la santé dans les écoles primaires.

INTRODUCTION: School-based health-promoting interventions (HPIs) aim to support youth development and positively influence modifiable lifestyle behaviours. Identifying factors that contribute to or hinder the perceived success of HPIs could facilitate their adaptation, improve implementation and contribute to HPI sustainability. The objective of this study was to identify factors in three domains (school characteristics, characteristics of the HPI and factors related to planning and implementing the HPI) associated with perceived success of HPIs among school principals in elementary schools. METHODS: Data were drawn from Project PromeSS, a cross-sectional survey of school principals and/or nominated staff members in a convenience sample of 171 public elementary schools in Quebec, Canada. School board and school recruitment spanned three academic school years (2016-2019). Data on school and participant characteristics, HPI characteristics, variables related to HPI planning and implementation and perceived success of the HPI were collected in two-part, structured telephone interviews. Descriptive statistics were used to characterize schools and study participants. Twenty-eight potential correlates of perceived HPI success were investigated separately in multivariable linear regression modelling. RESULTS: Participants generally perceived HPIs as highly successful. After controlling for number of students, language of instruction, school neighbourhood and school deprivation, we identified five correlates of perceived success, including lower teacher turnover, higher scores for school physical environment, school/teacher commitment to student health, principal leadership and school being a developer (vs. adopter) of the HPI. CONCLUSION: If replicated, these factors should be considered by HPI developers and school personnel when planning and implementing HPIs in elementary schools.

Associations of Quantity Smoked and Socioeconomic Status With Smoke-Free Homes and Cars Among Daily Smokers.

INTRODUCTION: An association between socioeconomic status (SES) and smoke-free private spaces among smokers could be due to heavier smoking among low SES smokers. We assessed whether quantity smoked or SES are independently associated with smoke-free homes or cars in daily smokers. METHOD: Data were drawn from a cross-sectional telephone survey (2011-2012) of 750 daily smokers age ≥18 years in Quebec, Canada (45% response). Multivariable logistic regression was used to model the independent association between (a) number of cigarettes smoked per day, and (b) each of educational attainment, annual household income, or active employment status and smoke-free homes or cars. RESULTS: Participants were 41.0 years old on average, 57% were female. Median (IQR) number of cigarettes smoked per day was 14 (10, 20). Forty-eight percent of participants reported smoke-free homes; 34% reported smoke-free cars. Quantity smoked was strongly associated with both smoke-free homes and cars. Income and education (but not actively employed) were associated with smoke-free homes. None of the SES indicators were associated with smoke-free cars. CONCLUSIONS: Interventions targeting smokers to promote smoke-free homes and cars should incorporate components to help smokers reduce quantity smoked or preferably, to quit. Interventions targeting smoke-free homes will also need to address SES inequalities by education and income. Our data suggest that reduction in quantity smoked may help smokers reduce SHS exposure in cars, but that an inequality lens may not be relevant.

Social inequalities in availability of health-promoting interventions in Québec elementary schools.

Availability of health-promoting interventions (HPIs) may vary across schools serving students with different socioeconomic backgrounds. Our objectives were to describe social inequalities across elementary schools in: (i) level of importance that school principals attribute to 13 common health-related issues among students in their school; (ii) availability of HPIs within their school addressing eight health topics and (iii) (mis)alignment between perceived importance and HPI availability. Data were collected in telephone interviews with school principals in a convenience sample of 171 elementary schools (59% of 291 schools contacted). Schools were categorized as serving very advantaged, moderately advantaged or disadvantaged students. Principals reported how important 13 health issues were among students in their schools and provided data on HPI availability for 8 health issues, 4 of which required school action under government mandates. Higher proportions of principals in schools serving disadvantaged students (36% of all 171 schools) perceived most health issues as important. The mean number of HPIs in the past year was 12.0, 12.1 and 11.7 in schools serving very advantaged, moderately advantaged and disadvantaged students, respectively. Only availability of mental health HPIs differed by school deprivation (60, 43 and 30% in very, moderately and disadvantaged, respectively). Although most schools offered oral health HPIs, dental problems were not perceived as important. Smoking was perceived as not important and smoking-related HPIs were relatively rare (9%). Given rapid evolution in public health priorities, (mis)alignment between perceived importance of specific health issues and HPI availability in elementary schools warrants ongoing reflection.

Interventions that promote health may not be present in all schools. Our objectives were to describe differences across elementary schools in: (i) level of importance that school principals attribute to common health-related issues among students in their own school; (ii) the presence of interventions that address these health issues and (iii) (mis)alignment between perceived importance and presence of interventions. Telephone interviews were conducted with school principals in 171 elementary schools serving very advantaged, moderately advantaged or disadvantaged students. Principals reported how important 13 health-related issues (four of which required school action under government mandates) were among students in their schools and whether interventions were present for 8 of the 13 issues. Higher proportions of principals in schools serving disadvantaged students perceived most health issues as important. Intervention availability did not differ across schools, except that higher proportions of schools serving advantaged students reported mental health interventions. Most schools offered oral health interventions, but dental problems were not perceived as important. Smoking was also not perceived as important and interventions were relatively rare. (Mis)alignment between perceived importance of health issues and intervention availability calls for ongoing reflection.

Do Social Inequalities in Smoking Differ by Immigration Status in Young Adults Living in an Urban Setting? Findings From the Interdisciplinary Study of Inequalities in Smoking.

OBJECTIVES: We assessed whether social inequalities in smoking observed among young adults born in Canada were also apparent in same-age immigrants. METHODS: Data were drawn from an investigation of social inequalities in smoking conducted in an urban setting (Montreal, Canada). The sample included 2077 young adults age 18 to 25 (56.6% female; 18.9% immigrants who had lived in Canada 11.6 (SD 6.4) years on average). The association between education and current smoking was examined in multivariable logistic regression analyses conducted separately in young adults born in Canada and in immigrants. RESULTS: About 19.5% of immigrants were current smokers compared to 23.8% of young adults born in Canada. In immigrants, relative to those with university education, the adjusted odds ratios (OR) (95% confidence interval) for current smoking were 1.2 (0.6, 2.3) among those with pre-university/vocational training and 1.5 (0.7, 2.9) among those with high school education. In non-immigrants, the adjusted ORs were 1.9 (1.4, 2.5) among those with pre-university/vocational training and 4.0 (2.9, 5.5) among those with high school. CONCLUSION: Young adults who had immigrated to Canada did not manifest the strong social gradient in smoking apparent in young adults born in Canada. Increased understanding of the underpinnings of this difference could inform development of interventions that aim to reduce social inequalities in smoking.