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.

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.

How Young Mothers Rely on Kin Networks and Formal Childcare to Avoid Becoming NEET in the Netherlands.

Motherhood is often cited as one of the main reasons for young women to become NEET (not in employment, education, or training). Given the potential long-term negative implications of NEET status, it is important to understand which types of resources can help young mothers to avoid becoming NEET around childbirth. In this paper we investigate how the chances of young mothers to become and stay NEET around the time of first birth are related to the availability and characteristics of members of their social support network, especially partners and grandparents, to assist in childcare. In addition, we consider the local availability of formal childcare. We use population-wide register data from the Netherlands and estimate discrete-time eventhistory models. Our results show that young mothers who are cohabitating or married are less likely to become NEETs than single mothers. We also show that economic activity and relative wage of both young mothers and their partners decreases the likelihood to become NEET and to exit NEET. With respect to the grandparents, we find that having more grandparents live in the immediate vicinity is associated with a lower likelihood to become NEET and a higher likelihood to exit NEET. Furthermore, we find that young mothers with economically inactive parents are more likely to become and less likely to exit NEET. Lastly, we find evidence for crowding-out of informal and formal childcare. Formal and informal childcare sources interact in such a way that the role of either becomes less important as more of the other is available.

Citizenship and education trajectories among children of immigrants: A transition-oriented sequence analysis.

During recent decades, the educational outcomes of the children of immigrants have been extensively studied, with a growing emphasis on the heterogeneity of the so-called second generation. Yet, the impact of host country citizenship on children's educational outcomes has only received limited attention so far, although children of immigrants do not get automatic birthright citizenship in most European countries. Focusing on the Netherlands, this paper compares educational trajectories among citizen and non-citizen children of immigrants. Register data and sequence analysis are used to map and cluster the trajectories of a full cohort of second-generation students from the start of secondary school. We apply a variant of optimal matching focusing on sequences of transitions, which enables us to uncover different patterns of (im)mobility within a stratified school system better than the standard approach. Multinomial logistic regressions show that students who acquire Dutch citizenship are significantly more likely to follow upward trajectories, taking advantage of the system's flexibility and "back doors". Conversely, not having Dutch citizenship is associated with a higher risk of dropout and school interruptions. These findings are in line with our theoretical expectation that, during the naturalisation process, parents acquire or further develop important resources for navigating a complex educational system such as the Dutch one.

Validation of the Dutch Version of the Boston Carpal Tunnel Questionnaire.

The Boston Carpal Tunnel Questionnaire (BCTQ) is a scale that has been developed specifically for carpal tunnel syndrome (CTS). It consists of the Functional Status Scale (FSS) and the Symptom Severity Scale (SSS). It is the most widely used patient reported outcome measure in CTS and has been validated in many languages. Although already widely used, psychometric properties of the Dutch version of the BCTQ are yet unknown. The aim of this study was to assess the validity, reliability, responsiveness, and acceptability of the Dutch version. Moreover, this paper focuses the longitudinal validity (the use after an intervention) of the BCTQ, which has not been investigated before. A total of 180 patients completed the BCTQ in addition to a six-point Likert scale for perceived improvement, before and about 6-8 months after carpal tunnel release (CTR). Principal factor analysis revealed that the FSS is unidimensional, consisting of a single latent factor ("functionality") and has a high internal consistency (Cronbach's α = 0.825). However, the SSS has three dimensions, which are all highly internally consistent: "daytime symptoms" (Cronbach's α = 0.805), "nighttime symptoms" (Cronbach's α = 0.835), and "operational capacity" (Cronbach's α = 0.723). Post-treatment, the FSS still consisted of one factor, but the SSS changed in dimensionality, as it had only two factors left post-treatment. The ΔFSS and ΔSSS had good correlation with the six-point Likert scale for perceived improvement (r = 0.524; p < 0.01 and r = 0.574; p < 0.01, respectively), a moderate correlation between FSS and pinch grip (r = 0.259; p < 0.01) was found, and a weak correlation between SSS and pinch grip (r = 0.231; p < 0.01) was found. Standard Response Mean for FSS and SSS was 0.76 and 1.49, respectively. Effect size was 0.92 and 1.96, respectively, both indicating a good responsiveness. Response rate was high (82-84%). We concluded that the Dutch version of the BCTQ has a proper reliability, validity, responsiveness, and acceptability to assess the symptom severity and functional disabilities of CTS patients. Because of multidimensionality, we would recommend to create sum scores of the four different dimensions instead of two. Caution is required when interpreting the results postoperatively, due to the insufficient longitudinal validity of the SSS.

Contextual explanations for numeracy and literacy skill disparities between native and foreign-born adults in western countries.

Using new direct measures of numeracy and literacy skills among 85,875 adults in 17 Western countries, we find that foreign-born adults have lower mean skills than native-born adults of the same age (16 to 64) in all of the examined countries. The gaps are small, and vary substantially between countries. Multilevel models reveal that immigrant populations' demographic and socioeconomic characteristics, employment, and language proficiency explain about half of the cross-national variance of numeracy and literacy skills gaps. Differences in origin countries' average education level also account for variation in the size of the immigrant-native skills gap. The more protective labor markets in immigrant-receiving countries are, the less well immigrants are skilled in numeracy and literacy compared to natives. For those who migrate before their teens (the 1.5 generation), access to an education system that accommodates migrants' special needs is crucial. The 1 and 1.5 generation have smaller numeracy and literacy skills gaps in more ethnically diverse societies.

A review of abortion laws in Western-European countries. A cross-national comparison of legal developments between 1960 and 2010.

The extent to which women have had access to legal abortions has changed dramatically in Western-Europe between 1960 and 2010. In most countries, abortion laws developed from completely banning abortion to allowing its availability on request. Both the timing and the substance of the various legal developments differed dramatically between countries. Existing comparative studies on abortion laws in Western-European countries lack detail, usually focus either on first-trimester abortions or second trimester abortions, cover a limited time-span and are sometimes inconsistent with one another. Combining information from various primary and secondary sources, we show how and when the conditions for legally obtaining abortion during the entire gestation period in 20 major Western-European countries have changed between 1960 and 2010. We also construct a cross-nationally comparable classification of procedural barriers that limit abortion access. Our cross-national comparison shows that Western-Europe witnessed a general trend towards decreased restrictiveness of abortion laws. However, legal approaches to regulating abortion are highly different in detail. Abortion access remains limited, sometimes even in countries where abortion is legally available without restrictions relating to reasons.