A translational approach to characterization and measurement of health-promoting school ethos.

A health promoting schools (HPS) approach is hypothesized to influence student health and wellbeing by promoting a 'school ethos' that reflects the physical environment, social relations, organisational structure, policies and practices within schools. This complex set of factors makes health promoting school ethos (HPSE) challenging to define and measure. This work sought to theorise, develop and pilot a measure of HPSE as the context for implementation of HPS initiatives. We used a multi-method, iterative process to identify relevant HPSE concepts through triangulation of conceptual literature, existing tools and the tacit knowledge of school stakeholders. The HPSE measurement tool was administered to 18 elementary schools through a principal and teacher survey and an environmental assessment, followed by the development of HPSE scores for each school. Testing for internal consistency of items was used to examine theorized concepts, and scores for each school are summarised. HPSE included eight conceptual dimensions with internal consistency ranging from α = 0.60 to α = 0.87. Total HPSE scores across schools (N = 18) ranged from 1 to 8 (mean = 3.94, SD = 2.1), with 28-65% of schools reporting 'high' on respective HPSE dimensions. Schools included a heterogeneous mixture of HPSE scores, particularly across different dimensions. Our novel approach to tool development allowed us to conceptualize HPSE using a flexible process comprising different types and sources of evidence. The HPSE tool holds potential for identification and measurement of critical components of different school context as it relates to HPS.

Moving from Policy to Practice: A Report of School Nutrition Policy Adherence in Nova Scotia.

PURPOSE: School food and nutrition policies have the potential to encourage healthier eating among children and youth to address rising concerns of poor diet quality. Despite their widespread implementation, there is little reported monitoring of policy adherence. This short report describes adherence to the provincial school food and nutrition policy in Nova Scotia (NS) that was implemented in 2006. METHODS: An online survey was distributed to NS public schools in 2014-2015 to assess adherence to the directives and guidelines of the policy. Descriptive information was obtained for schools and indicators for policy adherence were explored. RESULTS: A total of 242 schools completed the survey (73% response rate) and policy adherence was variable across the different components. Few schools adhered to the policy standard related to the sale of unhealthy foods and there was inconsistency in school adherence reported for other policy indicators. CONCLUSIONS: This research suggests that further action is need to ensure "minimum nutrition" food and beverages are not available in schools and that healthy eating is reinforced through prioritizing key policy actions like pricing strategies, discontinuing fundraising with unhealthy food, and ensuring food programs are available in a nonstigmatizing manner.

The picture of health: examining school-based health environments through photographs.

Health-promoting schools (HPS) is an effective approach to enhance the health and well-being of children and youth, but its measurement remains a challenge considering contextual differences across school environments. The purpose of this study was to qualitatively explore the physical features of the school environment through photographs of schools that had implemented an HPS approach compared with schools that had not. This study used a descriptive approach, wherein physical features of the school environment were distilled through visual images and qualitatively analyzed. School environment data were collected from 18 elementary schools (10 HPS, 8 comparison schools) from a school board in rural Nova Scotia (Canada). Evaluation assistants captured photographs of the physical school environment as part of a broader environment audit. Overarching themes included the promotion, access and availability of opportunities for healthy eating and physical activity, healthy school climate and safety and accessibility of the school. The photographs characterized diverse aspects of the school environment and revealed differences between schools that had implemented an HPS approach compared with schools that had not. There were increased visual cues to support healthy eating, physical activity and mental well-being, and indications of a holistic approach to health among schools that implemented an HPS approach. This research adds to understanding the environmental elements of HPS. The use of photographic data to understand school environments provided an innovative method to explore the physical features of schools that had implemented an HPS approach.

The relationship between bullying behaviours in childhood and physician-diagnosed internalizing disorders.

OBJECTIVE: Bullying and its potential consequence for poor mental health constitutes a public health concern, yet there is a dearth of longitudinal studies examining the topic. This study examines the temporal relationship between childhood bullying behaviours (being a victim, being a bully, or being a bully and a victim) and physician-diagnosed internalizing disorders over a 7-year timespan. METHODS: Data from the 2003 Children's Lifestyle and School performance Study (CLASS), a population-based health survey of grade 5 students in Nova Scotia, Canada were linked to administrative health-care records to examine the relationship between bullying behaviours and services where a physician diagnosis of an internalizing disorder (ID) was received. Negative binomial regression analyses were conducted to examine this relationship. RESULTS: Of the 4694 participants, 33.3% reported being involved in some form of bullying behaviour and 24.1% had a service where a physician diagnosis of ID was given over a 7-year timespan. Compared with children who reported not being involved in bullying behaviours, children who reported being a victim of bullying had a higher rate of subsequent physician-diagnosed ID services (IRR = 1.38, 95% CI = 1.11, 1.70). Children who reported being a bully had a lower rate of ID services (IRR = 0.67, 95% CI = 0.46, 0.99), while there was no difference for those who reported between being a bully and a victim (bully-victim) with respect to ID services. CONCLUSION: Bullying behaviours should be considered a serious public health issue due to their high prevalence in school environments and detrimental effects on the mental health of adolescents.