The impact of social inequalities on children's knowledge and representation of health and cancer.

Reducing inequalities in the field of cancer involves studying the knowledge and mental representations of cancer among children. A qualitative study was conducted on 191 children aged 9 to 12 using the "write and draw" technique to get spontaneous mental representations of "healthy things", "unhealthy things" and "cancer". We grouped the voluntary schools according to two deprivation levels. In response to the request to "write or draw anything you think keeps you healthy", the main responses categories were physical activity, healthy food and basic needs. Smoking, drinking alcohol, sedentary lifestyles/lack of sport were identified as "unhealthy". The first theme associated with "cancer" is the "cancer site" implying children have a segmented perception of cancer. Deprived children have radically different views about the key items representing cancer: they are more likely to believe the illness is systematically deadly. They are less likely to believe it is a treatable illness. They are less likely to associate cancer with risky behaviors, particularly alcohol consumption. CONCLUSION: Social inequalities affect representations of cancer and health literacy from early childhood. Prevention programs taking into account these representations need to be introduced at school. What is Known: • Social inequalities for cancer mortality are observed in all European countries and are particularly pronounced in France. • Reducing these inequalities in prevention programs implies studying the knowledge and mental representations of cancer among children. What is New: • This study identified representations of cancer in young children according to social level. • At age 9, children living in deprived areas are less able to produce content in discussions about cancer and have narrower mental representations and a more fatalistic view.

[School nurses in France's Éducation nationale: A mixed study on education and health promotion practices]. / Les infirmières de l'Éducation nationale en France : une étude mixte sur les pratiques en éducation et promotion de la santé.

School nurses in France's Éducation nationale are a specific community within the education sector, entrusted with the mission of education and health promotion, thus requiring an adaptation of their role, their status, and their professional practices. The literature emphasizes the link between knowledge, systems of social representation, and standards of practices that revolve around individual conceptions. Based on a mixed methodology, the study focuses on the analysis of the results of a qualitative study through interviews with a sample of the population, followed by a national survey using questionnaires. These conceptions are strongly influenced by professional practice in the Éducation nationale. The role of school nurses in health education evolves according to the duration of professional practice: from health concepts that need to be taught, to a holistic approach to health education, through to advice and support to schools and teachers. This study advances lines of thought in the organization of initial or in-service training, with the aim of constructing the specific role of the school nurse as "a specialized practice in professional nursing."

Occupational status as a determinant of mental health inequities in French young people: is fairness needed? Results of a cross-sectional multicentre observational survey.

BACKGROUND: Employment conditions are associated with health inequities. In 2013, French young people had the highest unemployment rate and among those who worked as salaried workers most of them had temporary job. The purpose of the study was to assess mental health state of French young people through the prism of their occupational status and to measure whether occupational status is a determinant of health inequities. METHODS: A cross-sectional multicentre observational survey was performed in June and July 2010 in 115 French Local Social Centres and 74 Health Examination Centres, who were available to participate. The survey was based on an anonymous self-administrated questionnaire delivered by social workers or healthcare professionals to young people age from 16 to 25 years old. The questionnaire was composed of 54 items. Several health outcomes were measured: self-perceived health, mental health, addictions and to be victim of violence. The association of occupational status and mental health was assessed by adjusting results on age and gender and by introducing other explanatory variables such as social deprivation. RESULTS: A total of 4282 young people completed the questionnaire, a response rate of 83%, 1866 men and 2378 women, sex-ratio 0.79. French young people having a non-working occupational status or a non-permanent working status were more exposed to poor self-perceived health, poor mental health, addictions and violence. To be at school particularly secondary school was a protective factor for addiction. CONCLUSIONS: Occupational status of French young people was a determinant of mental health inequities. Young people not at work and not studying reported greater vulnerability and should be targeted therefore by appropriate and specific social and medical services.

[Sex education : representations of 13- to 15-year-old junior high school children and slow learners]. / Éducation à la sexualite : conceptions des élèves de 4e et 3e en collège et SEGPA.

In France, the National Education system has attributed an important health and sex education role to its teachers, based on a global and positive vision of sexuality Parents, teachers, public services and specialized resources each have a role to play in sex education for children and adolescents so that each young person can receive an education allowing him or her to enjoy a healthy sexuality. This study investigated the individual representations of sexuality, declared practices and knowledge of junior high schoolchildren and Section d'Enseignement G6n6ral et Professionnel Adapt6 (SEGPA) students, a structure for children with serious learning difficulties. The study methodology was based on administration of questionnaires (n = 524) to the two cohorts concerned. The secondary objective was to compare these two populations and identify the specificities of SEGPA pupils. The conclusions of this study should allow adults in charge of sex education in junior high schools and SEGPA to adapt sex education tools.

[Teacher educators and health education: from their concepts to their professional identity]. / Formateurs d'enseignants et éducation à la santé: de leurs conceptions à leur identité professionnelle.

INTRODUCTION: The objective of this study was to determine why some teacher educators use health education actions as part of their teacher training. METHODS: We therefore studied the educators' discourse in order to identify factors affecting declared practices and adhesion to health education training. The study was conducted in two steps. Teacher educators were interviewed by telephone using a questionnaire and teacher training curricula were reviewed to assess current teacher training practices. A qualitative analysis was then conducted by structured telephone interviews of 16 teacher educators. RESULTS AND DISCUSSION: The teacher educators interviewed in this study presented a holistic approach to health and health education, focusing on the individual, which had a positive impact on implementation of health education training. All of the teacher educators interviewed had also adopted health education as part of their professional identity: they felt competent in health education, and considered it to be part of their job. However, most teacher trainers reported concepts and declared practices according to an application-based model, focussing on acquired knowledge, or a didactic model, focussing on implementation of projects. The holistic model, focussing on individual health, remained very marginal and was not part of teacher educators' perceptions of their role in the training future teachers.

[A participatory approach to general health promotion in secondary schools: "diagnosanté" in the Rhône-Alpes region]. / Démarche participative de santé globale en collège et lycée : le « diagnosanté ¼ en Rhône-Alpes.

A diagnosis questionnaire ("diagnosanté", or health diagnosis program) was administered in 10 secondary schools in the Rhône-Alpes region of France. The study was based on a sample of 2,553 students. The health diagnosis program includes questions about lifestyle, the environment, risk behaviors, emotional life and self-esteem. The students were asked to respond to 18 components with an impact on wellbeing (perceived health) and to describe how they experience these components (experienced health). Beyond providing individual diagnoses, the data could be used by secondary school staff to focus health education programs on real needs and to promote local health education. The diagnosis questionnaire, which does not focus on individual behaviors, provides a new tool for developing a school-community approach, for motivating teaching staff and for promoting partnerships. The diagnosis questionnaire is also participatory insofar as it encourages discussion among students, educators, teachers and staff on health promotion in schools.

School health promotion: organization of services and roles of health professionals in seven European countries.

BACKGROUND: This comparative study is intended to provide a better understanding of how health promotion services are organized in school settings in Europe and to show how health professionals involved outside or within the school setting help to improve young people's health. METHODS: This study was based on an analysis of school health policies and the organization of school health services, where these existed, as well as on interviews with health and education professionals. The countries concerned were Belgium (French-speaking community), Denmark, France, Spain (Catalonia), Switzerland (Jura), Poland and Portugal. RESULTS: Although the provision of health services for children and adolescents varied considerably, the health services available were very similar in each of the countries. The emphasis put on particular aspects of these services varied depending on the political and institutional culture in each country. Three different types of school health service provision were identified: community-based, school-based or health needs-focused. CONCLUSION: All countries had health education and health promotion services but the provision of these services varied considerably from country to country. They were provided either by a specific category of professionals (health personnel or teachers) or considered to be the responsibility of the educational community as a whole.

[School nurses: representations and practices in health education]. / Infirmiers scolaires: représentations et pratiques d'éducation à la santé.

A survey of nurses (n = 188) from the National Education for the Academies of Lyon and Clermont-Ferrand highlights the heterogeneity of their representations and professional practices. These results underline the link between individual conceptions and the nature of the practices being used, and they show the impact of training and experience acquired in the school setting with respect to various practices and the difficulties they encounter in the fulfillment of their objectives as school nurses. The specificity of the school nurse profession is not necessarily solely related to the provision of care, but rather it is more accurately articulated around a set of educational tasks and goals, without of course being in a competitive position with the educational disciplines. This radical change in the fundamental core of the professional mission underlies the need to define a new professionalism and develop specific training tailored to the school setting and its distinctive features.

[Impact of teachers' conceptions on sex education in four Mediterranean countries.]. / Description et déterminants des conceptions des enseignants de 4 pays méditerranéens sur l'éducation à la sexualité

Nowadays, sex education contributes to public health not only with regard to the prevention of HIV/AIDS, other sexually transmitted infections and sex abuse, but it is also concerned with addressing aspects such as interpersonal relationships and psychosocial implications. The school setting has emerged as a unique environment for access to information and scientific knowledge that contribute to better understanding of the various dimensions of sexuality. Teachers' and future teachers' conceptions about sex education are analysed in this paper. Data were obtained from a questionnaire designed by the European Biohead-Citizen research project. Responses were received from 2 537 teachers from four Mediterranean countries (Tunisia, Lebanon, Morocco and France) who completed the questionnaire. The methodology is based upon analyses of core components that support the discovery of teachers' conceptions. Following that exercise, standardised factorial scores were calculated. Results for in-service and pre-service teachers show high correlations between their conceptions and national culture, religious beliefs, and level of academic training. Detailed results are presented and discussed.

[Opinions, perceptions and description of cannabis amongst future health educators in training in France]. / Représentations du cannabis des futurs acteurs de prévention en formation.

In France, the number of cannabis users has doubled over the last ten years. The groups most affected are 18-25 year old adults in higher education. This study involved 300 persons currently undergoing core health education training (79 teachers, 135 nurses and 86 social workers). As health educators in training, they were subject to the completion of an adapted version of the EROPP survey (Exploring the Representations, Opinions and Perceptions of Psychotropic Drugs). Results were compared with those of a French survey of the general population undertaken in 2002. Differences between the study and the control groups, and between the different types of students, were analysed using the Chi-square test. Cannabis users were also compared with non-users. The results show an over-consumption of cannabis in the study group compared to the general population, especially in men, both in terms of experimentation and current use. The specificities of each group are analysed and the results discussed in light of the study group's potential role in health education.

[Perspectives on junior high school students' well-being according to members of the educational community: an exploratory study]. / Représentations du bien-être du collégien selon la communauté éducative: étude exploratoire.

The objective of this study was to explore descriptions and portrayals of students' well-being developed by members of the educational community. Fourteen semi-structured interviews were conducted in a secondary school in Burgundy (France). The results reveal that the educational staff and the school in general do not pay much attention to the students' physiological needs or their most basic fundamental needs. When educational team members discuss students' well-being, they essentially refer to material and organizational needs, and tend to associate the idea of well-being with a medical concept. Study results highlight a significant need for training educational staff about physical and psychological changes of adolescent and teenaged students. A complementary study could help investigate these exploratory results on a larger scale for more broad-based general conclusions.

In search of a health education model: teachers' conceptions in four Mediterranean countries.

School programs are defined to promote the health of the pupils and to develop their competencies so that they can adopt behaviors favorable to their health. With the European project FP6 Biohead-Citizen (2004-2007), we analyzed the conceptions of teachers as regards health education, in France, Lebanon, Morocco and Tunisia, in reference to the biomedical model and the social health model. These four countries were selected because their school curricula represented different models of health education. Lebanon and Tunisia addressed health education with the biomedical model. In Morocco, the curriculum was also primarily based on the biomedical model and enclosed a few instructions issued from the social health model. In France, the health education curriculum declared an approach based on the health promotion model. Our study was based on multivariate statistical analyses of questionnaires filled out by 2537 in-service and pre-service teachers. Our analysis showed that the conceptions of the teachers concerning health education were not structured and related to a specific model. We also found that the dominating factors of influence on the choices expressed with regards to health education were, among different sociocultural variables, the religion, the home country, and, to a lesser extent, the level of training. Thus, the conceptions of the teachers were not integrated into comprehensive approaches but related to individual characteristics. Consequently health education implementation would require thorough training for pre-service and in-service teachers and should also explicitly take into account their conceptions and values.