A 10-week implementation of the FIT FIRST FOR ALL school-based physical activity concept effectively improves cardiorespiratory fitness and body composition in 7-16-year-old schoolchildren.

Introduction: The purpose of the present study was to investigate the impact of the FIT FIRST FOR ALL school-based physical activity program on health-related physical fitness in Faroese schoolchildren. The program aimed to add three weekly sessions of organized high-intensity physical activity to the standard weekly physical education sessions for all pupils across the entire school. Methods: A non-randomized controlled design was used to evaluate the effects of the program. Two schools participated, including one intervention school (INT; n =179) and one control school (CON; n =181), with pupils aged 7-16 years (grades 1-9). The FIT FIRST FOR ALL program consisted of three weekly 40-minute sessions of age-adjusted high-intensity physical activity over 10 weeks for the INT school, while the CON school continued their normal school program. Pre- and post-intervention assessments included cardiorespiratory fitness (Yo-Yo IR1C test), agility (Arrowhead Agility test), postural balance (Stork Stand), standing long jump performance, body composition, blood pressure, and resting heart rate. Results: A significant time × group effect (p < 0.001) was observed for cardiorespiratory fitness, which increased by 31% [23;39] in INT (p < 0.001) and remained unaltered in CON (7% [-2;16], p = 0.13). In addition, a time × group effect (p < 0.001) was observed for agility, which improved by 2.1% [1.0;3.2] in INT (p < 0.001) and regressed by 3.3% [2.3;4.4] in CON (p < 0.001). No significant between-group effects were found for standing long jump and balance. A time × group effect (p < 0.001) was observed for changes in total muscle mass, which increased by 1.4 kg [1.2;1.5] in INT (p < 0.001) and by 0.4 kg [0.3;0.6] in CON (p < 0.05). Furthermore, a time × group effect (p < 0.001) was observed for total fat percentage, which decreased by -2.3% [-2.8;-1.9] in INT (p < 0.001) and remained unchanged in CON (-0.3% [-0.7;0.1], p = 0.16). No significant time × group effects were found for blood pressure and resting heart rate. Discussion: The FIT FIRST FOR ALL program significantly improved cardiorespiratory fitness and agility, and it led to favorable changes in body composition in the intervention school. These findings suggest that the program is highly effective in enhancing physical fitness and health status across all investigated age groups when implemented at a school-wide level.

Introducing comprehensive sexuality education in Italian schools: from the co-construction to the evaluation of a pilot intervention.

INTRODUCTION: School-based comprehensive sexuality education (CSE) is a powerful tool that provides young people with information on all aspects of sexuality and is aimed at protecting their sexual and reproductive health and well-being throughout their lives. Currently, CSE is not integrated within the schools' curriculum in Italy. This study describes the co-construction, implementation, and evaluation of a CSE project piloted among students attending lower secondary schools, in four regions of Italy. Evidence-based evaluation will be helpful in promote the inclusion of CSE programs in the Italian schools' curriculum. METHODS: The pilot scheme was co-constructed by a multidisciplinary curriculum development group through a Delphi process, including educators who conducted the activities. The evaluation followed three directions: the program (based on a literature review of CSE principles and recommended characteristics), implementation (assessing the execution of the program through the analysis of the reflection tools used by the educators), and short-term outcomes (assessing critical thinking and conscious behavioural choices through pre-post and satisfaction surveys). RESULTS: The main goal, learning modules and content were defined and structured in five interventions with the students, and two with families and teachers. A total of 638 students were involved in the activity, across 11 schools. Data analysis of pre/post surveys reported a significant increase in knowledge in 12 of the 15 items investigated (p < 0.05), and a high level of satisfaction with the topics addressed. Qualitative analysis added information on the pivotal role of educators in CSE. CONCLUSIONS: The national piloting of this educational activity provided positive insights regarding the co-construction, implementation and short-outcome evaluation, suggesting potential for scalability and future inclusion of CSE in the curricula of Italian schools.

Nurturing Tomorrow's Antibiotic Stewards: An Innovative School Campaign to Combat Antimicrobial Resistance in Delhi.

SUMMARY: Antimicrobials are lifesaving medicines, but their misuse drives antimicrobial resistance. Schools, as educational hubs wield transformative potential in fostering responsible antimicrobial behavior among students and the broader community. An online campaign targeted Delhi schools, training teachers as master trainers who, in turn, educated 359,940 students. Significant pre- to post-test score improvements were observed among teachers (6.98-8.14; P < 0.01) and students (5.20-6.56; P < 0.01). The campaign received excellent feedback (85%), with 966 students participating in the "IDEAthon" competition. While a single session improved knowledge, continuous engagement and activities are imperative for sustained behavioral change in antibiotic usage.

School-Based Occupational Therapists' Roles Supporting Transitions Into and Throughout Kindergarten to Grade 12: A Scoping Review.

IMPORTANCE: Large educational transitions occur when students enter and exit school or move between grades or divisions within the kindergarten to Grade 12 (K-12) school system. For students with disabilities, the quality of large educational transitions affects academic and postschool outcomes, which is germane to school-based occupational therapists. OBJECTIVE: To explore the school-based occupational therapy literature to describe the roles of occupational therapists in supporting large educational transitions and to identify relevant terminology. DATA SOURCES: We searched six databases (CINAHL, EMCare, Embase, ERIC, MEDLINE, and PsycINFO) for peer-reviewed publications in English with no date limitations. STUDY SELECTION AND DATA COLLECTION: We included articles focused on children and youth with disabilities and school-based occupational therapy services supporting large transitions within K to 12 education. Using directed content analysis, we reported on publication characteristics, occupational therapy roles, and terminology. FINDINGS: We included 46 publications spanning 37 yr that addressed transitions into school (n = 3), within K to 12 grades or divisions (n = 10), or to exit secondary education (n = 33). Occupational therapists assumed many roles in supporting large transitions, some much more frequently than others; 125 transition terms were used across included articles with few terms explicitly defined. CONCLUSIONS AND RELEVANCE: School-based occupational therapists' involvement in educational transitions is extensive, with potential for expansion. Consistency in terminology would support future research and practice. Plain-Language Summary: A large educational transition occurs when students move between a school, grade, or division as part of their K to 12 education. For students with disabilities, the quality of a large educational transition affects their academic and postschool outcomes. This review provides an understanding of how school-based occupational therapists support educational transitions for youth with disabilities. The review found that occupational therapists took on many roles, with the potential for expanding their roles. The review also identified 125 transition terms that were used across the literature review and found that few terms were explicitly defined. Consistency in terminology would support future research and expanded occupational therapy practice in this area.

Reducing asthma attacks in disadvantaged school children with asthma: study protocol for a type 2 hybrid implementation-effectiveness trial (Better Asthma Control for Kids, BACK).

BACKGROUND: Asthma is a leading cause of children's hospitalizations, emergency department visits, and missed school days. Our school-based asthma intervention has reduced asthma exacerbations for children experiencing health disparities in the Denver Metropolitan Area, due partly to addressing care coordination for asthma and social determinants of health (SDOH), such as access to healthcare and medications. Limited dissemination of school-based asthma programs has occurred in other metropolitan and rural areas of Colorado. We formed and engaged community advisory boards in socioeconomically diverse regions of Colorado to develop two implementation strategy packages for delivering our school-based asthma intervention - now termed "Better Asthma Control for Kids (BACK)" - with tailoring to regional priorities, needs and resources. METHODS: In this proposed type 2 hybrid implementation-effectiveness trial, where the primary goal is equitable reach to families to reduce asthma disparities, we will compare two different packages of implementation strategies to deliver BACK across four Colorado regions. The two implementation packages to be compared are: 1) standard set of implementation strategies including Tailor and Adapt to context, Facilitation and Training termed, BACK-Standard (BACK-S); 2) BACK-S plus an enhanced implementation strategy, that incorporates network weaving with community partners and consumer engagement with school families, termed BACK-Enhanced (BACK-E). Our evaluation will be guided by the Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) framework, including its Pragmatic Robust Implementation Sustainability Model (PRISM) determinants of implementation outcomes. Our central hypothesis is that our BACK-E implementation strategy will have significantly greater reach to eligible children/families than BACK-S (primary outcome) and that both BACK-E and BACK-S groups will have significantly reduced asthma exacerbation rates ("attacks") and improved asthma control as compared to usual care. DISCUSSION: We expect both the BACK-S and BACK-E strategy packages will accelerate dissemination of our BACK program across the state - the comparative impact of BACK-S vs. BACK-E on reach and other RE-AIM outcomes may inform strategy selection for scaling BACK and other effective school-based programs to address chronic illness disparities. TRIAL REGISTRATION: Clinicaltrials.gov identifier: NCT06003569, registered on August 22, 2023, https://classic. CLINICALTRIALS: gov/ct2/show/NCT06003569 .

Perceived impacts of a school-based growth mindset programme 'Mindset Teams' in Scotland: a qualitative study.

BACKGROUND: Teachers as delivery agents within school-based mindset programmes is a potential intervention strategy for improving pupils' outcomes. The Mindset Teams programme, utilises teachers as delivery agents, with an aim to improve learning resilience for health and attainment outcomes among schools in Scotland. This study examined the perceived impacts of the programme to develop a programme theory of change and refine an earlier co-produced logic model. METHODS: Across six intervention schools, one-to-one interviews were conducted with teachers (N = 18) and focus groups were conducted with 23 pupils aged 8-11-years. Fourteen stakeholders involved in programme provision, secondary school delivery, funding decisions or policy-related areas also participated in a one-to-one interview. Qualitative data were analysed using thematic analysis with a combined deductive and inductive coding approach. RESULTS: Themes were identified in relation to impacts on teachers (five themes), pupils (eight themes), and broader outcomes (two themes), with most themes discussed by teachers and wider stakeholders. Across data, findings highlighted the proposed mechanisms by which the programme was intending to produce impacts, largely through increasing teacher knowledge and facilitating a positive school environment. Themes demonstrated the breadth of perceived programme impacts, highlighting both attainment and wellbeing outcomes among pupils. CONCLUSIONS: Findings provide support for Mindset programmes focusing on the development of teachers' mindsets, highlighting the resultant perceived impacts this can have on both teachers and pupils alike. Future research should seek to capture health and wellbeing measures alongside attainment data to fully explore programme impacts.

Epidaure Market-Effectiveness and transferability of a school-based intervention to improve healthy and sustainable food choices by schoolchildren: Protocol of a randomized controlled trial and qualitative study.

CONTEXT: At least 40% of cancers are linked to environmental or behavioral factors, and dietary behavior appears to be a major lever. Epidaure Market is a prevention initiative developed using a method for co-constructing health promotion initiatives and prevention programs that stratifies evidence from the scientific literature and combines it with experiential knowledge (DEVA, TPB, BCT). It promotes a sustainable diet (i.e., healthy, ecological and ethical nutrition) among 5th and 4th grade students during the crucial period of adolescence, when these behaviors are often far from the recommendations. METHOD: The protocol implemented was carried out in 72 middle school classes in the Montpellier and Dijon academies. The intervention included teaching sessions and a virtual supermarket game, integrated into the school curriculum and delivered by science teachers. Effectiveness is tested in a cluster randomized controlled trial with 3 evaluation times (pre- and post-intervention and 1 follow-up). The study also includes an implementation assessment, with process analysis and implementation elements, as well as a transferability assessment based on key functions (FIC model and Astaire grid). EXPECTED OUTCOMES: The study is still underway within the school. The primary expected outcome is a positive influence on the motives underlying food choices to move towards a sustainable diet. Secondary expectations involve changes in variables such as self-efficacy and perceived social norms, as well as an increase in knowledge about healthy eating. We also expect the qualitative approaches to provide information on the deployment process in the new territories. DISCUSSION: The study aims not only to demonstrate the effectiveness of Epidaure Market, but also to identify the optimal conditions for its nationwide implementation in France's middle schools. Ultimately, the initiative aims to help reduce the incidence of cancer by promoting healthier eating habits among teenagers.

PlanoUp!: A pilot program for the identification and treatment of depression for youth in low-income secondary schools.

Rates of depression in youth are continuing to increase at a steady rate, yet these youth often do not receive mental health services (Bertha & Balázs, 2013; Thomas et al., 2011). Schools are an ideal setting to connect youth to mental health services; however, many barriers exist with respect to schools having adequate resources and access to the appropriate levels of services (Duong et al., 2021; Owens & Peltier, 2002). Schools may collaborate with local community providers with available resources to address these gaps. The current article describes the pilot of a school-based mental health promotion program intended to reduce depression in youth by promoting access to care through referrals to community providers. Data were collected, via self-report measures, every 3 months for 12 months from students from three middle and high schools in North Texas. The students (N = 88) enrolled in this program experienced significant reductions in their depression symptoms at the end of 12 months. This program highlights the importance of school-community partnerships to promote access to care to address mental health concerns. The results from our pilot study demonstrate the feasibility and the potential of school-based programs in improving the mental health of youth in schools through community partnership. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Impact of the ActTeens Program on physical activity and fitness in adolescents: a cluster randomized controlled trial.

BACKGROUND: The aim of our study was to evaluate the impact of the ActTeens Program on physical activity and health-related physical fitness among adolescents in Brazil. METHODS: The "ActTeens Program" was conducted using a cluster-randomized controlled trial during 24-week school term. The sample consisted of 317 adolescents (52.7% girls; 13.61 ± 0.70 years) from four secondary schools that were randomly assigned to intervention group (N = 169) or control group (N = 148). This school-based physical activity (PA) intervention involved two components: (i) structured physical activity sessions delivered within physical education (PE) and (ii) healthy lifestyle guidance (mHealth). The primary outcome was PA assessed using Physical Activity Questionnaire for Adolescents (PAQ-A); secondary outcomes included muscular (MF) and cardiorespiratory fitness (CRF) assessed using 90-push-up, handgrip dynamometer, standing long jump, and 20 m PACER shuttle run test. Assessments were conducted at baseline, 12- and 24-week. Intervention effects were assessed using linear mixed models (LMM). RESULTS: For the primary outcome (PA), no significant group-by-time effects were observed for physical education based-PA (0.3 score; 95%CI: -0.1; 0.6; and - 0.01 score; 95%CI: -0.03; 0.03, at 12-wk and 24-wk respectively) and total PA (-0.02 score; 95%CI: -0.2; 0.2; and - 0.01score; 95%CI: -0.2; 0.2, at 12 and 24 weeks respectively). After 24 weeks, we observed a significant group by time effects for lower body muscular fitness (12.9 cm; 95%CI, 3.2 to 22.2). CONCLUSION: The implementation of aerobic and muscle-strengthening exercises used in the ActTeens intervention did not lead to improvements in physical activity. The intervention resulted in improved lower body muscular fitness, however, we found no significant differences for upper body muscular and cardiorespiratory fitness.

Study protocol for a stepped-wedge implementation study investigating the intersectoral collaboration of implementering the TREAT INTERACT intervention for primary school teachers and the mhGAP for health care workers for child mental health promotion in Uganda.

BACKGROUND: Mental and neuropsychological disorders make up approximately 14% of the total health burden globally, with 80% of the affected living in low- and middle-income countries (LMICs) of whom 90% cannot access mental health services. The main objective of the TREAT INTERACT study is to adapt, implement, and evaluate the impact of a novel, intersectoral approach to prevent, identify, refer, and treat mental health problems in children through a user centred task-sharing implementation of the TREAT INTERACT intervention, inspired by the World Health Organization (WHO) Mental Health Gap Action Programme Intervention Guide (mhGAP-IG) for primary school staff in Mbale, Uganda. Health care personell will be trained in the mhGAP-IG. METHODS: This is a pragmatic mixed-methods hybrid Type II implementation-effectiveness study utilizing a co-design approach. The main study utilize a stepped-wedged trial design with six starting sequences, randomizing three schools to the intervention at each interval, while the remaining act as "controls". Other designs include a nested prospective cohort study, case control studies, cross-sectional studies, and qualitative research. Main participants' outcomes include teachers' mental health literacy, stigma, and violence towards the school children. Implementation outcomes include detection, reach, sustainability, and service delivery. Child and caregiver outcomes include mental health, mental health literacy, and help-seeking behaviour. DISCUSSION: Based on the results, we will develop sustainable and scalable implementation advice on mental health promotion and draft implementation guidelines in line with current WHO guidelines. This project will generate new knowledge on the structure, organization, delivery, and costs of mental health services in a LMIC setting, as well as new knowledge on the implementation and delivery of new health services. TRIAL REGISTRATION: ClinicalTrials, NCT06275672, 28.12.2023, retrospectively registered.

Reimagining Social and Emotional Supports in Schools for Immigrant Students: A Contextual and Structural Approach.

Immigrant students and families experience disproportionate exposure to trauma, immigration-related stress, structural inequities, and poor access to mental health and social services which can lead to mental health inequities. Immigrant students and their families also have many strengths that can buffer potential negative mental health outcomes. Schools, which address social and emotional development in addition to academic achievement, are critical institutions that can play a unique role in enhancing the strengths and responding to the needs of immigrant students and families. In this review, we adapt the Behavioral Model for Vulnerable Populations to acknowledge the contextual and macro-level factors (e.g., relevant policies, environmental influences, and structural factors) and the predisposing, enabling, and need factors that immigrant students and families experience and impact access to school mental health and social services. We discuss school-based interventions that show efficacy for improving mental health outcomes and focus on addressing acculturative stress among immigrant students. We also discuss models to address social determinants of health need among immigrant students and families within schools, including the community schools model applied to immigrant students and families. We conclude this review by providing recommendations and strategies for pediatricians and schools to transform school-based supports for immigrant students and families and promote equitable outcomes. Our recommendations include incorporating multi-level school supports for addressing mental health, social need, and acculturative stress among immigrant students, along with reinforcing the strengths of immigrant students, and promoting school collaborations with pediatricians, school-based health centers, and trusted community partners.

School-Based Behavioral Health Programming for Newcomer Youth: A Scoping Review.

OBJECTIVE: Newcomer youth experience health disparities in accessing behavioral health services. School-based mental health programming is proposed a potential solution to address these disparities. The present study uses a scoping review methodology to examine the state-of-the-art of the evidence base for school-based mental health programming for newcomer youth. Studies were categorized into a tiered typology using the framework established by the National Center for School Mental Health. METHODS: Several databases were examined as well as the results of one scoping and two systemic recent reviews. RESULTS: A total of 37 studies were included in the present analysis, over half from the last decade. Most studies were conducted in the United States and Europe, and most programs were focused on mental health promotion and wellness (Tier 1) or were multi-tiered. Programming for younger children, especially those in early childhood settings, were underrepresented. CONCLUSIONS: While the literature is promising regarding programming for newcomer youth, particularly the advent of complex multi-tiered programming, many gaps still remain. For example, most programs do not provide information on how programming was adapted for different groups of newcomers with different cultural and contextual needs. Tier 1 programs lack theoretical foundations or theories of change in the design of programming. Further, more research is needed for a group with rising numbers across high- and middle-income countries, particularly for programming targeting early and middle childhood.

Addressing Post-Pandemic Adolescent Health in Schools.

The coronavirus disease 2019 pandemic disrupted in-person learning for adolescents and young adults across the world. Inequities in learning outcomes were primarily caused by digital inequalities. Social needs of adolescent and young adult (AYA) emerged during the pandemic and school is a key part of supporting AYA social health. School-based health clinics can serve as a method to improve mental and physical health outcomes for AYA.

Improvement of Adherence to the Mediterranean Diet through a Nutrition Education Teaching Pack for Teachers within the "School Fruit Scheme" Program: An Italian Long-Term Trial in School Children.

A previous short time span study related to the effectiveness of a teaching pack (TP) in improving the adherence to the Mediterranean Diet (MD) showed positive results. The present study was aimed at investigating and confirming those results, with a follow up data collection, in the same sample, a year after the baseline intervention. Pre- and post-intervention assessments were conducted. Weight and height were measured. Eating patterns/lifestyle were assessed by the KIDMED test and questionnaires. Thirteen schools in three areas with low, medium and high prevalence of overweight/obesity (North, Center and South respectively) were involved, with a representative baseline cluster sample of 494 fourth class children (8-10 years old) in 2015. An intervention group and a control group were recruited in each school; the intervention group (n = 395) got the intervention, the control group (n = 99) did not. The children's KIDMED score changes were the main outcome measures. Differences in percentages of adherence and in yes/no answers on the KIDMED test, at baseline and after one year, for both the intervention and the control groups, were assessed through contingency tables and statistical tests. Improvements in the high and low adherence rates to MD were observed (high adherence: 24.4% to 43.3%; low adherence: 15.0% to 3.9%, p < 0.0001). The percentages of subjects with optimal adherence improved in both sexes (females: 25.5% to 49.5%, p < 0.0001; males: 23.1% to 36.6%, p < 0.0001) in all the geographical areas and ponderal status classes. Accompanying free distribution of fruit and vegetables with a nutritional intervention led by trained teachers with a cross-curricular approach can be successful in promoting healthy eating in children.

State of the Data Summary: National School Health Data Set: Every Student Counts! 2023-2024 School Year.

The National School Health Data Set: Every Student Counts! (ESC!) is NASN's data initiative focusing on building data capacity for school nurses, a uniform data set with standardized definitions, and promoting data infrastructure including school nurse access to electronic documentation, interoperability of educational systems and school health records, and build partnerships to increase data collection, storage, retrievable, and utilization. Each year since 2018, states have submitted data to NASN for inclusion in the National School Health Data Set. Participation is built on a tiered programing model to include school nurses at the school, state, and national level. Every state has identified a State Data Coordinator (SDC) who serves as a liaison to NASN to support ESC! but also provides support to school nurses in their state. This article provides an overview of the ESC! data initiative for the 2023-2024 school year, which includes the data from the 2022-2023 school year.

Study protocol for the Multimodal Approach to Preventing Suicide in Schools (MAPSS) project: A regionally based feasibility trial of an integrated response to suicide risk among UK secondary school pupils.

BACKGROUND: Suicide is the leading cause of death of children and young people under 35 in the UK, and suicide rates are rising in this age group. Schools are considered an appropriate and logical setting for youth suicide prevention activities, with universal, selective, and indicated approaches all demonstrating efficacy. Given that international best practice recommends suicide prevention programmes combine these approaches, and that to date this has not been done in school settings in the UK, this study aims to evaluate the feasibility of delivering a suicide prevention programme incorporating universal, selective, and indicated components in UK schools. METHODS: This study is a feasibility cluster-randomised controlled trial (RCT) of an adapted version of the Multimodal Approach to Preventing Suicide in Schools (MAPSS) programme. The programme, initially developed in Australia, involves delivering universal psychoeducation to all pupils, screening them for suicide risk, and delivering Internet-based Cognitive Behavioural Therapy (Reframe IT-UK) to those students identified as being at high-risk for suicide. The programme will be trialled in six secondary schools in Northwest England and will target Year 10 students (14- and 15-year-olds). The primary aims are to assess: 1) the acceptability and safety of delivering MAPSS in a school setting in the UK; 2) the social validity of the MAPSS programme; and 3) the feasibility of delivering a large-scale, appropriately powered, cluster-RCT and economic evaluation of this intervention in the future. Secondary aims are to assess changes over time in mental health and wellbeing outcomes. DISCUSSION: This study is the first to evaluate a suicide prevention programme comprising universal, selective, and indicated components in UK schools. If the programme is found to be feasible, it could be more widely tested in schools and may ultimately lead to reduced rates of suicide and suicidal behaviour in young people.

The effectiveness of the WHO school mental health package in promoting mental health literacy among secondary school teachers in Qatar: a randomized controlled trial.

Teachers' mental health literacy (MHL) is fundamental for recognizing and assisting students with mental disorders. The aim of this study was to assess the effectiveness of the World Health Organization School Mental Health Program (WHO-SMHP) in promoting MHL among secondary schools' teachers in Qatar. We conducted a two-arm randomized control trial. Teachers working in governmental secondary schools were eligible for selection. A total of 16 schools (8 intervention, 8 control) randomly selected and stratified by gender then randomly assigned (1:1). Participants and study team were aware of group assignment. Assessment of teachers' MHL was at day 0, 3 then 3 months afterward. Bivariat analysis and Generalized Estimating Equations were used in analysis. The primary outcome was teachers MHL. Secondary outcome was the influence of sociodemographic characteristics on the level of MHL. Between October 30, 2018 and March 21, 2019, we randomly assigned 195 teachers from 16 schools to attend training workshop on WHO-SMHP (n = 95) or usual practice (n = 100). Compared with controls, teachers from intervention group demonstrated a significant improvement in the level of MHL at day three (mean difference = 19.1, 95% CI = 17.0-21.2, Cohen's d = 2.63; p < 0.001).) and after three months (mean difference 16.61, 95% CI = 13.96-19.26, Cohen's d = 1.86; p < 001). There were no significant differences related to influence of other variables on MHL. To our knowledge, this is the first trial to prove the effectiveness of the (WHO-SMHP) in promoting teachers MHL, which can be successfully implemented in a wider scale.

The Role of School Health Promotion in Students' Dietary Intake during School Hours: A Qualitative Comparative Analysis.

Many children in the Netherlands do not adhere to dietary guidelines. Therefore, the Healthy School (HS) program stimulates healthier dietary intake of students through schools. However, evaluating the effectiveness of school health promotion in improving dietary intake is challenging due to the influence of contextual factors. Qualitative Comparative Analysis (QCA) considers these contextual factors. Therefore, we performed a QCA to examine which (combinations of) contextual factors contribute to the healthier dietary intake of students during school hours in primary schools (approximate age range children 4-12 years) and secondary schools (age range 12-18 years) when implementing the HS program for nutrition. Data were collected mainly through interviewing school staff and a school-level questionnaire in fifteen primary schools and twelve secondary schools. We included five factors for primary schools: implementation of the HS program for nutrition, degree of implementation, socioeconomic status, parental support, and student support. For secondary schools, we included school environment instead of parental and student support. For primary schools, the best results were obtained if the HS program for nutrition was implemented in high socioeconomic status schools with a combination of high implementation, parental support, and student support. Findings indicate that if secondary schools have an impeding environment and low socioeconomic status, implementation of the HS program for nutrition can result in healthier dietary intake.