Health Promotion International - current issue

Have the health services reoriented at all?

de Leeuw, E. — 2009-05-08

Sexual behavior and drinking style among teenagers: a population-based study in Finland

Lavikainen, H. M., Lintonen, T., Kosunen, E. — 2009-05-08

In this large-scale study, we examined the relationship between an adolescent’s sexual behavior and drinking style. Three aspects of sexual risk-taking were included: early activity, unprotected sexual intercourse and having sex with multiple partners. A distinction was made between different drinking styles, i.e. alcohol drinking and drunkenness-related drinking. Cross-sectional school survey data from the School Health Promotion Study was collected in Finland in 2002–2003. The national sample consisted of adolescents from the eighth and ninth grades (n = 100 790). The mean ages were 14.8 and 15.8 years. Using logistic regression analysis, we investigated the association between sexual behavior and drinking style among teenagers. The likelihood of engaging in sexual intercourse increased with the frequency of alcohol use. In particular, frequent drunkenness-related drinking increased the probability that the teenager had experienced sexual intercourse. The likelihood of engaging in unprotected sex and/or having multiple sexual partners was many-fold for adolescents drinking frequently until they were in a state of drunkenness. Particularly for girls, weekly drunkenness-related drinking was associated with multiple partners. The vast majority of sexually experienced under-aged adolescents drink alcohol, many of them until they are drunk. Thus, it could be effective to combine both alcohol education and sex education, including contraceptive counseling, in early adolescence.

Consumer testing of the acceptability and effectiveness of front-of-pack food labelling systems for the Australian grocery market

2009-05-08

The placement of nutrition information on the front of food packages has been proposed as a method of providing simplified and visible nutrition information. This study aimed to determine the most acceptable and effective front-of-pack food labelling system for Australian consumers. Consumers' preferences and ability to compare the healthiness of mock food products were assessed for different front-of-pack labelling systems. Four systems were tested, including two variations of the Percentage Daily Intake system (Monochrome %DI and Colour-Coded %DI), which displays the proportion of daily nutrient contribution that a serve of food provides; and two variations of the Traffic Light (TL) system (Traffic Light and Traffic Light + Overall Rating), which uses colour-coding to indicate nutrient levels. Intercept surveys with 790 consumers were conducted, where each participant was exposed to a single labelling system for performance testing. Participants indicated strong support for the inclusion of nutrient information on total fat, saturated fat, sugar and sodium on the front of packages, and a consistent labelling format across all products. Using the TL system, participants were five times more likely to identify healthier foods compared with the Monochrome %DI system [odds ratio (OR) = 5.18; p < 0.001], and three times more likely compared with the Colour-Coded %DI system (OR = 3.01; p < 0.05). Consumers supported the introduction of consistent front-of-pack food labelling. The TL system was the most effective in assisting consumers to identify healthier foods. Mandatory TL labelling regulations are recommended to assist consumers in making healthy food choices.

Wellness appraisal among adolescents in Jordan: a model from a developing country: a cross-sectional questionnaire survey

Haddad, L. G., Owies, A., Mansour, A. — 2009-05-08

The demographic and economic transition that many developing countries, including Jordan, are undergoing is producing important changes in diet and lifestyle that greatly impact the development of chronic illness. The health behavior of adolescents in developing countries constitutes one of the most serious global challenges we face. The purpose of this study was to explore the wellness appraisal of Jordanian adolescents. It specifically describes the (i) self-care and health history pattern, (ii) to assess physical activity and nutrition appraisal, (iii) quality of life appraisal and (iv) school and outside activities appraisal. A self-administrated questionnaire collected the data from adolescent groups (boys and girls.). A multi-stage stratified random sample was obtained from six public schools by first selecting the educational directorate located in the city of Irbid, which is located in the north of Jordan. A random sub sample of six individual schools was then selected. Individual classes were then selected. A total of 269 boys and 261 girls (12–17-year old) were included in the analysis. The results showed that the students engaged in risky health behaviors which could lead to short- and long-term health problems. The most alarming finding of this study was students’ nutritional habits, including less than the daily requirements of fruits, vegetables, milk and meat, while the intake of fast food, soft drinks and sweets were higher than recommended. School-based health promotion and wellness programs should be established in Jordan to influence the health behaviors of adolescents and parents and to avoid further deterioration of their health. Jordanian school curriculum needs to integrate more precise health education programs about diet, exercise, self care and other life style behaviors. More detailed studies are needed with more elaborate instruments about food habits, physical activities and psycho social life.

A retrospective analysis of a community-based health program in Papua New Guinea

Ashwell, H. E. S., Barclay, L. — 2009-05-08

The Women and Children's Health Project was a large Australian funded aid Project that sought to improve the health of women and children in Papua New Guinea between 1998 and 2004. Community development and health promotion interventions aimed to increase community support for attended birth and children's health. Green and Kreuter's [Green, L. W. and Kreuter, M. W. (2005) Health Program Planning: An Educational and Ecological Approach, 4th edition. McGraw-Hill, New York] precede–proceed model of health program planning was applied retrospectively to critique the design, implementation and evaluation of the Project. An outcome evaluation (2006) provided data for this analysis and investigated long-term impact using a multi-methods approach. Application of the precede–proceed model was useful, but the model fails to sufficiently well identify ‘inhibiting factors’ as part of the educational and ecological assessment during the planning phase. Pre-defined objectives and contractually obligated outputs in a donor funded business model negatively influenced Project activity and outcomes. Despite this and the challenging context for implementation, Project interventions improved interaction between the community and health systems, and improved use of maternal child health services.

A comparative study on resilience level between WHO health promoting schools and other schools among a Chinese population

Wong, M. C.S., Lee, A., Sun, J., Stewart, D., Cheng, F. F.K., Kan, W., Ho, M. — 2009-05-08

The WHO health promoting school (HPS) approach covers key areas including school-based programmes improving students' psychological health, but there have been few studies evaluating the resilience performance of these schools. This study compared the resilience scores between schools within the healthy school award (HSA) scheme (HPS group) and those not (non-HPS group). We conducted a cross-sectional survey of grade-one students (aged 12), all teachers and parents of mainstream secondary schools recruited by stratified random sampling in one large Territory of Hong Kong using validated resilience questionnaires during November–December 2005. Four non-HPS and four HPS secondary schools were recruited, respectively, involving 1408 students, 891 parents and 91 teachers, with similar baseline characteristics. The HPS students were found to have better scores than non-HPS students (average age 12.4 year-old in both groups) in all dimensions with significantly higher scores in ‘Peer Support’ (p = 0.013), ‘Making a Difference’ (p = 0.011), ‘About Me’ (p = 0.027) and ‘Generally Happy’ (p = 0.011). There was no difference in the scores between non-HPS and HPS parents. The HPS teachers reported significantly higher scores in ‘Health Policies’ (p = 0.023), ‘Social Environment’ (p = 0.049), ‘School Community Relations’ (p = 0.048), ‘Personal Skills Building’ (p = 0.008) and ‘Partnership & Health Services’ (p = 0.047). The secondary HPS students and teachers reported significantly higher resilience scores than those of non-HPS. This study shows that the HSA scheme under WHO has the potential to exert positive changes in students and teachers and the concept of HPS is effective in building resilience among major school stakeholders.

Understanding suicidality and correlates among Chinese secondary school students in Hong Kong

Lee, A., Wong, S.Y.S., Tsang, K.K., Ho, G.S.M., Wong, C.W., Cheng, F. — 2009-05-08

Suicide has become a leading cause of mortality and morbidity for adolescents in Hong Kong. This study investigated the factors associated with suicidal ideation and attempt among the secondary school students in Hong Kong by studying a representative sample of 3383 students with a self-administered questionnaire and analysed by multiple logistic regressions analysis. Youth risk behaviours, such as heavy smoking, episodic heavy alcohol drinking, early sexual experience, and feeling hopeless, were found to be associated with both suicidal thoughts and attempts, with ‘misuse of drugs’ as discriminating factor that solely related to attempt and ‘involvement in physical fight’ solely related to suicidal thoughts. Addition of suicidal ideation is a significant explanatory variable of suicidal attempt over and above health risk behaviours. Stratified analysis of upper and lower secondary students would give better understanding of significance of various risk factor for different age groups. The disturbing prevalence of suicidal behaviour and its coexistence with other high-risk behaviour in secondary school students have implications for teachers, youth workers and public health practitioners to develop and evaluate programmes for suicide prevention.

Health promoting schools in urban, semi-urban and rural Lao PDR

2009-05-08

Health promoting school activities have been implemented in developing countries, but their experiences have not been fully shared. Our objective is to explore the differences of health promoting school status in urban, semi-urban and rural areas in Lao PDR. To accomplish this we evaluated 138 schools in three provinces using a checklist developed by the government school health taskforce. We interviewed first through fifth grade pupils, school principals, food vendors, community chiefs, and observed school environments. We found that urban and semi-urban schools had higher scores than rural schools in the areas of, "personal health and life skills," "healthy school environment," "health and nutrition services," and "common disease control and prevention." However, semi-urban and rural schools showed better results than urban schools for some questions within the "school and community partnerships" component. When the results of individual schools were examined, there was considerable variation. We found a tendency for higher scores in urban areas, which went down for semi-urban areas and further decreased for rural areas. However, we also found differences among schools within each study site. In conclusion, we found not only a large difference among urban, semi-urban and rural schools but also clear differences in health promoting school status among schools within each study site in Lao PDR. Based on the results, we recommend that each school adopt a tailored approach for the health promoting school programme based upon an analysis of its own scores.

Participation, resource mobilization and financial incentives in community-based health promotion: an economic evaluation perspective from Sweden

Johansson, P. M., Eriksson, L. S., Sadigh, S., Rehnberg, C., Tillgren, P. E. — 2009-05-08

Local community participation is an important objective for many health promotion interventions, but it hinges on the incentives for local organizations to participate. Both aspects might be explored with information obtained from economic evaluations, illustrated in this study with data from a cost-effectiveness analysis of an elderly safety promotion programme implemented in Sweden. Previously, resource mobilization has been used as a process indicator for successful community participation. We propose that resource mobilization can be measured as the proportion of total intervention costs paid by collaborators. In the case presented here, local collaborators contributed 50 per cent of the total intervention costs (SEK 6.45 million, in Swedish krona 2004; 1 USD = 7.35 SEK), while participants, i.e. the elderly in the intervention area, contributed 13 per cent and the remainder, 37 per cent, was paid by project funds. In a subsector financial analysis, the distribution of costs and financial benefits from interventions among different sectors in society is described. The estimated financial benefits in the case were divided between the health-care system (SEK 2.5 million), the local authority (SEK 3.7 million) and the elderly and their relatives (SEK 0.3 million). The only net beneficiary was the local authority. In the case presented here, the health promotion objective of local community participation was achieved as half of the total costs was mobilized from local collaborators. The local community participation objective was supported by financial incentives for at least one key collaborator.

The historical origins of the basic concepts of health promotion and education: the role of ancient Greek philosophy and medicine

Tountas, Y. — 2009-05-08

Although it is commonly accepted that the basic concepts of ‘Health Promotion’ have been developed in the last two decades, they have their roots in ancient civilizations and in particular in Greek antiquity. As evident from medical and philosophical documents of the sixth to fourth centuries B.C., the ancient Greeks were the first to break with the supernatural conceptions of health and disease that had so far dominated human societies. The ancient Greeks developed the physiocratic school of thought, realizing that maintaining good health and fighting illness depend on natural causes and that health and disease cannot be dissociated from particular physical and social environments nor from human behavior. In this context, they defined health as a state of dynamic equilibrium between the internal and the external environment, they took under consideration the physical and social determinants of health, they empowered individuals and communities through new democratic and participatory institutions, they gave emphasis in health education and skill development, they recognized the importance of supportive environments and of healthy public policy and they re-oriented medicine toward a more naturalistic and humanistic perspective. The aim of the present study is to highlight such core concepts from these early times that helped establishing the foundations for health promotion and education in the modern era according to the Ottawa Charter.

Escaping from the Phantom Zone: social determinants of health, public health units and public policy in Canada

Raphael, D. — 2009-05-08

Despite the Canadian record of concern with the social determinants of health (SDOH), actual public health activities consistent with such an approach are sporadic at best. Canadian research and advocacy activities in the service of strengthening the SDOH are so divorced from everyday public policy activity, media discourse and public awareness as to metaphorically suggest that SDOH researchers and advocates exist in a Phantom Zone of irrelevance. Why this might be the case and means of escaping from such irrelevance are presented. Implications for jurisdictions where the situation appears to be even worse—such as the USA—and for those where the situation may be somewhat better are also presented.