Showing papers in "Health Promotion International in 2002"

Well-being in schools: a conceptual model.

Abstract: Health and well-being have mostly been separated from other aspects of school life. Health services and health education have been available for school-aged children in Western societies for a long time. Recently, more comprehensive school health programmes have been developed, e.g. the WHO 'health promoting school' and 'coordinated school health programme' in the USA. They focus on how to implement health promotion and health education in school. However, a theoretically grounded model based on the sociological concept of well-being is needed for planning and evaluation of school development programmes. The School Well-being Model is based on Allardt's sociological theory of welfare and assesses well-being as an entity in school setting. Well-being is connected with teaching and education, and with learning and achievements. Indicators of well-being are divided into four categories: school conditions (having), social relationships (loving), means for self-fulfilment (being) and health status. 'Means for self-fulfilment' encompasses possibilities for each pupil to study according to his/her own resources and capabilities. 'Health status' is seen through pupils' symptoms, diseases and illnesses. Each well-being category contains several aspects of pupils' life in school. The model takes into account the important impact of pupils' homes and the surrounding community. Compared with others, The School Well-being Model's main differences are the use of the well-being concept, the definition of health and the subcategory means for self-fulfilment. Making the outline of the well-being concept facilitates the development of theoretically grounded subjective and objective well-being indicators.

Factors affecting the initiation of breastfeeding: implications for breastfeeding promotion

Abstract: Breastfeeding rates in the United Kingdom (UK) are one of the lowest in the developed world and certainly the lowest in Europe. There have been numerous studies of breastfeeding in the UK, most of which have adopted a quantitative approach, and they have largely focused on obstetric or socio-demographic factors in the decision to breastfeed. Whilst these studies have an important role to play, this paper draws on a study that adopts a qualitative methodology to explore women's personal experiences and perceptions of breastfeeding. A qualitative study of 19 primagravidae was undertaken and completed in 1998. Participants were recruited to the study via 12 antenatal clinics in the West Midlands, England, UK. Their ages ranged from 16 to 30 years and the majority described themselves as 'white'. The majority of participants were in paid employment in a variety of occupations. The study was prospective in design. Participants were interviewed three times either during pregnancy or after childbirth: the first stage was between 6 and 14 weeks of pregnancy; the second stage was between 34 and 39 weeks; and the third stage was between 6 and 14 weeks after childbirth. The data indicate that there are several factors affecting breastfeeding initiation. First, infant feeding decisions seem to be made prior to, or irrespective of, contact with health professionals. Secondly, the data suggest that health promotion campaigns in the UK have been influential in their ability to educate women about the benefits of breastfeeding. However, this did not dissuade participants from formula feeding once their decision was made. The desire for paternal involvement also seemed to be another influential factor; fathers were either seen as able to alleviate the daily grind of early motherhood, or there was a desire for 'shared parenting'. Finally, some of the formula feeding women expressed a strong desire to re-establish their identities as separate individuals and as 'non-mothers'.

'Opportunity structures': urban landscape, social capital and health promotion in Australia.

Abstract: This paper presents data from 40 in-depth interviews that were conducted as part of a study of social capital and health in relation to people’s perceptions of the influence of ‘place’ on their participation levels and health. These data were used to examine features of the western suburbs of Adelaide that were perceived as health damaging and health promoting. The paper demonstrates that our Australian suburban respondents expressed a considerable concern about these features and the impact they have on their perception of community and their ability to participate in it. Safety, connectedness to the area, the reputation of an area and the extent and nature of community facilities are all seen as important to a healthy community. The research found that in the more deprived socioeconomic areas within the study area, there was a significant degree of dissatisfaction with features of the urban environment, such as availability of amenities, provision of public transport, and proximity of industry to private dwellings. The paper concludes by considering certain features of urban environments that might make them more supportive of health through encouraging contact between people. We conclude that these environments could be improved using the following measures: a subsidy scheme to support the viability of local shops and cafes (thereby providing meeting places and employment); parks with facilitators (who could play a role in increasing safety in the park but also encouraging community development); attractive places to walk; and a general environmental improvement program.

Impact of the Pick the Tick food information programme on the salt content of food in New Zealand.

Abstract: The Pick the Tick programme of the National Heart Foundation of New Zealand aims to provide a framework for cooperation with the food industry to improve nutrition labelling and to develop a healthy food supply. Food manufacturers, whose products meet defined nutritional criteria, are able to display the Pick the Tick logo on food labels. The tick is used by 59% of shoppers in assisting them make healthy food choices. Food companies are encouraged to reformulate product composition if they fail to meet criteria and develop new products to specifically meet the Pick the Tick criteria. The objective of this study was to evaluate the impact of the programme on food formulation. The main outcome measure was the amount of salt not added to food products. Changes to sodium levels were multiplied by the volume of sales and then converted to salt in tonnes to provide a tangible measure of the impact of the programme. In a 1-year period, July 1998 to June 1999, Pick the Tick influenced food companies to exclude approximately 33 tonnes of salt through the reformulation and formulation of 23 breads, breakfast cereals and margarine. Breakfast cereals showed the largest reduction in sodium content by an average of 378 mg sodium per 100 g product (61%). Bread was reduced by an average of 123 mg per 100 g product (26%) and margarine by 53 mg per 100 g (11%). Pick the Tick appeals to the food industry as a tool for marketing food products and has provided an incentive to improve the nutritional value of foods. The tick on approved products not only acts as a 'nutrition signpost' for consumers but can also significantly influence the formulation of products without sacrificing taste or quality.

Role of knowledge in public health and health promotion policy change

Abstract: A framework of policy development is presented that identifies the role various forms of knowledge can play in the policy formation process. The framework is based upon the premise that public health and health promotion issues should be addressed within an analysis of policy change that considers concepts of interactive and critical knowledge in addition to scientific knowledge. Progress in developing meaningful health policy will require accepting the validity of these various forms of knowledge and developing frameworks that see experts and citizens working together to develop and achieve public health and health promotion goals.

Impacts from repeated mass media campaigns to promote sun protection in Australia

Abstract: SUMMARY Campaigns using television, radio and print media were conducted over three summers in New South Wales, Australia, aiming to increase the use of sun protection measures among children under 12 years. The evaluation entailed crosssectional telephone surveys before and after each of the first two campaigns and following the third campaign. The study group were parents of children under 12 years. Random digit dialling yielded samples of approximately 800 for each survey. Measures addressed campaign recall and sun protection knowledge, attitudes and behaviours. The surveys revealed significant levels of campaign recall. Knowledge about the protective benefits of sunscreens, hats and protective clothing was high at baseline and showed little improvement over the campaigns. Knowledge levels about the benefits of shade cover and of the relative risks of skin cancer from childhood sun exposure were lower, and also did not show improvement. Just one of the four attitude factors showed significant improvement, and this concerned the importance that parents placed on the issue of child sun protection. After the final campaign there were increases compared with baseline in childrens’ use of sunscreen, protective clothing and shade, but it was notable that between campaigns levels of these behaviours were similar to or below those at baseline. There was no evidence of a campaign-related increase in hat wearing by children. All sun protection measures were used less often by adults than children, but these showed similar trends. Mass media campaigns may contribute to short-term increases in some sun protection behaviours; however, as their impact is not sustained they should be repeated and supplemented by educational, policy and environmental strategies.

The limitations of population health as a model for a new public health.

Abstract: Population health as developed by the Canadian Institute for Advanced Research (CIAR) has influenced the shape and direction of Canadian public health policy, and has the potential to do so in the USA and elsewhere. There is reason to be concerned about this ascendence of CIAR thinking: population health is rooted within epidemiology, a militantly quantitative discipline; population health eschews analysis of societal structures as determinants of health; and population health elevates scientific understanding over health promotion action. Its lack of an explicit values base is also problematic. Policy makers should recognize these and other limitations as they consider models for a new public health.

School journeys and leisure activities in rural and urban adolescents in Norway.

Abstract: Health promotion measures in order to increase physical activity should include environmental and policy approaches. Studies in natural living environments such as rural and urban areas may provide valuable information about the effects of environmental factors on physical activity. The present study was performed among 88 adolescents living in one rural and one urban area in Norway, with particular focus on the availability of cycling tracks and walking trails. The study showed that both rural and urban adolescents spent more time on sedentary activities, such as watching TV/video and playing TV/data-games, than on regular physical activity. No differences were observed between the two groups in regard to activity patterns. However, the median distance the urban adolescents walked or cycled to school was three times greater than the median distance the rural adolescents walked or cycled to a bus stop or to school. The urban adolescents also walked or cycled more to regular activities than the rural ones. Positive correlations were found between walking or cycling from home to school and walking or cycling to regular activities. In multiple regression analysis, urban area, female gender and distance walked or cycled to school or bus stop predicted increased walking or cycling to activities. The results confirm other studies on adolescents, showing that much more time is spent on sedentary rather than on physical activity. Knowledge is still lacking concerning predictors of sedentary and general physical activity, but the results indicate that access to cycling tracks and walking trails in residential areas may increase both walking or cycling to school and to leisure activities. A relevant strategy for health promotion may therefore be to make cycling tracks and walking trails accessible; some passive transport both to school and to leisure activities may thus probably be replaced by walking or cycling.

Community-based childhood injury prevention interventions: what works?

Abstract: Unintentional injury, with its broad range of injury types, possible countermeasures, and great number of agencies involved in its prevention, lends itself to community-based approaches. In this paper we examine 10 community-based injury prevention programmes that have targeted childhood injury prevention and have been evaluated using some measure of outcome. We investigate the nature of the intervention, targeting, the length of programmes and multi-agency involvement. We also consider how the programmes have been evaluated, and what outcome, impact and process measures have been used. The information on the intervention and how it was evaluated, how effective the programme was, and the strength of the evidence, is summarized in tabular form. There is increasing evidence emerging about the effectiveness of community-based approaches in injury prevention. Important elements of such approaches are long-term strategy, effective focused leadership, multi-agency collaboration, tailoring to the needs of the local community, the use of local injury surveillance, and time to coordinate existing and develop new local networks. We recommend that there is a need to develop indicators to assess and monitor a culture of safety, programme sustainability and long-term community involvement.

The importance of policy orientation and environment on physical activity participation--a comparative analysis between Eastern Germany, Western Germany and Finland.

Abstract: SUMMARY Environmental and policy interventions are seen as boosting physical activity because they are designed to influence large groups. However, they have not been much researched and the evidence on their role is still quite limited. The purpose of this study was to investigate differences in and relationships between policy orientation, the objective and perceived physical environment, and physical activity between Finland, Eastern Germany and Western Germany. The data are taken from a public telephone survey carried out as part of the international MAREPS project (Methodology for the Analysis of Rationality and Effectiveness of Prevention and Health Promotion Strategies; Eastern Germany, n = 913; Western Germany, n = 489; Finland, n = 400), statistics of sports facilities and policy documents. Results from the survey showed that Finns are more active than Germans and that they differ in their way of practising physical activity from Germans. Finns were more satisfied with their opportunities for physical activity and were better informed about physical programmes and measures. Finland also has the best opportunities in indoor sports facilities and outdoor sports grounds per number of inhabitants (excluding indoor swimming pools). Analysis of policy orientations showed that Finland had the most extensive ‘Sport for All’ policy, although West Germany’s policy orientation did not differ that much from Finland’s. East Germany’s policy orientation was characterized by competitive sports. A policy orientation that places emphasis on the physical activity of the whole population seems to be related to better opportunities and a better infrastructure for sports and physical activity. This study suggests that there is a relationship between policy orientation, physical environment and physical activity participation.

Impact evaluation of an oral health intervention amongst primary school children in Ireland

Abstract: A pilot oral health programme was developed which aimed to improve dental health knowledge and behaviour amongst Irish school children aged 7-12 years. The programme comprised two integral components: a television campaign, run over a 6-week period, was incorporated into the children's programme 'Den TV' on national television, with video clips of a member of the music band Boyzone promoting key oral health messages; and a Smile of the Year contest. Concurrently, a dental nurse delivered an interactive talk with pupils, showed a video of the Den TV oral health programme and distributed posters and leaflets. The aim of this study was to assess the impact of the overall intervention on school pupils' dental health knowledge and reported behaviour. Thirty-two primary schools in two health board regions in the Republic of Ireland participated in the study. At baseline and after 6 weeks, 1534 school children completed specially developed questionnaires. There was a positive net effect of the dental nurse intervention in all but one question. The percentage of children who reported using the recommended amount of toothpaste and brushing for 3 min appeared to have been further increased having observed the television campaign. These results are in line with the argument that mass media campaigns work to supplement the one-to-one activities of health professionals in order to effect knowledge and behavioural change.

Health promotion behaviors in Chinese family caregivers of patients with stroke.

Abstract: SUMMARY The purpose of this study was to explore the relationship between and among the caregiver’s personal factors, the care recipient’s functional status, the caregiver’s perceived self-efficacy, social support, reactions to caregiving, and health promotion behaviors in family caregivers of communitydwelling stroke patients in Taiwan. A structured homeinterview survey methodology was used to collect data from 134 primary caregivers responsible for care of stroke patients in Taipei, Taiwan. The study results indicated that, in general, caregivers were female spousal caregivers (mean age 52 years, average caregiving period 24 months). Regression analyses revealed that the caregiver’s health status was the strongest positive predictor of caregiver self-efficacy. Spousal caregivers with a better-perceived health status were more satisfied with their resources of social supports. Spousal caregivers with poor perceived health status had a higher level of caregiving strain. Results for the overall model indicated caregiver’s social support and the care recipient’s functional status made significant contributions in explaining the caregiver’s health promotion behaviors. Implications for further practice suggest establishing community training programs and support groups for family caregivers.

More than words? The status and impact of smoking policies in Scottish schools.

Abstract: The aim of this study was to investigate the current status of smoking policies in Scottish schools, and the relationship between policy status, enforcement of smoking restrictions and perceptions of smoking behaviour among pupils and teachers. A representative sample of 15-year-old school pupils from 77 Scottish secondary schools was surveyed in 1998 regarding their perceptions of smoking in several locations within and outside the school building. Two staff members from each school were also surveyed regarding school smoking policies for pupils and teachers, the nature of the school's smoking restrictions, and the extent to which the restrictions were enforced. The results showed that more schools had a written policy on teacher smoking than on pupil smoking. All schools in the sample banned smoking by pupils, but the majority allowed smoking by teachers in restricted areas. Irrespective of the type of policy or restrictions on smoking, pupils reported seeing smoking among both pupils and teachers on school premises in all of the sample schools. Whether or not a school had a written policy appeared to be unrelated to pupil smoking in the toilets or teacher smoking outdoors on school premises. However, pupils were less likely to be aware of pupils smoking outdoors and teachers smoking in the staff rooms in schools where there were written policies on pupil and teacher smoking, respectively. Consistent enforcement of a ban on pupil smoking was associated with lower levels of perceived smoking among pupils. Where a complete ban on teacher smoking existed, smoking among teachers was seen less often in the staff rooms, but more often in outside areas on school premises. The results have implications for the use of policy in promoting a healthy school environment.

Reorienting health services with capacity building: a case study of the Core Skills in Health Promotion Project.

Abstract: This paper presents a case study of the application of a framework for capacity building [Hawe, P., King, L., Noort, M., Jordens, C. and Lloyd, B. (2000) Indicators to Help with Capacity Building in Health Promotion. NSW Health, Sydney] to describe actions aimed at building organizational support for health promotion within an area health service in New South Wales, Australia. The Core Skills in Health Promotion Project (CSHPP) arose from an investigation which reported that participants of a health promotion training course had increased health promotion skills but that they lacked the support to apply their skills in the workplace. The project was action-research based. It investigated and facilitated the implementation of a range of initiatives to support community health staff to apply a more preventive approach in their practice and it contributed to the establishment of new organizational structures for health promotion. An evaluation was undertaken 4 years after the CSHPP was established, and 2 years after it had submitted its final report. Interviews with senior managers, document analysis of written reports, and focus groups with middle managers and service delivery staff were undertaken. Change was achieved in the three dimensions of health infrastructure, program maintenance and problem solving capacity of the organization. It was identified that the critically important elements in achieving the aims of the project-partnership, leadership and commitment-were also key elements of the capacity building framework. This case study provides a practical example of the usefulness of the capacity building framework in orienting health services to be supportive of health promotion.

Externalizing and internalizing problems at school as signs of health-damaging behaviour and incipient marginalization.

Abstract: This study aimed to investigate whether behavioural or emotional problems in adolescents detected by their teachers are signs of a common psychosocial maladjustment and of the beginning of social marginalization. Altogether, 171 pupils (15 years of age) from the eastern part of Finland participated in the survey. Behavioural and emotional problems and academic achievements were assessed separately by two teachers. Pupils filled in a questionnaire about alcohol use, smoking, physical exercise and fitness, self-rated health, psychosomatic symptoms, social relationships and future educational plans. Results showed that poor success at school and the absence of or limited educational plans were associated with both externalizing and internalizing problems. Externalizing problems were associated with health-damaging behaviour and with bullying others. Internalizing problems were associated with poor perceived health and a low level of exercise, with mental symptoms, and with problems in social relationships. Thus, the pupils in both problem groups had a clustering of different risk factors. We conclude that the accumulation in adolescents of self-reported health-damaging behaviour, problems related to school, to future educational plans and to social relationships are already obvious in pupils with externalizing and/ or internalizing problems detected by their teachers at the age of 15 years. The capacity of teachers to identify pupils at risk as early as possible should therefore be utilized. The development of a vicious circle might be prevented through early intervention at school, by offering pupils guidance, counselling and treatment.

Cost-effectiveness of a community anti-smoking campaign targeted at a high risk group in London

Abstract: Surveys of Turkish speaking people in London found 74% of men and 45% of women were smokers, and knowledge of the health effects of smoking was low. Camden and Islington Health Authority has a substantial Turkish community. We report an economic evaluation of a community smoking cessation intervention, aimed at the Turkish community, undertaken by Camden and Islington Health Promotion Agency. The intervention aimed to highlight the dangers of smoking, and to reduce the amount smoked and the number of current smokers. It included a play, a poster and media campaign, and purpose-designed leaflets. A panel survey of the Turkish population determined smoking habits, attitudes to smoking and knowledge about the health effects at baseline and 12 months. The intervention effect was estimated from the changes between baseline and final surveys. To allow for the non-response to the second survey we analysed effectiveness in two ways: first by assuming that the responders represented the true situation, and secondly by making a more pessimistic assumption that there was no change in the non-responders. Fifty-seven per cent of the Turkish population were smokers at baseline, compared with 39% in the general population of Camden and Islington. Levels were particularly high in younger women. At follow-up there was a net reduction in smokers of 6.4% [95% confidence interval (CI) 0-13.6%] in responders. When all study subjects were included the net reduction was 2.9% (CI 0-6.3%). Most quitters were light smokers to start with. At follow-up, 51% of respondents recognized at least one of the Turkish language interventions. The estimated cost-effectiveness of this intervention was 105 pound (range 33-391 pound) per life year gained. Campaigns targeted at groups with high smoking prevalence may be more cost-effective than general population campaigns.

Promoting physical activity in women: evaluation of a 2-year community-based intervention in Sydney, Australia.

Abstract: Women are less likely than men to reach recommended levels of physical activity and have unequal access to active leisure time. Studies in Australia have consistently found that women are only half as likely as men to be adequately active. A community-based multi-strategic health promotion intervention, 'Concord, A Great Place to be Active', was implemented from 1997 to 1999. It aimed to increase the physical activity levels of women aged 20-50 years living in the Concord Local Government Area (LGA), an inner-western region of Sydney, Australia. A key feature of this intervention was a partnership between Concord Council (the local government) and the Central Sydney Health Promotion Unit (CSHPU). The project was evaluated using qualitative and quantitative methods. Key informant interviews and focus groups were conducted to inform the development of the intervention and to assess the impact of the project on Concord Council. Pre- and post-intervention telephone surveys of the target group were also conducted. Following the intervention, there was a statistically significant (6.4%) reduction in the proportion of sedentary women. Further, there were a number of positive enhancements in the Council's capacity to promote physical activity in the community. These findings demonstrate that a community-based intervention targeting a specific population can achieve positive changes in physical activity and that a local government has the capacity to be involved in and sustain physical activity interventions.

Closing the gap: building the capacity of non-government organizations as advocates for health equity.

Abstract: Seeking achievement of health equity has underpinned national government and global health policies for decades. However, major difficulties and challenges faced in the practice of achieving 'Health for All' has led to a recognition of the need to broaden the focus of efforts to improve health equity. Civil society groups have been identified as key stakeholders in attempts to achieve health equity, and the importance of strengthening their capacity to influence relevant government policy and practice has been highlighted. This paper presents the results of a qualitative study which examined the role of organizations outside government in advocating for health equity, and the capacities and conditions that were related to their success. In-depth, unstructured interviews were conducted with 26 non-government organizations (NGOs) who were active in three important health policy debates in Australia. The grounded theory method was used to direct data collection and analysis, and member checking was employed to ensure soundness and build ownership of the findings. Effective advocacy was found to be a dynamic process characterized by flexibility and opportunism within a framework of longer term goals. Two key ways of working were identified--in partnership and in conflict with government, with shifts in emphasis in response to organizational strengths and a changing environment. A number of domains of capacity, which together are termed 'capacity for advocacy', were also identified. It is clear that NGOs can learn a great deal from each other, but there needs to be investment by governments, international agencies and NGOs themselves if advocacy for health equity is to be strengthened.

The educational experiments of school health promotion for the youth in Japan: analysis of the 'sport test' over the past 34 years.

Abstract: The objective of this study was to analyze independently the results of a 'sport test' that had been conducted in Japanese schools for 34 years without interruption, and to examine how physical education in Japanese schools affects health promotion in youths and what problems remain to be solved. The source of materials for the present study were the Annual Reports on the Survey of Physical Fitness and Athletic Ability for the period 1965-1998, published by the Ministry of Education, Science, Sports and Culture. Means and standard deviations of total scores from physical fitness and athletic ability tests in 11-year-olds (6th graders in elementary school), 14-year-olds (3rd graders in junior high school) and 17-year-olds (3rd graders in senior high school) were analyzed. The results of this study suggest that the trends of changes in mean score and coefficient of variation (CV) for physical fitness and athletic ability in Japanese youths are associated with the outcome of physical training through physical education in school, as well as the effect of the media--mainly television and television games. (1) The increase in mean scores and the decrease in CV observed from 1964 to the first half of the 1970s were probably due to the positive influence of the Guideline for Teaching. This guideline emphasized a systematic approach to athletic techniques, together with active practice of physical fitness training in schools, under the directives of the Boards of Education in response to the social 'Physical Fitness Campaign' policy at that time. (2) The leveling off of mean scores and CVs observed from the early half of the 1970s to the later half of the 1980s might be a result of the invasion of television into Japanese family life. (3) The decrease in mean scores and increase in CV observed since the later half of the 1980s were assumed to be caused by the negative influence of a Guideline for Teaching characterized by the key words 'Physical Education for More Pleasure' and a steep increase in the number of television games. (4) In terms of methodology, analyzing not only the mean scores but also the CV probably provided a more accurate evaluation of the outcome of health promotion in youths. In conclusion, strategies for health promotion in youths, especially for proper nurturing of physical fitness and athletic ability, should include not only delivery of physical fitness training in schools, but also continuous monitoring of multiple indicators, and ensuring proper 'Learning of the Body'. The latter should include providing learning opportunities centering on the 'body' (not the 'body' for the sake of labour or military manpower, but one's own 'body' per se); guiding young people to recognize the states of their own body and physical fitness, and to understand how they can be improved. To be effective in implementation, the need to increase the number of professional teachers in physical education should be examined. All possible opportunities should also be taken to inform youths of the negative effects of television and television games, and to encourage them to spend less time on these and more time being physically active from the moment they arise.

Comparison of tobacco use knowledge, attitude and practice among college students in China and the United States

Abstract: The purpose of this study was to compare the knowledge, attitudes and practice regarding tobacco use of college students in China and the United States (US). A modified existing questionnaire originally developed for use in the US was adopted. A Chinese version of the final questionnaire was approved by a bilingual panel of scholars. American participants were students at a large Midwestern University, while Chinese participants were selected from a large south-east China university. A total of 2131 usable surveys were collected. Both descriptive and inferential statistical tests were employed in data analysis. Compared with Chinese college students, American students scored higher in knowledge but lower on the attitude scale of the questionnaire. American respondents also were more likely to smoke cigarettes and use other tobacco products. Chinese students, on the other hand, had a higher rate of starting smoking at age 13 years or younger and were less likely to have tried to quit. The findings should provide exploratory information for health educators in understanding tobacco use and its prevention.

Youth social action: building a global latticework through information and communication technologies

Abstract: New technologies and a growing global consciousness have created innovative opportunities for young people to connect locally nationally and internationally for social action. This paper describes the dynamics of collective action in this new environment. Particular attention is given to how youth social action initiatives use information and communication technologies (ICT) to foster connection action and sustainability. In-depth interviews were performed with five youths (aged 18-24 years) and two youth workers at two international non-government organizations (NGOs) focusing on social justice and human rights: Global Youth Connect and Amnesty International Canada. Qualitative methods were used to code and analyze the interview tapes and notes. Three main results are discussed: (i) the role of connection in building a youth action movement; (ii) the differential use of various communication technologies; and (iii) access barriers to connection opportunities. ICT enables new and expanded ways of connecting youth to express and share their experiences which is a key success factor for social action initiatives. (authors)

A stage model for assessing a community-based diabetes prevention program in Sweden

Abstract: Type 2 diabetes is the most common type of diabetes, with a prevalence of at least 4% in Sweden. Aiming at primary prevention of the disease, the Stockholm Diabetes Prevention Program (SDPP) was developed as a joint program between the Departments of Endocrinology, Social Medicine and Epidemiology at the Karolinska Institute. The program was designed to include three stages, i.e. a combined baseline and aetiological study, a community-based intervention program and a follow-up study after 10 years. In 1995, the intervention program was initiated in Stockholm County with the aim of reducing the incidence of type 2 diabetes. The intervention has focused on the whole adult population in three intervention municipalities, where the local authorities have been involved in planning, initiating and implementing the program. Activities to prevent diabetes, aiming at risk factors such as obesity, low physical activity, dietary habits and tobacco use, have been initiated together with people from different fields and backgrounds, and with different ideas and approaches to health promotion and diabetes prevention. This paper provides a description and reflects upon the development and implementation process of SDPP as well as its interaction with the intervention communities. The stage model that was used for planning SDPP will be used for describing the various phases of the program. Over the period of the program, interest and responsibility has grown at the municipal authorities. The program has been a concern for the municipalities, as the program intermediate goals are also important for other health promotion issues.

A framework for health promoting emergency departments.

Abstract: Since 1986, the World Health Organization (WHO) has been advocating for the health sector to move increasingly in a health promotion direction, beyond its responsibility for providing clinical and curative services (WHO, 1986). Some Emergency Departments (EDs) have partially achieved this through providing patient health information, screening and early intervention programs, injury prevention and asthma education. While EDs are a suitable setting for health promotion, they are grounded in a medical paradigm where most of the staff are educated to think exclusively of relation care. As such, a significant organizational shift is required for EDs to be more inclusive of health promotion principles. Following a comprehensive literature review, a theoretical framework was developed for the Health Promoting Emergency Departments Program (HPEDP). It describes the opportunities for health promotion in EDs through combining the 'strategies for health promotion' with the 'spectrum of health and disease'. This forms a matrix to enable health development, primary prevention and secondary prevention interventions to be planned in EDs. The framework is a tool to support the development of coordinate and comprehensive health promotion programs and to avoid the use of isolated victim-blaming strategies. Beyond EDs, planners in other health care institutions may also find the framework useful-particularly those settings where staff health promotion training and experience is limited.

Development of a Swedish bicycle helmet promotion programme--one decade of experiences.

Abstract: OBJECTIVE: to describe 10 years of experiences of the Swedish National Bicycle Safety Programme which started during 1990 as part of an initiative taken by the World Health Organization (WHO). In relation to WHO's efforts with regard to accident and injury prevention, a global programme to increase helmet-wearing by two-wheel riders was launched. The idea was to introduce a simple 'vaccine' for everyone that was achievable at a low cost. The Swedish initiative was taken up by the Karolinska Institute and the National Institute of Public Health. METHOD: at an operational level, all available methods and data sources were utilized in the programme: surveillance of injuries, provision of information and advice, training and supervision, environment and product improvements, and legislation. RESULTS: considerable progress has been made in reducing bicycle-related injuries in Sweden over the last two decades. Cycling injuries among the elderly must be a matter of particular concern. CONCLUSIONS: our 10 years of experiences from a bicycle helmet promotion programme lead to the conclusion that there is a case for mandatory helmet wearing, as one of the most important strategies on the national level. But regional and community-based efforts will still need to be more comprehensive. Besides this, efforts must be made to intensify the activities of parties already involved in prevention programmes. New target groups must be approached, such as immigrants, vulnerable social groups, and teenagers. Sustainability of the Swedish Bicycle Helmet Initiative Group, including continued participation of group members and organizations, is the key--in the long term--to protecting Swedish bicyclists against head injuries.

Balancing breastfeeding and paid employment: a project targeting employers, women and workplaces.

Abstract: Since breastfeeding is acknowledged as the best nutrition for young babies, it needs to be protected, supported and promoted. This includes enabling mothers to continue breastfeeding even when they return to work. This paper describes a project that promotes balancing breastfeeding and paid work through the development, distribution, promotion and evaluation of suitable materials to workplaces, employers and women in Australia. Information provided in a workplace kit was based on previous successful strategies from published works in refereed journals and in consultation with employers, employees and other key people. Information for employees was further summarized and translated into Arabic, Chinese, Turkish, Spanish and Vietnamese. Over 50,000 information kits were distributed Australia-wide using a database that comprised contact details of medium to large workplaces plus employee and employer organizations, with preference given to workplaces that employed women of childbearing age and women from diverse cultural backgrounds. The translated material was also distributed to migrant resource centres and working women's centres around Australia. Promotion of the project was extensive, resulting in 20 newspaper articles, 17 radio interviews or news items, and articles in 18 newsletters and professional journals and three magazines. The project was also promoted at three conferences and one seminar. Evaluation (directed at employers) focused primarily on the distribution and content of the information kit, since the evaluation was conducted soon after distribution. The evaluation survey was sent to 1571 valid contacts (808 e-mail addresses, 1360 fax numbers). The response rate was 12.8% (n = 202). Seventy per cent of responding businesses rated the information kit as excellent. Over half anticipated the kit would be useful in their organization, while over two-thirds agreed that the kit provided sufficient information and suitable solutions to support balancing breastfeeding and work in their organization. While this project has achieved its objectives, further work is required to assist organizations to develop and implement policies and procedures for balancing breastfeeding and work, so that breastfeeding mothers who are returning to work can continue to breastfeed as long as they and their baby require it.

Influence of health promotion bureaucracy on community participation: a Canadian case study

Abstract: The purpose of this paper is to illustrate, through a Canadian case study, the bureaucratic support and obstacles for community participation in health promotion. The paper begins with a brief history of the development of a participatory health promotion programme in Canada. The role of bureaucracies on participation of communities is highlighted. Secondly, the paper describes how a variety of bureaucratic factors affected grassroots community participation efforts of local projects in one province. Finally, discussion focuses on how community participation is constrained in a bureau-cratically mediated activity such as health promotion.

Breast cancer health promotion model for older Puerto Rican women: results of a pilot programme

Abstract: This article focuses on the development of a health promotion model programme for elderly Puerto Rican women intended to minimize barriers for early detection of breast cancer and to increase women's compliance with recommended guidelines. The programme was designed based on the findings of a national sample to assess knowledge, beliefs and practices of breast cancer early detection in Puerto Rican elderly women and their perceptions of barriers associated with non-compliance. It involves the combination of educational and environmental support for actions and conditions conducive to health behaviour and consists of the following components: (i) a culture- and cohort-sensitive health education programme for elderly women on breast cancer screening and assertive strategies for client-physician relationship; (ii) training for primary-care providers on current guidelines and barriers affecting compliance among older women in Puerto Rico; and (iii) coordination of necessary support services to facilitate access to clinical breast exams and mammograms. Programme implementation considers appropriate theories for health promotion and education in the older population. Evaluation measured progress in the plan implementation by assessing immediate products and long-term impact of the programme. Results of the pilot programme revealed a slight increase in knowledge and a significant decrease (p < 0.05) in beliefs after the health education sessions. Interventions in breast cancer early detection practices showed significant changes (p < 0.05) for mammogram and clinical breast examination. Different strategies must be combined to increase older women's compliance with breast cancer screening. Health system and access barriers to preventive care must be addressed.

Cultural context, older age and smoking in Scotland: qualitative interviews with older smokers with arterial disease

Abstract: This paper explores how smoking among older smokers with a smoking-related illness is influenced by the wider cultural context of smoking. The paper draws upon a Scottish qualitative interview study to explore lifecourse changes in smoking-related beliefs and behaviours, in current smokers between the ages of 65 and 84 years with arterial disease. The respondents' understanding of smoking, as a socially acceptable behaviour of their youth, had undergone dramatic change over the course of their lives. While some respondents continued to associate their current smoking with their, albeit reduced, participation in social activities, others now smoked at home alone and associated smoking with increasing levels of isolation in their lives. Through an examination of how social attitudes may contribute to smoking as a solitary activity, the paper highlights the implications of cultural context for the adaptive strategies that older people use to cope with the circumstances and conditions of later life. The paper concludes that the wider cultural context of smoking is influential in shaping smoking as either an isolated 'home' activity, or as a 'social' activity for those whose opportunities to smoke in the private sphere are limited by disapproval of significant others. Within the social context, however, these 'social' smokers experience further constraints which shape and reduce their smoking behaviour. The data suggest that in order to be successful with this group of smokers, further research is needed to identify aspects of the lives of older people that sustain smoking in later life. These data will be necessary to develop appropriate health promotion measures to successfully target aspects of lives that support smoking in later life.