Schools are vital environments for cultivating lifelong health behaviors. This study evaluated the outcomes associated with a 15-week comprehensive after-school health program, Healthy Kids+, on students' health-related knowledge, attitudes, and self-efficacy in five public elementary schools. Using a quasi-experimental pre-post design, 228 students aged 8-11 years (grades 3-6) participated in a multi-component program that integrated nutrition, physical activity, social-emotional learning, and family engagement. Data was collected using the validated After-School Student Questionnaire (ASSQ). Descriptive statistics, paired samples t-tests, and repeated-measures ANOVA evaluated pre-/post-differences. Program participation was associated with significant improvements in health knowledge (Delta M = +17.8, p < .001, d = 1.62), attitudes (Delta M = +.66, p < .001, d = 1.54), and self-efficacy (Delta M = +.72, p < .001, d = 1.53). Interaction effects among gender, grade level, and socioeconomic status were not significant, indicating that the program had an equitable impact across all student subgroups. Hierarchical linear regression confirmed that baseline attitudes (beta = 0.36, p < .001) and student age (beta = 0.12, p = .008) were both significant predictors of post-test attitude scores, with the model accounting for 44% of the variance (R2 = .44, p < .001). Findings support the short-term potential of multi-component programs in enhancing elementary students' health-related cognition and motivation. The results underscore the importance of intensive educator capacity-building and family engagement to maintain high program fidelity and achieve consistent outcomes across diverse school settings.
Prior research shows a severe burden of secondhand smoke (SHS)-related morbidity and mortality across sub-Saharan Africa. However, despite high susceptibility to SHS-related health issues, no study has assessed the situation of SHS among Nigerian household members. Therefore, we analyzed the most recent Nigeria Demographic and Health Survey 2024 data and assessed the prevalence and predictors of indoor SHS exposure among 175,892 household members. Bivariate and multivariate analyses were carried out. The prevalence of indoor SHS was 15.49%. Being male (adjusted odds ratio [aOR]: 1.17; 95% confidence interval (CI): 1.13 to 1.21), having never married (aOR: 1.10; 95% CI: 1.51 to 1.68), being an urban resident (aOR: 1.08; 95% CI: 1.03 to 1.13), belonging to a bigger household size (aOR: 1.02; 95% CI: 1.02 to 1.03), having a richer wealth index (aOR: 2.08; 95% CI: 1.90 to 2.27), having achieved a higher education status (aOR: 1.59; 95% CI: 1.51 to 1.68), and having access to mobiles (aOR: 1.13; 95% CI: 1.04 to 1.23), computers (aOR: 1.12; 95% CI: 1.05 to 1.19), and televisions (aOR: 1.11; 95% CI: 1.05-1.17) were positively associated with indoor SHS. Regional variations were also significantly associated with indoor SHS. Importantly, the prevalence of indoor SHS is alarmingly high in Nigeria. Particularly, males, never-married, and educated individuals are at higher risk. The higher wealth quintile is positively associated with indoor SHS. Access to mobile phones, computers, and televisions intensifies indoor SHS. Policy reforms reducing tobacco use and health education interventions for smoke-free homes are discussed and recommended.
Half of all mental health conditions begin before 14 years of age, and students in this age group spend a substantial amount of time in school. This umbrella review synthesised evidence on contemporary, effective school-based interventions designed to improve the mental health and wellbeing of students in low- and middle-income countries (LMICs). Four databases (Web of Science, PubMed, CINAHL and Ovid PsycINFO) were searched from January 2013 to December 2023, identifying 12,126 records. After removing duplicates and screening titles, abstracts, and full texts, 85 systematic reviews (comprising 2932 primary studies) were included. Primary studies were predominantly conducted in North America (42.3%). Among reviews focusing on mental health symptoms (41 of 85), most targeted depression, anxiety and stress, with cognitive-behavioural therapy (CBT) and mindfulness emerging as the most effective interventions. Mental health literacy, socio-emotional competence and psychological wellbeing were the most frequently addressed domains within mental health promotion interventions (25 of 34 reviews). Seven reviews focused on suicide prevention, with Question Persuade Refer (QPR), Signs of Suicide (SOS) and Sources of Strength being the most frequently explored and effective interventions. No reviews included interventions based on the Health Promoting Schools (HPS) framework or a whole-school approach. Overall, evidence for school-based mental health interventions remains heterogeneous, with a concentration on depression, anxiety, CBT and mindfulness-based approaches, primarily in high-income countries (HICs). There is a critical need for further research and meaningful stakeholder engagement in LMICs to develop interventions responsive to local needs.
Women's experiences of consulting their primary care practitioner with symptoms of suspected breast cancer are understudied. This is despite breast cancer being the most commonly diagnosed cancer in women, most cases being diagnosed after presentation in primary care, and early detection being a key driver for better health outcomes and survival. This study aims to explore female patient experiences of presenting with breast health concerns in primary care. A meta-aggregation of qualitative studies was conducted using the JBI methodology for qualitative systematic reviews and reported according to ENTREQ guidelines. Included studies needed to use qualitative methods and analysis to capture female perspectives. Key characteristics and findings were extracted, and findings synthesised. From 5,170 published/unpublished research articles, 17 studies met the inclusion criteria with participant numbers ranging from 6 to 182. Findings were synthesised for the 13 of the included studies with evidentially supported findings. Ten finding categories were then aggregated. From these, four synthesised findings were identified: Promptness of action; quality of communication/empathy; patient personal resources; clinical judgement. Values and unmet needs of presenting women, patient factors and professional clinical judgement all variously impact the referral process for those females consulting their primary care practitioner with breast health concerns. Recommendations to improve clinical practice have been made relating to transparency and timeliness of action; breast examination; empathetic communication; continuity of care and patient safety; health literacy and access to care; and training and competencies, alongside further research recommendations.
Higher education institutions (HEIs) play a crucial role in developing healthier communities through diverse functions including research, education, operations, culture, advocacy and civic engagement. However, the implementation of a 'settings-based approach' to a comprehensive campus-wide health promotion strategy remains challenging due to the diverse and complex nature of HEI organisational structures. Toolkits have been developed to guide HEIs in evaluating their health promotion approaches but, to our knowledge, no comprehensive review of these toolkits has been conducted. This scoping review, with a narrative synthesis, sought to identify, map and compare available toolkits, assessing their comprehensiveness in supporting health promotion. Following a search of five online databases and pertinent grey literature, six toolkits were identified that were examined using a 58-item checklist to assess how each toolkit addresses health promotion domains within HEIs. Our narrative synthesis identifies areas of universal coverage, such as the integration of health into HEI policies and context-specific initiatives, including support for minority groups. Across toolkits, governance/leadership integration and monitoring and evaluation were consistently represented, with strong emphasis on mental health and physical activity. Coverage of areas, such as substance use, sexual health, disability-friendly services and indigenous/minority inclusion, was less consistent - highlighting differences in how comprehensive toolkits address equity-focused and specialised components of health promotion. Our analysis offers valuable insights for the ongoing assessment and refinement of health promotion strategies in HEIs globally, aiming to enhance their capacity to cultivate healthy, inclusive and sustainable campus environments.
Understanding the relationship between social support and physical activity (PA) in Latin America is essential for designing culturally relevant interventions. This cross-sectional study investigates the relationship between perceived family social support and meeting the physical activity (PA) recommendations among adolescents aged 11 to 18 years from the city of Monteria, Colombia. A multi-stage probabilistic sampling method yielded a sample of 1573 participants. Perceived family social support and PA levels (SAYCARE PA) were assessed by validated questionnaires in a sample of 1573 participants. Logistic regression models were used to analyze associations, adjusting for sociodemographic factors. High overall social support was associated with meeting the PA recommendations (under 15 years, OR: 1.8; CI 95% 1.2-2.7; p-value = 0.004; 15 years and older, OR: 1.9; CI 95% 1.1-3.3; p-value = 0.02). Results showed that adolescents under 15 years with high social support from all types and sources were more likely to meet PA recommendations (OR from 1.6 to 2.5). In contrast, among those 15 years and older, high social support from siblings (OR: 2.0; CI 95% 1.3-3.0; p-value = 0.003), and high observational support (OR: 1.7; CI 95% 1.1-2.7; p-value = 0.02), were associated with being physically active. These findings suggest that the relationship between perceived family social support and meeting the PA recommendations varies by age group, with younger adolescents benefiting from a broader range of support sources and types, while older adolescents benefit primarily from siblings and observational support. These findings could be useful for designing longitudinal or intervention studies.
Accessible and effective health education fosters values and beliefs that support positive health behaviors, particularly for parents and adolescents. As parents seek guidance to help their children through adolescence, they overwhelmingly turn to the Internet to learn about their children's health, given the breadth and convenience of available resources. However, the deficiencies in the readability of parent-focused online health education materials, such as the use of complex vocabulary, dense sentence structures, and high reading grade levels, which can limit comprehension, have raised concerns about their effectiveness and reliability. Online health educational materials have the potential to serve as a cost-effective health communication tool by addressing gaps in knowledge and skills. This case study aimed to identify and apply effective readability-scoring methods to assess online health information for parents and adolescents. Readability scores were calculated using multiple validated algorithms: the Flesch Reading Ease, Flesch-Kincaid Grade Level, and Simple Measure of Gobbledygook. These tools evaluate factors such as sentence length, syllable count, word complexity, and average grade level required to facilitate comprehension and motivation. Results indicated that parent-focused materials had an average FRE score of 66.61, an FKGL score of 7.55, and an SMOG score of 10.15, indicating that most materials substantially exceeded the recommended reading levels for the target audiences. Our findings provide insights and practical strategies for improving the readability of online health materials. Enhancing the readability of such materials can improve understanding and positively impact overall health outcomes.
This article reports on the overall wellbeing and positive outlook of 106 pupils in a city secondary school in England. The pupils were in Year 7 (n = 38) [age 11-12], Year 8 (n = 31) [age 12-13], and Year 10 (n = 37) [age 14-15]. The demographic experienced high levels of socio-economic challenge with a range of social, emotional, and mental health needs requiring support. The percentage of Free School Meals (FSM) and Pupil Premium (PP) across the year groups ranged from 32.4% to 48.4%. All pupils were involved in school intervention to support their mental health literacy and wellbeing between April and July 2024. The findings demonstrated that in-school intervention supported pupils to understand aspects of poor mental health and maintain a positive wellbeing. In Year 7 and Year 8, 68% and 90% of pupils respectively knew what caused poor mental health which increased by 32% for Year 8 pupils and slightly decreased by 3% for year 7 pupils post-intervention. There was less surety in the causes of poor mental health amongst Year 10s with a decrease of 11% post-intervention. There was an observable statistical difference (determined by Pearson's Correlation Coefficient) in the outlook of Year 8 pupils with just 22.6% reporting a positive general attitude to life.
Persons with severe mental illness (SMI) are at increased risk of developing physical illnesses. Therefore, there is a need to promote prevention programs that improve the quality of their nutrition. However, efforts to achieve this goal may face difficulties due to unique barriers they encounter. To examine the types and levels of perceived barriers affecting the promotion of healthy nutrition among persons with SMI living in community residential facilities, a mixed-methods research approach was employed. The study was conducted with 86 persons with SMI at the start of their participation in health promotion programs. The findings illuminate the impact of barriers stemming from the effects of mental illness, psychiatric medications, hospitalization, and a lack of knowledge about how to improve nutritional quality. They also highlight the role of external barriers, including a lack of companionship, insufficient support for promoting healthy nutrition, and a lack of healthy nutrition choices, in community residential facilities. The findings suggest that prevention programs should go beyond simply providing nutritional knowledge. A bio-psycho-social perspective should be adopted to address personal, social, and systemic factors that may be related to the perception of barriers, thereby helping persons with SMI overcome challenges in improving their nutritional quality.
