Schools as smoke-free zones?:Barriers and facilitators to the adoption of outdoor school ground smoking bans at secondary schools

Introduction Whereas smoking bans inside secondary school buildings are relatively widespread, a smoking ban for the outdoor school grounds is less common. Therefore, this study investigates why many secondary schools fail to adopt an outdoor school ground smoking ban. The aim is to elucidate the perceived barriers and facilitators of stakeholders at schools without an outdoor school ground smoking ban. Material and Methods Qualitative data were obtained from 60 respondents of 15 secondary schools. Semi-structured interviews were held with various key stakeholders and a thematic approach was used for analysis of the transcripts. Results The perceived barriers and facilitators of the stakeholders fell into four categories: 1) socio-political characteristics (legislation and social norm), 2) school characteristics (policy, decision process, enforcement, resources, workforce conditions, communication and collaboration), 3) individual characteristics (support, knowledge, and target group), and 4) smoking ban characteristics (environmental factors, guideline recommendations, outcome expectations, and evidence). Conclusions These findings highlight the importance of legislation for outdoor smoking bans. Moreover, collaboration, communication and involving stakeholders during an early stage of the process should be stimulated, as this might increase adoption. These results can be applied in future studies on outdoor tobacco control policies; moreover, they may facilitate tobacco control initiatives leading to more smoke-free environments to further protect youth from the harmful effects of tobacco

Outdoor play among children in reletion to neighborhood characteristics. A cross-sectional neighborhood observation study.

<p>Abstract</p> <p>Background</p> <p>Although environmental characteristics as perceived by parents are known to be related to children’s outdoor play behavior, less is known about the relation between independently measured neighborhood characteristics and outdoor play among children. The purpose of this study was to identify quantitative as well as qualitative neighborhood characteristics related to outdoor play by means of neighborhood observations.</p> <p>Methods</p> <p>Questionnaires including questions on outdoor play behavior of the child were distributed among 3,651 parents of primary school children (aged 4–12 years). Furthermore, neighborhood observations were conducted in 33 Dutch neighborhoods to map neighborhood characteristics such as buildings, formal outdoor play facilities, public space, street pattern, traffic safety, social neighborhood characteristics, and general impression. Data of the questionnaires and the neighborhood observations were coupled via postal code of the respondents. Multilevel GEE analyses were performed to quantify the correlation between outdoor play and independently measured neighborhood characteristics.</p> <p>Results</p> <p>Parental education was negatively associated with outdoor play among children. Neither the presence nor the overall quality of formal outdoor play facilities were (positively) related to outdoor play among children in this study. Rather, informal play areas such as the presence of sidewalks were related to children’s outdoor play. Also, traffic safety was an important characteristic associated with outdoor play.</p> <p>Conclusions</p> <p>This study showed that, apart from individual factors such as parental education level, certain modifiable characteristics in the neighborhood environment (as measured by neighborhood observations) were associated with outdoor play among boys and girls of different age groups in The Netherlands. Local policy makers from different sectors can use these research findings in creating more activity-friendly neighborhoods for children.</p

Impact of an outdoor smoking ban at secondary schools on cigarettes, e-cigarettes and water pipe use among adolescents:An 18-Month Follow-Up

The effectiveness of outdoor smoking bans on smoking behavior among adolescents remains inconclusive. This study evaluates the long-term impact of outdoor school ground smoking bans among adolescents at secondary schools on the use of conventional cigarettes, e-cigarettes (with/without nicotine) and water pipes. Outdoor smoking bans at 19 Dutch secondary schools were evaluated using a quasi-experimental design. Data on 7733 adolescents were obtained at baseline, and at 6 and 18-month follow-up. The impact of outdoor smoking bans on ‘ever use of conventional cigarettes’, ‘smoking onset’, ‘ever use of e-cigarette with nicotine’, ‘e-cigarette without nicotine’, and ‘water pipe’ was measured. Multilevel logistic regression analysis was used. At schools with a ban, implementation fidelity was checked. At schools where a ban was implemented, at 18-month follow-up more adolescents had started smoking compared to the control condition. No effect of implementation of the ban was found for smoking prevalence, e-cigarettes with/without nicotine, and water pipe use. Implementation fidelity was sufficient. No long-term effects were found of an outdoor smoking ban, except for smoking onset. The ban might cause a reversal effect when schools encounter difficulties with its enforcement or when adolescents still see others smoking. Additional research is required with a longer follow-up than 18 months

Determinants of first-time utilization of long-term care services in the Netherlands:An observational record linkage study

Background: Since in an ageing society more long-term care (LTC) facilities are needed, it is important to understand the main determinants of first-time utilization of (LTC) services. Methods: The Andersen service model, which distinguishes predisposing, enabling and need factors, was used to develop a model for first-time utilization of LTC services among the general population of the Netherlands. We used data on 214,821 persons registered in a database of general practitioners (NIVEL Primary Care Database). For each person the medical history was known, as well as characteristics such as ethnicity, income, home-ownership, and marital status. Utilization data from the national register on long-term care was linked at a personal level. Generalized Linear Models were used to determine the relative importance of factors of incident LTC-service utilization. Results: Top 5 determinants of LTC are need, measured as the presence of chronic diseases, age, household size, household income and homeownership. When controlling for all other determinants, the presence of an additional chronic disease increases the probability of utilizing any LTC service by 45% among the 20+ population (OR = 1.45, 95% CI: 1.41–1.49), and 31% among the 65+ population (OR = 1.31, 95% CI: 1.27–1.36). With respect to the 20+ population, living in social rent (OR = 2.45, 95% CI = 2.25–2.67, ref. = home-owner) had a large impact on utilizing any LTC service. In a lesser degree this was the case for living alone (OR = 1.63, 95% CI = 1.52–1.75, ref. = not living alone). A higher household income was linked with a lower utilization of any LTC service. Conclusions: All three factors of the Anderson model, predisposing, enabling, and need determinants influence the likelihood of future LTC service utilization. This implies that none of these factors can be left out of the analysis of what determines this use. New in our analysis is the focus on incident utilization. This provides a better estimate of the effects of predictors than a prevalence based analysis, as there is less confounding by changes in determinants occurring after LTC initiation. Especially the need of care is a strong factor. A policy implication of this relative importance of health status is therefore that LTC reforms should take health aspects into account. (aut. ref.

Worth a thousand words?:Visual concept mapping of the quality of life of people with severe mental health problems

Objectives: Conventional approaches to quality of life (QoL) measurement rely heavily on verbal, language-based communication. They require respondents to have significant cognitive and verbal ability, making them potentially unsuitable for people with severe mental health problems. To facilitate an alternative approach to QoL assessment, the current study aims to develop an alternative, visual representation of QoL for people with severe mental health problems. Methods: An alternative, visual adaptation of the concept mapping method was used to construct this visual representation of QoL. Eighty-two participants (i.e., patients, care professionals, and family members) contributed to this study. Results were processed statistically to construct the concept map. Results: The concept map contains 160 unique visual statements, grouped into 8 clusters labelled (1) Support and Attention, (2) Social Contacts, (3) Happiness and Love, (4) Relaxation and Harmony, (5) Leisure, (6) Lifestyle, (7) Finances, and (8) Health and Living. Examples of visual statements are pictures of family silhouettes, romantic couples, natural scenes, houses, sports activities, wallets and coins, smiley faces, and heart shapes. The clusters were interpreted and labelled by participants. Conclusions: Almost all of the statements correspond to clusters found in previous (non-visual) QoL research. Hence, QoL domains can also be presented visually

Actors' awareness of network governance in child welfare and healthcare service networks

To ensure that families with social and behavioral health problems get the support they need, organizations collaborate in child service networks. These networks are generally lead-organization governed. It is assumed that network members have relatively accurate information about the governance mode. However, discrepancies between the formally administered and perceived governance mode could raise legitimacy questions and lead to conflicts, and ultimately affect network effectiveness. Therefore, we investigated to what extent such discrepancies exist and how they might be explained. Hereby, the focus was on the concepts level of trust, interaction, and strength of relationship with the lead organization in the network. A comparative case study was conducted of three inter-organizational networks of child services in different-sized municipalities in the Netherlands in 2018 and 2019. A multiple generalized linear mixed model analysis was used. We found that only a minority of the network members had an accurate perception of the governance mode. This awareness did improve over time. The level of interaction and relationship strength with the lead organization were independently associated with an accurate perception of the governance mode. Trust of a network member in the network, however, had no significant association. These insights underline the necessity to consider network information accuracy as an important variable for understanding network behavior and as crucial for the effective delivery of child services

Effectiveness of alcohol prevention interventions based on the principles of social marketing:A systematic review

Background Alcohol education aims to increase knowledge on the harm related to alcohol, and to change attitudes and drinking behaviour. However, little (lasting) evidence has been found for alcohol education, in changing alcohol-related attitudes and behaviour. Social marketing uses marketing techniques to achieve a social or healthy goal, and can be used in alcohol education. Social marketing consists of eight principles: customer orientation, insight, segmentation, behavioural goals, exchange, competition, methods mix, and is theory based. This review investigates the application of social marketing in alcohol prevention interventions, and whether application of social marketing influences alcohol-related attitudes or behaviour. Method A literature search was conducted in PubMed, PsychInfo, Cochrane and Scopus. Inclusion criteria were that original papers had to describe the effects of an alcohol prevention intervention developed according to one or more principles of social marketing. No limits were set on the age of the participants or on the kind of alcohol prevention intervention. The abstracts of the 274 retrieved studies were reviewed and the full texts of potentially relevant studies were screened. Results Six studies met the inclusion criteria and were included in this review. These six studies showed associations for the application of social marketing techniques on alcohol-related attitudes or behaviour; one study relates to participation in a drinking event, four to alcohol drinking behaviour, two to driving a car while under the influence of alcohol, two to recognition of campaign messages or campaign logo, and one to awareness of the campaign. However, no associations were also found. In addition, the studies had several limitations related to a control group, response rate and study methodology. Conclusion Based on this review, the effect of applying the principles of social marketing in alcohol prevention in changing alcohol-related attitudes or behaviour could not be assessed. More research, with a good quality methodology, like using a randomized control trial and measuring short, medium, and long-term effects, is required on this topic. Policy implications are discussed. Keywords: Alcohol, Prevention, Effectiveness, Social marketing, Interventio

Towards guideline implementation for integrated local health policies:Evaluation of an experimental implementation strategy in regional health services

To enhance implementation of a Guideline for integrated local health policy, a draft implementation strategy (DIS) was developed. It was hypothesized that the DIS would be feasible and effective to enhance the use of a Guideline for integrated local health policy. To examine its feasibility and effectiveness, the DIS was pilot tested simultaneously in two Regional Health Services (RHSs) and compared with the 'care as usual' in two other RHSs that did not receive a predefined strategy for Guideline implementation. The DIS was evaluated in a qualitative way by means of semi-structured individual-and group interviews. We applied the Nutbeam framework for evaluation on: i) program integrity, ii) program reach, iii) program acceptability, and iv) observed change. Comparison of pilot results with the two other RHSs included semi-structured group interviews. Both RHSs conducted implementation largely as planned. The purpose of the Guideline for RHS policy objectives was not discussed at all desired levels. Increased Guideline use was mainly found among health promoters. Comparison with Guideline implementation in the other RHSs revealed information for further evaluation of the DIS. The feasibility and effectiveness of the DIS applied to building blocks which aimed at alignment of goals and ambitions between RHS management and executive disciplines. Possible implications for future application of the DIS are dealt with in the discussion section of this pape