Published by SHEU since 1983 Volume 33 Number 1, 2015 ISSN 2049-3665

Education and Health

John Balding 1935-2015

Why adolescents don't seek help for problematic technology use

Mark D. Griffiths

The Alcohol Education Trust : alcohol programme for 11- 18 year

olds, parents and teachers

Helena Conibear

What can be changed by nutrition education? Evaluation of the

educational influence on children’s behaviour and nutritional

knowledge

Alexandra Makeeva

Improving pupils’ health in Central Bedfordshire

Sarah James

2 Education and Health Vol.33 No.1, 2015

Education and Health Editor David McGeorge (e-mail: david.mcgeorge@sheu.org.uk) Welcome to the first issue for 2015. We receive articles from many parts of the world and some do not make it into the journal. This is mainly due to our focus on young people and, although we do not specify an age range, most published articles are about those between the ages of 5-20 years old. There are exceptions and the Editor welcomes your contribution. This issue continues with the proud tradition of independent publishing and offers an eclectic mix. The journal, published since 1983, is aimed at those involved with education and health who are concerned with the health and wellbeing of young people. Readers, in the UK, come from a broad background and include: primary, secondary and further education teachers, university staff, and health-care professionals working in education and health settings. Readers outside of the UK share similar backgrounds. The journal is also read by those who commission and carry out health education programmes in school and college. Articles focus on recent health education initiatives, relevant research findings, materials and strategies for education and health-related behaviour data.

Contributors (see a recent list)

Do you have up to 3000 words about a relevant issue that you would like to see published?

Archive The archive is also online. Please visit: http://sheu.org.uk/content/page/eh I look forward to your company in the next issue.

SHEU publications

‘Education and Health’ is published by SHEU, an independent organisation, providing research, survey and publishing services to those concerned with the health and social development of young people. SHEU incorporates the Schools Health Education Unit, founded in 1977 by John Balding. The address for all correspondence is: SHEU, 3 Manaton Court, Manaton Close, Matford Park, Exeter EX2 8PF

Many publications can be viewed online http://sheu.org.uk or purchased from SHEU e-mail: sheu@sheu.org.uk

SHEUbytes: nuggets of information about children and young people health and wellbeing

A series of short reports showing SHEU data with some Internet links to relevant websites. Topics so far include: Water - Enjoy lessons - Birth control services - Sleep - Smoking - Teachers' expectations - Fitness - Visiting the Doctor - Fruit Veg 5-a-day - Beer and Lager - GoodNews about YP H&WB - Self-esteem.

The Young People series http://sheu.org.uk/content/page/publications

Large numbers of young people, between the ages of 10 and 15 years, respond to over 100 questions about their health-related behaviour.

Free resources

Topics include:- Planning PSHE in your school; Research news about young people’s health and wellbeing; Literature search resource; Young People Reports into health and wellbeing; and more. http://sheu.org.uk/free

SHEU Schools and Students Health Education Unit

The specialist provider of reliable local survey data for schools and colleges

and recognised nationally since 1977.

"The survey reports have been used to inform commissioning at specific commissioning groups. They are also being used within our Extended Schools Clusters and to inform The Annual Public Health and the Joint Strategic Needs Assessment."

Programme Manager - Young People

For more details please visit http://sheu.org.uk

TO SUPPORT YOUR WORK WITH YOUNG PEOPLE TRY SHEU’S FREE RESOURCES

3 Education and Health Vol.33 No.1, 2015

John Balding 1935-2015

J ohn was Director of the Schools Health Education

Unit from 1977-2005, and died in January 2015. This appreciation was written by SHEU staff.

Before SHEU John did his National Service

in the RAF, becoming a radio technician. He was repeatedly identified as officer material but just as frequently declined the opportunity. He was once assigned the task of planting Spring bulbs either side of the barracks' main drive, but mysteriously they came up in the shape of the word HATE.

John then read Natural Sciences at Selwyn College, Cambridge, where he was awarded a 'blue' for football. He became a Science teacher in a secondary school, where his second-stream Chemistry class became more successful than the top stream.

John was for a while a dedicated mycologist, and produced a dissertation on the decay of the leaves of Typha latifolia (the Greater Reedmace, which you might call a bulrush), by freshwater fungi with tetrahedrally-spined spores.

Partly on the strength of that research work, he was given the post of Biology Lecturer at St.Luke's College, later the Department of Education of the University of Exeter, teaching on the Bachelor of Education course. He enjoyed ecology, for example, using Max Hooper's rule to estimate the age in centuries of a hedgerow by counting the number of woody species in a 30-foot run. In the middle of arguments with the Health Education Authority, he would often recall those days with fondness.

He was deeply interested in young people in his charge, and became involved in the student counselling service. Later, he took a variety of leadership courses that used the T-group or encounter group approach, the last one he attended being led by Terry Waite. He supported George Foot's course on Human Relationships, which used similar experiential learning techniques. It had something of a

reputation for taking student teachers and turning them into such giants that they could hardly be teachers any more.

Health Education and PSHE John became involved in

Health Education and for many years ran an in-service training Certificate course for teachers.

He took a Master's degree at Nottingham University, where he developed a survey method for canvassing teachers for their views about topics in health and social curriculum. The results could be regarded with some amusement – teachers really told you more about themselves than the pupils in their charge. For example, the importance of 'sex' in responses from male teachers appeared to … drop off with age.

"I can remember teachers having real eyeball-to-eyeball arguments about what schools should be doing for pupils. These debates were sometimes based on different philosophies or values, but teachers quite often have similar values about their work. What more often seemed to be at issue was what they thought young people were 'really' like.

We have our own experiences of pupils in our charge to reflect upon, and also so important are our own experiences of childhood and of being a parent. But however potent these experiences and reflections, they are necessarily personal, and often strongly affected by particular incidents or colourful stories that could not be owned by others in the group.

This is the key thing that made me start looking for ways of assessing behaviours: wouldn't it be better if, instead of having only our own perceptions about what pupils' lives are like, we asked young people in our community to tell us more about what life was like for them." (Balding, 2005).

This was the foundational principle of the Health-Related Behaviour Questionnaire (HRBQ), an anonymous survey approach to helping teachers listen to pupils. It had a modest start, but a devoted and growing clientele, run under the supervision of Beryl Parkes, allegedly from a broom cupboard.

4 Education and Health Vol.33 No.1, 2015

Growth and development John's work in the 1970s had attracted

national attention: the Health Education Council (HEC) sponsored the use of Just One Minute topic questionnaires in schools, and it was also taken up by the Open University. He employed James Muirden as a Research Officer, who in 1983 established our journal Education and Health, and in 1986 published MayFly, a compilation of results from the HRBQ, then in 1987 the first of our Young People series, Young People in 1986. This led to contrasting national headlines: Teenagers take homework and drink in moderation, noted the Guardian, while the Express preferred Layabout lifestyles of the teenage tipplers. We have battled with the news media to get proper coverage of young people's issues ever since.

In 1982, John won a more substantial grant from the HEC to run two research projects over 5 years:

1) Health Education Topics in the Primary School Curriculum (Just a Tick), a national survey in ten local authorities, led by Teresa Code and Karen Redman.

2) A subsidy for schools to take up the Health-Related Behaviour Questionnaire.

The Unit was given liaison support by officers like Hugh Graham, and an Advisory Committee led by Jessie Leighton.

In 1987, the Health Education Authority began a period of further support, managed by Linda Finn and Bill Bellew.

The Unit began offering a Primary School version of HRBQ in 1988, developed by John with Carrie Shelley.

Over these years, the HRBQ had grown to become a widely-used method of consulting young people of great utility to schools, health authorities and county education departments, and resulted in a unique archive of young people's behaviour across the years.

SHEU left the umbrella of the University in 1987 to become an independent organisation. John retired as Director in 2005, and the Unit is now led by his daughter, Angela.

Hard-working family The facts are simple to relate, but it's less easy

to give a flavour of John as a person. He was kind and gentle employer, a wise mentor, a

painstaking researcher, a leader in the world of health education ... He was also a truly Olympic-standard tease, and a man with a tireless fondness for the phrase 'hypodemic nurdle'.

The Unit has been a rather special place to work for the quality of its care and relationships. John had a magic about him in his dealings with people, and it was reflected in the place he created to work. John often referred to it as the "family" – it is a place which looked after you, and a number of waifs and strays came to stay there for a while and gained strength and confidence before taking flight, as well as many who arrived and left as giants.

John was capable of mighty efforts, but was also very content with being quiet and still, coming to the end of what he felt he had to say, either to listen or just to be companionably silent. He did that once while he was interviewing somebody for a job… Annie Wise proved she could manage the moment successfully, and was offered the post.

A lasting legacy The Unit has grown a lot from the days of

Beryl in the broom cupboard, and has had international reputation and an international influence, built on John's vision, drive and characteristic attention to detail. A pupil completing one of his surveys once wrote, "I've never looked at myself in this way before". John had a remarkable capacity for prompting that sort of learning and reflection in others, and we are sure that the survey work continues to achieve it.

Following news of his death, we have been receiving messages from all over the country and abroad, saying how much they appreciated his warmth, his capacity to get things done, and his generous support at the start of their careers. One of those messages from one colleague among many, Alan Tarn from Cumbria:

"I often remember John with fondness and a smile; he helped and inspired me from day one of meeting him. He was always positive with a can-do attitude. He will be greatly missed by so many."

Acknowledgements John was always keen to acknowledge the

support of the many people he worked with,

5 Education and Health Vol.33 No.1, 2015

FREE RESOURCES

including:

Clerical support: Sally Thorneycroft, Angela Morrow, Sally Forster, Sam Alister-Jones, Michelle Dickinson.

Data prep support: Alison Salway, Anna MacConachie, Jane Wood, Jane Lavis, Val Cooper, Di Bish

Research support: Christopher Brailey, Tony Hincks, Patsy Hollins, Teresa Code, Karen Redman, Carrie Shelley, Anne Wise Computing support: Neil Brooks, Ian Campbell, George Foot

References

Balding, JW (1975). Health Topics and the Adolescent. Dissertation for M Med Sci, University of Nottingham.

Balding, JW. (1977) Just One Minute – health education questionnaires. (London, Health Education Council).

Balding, JW (1983). 'Developing the Health-Related Behaviour Questionnaire.' Education and Health, 1(1): 9-13. http://sheu.org.uk/x/eh11jb.pdf

Balding, JW (1984). 'HEC Primary Health Topics Project: A 'primary health topics' parents' evening.' Education and Health, 2(2): 40-42. http://sheu.org.uk/x/eh22hec.pdf

Balding, JW (1987). Young People in 1986. Exeter: University of Exeter.

Balding, JW (2005). 'If I knew then ... over 25 years of schools, health and education.' Education and Health, 23(2): 29-32. http://sheu.org.uk/x/eh232jb.pdf

Education and Health The journal, published by SHEU since 1983, is aimed at those involved with education and health who are concerned with the

health and wellbeing of young people. Readership is worldwide and in the UK include: primary; secondary and further education

teachers; university staff and health-care professionals working in education and health settings. The journal is online and open

access, continues the proud tradition of independent publishing and offers an eclectic mix of articles.

Contributors (see a recent list) - Do you have up to 3000 words about a

relevant issue that you would like to see published? Please contact the Editor

SHEU Schools and Students Health Education Unit

The specialist provider of reliable local survey data for schools and colleges and recognised nationally since 1977.

"The (named) Children and Young People's Partnership has benefitted from the results of the SHEU survey locally for many years

now, and we should like to continue to do so in future." Consultant in Public Health Medicine

For more details please visit http://sheu.org.uk

6 Education and Health Vol.33 No.1, 2015

I n recent issues of Education and Health, I have briefly reviewed the empirical evidence relating

to problematic use of technology by adolescents including online video gaming (Griffiths, 2014), social networking (Griffiths, 2013a; Kuss & Griffiths, 2011), and mobile phone use (Griffiths, 2013b). Most of the research studies that have examined ‘technological addictions’ during adolescence have indicated that a small but significant minority experience severe problems resulting in detriments to education, physical fitness, psychological wellbeing, and family and personal relationships (Griffiths, 2010; Kuss, Griffiths, Karila & Billieux, 2014). Given these findings, why is it that so few teenagers seek treatment? This article briefly outlines a number of reasons why this might be the case by examining other literature on adolescent drug use and adolescent gambling (e.g., Chevalier & Griffiths, 2005; 2005; Griffiths, 2001). Three different types of explanation are discussed: (i) treatment-specific explanations, (ii) research-related explanations, and (iii) developmental and peer group explanations.

Treatment-specific explanations This first set of explanations directly concern

aspects of treatment-seeking behaviour that may impact on whether adolescents would seek treatment for problematic technology use.

Adolescents do not seek treatment in general: Griffiths and Chevalier (2005) noted that teenage males rarely contemplate seeking treatment for anything (apart from life-threatening traumas and extremely severe acne). Female adolescents are a little more likely than young males to consult health professionals (especially for gynaecological reasons). The reasons why adolescents in general do not

consult health professionals are their perceived invincibility, invulnerability, and immortality. In addition, adolescents are constantly learning and appear to want to resolve their own problems rather than seek help from a third party. Who better than themselves knows what to do with their lives and whatever problem they are facing? They might experience more denial then adults, but come to the conclusion that others (usually adults) do not understand them. Ultimately, if adolescents rarely present themselves for any kind of treatment, it would be surprising to see them turn up for very specific treatments related to problematic technology use.

Adolescents may acknowledge they have a problem concerning their use of technology but do not want to seek treatment: Again, this explanation is plausible, but there is little empirical evidence to support the claim. However, it has been noted that families of adolescent problem gamblers are often protective – if not overprotective – and try to keep the problem within the family (Griffiths, 2002). Therefore, it may be speculated that seeking formal help for problems with technology use may be a last resort option for most adolescents and their families.

There are few or no treatment programmes available for adolescents: It is true that specialized treatment programmes for problematic technology use are almost non-existent in the UK. Although there are a few private addiction clinics that treat gaming addicts, services specifically for adolescents with problematic technology use appear to be few and far between. It could be argued that this is a ‘Catch 22’ situation. If only a few adolescents turn up for treatment, treatment

Dr Mark D. Griffiths is Professor of Gambling Studies and Director of the International Gaming Research Unit, Nottingham Trent University. For communication, please email: mark.griffiths@ntu.ac.uk

Mark D. Griffiths

Problematic technology use during adolescence: Why don’t teenagers seek treatment?

7 Education and Health Vol.33 No.1, 2015

programmes will not be able to provide specialized services, and adolescents with problematic technology use do not turn up for treatment if it does not exist.

Available treatment programmes are not appropriate and/or suitable for adolescents: To some extent, this explanation is interlinked with the previous reason, but is different. The explanation here is that there may be treatment programmes available, but that most are adult-oriented (e.g., group therapy in private and/or residential addiction treatment clinics). Adolescents may not want to be integrated into what they perceive to be an adult environment.

Attending treatment programmes may be stigmatising for adolescents: Adolescents might not seek treatment for problematic technology use because of the stigma attached to such a course of action. Seeking treatment may signify that they can no longer participate in the activities by which they and their group define themselves. Furthermore, it may draw attention to what they perceive as a ‘failure’ in their lives.

Adolescents may seek other forms of treatment, but problematic technology use are less likely to be seen as requiring intervention: Adolescent problematic technology use is associated with other comorbid behaviours such as substance abuse (van Rooij, Kuss, Griffiths, Shorter, Schoenmakers & van de Mheen, 2014) and problem gambling (Wood, Gupta, Derevensky & Griffiths, 2004). Adolescents may engage in all of these behaviours for the same reasons (to feel part of their peer group, to modify their mood state, to escape other problems in their lives, etc.). Therefore, the few adolescents who do seek treatment may do so for a comorbid behaviour rather than for problematic technology use itself. In most Western societies, problematic technology use is not perceived as a real problem, especially when compared with problems related to alcohol or substance abuse.

Treating other underlying problems may help adolescent problematic technology use: Problematic technology use could be (and quite often is) symptomatic of an underlying problem such as depression, dysfunctional family life, physical disability, lack of direction or purpose of life (Király, Nagygyörgy, Griffiths & Demetrovics, 2014; Kuss et al., 2014). Therefore,

if these other problems are treated, the symptomatic behaviour (i.e., problematic technology use) should disappear, negating the need for specific problematic technology use-specific treatment.

Research-related explanations Another set of explanations may relate to the

fact that the empirical research that has been carried out into problematic technology use is over-inflating the prevalence rates because of many different factors. The implication here is that adolescents are not turning up for treatment because there is no real problem in the first place.

Adolescents with problematic technology use may lie or distort the truth when they fill out research surveys: This is a reasonable enough assumption to make and can be made against anyone who participates in self-report research — not just adolescents. All researchers who utilize self-report methods put as much faith as they can into their data but are only too aware that other factors may come into play (e.g., social desirability, motivational distortion, etc.) that can either underscore or overplay the situation. In these particular circumstances, it may be that adolescents are more likely to lie than adults. However, it seems unlikely that any differences would be due to this factor alone.

Screening instruments for assessing problematic gambling may not be valid for adolescents: Although there are many debates about the effectiveness of screening instruments for assessing problematic technology use (King, Haagsma, Delfabbro, Gradisar & Griffiths, 2013), it could be the case that many of these question-based screening instruments are not applicable, appropriate and/or valid for assessing adolescent technology use. For instance, King et al. (2013) reviewed 18 different instruments that assess problematic video gaming but only one had specifically been developed for adolescents.

Screening instruments for adolescent problematic technology use are being used incorrectly: With measures developed for adolescents, as with those for adults, there may be incorrect use of screening instruments. For instance, there may be a lack of consistency in methodology, definitions, measurement, cut

8 Education and Health Vol.33 No.1, 2015

scores, and diagnostic criteria across studies, and particularly in the use of lenient diagnostic criteria for problematic technology use youth in some studies (King et al., 2013).

Adolescents may not understand what they are asked in research surveys: Another reason that the prevalence rates of adolescent problematic technology use may be elevated is because of measurement error. If adult instruments are administered to youth (which some researchers including myself have done) adolescents may endorse items they should not, doing so because they do not fully understand the item. For instance, in research on adolescent problem gambling, Ladouceur, Bouchard, Rhéaume, et al. (2000) showed that many of the items on the adolescent version of the South Oaks Gambling Screen were misunderstood, with only 31% of youth understanding all of the items correctly.

Researchers consciously or unconsciously exaggerate the problem of adolescent technology use to serve their own careers: This explanation is somewhat controversial but cannot be ruled out without at least examining the possibility. If this explanation is examined on a logical and practical level, it can be argued that those of us who have careers in the field of problematic technology use (like myself) could potentially have a lot to lose if there were no problems. Therefore, it could be argued that it is in the researcher's interest for problems to be exaggerated. However, there is no empirical evidence that this is the case, and all researchers are aware that their findings will be rigorously scrutinized. In short, it is not in researchers’ best long-term interest to make unsubstantiated claims.

Developmental and peer group explanations

Finally, there may be some explanations of why adolescents do not seek treatment for problematic technology use as being due to some aspects associated with adolescent development and peer group influence.

Adolescents with problematic technology use may undergo spontaneous remission and/or mature out of gambling problems, and therefore, may not seek treatment: There are many accounts in the literature of spontaneous

remission of problematic behaviour (e.g., alcohol abuse, heroin abuse, cigarette smoking, problem gambling), and problematic technology use is no exception. Because levels of problematic technology use appear to be much higher in adolescents than in adults (Kuss et al., 2014), and fewer adolescents receive treatment for their problematic technology use, it is reasonable to assume that spontaneous remission occurs in most adolescents at some point, or that there is some kind of "maturing out" process. There is a lot of case-study evidence highlighting the fact that spontaneous remission occurs in problem adolescent gamblers, and that gambling often ceases because of some kind of new major responsibility such as getting one’s first job, getting married, or birth of a child (Griffiths, 2002).

Adolescent excesses may change too quickly to warrant treatment: Adolescence is sometimes about excess and many addictions peak in youth (Griffiths, 1996). It could be that transfer of excess is a simpler matter for adolescents. They might have an excess 'flavour of the month' syndrome, where one month it is binge alcohol drinking, one month it is joyriding, and one month it is video gaming. Adolescents may not seek treatment not because of spontaneous remission in the classical sense, but because of some sort of transfer of excess.

The negative consequences of adolescent problem gambling are not necessarily unique to problematic technology use and may be attributed either consciously or unconsciously to other behaviours: Some adolescents may attribute their undesirable behaviour or negative consequences to other potentially addictive behaviours that co-occur during adolescent development, such as alcohol abuse or using illicit drugs (Griffiths & Chevalier, 2005).

Adolescent problematic technology use may be socially constructed to be non-problematic: Problems, whether they are medical or otherwise, are socially constructed (Castellani, 2000). For example, denial may not be experienced because there is no perception of a problem. For instance, if the peer group, or school class of the adolescent is pro-technology use, actively engaged in technology use, and

9 Education and Health Vol.33 No.1, 2015

shows signs of problems, it may appear to the adolescent that problems go with the territory. Playing the guitar is hard on the fingers, playing football is hard on the shins, and playing video games is hard on sleep, and schoolwork. Therefore, it may not be perceived as a medical, psychological, and/or personal problem, but merely a fact of adolescent life.

Conclusions Although this list may not be exhaustive, it

does give the main reasons why adolescents with problematic technology use may be under-reported in turning up for treatment. It is likely that no single reason provides more of an explanation than another. The reasons provided also raise many questions that require answers. Why do adolescents appear to be reluctant to seek help for problems related to technology use? What is the true prevalence of problematic technology use among youth? Are the available statistics on problematic technology use inflated by a lack of understanding of the survey questionnaire items? Where does problematic technology use fit among the many difficulties young people face during the developmental process? Are the heightened rates of problematic technology use among youth the result of having grown up during times of such extensive availability (i.e., a cohort effect) or are they merely a reflection of adolescent experimentation that they will grow out of (or a combination of the two)?

Research needs to address directions and magnitudes of causality among problematic technology use behaviours and other health and psychosocial problems. What is clear is that there is no single assertion made in this article provides a definitive answer to the treatment paradox in relation to adolescent problematic technology use. It is most likely the case that many of the plausible explanations interlink to produce the obvious disparities between

prevalence rates of adolescent problematic technology use and adolescents not enrolling in treatment programmes.

References

Griffiths, M.D. (2002). Gambling and Gaming Addictions in Adolescence. Leicester: British Psychological Society/Blackwells.

Griffiths, M.D. (2001). Why don’t adolescent gamblers seek treatment? Journal of Gambling Issues, 5, Located at:

http://jgi.camh.net/doi/full/10.4309/jgi.2001.5.6

Griffiths, M.D. (2010). Trends in technological advance: Implications for sedentary behaviour and obesity in screenagers. Education and Health, 28, 35-38. Located at: http://sheu.org.uk/x/eh282mg.pdf

Griffiths, M.D. (2013a). Adolescent gambling via social networking sites: A brief overview. Education and Health, 31, 84-87. Located at: http://sheu.org.uk/x/eh314mg.pdf

Griffiths, M.D. (2013b). Adolescent mobile phone addiction: A cause for concern? Education and Health, 31, 76-78. Located at: http://sheu.org.uk/x/eh313mg.pdf

Griffiths, M.D. & Chevalier, S. (2005). Addiction in adolescence: Why don’t adolescent addicts turn up for treatment? Psyke & Logos (Journal of the Danish Psychological Society), 26, 27-31.

King, D.L., Haagsma, M.C., Delfabbro, P.H.,

Gradisar, M.S.

,

Griffiths, M.D. (2013). Toward a consensus definition of pathological video-gaming: A systematic review of psychometric assessment tools. Clinical Psychology Review, 33, 331-342.

Király, O., Nagygyörgy, K., Griffiths, M.D. & Demetrovics, Z. (2014). Problematic online gaming. In K. Rosenberg & L. Feder (Eds.), Behavioral Addictions: Criteria, Evidence and Treatment (pp.61-95). New York: Elsevier.

Kuss, D.J. & Griffiths, M.D. (2011). Excessive online social networking: Can adolescents become addicted to Facebook? Education and Health, 29. 63-66. Located at: http://sheu.org.uk/sites/sheu.org.uk/files/imagepicker/1/eh294mg.pdf

Kuss, D.J., Griffiths, M.D., Karila, L. & Billieux, J. (2014). Internet addiction: A systematic review of epidemiological research for the last decade. Current Pharmaceutical Design, 20, 4026-4052.

Ladouceur, R., Bouchard, C., Rhéaume, N., Jacques, C., Ferland, F., Leblond, J., et al. (2000). Is the SOGS an accurate measure of pathological gambling among children, adolescents and adults? Journal of Gambling Studies, 16, 1–24

van Rooij, A.J., Kuss, D.J., Griffiths, M.D., Shorter, G.S., Schoenmakers, T.M. & van de Mheen, D. (2014). The (co)ocurrence of video game addiction, substance use, and psychosocial problems in adolescents. Journal of Behavioral Addiction, 3(3), 157–165.

Wood, R.T.A., Gupta, R., Derevensky, J. & Griffiths, M.D. (2004). Video game playing and gambling in adolescents: Common risk factors. Journal of Child and Adolescent Substance Abuse 14, 77-100.

Education and Health The journal, published by SHEU since 1983, is aimed at those involved with education and health who are concerned with the health and wellbeing of young people. We receive articles from many parts of the world and some do not make it into the journal. This is mainly due to our focus on young people : most published articles are about those between the ages of 5-20 years old. The journal is online and open access, continues the proud tradition of independent publishing and offers an eclectic mix of articles. Do you have up to 3000 words about a relevant issue that you would like to see published? Please contact the Editor

10 Education and Health Vol.33 No.1, 2015

T he Alcohol Education Trust, a charity established in 2010, was created once it was

clear that PSHE, and therefore alcohol education, was not going to be a curriculum subject when dropped from The Education Bill in 2009. The Trust’s vision is that young people should enter adulthood having a responsible understanding of alcohol. We are working to achieve this by equipping young people with the knowledge and skills they need to make sensible and informed choices around alcohol. Our goals are to raise the age of onset for youth drinking, if they choose to drink at all, to reduce drinking to drunkenness and its associated harms and hence, to reduce the amount of alcohol related illnesses and harm in adulthood.

The mission of the Alcohol Education Trust (AET) is to ensure that teachers, parents and secondary school pupils are supported directly via schools with evaluated alcohol education resources. Our interactive programme has tailored approaches for different age groups, abilities, experience and learning needs. The AET ensures it remains at the forefront of effectiveness through the continued development of resources, digital approaches and training as well as research and advocacy. Our core values are: Research-led – We are an organisation that

places evidence and research at the heart of our activities. All of our work is based upon strong evidence and our “talkaboutalcohol” programme has been evaluated among 4,000 pupils in 30 schools across England over 2 years.

Open and positive – Many preventative approaches focus on negative behaviour and scare tactics. Many programmes are top-down and do not assess knowledge,

perceptions or attitudes before teaching. In our programme, bottom-up participation encourages young people to share their experiences, worries and attitudes to alcohol resulting in mature dialogue. A social norms approach also highlights that among young people, trends and behaviours for all risk taking including alcohol consumption are improving. By intervening at the tipping point before alcohol consumption begins, pupils are equipped with resilience skills, can develop strategies to avoid and manage risky situations and develop behaviour that encourages positive decisions and choices, for them and their community.

Holistic – Through its three pillars (Training and equipping teachers effectively in alcohol education; Ensuring parents are engaged via schools to be good role models and to set boundaries; and Engaging pupils with role play, film clips, information and interactive resources) the AET integrates alcohol education with development around life skills and resilience. We look to the wider community and ways we can support young people’s transition into adulthood. We work with schools, local authorities, youth groups, foster agencies, police and fire school support officers and parents to provide holistic support to young people throughout society, bringing people together across different communities and settings.

Innovative – The AET recognises it must always move forward in order to improve and grow. This includes exploring the latest technology, learning from new evidence and assessing feedback, in order to improve

Helena Conibear is the Director of the Alcohol Education Trust. For communication, please email: helena@alcoholeducationtrust.org

Helena Conibear

The Alcohol Education Trust : alcohol programme for 11- 18 year olds, parents and teachers

11 Education and Health Vol.33 No.1, 2015

our outreach to hard to reach groups, different cultures and abilities.

Why alcohol? The earlier children (under 15) start drinking

regularly, the less likely they are to do well at school. If they drink weekly, their GCSE grade predictions drop by 20 points, that’s a fall from an A* to a C. School attendance also drops.

Underage drinkers, who consume alcohol regularly, are also more likely to smoke and engage in other risky behaviours such as drug taking and unprotected sex. They are more likely to suffer unintentional injuries, accidents, assault and theft after drinking. So there is every incentive to delay the onset of drinking among our young people.

Background of The Alcohol Education Trust

The Alcohol Education Trust has a very specific remit – the provision of alcohol education in different ways, to pupils age 11 – 18 and their parents and to provide engaging and evidence based resources and lesson plans for teachers. There are five eminent teacher trustees and an extensive review network of over 40 PSHE specialists, Head Teachers, medics, nurses, healthy school coordinators, Governors and parents. There are approximately 3.6 million students in the AET target audience and 3,000 schools have been identified as suitable recipients of the AET programme. The aims of the Alcohol Education Trust are: to increase young people’s knowledge,

awareness and understanding of alcohol, its effects on the immature body and the social and physical risks associated with its misuse;

to raise awareness of the laws restricting the consumption of alcohol, and why these exist;

to promote dialogue about alcohol between teenagers and their parents and teachers;

to build young people’s resilience and life skills, to understand personal responsibility, planning ahead and facilitating informed choices;

to raise the age of onset of drinking (first whole drink) from the current age 13.5 to at

least the CMO guidance of age 15 in a supervised environment;

to increase the understanding of units, guidelines and responsible drinking;

to reduce the incidence of ‘binge drinking’ and alcohol related harm;

to ensure parents understand the law, the importance of setting boundaries, being good role models, knowing where their children are and who they are with. The AET takes a general population approach

(i.e. a class wide approach) and is developing visual rich resources for Special Educational Needs and Disabilities (SEND) and has evidence that its programme works equally well for minority ethnic students.

Activities – Pupils are supported with

www.talkaboutalcohol.com a five hundred page web resource of interactive games, quizzes and activities for 11 – 16 year olds. 4 BAFTA-winning films assist learning and there is an information leaflet for older teenagers.

There is a stand alone website for teachers www.alcoholeducationtrust.org/teacher-area/ which details resources by subject and year group, such as alcohol and its effects (social and physical) and staying safe. The site has short film clips as ‘conversation starters, facts and figures, worksheets and games. Teachers are supported with bi-termly newsletters, email and phone support and, if requested, in house training.

12 Education and Health Vol.33 No.1, 2015

There is a detailed 100 page teacher workbook of lesson plans, implementation advice, pictorial rich sheets for less able students all indexed by subject and year group available free of charge for schools. You can download a copy here: http://www.alcoholeducationtrust.org/teacher-area/download-teacher-workbook/

The Evidence base shows parents need to be engaged, if alcohol education is to be effective. Hence parents are encouraged to be good role models regarding alcohol, to set boundaries and engage their children in a knowledgeable way. The AET : maintains a dedicated parent website - www.alcoholeducationtrust.org/parent-area/ produces a bi-termly newsletter and

supports direct presentations in schools to parents.

Contact : kate@alcoholeducationtrust.org

How do we know it works? The AET has supported 1400 secondary

schools across the UK directly since 2010, as well 700 organisations such as youth clubs, school nurses, fire and police school officers, health and wellbeing boards, healthy school teams, local government providers and sports clubs who deliver alcohol education . Teacher feedback and repeated use assures us that the programme is liked by pupils and teachers, is easy to implement and adapt to differing time frame,settings, abilities, facilities and cultures. Delivery of a programme does not ensure it is effective in meeting its objectives; therefore, the AET talkaboutalcohol programme has been independently evaluated by The National Foundation for Education Research (NFER).

Evaluation A longitudinal matched evaluation took place September 2011 - July 2013 to test the impact of the talk about alcohol programme on the key objectives , namely to raise the age of onset of whole alcoholic drink, to improve knowledge and reduce binge drinking and drunkenness. The National Foundation for Education Research (NFER) led the evaluation involving 4,000 pupils in 15 intervention schools and 15 control schools between 2011 - 13. Teachers in the intervention schools delivered 4 lessons in Year 8 covering assessing knowledge, units and

guidelines and alcohol and its effects social and physical. In Year 9, a further two lessons were delivered on alcohol and the law and staying safe. In addition pupils spent at least an hour on activities on www.talkaboutalcohol.com.

Pupils were assessed at three time points, before the intervention, at the end of Year 8 and one year later and the end of Year 9 [Figure 1 below]. Teachers were supported by email and by phone, but did not receive face to face training.

The findings showed a statistical improvement in knowledge in the intervention schools versus the comparison [control] schools and a significant rise in engagement with PSHE lessons as a source of useful information.

Most importantly, the evaluation shows a statistically significant delay in the onset of drinking in the intervention group, 8% increase [41%-49%], in take up of first whole alcohol drink over 18 months versus the comparison group’s 20% increase [43%-63%] take up.

The intervention programme was shown to be even more effective for minority ethnic pupils. Finally, the intervention schools showed less binge drinking and drunkenness although not enough pupils were engaging in these behaviours to be able to make statistically significant associations, hence the cohort is being evaluated further in 2015 now that more pupils (at age 15/16) may be drinking more riskily.

You can read the complete evaluation via : www.nfer.ac.uk/publications/AETE01/AETE01.pdf ... and … www.tandfonline.com/doi/full/10.1080/14635240.2014.915759

Figure 1: % responding Have you ever had a whole alcoholic drink? Yes

13 Education and Health Vol.33 No.1, 2015

In addition, the AET “talkaboutalcohol” programme has been assessed by the PSHE Association and is PSHE Association Quality Assured.

Furthermore, external evaluations by The Centre for Analysis for Youth Transitions [appointed by the Department for Education] awarded the talk about alcohol programme 3/3 for effectiveness and 5/6 for the quality of the evaluation: http://www.ifs.org.uk/publications/6904

“talkaboutalcohol” is also selected by The Early intervention Foundation in the 50 best early intervention programmes across all disciplines 2014. You can download the ebook here: http://guidebook.eif.org.uk/

Partnerships and Testimonials The Alcohol Education Trust

“talkaboutalcohol” programme is used across Britain. Delivery partners include, local authorities, PSHE leads, groups of academies, Public Health Directorates, Health and Wellbeing boards, commissioned service providers, Healthy school partnerships, youth groups, charities, police forces, community interest companies and school nurses. Some of the endorsements of our programme can be found here: http://www.alcoholeducationtrust.org/Pages/testimonials.html

What else we need to achieve? OFSTED found in 2013 that alcohol education

was still ‘not yet good enough’ in 40% of secondary schools, this is an improvement of 10% since it’s last assessment, but there is still considerable work to be done in schools where there is little or no PSHE provision. The AET wishes to reach the balance of estimated 1,500 schools across the UK identified as suitable for the programme. The AET wants to ensure that the 20% of students with English as a second

language and 10% SEND pupils have access to appropriate visual rich alcohol education and this is a priority for 2015. Please do contact us if you would like to consider a joint bid for funding or to help us with this project.

The AET aims to extend its network of specialist Alcohol Education coordinators based regionally across the UK to deliver parent seminars, teacher CPD and liaise with schools in areas where alcohol related harms for U18 are highest. We have dedicated coordinators in the North East and North West at present.

The AET is working to ensure its digital and on line games and interactive teaching resources on the www.talkaboutalcohol.com website are updated and are useable on smart phones and tablets. The 500-page website is increasingly looking dated and this is a large and complex project that will require significant funding.

The AET hopes that newly-qualified teachers are provided with PSHE and alcohol education as part of ITE. The first steps are in place with Public Health England hosting a joint seminar with the PSHE Association for ITE providers. In our survey of ITE providers, under 20% provided any PSHE training for their students.

Finally, the AET wishes to ensure that its key resources of a 100-page teacher workbook, parent and student information leaflets and online offerings remain free of charge for schools. If you would like to commission the AET to work with schools in your area, each school costs an average of £147.50 to support with a workbook and enough information leaflets for one year group per annum. Train the trainer and familiarisation sessions cost an average of £500 to facilitate. The programme is sustainable in that confident teachers who know their pupils well, can then deliver effective alcohol education year on year ensuring talk about alcohol is cost effective and strategies that reduce all risk taking become embedded in teaching methods used in PSHE.

If you would like to learn more, get involved with the Trust and its work - or as a school, receive our workbook free of charge, book a teacher training or parent workshop, then please email kate@alcoholeducationtrust.org or phone 01300 320869. Do follow us on twitter via @talkalcohol or Facebook via https://www.facebook.com/talkaboutalcohol

14 Education and Health Vol.33 No.1, 2015

I n recent years development of a healthy lifestyle among children has become one of the

main goals of Russian education. The responsibility of schools, to shape a healthy life for young people so that they are able to make healthy choices, is fixed in the Federal State Educational Standards. Numerous health education programmes are being currently implemented in Russian schools. In 2013, more than 70 educational programmes, targeting various age groups and aimed to form and maintain healthy habits, were implemented in Moscow.

One of the most popular healthy lifestyle programmes is the ‘Good Nutrition Programme’ which is part of the global initiative of the Nestlé Healthy Kids Programme aimed to form a healthy culture among children. This programme has been working in Russian schools since 1999. Its main purpose is to form healthy nutrition habits among children and teenagers aged 6-14. In 2014, more than 1,000,000 children from 51 regions of Russia participated. The programme is scheduled for 3 years and covers various aspects of nutrition, including culinary history, nutritional traditions of different countries, etc. The programme is supported by regional and federal ministries of education.

So it can be stated that the programme is an important tool for healthy life education in many schools in different regions. But to be able to plan their healthy life activity, local schools need to have a clear idea about the particular results that can be achieved by the programme’s implementation. That is why research was conducted in 2013-2014 to evaluate the

programme’s effectiveness. This research does not only provide significant information for the schools participating in the programme but demonstrates the role of education in promotion of a healthy life style among children in general. That is why it can be used for the development of methods of healthy life education.

Methods The research was performed among 729

schoolchildren from 4 regions of Russia. The main group consisted of children at the age of 8-9, who studied the first part of the Good Nutrition Programme (participated in the programme during one year) and children at the age of 10-12, who studied 3 parts of the programme (participated in the programme during 3 years). The control group included students who were not involved in the programme. The groups were formed on the basis of age as well as on the basis of social and cultural features - children of both groups studied in the same schools.

The information was collected through questioning and personal interviews with children. Two types of questionnaires were used, both developed in the Institute of Anthropology of the Russian Academy of Science.

The first type of questionnaires was developed for a one-time data collection. It was used to study the structure and the contents of the information about nutrition, which the respondents had. The questions in the questionnaire were selected with consideration of children’s age. The questions for 8-9 years old students were aimed to reveal their familiarity

Dr Alexandra Makeeva is a Senior Research Scientist of the Institute of Developmental Physiology of the Russian Academy of Education, Moscow. For communication, please email: Alexandra.Makeeva@ru.nestle.com

Alexandra Makeeva

What can be changed by nutrition education? Evaluation of the educational influence on children’s behaviour and nutritional knowledge

15 Education and Health Vol.33 No.1, 2015

with the rules of healthy nutrition, hygienic rules, products and food, which should be included in the daily food ration. The questionnaire developed for 10-12 year-olds covered a wider range of questions, such as the role of main nutrients, the products containing these nutrients, the rules of table setting, table manners, the contents of information on the food packages, rights and duties of customers. All the questionnaires also contained some points related to food preferences of children – i.e. their favourite dishes and types of food.

The second questionnaire was meant for a weeklong data collection and was connected with studying the respondents’ lifestyle. All children had to fill in a diary, describing their previous day. The following information was gathered: actual food intake of a schoolchild (products and dishes in his breakfast, lunch and dinner, afternoon snack, other snacks), nutritional regime (time of the main meals), the main types of activity and their duration (studying at school, preparing homework, walking, sports, reading, etc.)

The results in the control and the main groups were compared. This analysis enabled us not only to evaluate the particular impact of the programme’s implementation but also to clarify how this impact depends on the period of training. Table 1. Structure of groups-research participants

Year Scope Number of regions Main group characteristics Control groups characteristics

2013 373 students (11-13 y. o.) and their parents

4 180 studied the programme for 3 years

193 did not participate in the programme

2014 356 students (8-9 y. o.) and their parents

4 167 studied the programme for 1 year

188 did not participate in the programme

Results and discussion Awareness of students about nutrition

The level of awareness about nutrition in the main group is higher in general. Students – participants of the programme give more correct answers about regime, ratio, rules of hygiene etc. in comparison with their peers not participating in the programme. Percentage differences between the number of correct answers are summarized in Table 2. Attention should be paid to the fact that the difference in awareness in control and main groups increases with age. So the difference in control and main groups of children aged 7-8 is 18% and 28% in groups aged 9-11. These statistics do not only demonstrate the positive impact the programme has on children’s awareness, but also confirm the effectiveness of long-term systematic learning. The three-year course allows to equip children with deeper knowledge than the one-year course. Table 2. Awareness of the students about nutrition

Students 8-9 y.o.(1 year of studying) Students 11-13 y.o.(3 years of studying)

Main group

(n=167)

Control group

(n=188)

Significance level

Main group

(n=180)

Control group

(n=193)

Significance level

70% 52% P<0,001 88% 57% P<0,001

Taste preferences of students

Further analysis was intended to study children’s food preferences. Children had to indicate their “favourite” food. On the basis of their answers the list was created, which included 8 types of food and dishes most frequently mentioned (Figure 1). The list of “the favourite food” proved to be the same in both groups, as well as no age difference in food preferences among children aged 8-9 and 11-13 was revealed. The most popular types of food are potato dishes, some fruits, different types of soups, раsta, several types of meat dishes, sweets.

16 Education and Health Vol.33 No.1, 2015

0

10

20

30

40

50

60

70

80

90

Sweets

Cookies

Pasta

Sausage

Meat dishes

Potatoes

Fruits

Soups

Main group

Control group

At the same time the ratings of the “preferred” dishes (by frequency of mentioning) are various. Children from the main group demonstrate “healthier choice” in comparison with the control group (they mention fruits, soups more often, while the children from the control group choose sweets and cakes more often). Figure 1. The favourite products mentioned by students

Thus nutrition education did not radically change the typical food preferences among children. The

list of “the most favourite food” is determined mainly by social and economic characteristics of families, (presence of particular types of products on a family menu, family culinary traditions, etc.). But health education can correct already formed food preferences and increase children’s interest in healthier products.

Regime and intake of students

It turned out that eating 4-5 times a day (including breakfast at home, breakfast at school, lunch, afternoon snack and dinner) was typical for children aged 8-9 from both groups. Significant differences though are found in groups of children aged 11-13 (studying the programme for 3 years). A regime with 4-5 meals per day remained typical in the main group, while in the control group, students tended to have only 3 meals a day. Children of the control group had their afternoon snack and breakfast at school less often in comparison with the main group.

It is known that at the age of 8-9 food regime is controlled mostly by parents and teachers. That is why the majority of the students (participants and not participants) follow the best food regime. At the age of 10-12, students become more independent, while parents’ control decreases. As a result the children in the control group may miss their breakfast and their afternoon snack. And in the main group, the most correct regime was preserved because children continue to follow the right regime without constant control of parents.

17 Education and Health Vol.33 No.1, 2015

We analysed the weekly menu of the respondents and outlined the most typical products and dishes. The lists of the typical food are the same for the control and the main groups and they do not depend on the age. Description of the daily meals is presented in Table 3. Table 3. Typical products and dishes included in the students’ daily menu

Breakfast Porridge or flakes, bread, a sausage sandwich, sausage products (sausages, small sausages, pastry, tea, milk)

Lunch Soup (meat or vegetable soup), bread, meat dish (cutlet, stew), macaroni, fresh vegetables, fish, sausage products (sausages, small sausages), tea, juice

Afternoon snack Fruit, pastry, bread, milk products (yoghurt), sandwiches, sweets, tea, juice

Dinner Meat dishes, macaroni, sausage products, fresh vegetables, stewed vegetables, tea, juice, milk products

The set of products for the daily menu corresponds to recommendations of dietitians in general. It includes the main types of food: meat, dairy products, fruits and vegetables, cereals products. At the same time the frequency of eating some products in both groups do not completely correspond to the dietitians’ recommendations (Table 4). The student-participants and non-participants do not eat enough fish, fruits and vegetables. It all means that education itself did not radically improve the typical intake of children. The main role here is played by social and economic factors.

Despite this, education can still have a positive influence on students’ diet. As we’ve found out, the frequency of consumption in the control group changed with age in groups of 8-9 to 10-12 y.o, while in the main group it was preserved at the same level. As a result the diet of 3-year course students can be evaluated as healthier and better in comparison with their peers. They eat fruit and vegetables and cereal dishes (porridge, flakes) twice as often than non-participants, and milk products – half as much. In the main group of 10-12 y.o. students frequency of eating fish products is 0,3 times per week, while in the control group it is 0,1 times per week. In the same group, those who took part in the programme were half as likely to eat junk food (0,3 times per week) as those who did not take part (0,6 times per week). Table 4. Frequency of consumption : products and dishes (average number of intakes per week)

Products and dishes

Students, 8-9 y.o. (1 year of studying, n=167)

Significance level

Students, 10-12 y.o. (3 years of studying, n=180)

Significance level

Main group Control group Main group Control group

Fruit 2 2 N/S 3 1,5 P<0,05

Vegetables 1,2 0,9 N/S 1,2 0,6 P<0,05

Fish 0,3 0,2 N/S 0,3 0,1 P<0,001

Milk products 1 0,8 N/s 1,3 0,7 P<0,05

Porridges and cereal dishes

0,9 0,5 P<0,05 0,9 0,5 P<0,05

Junk food 0,3 0,3 N/S 0,3 0,6 P<0,05

Students’ lifestyle The analysis of the data collected during one week allowed us to define the main types of students’

life activities and their average duration. Most of the children have a sedentary lifestyle. They give much of their time to learning (lessons at school, homework at home), as well as watching TV programmes or web-activities. Such types of activities as morning exercises, sport and walking are less popular. Prevalence of sedentary lifestyles among the young generation is a critical trend, noticed by many researches and education courses have not broken it.

There are no significant differences connected with participation in the programme and/or age of children in this case. The general results (without age split) of students’ lifestyle analysis are

18 Education and Health Vol.33 No.1, 2015

summarized in the Table 5. At the same time we can notice that the level of participants’ involvement in physical activities is still higher in comparison with non participants. The programme can stimulate children to do morning exercise, walk much and do sport more often. Table 5. The percentage of children involved in the main daily activities and the average duration of the main daily activities

The daily activities The main group (8-9 y.o. and 10-12 y.o students, n=167)

The control group (8-9 y.o. and 10-12 y.o students, n=188)

Morning exercises 27%

(10 min a day)

24%

(9 min a day)

Walking 68%

(1 hour a day)

62%

(47 min a day)

Sports 56%

(90 min a week)

51%

(80 min a week)

Watching TV / computer game (more than 1 hour a day)

57%

(90 min a week)

63%

(90 min a week)

Learning (school lessons, homework)

100%

(7 hours a day)

100%

(7 hours a day)

Conclusion To include the healthy nutrition programme, in the general plan of school activities aimed to

promote a healthy lifestyle among children, it is necessary to be informed of the results that can be obtained by the nutrition education.

The nutrition culture of children is a multicomponent personality issue, measured by a number of characteristics. Some of these characteristics can be changed or developed by education. The others are outside the direct educational impact.

Our research demonstrated that the nutrition education broadens children’s knowledge in this sphere. There is a significant difference between the levels of awareness in the main and control groups.

But it also proved that the training do not develop taste preferences of schoolchildren. The answers of children describing their “favorite products” in both groups are the same. Social and economic factors tend to play the main role (presence of particular types of products on a family menu, family culinary traditions etc.). For the same reason the lists of typical food of weekly ratio are similar in both groups.

Although the training is not capable of changing the list of the typical products consumed by children, it can stimulate the children-participants to consume some of the products (vegetables, fruits, dairy products) more often and some (junk food) less often in comparison with non participants. So the educational programme positively affects childrens’ diet by changing the frequency of consumption of certain products.

It was also revealed that participation in the programme motivates children to follow a healthy regime. There is a significant difference between the number of daily meals in groups of participants and non participants.

The special nutrition education did not change the key characteristics of children’s lifestyle. The lifestyle of children involved and not involved in the programme can be defined as sedentary in general. Despite this, there are more children who do morning exercise, sports or walk in the open air in the main group. The differences between groups are not significant in this case and can be considered only as a suggestion. Studying healthy nutrition (as one aspect of a healthy life) contributes to developing a more caring attitude towards health in general.

Thus the contribution of the programme to development of nutrition culture among children involves the following issues: building up general knowledge about nutrition, increasing the frequency of healthy products consumption, deсreasing the frequency of consumption of unhealthy

19 Education and Health Vol.33 No.1, 2015

FREE RESOURCES

food, improving nutrition regime. So we suggest to schools, participating in the programme, to expect such kind of outcomes when planning healthy life school activities.

It is also necessary to take into account the programme’s influence on students’ personal characteristics can be both stimulating and supportive. The training expands children’s awareness about nutrition. At the same time the educational programme supports their adherence to a healthy regime and frequency of healthy products consumption. These characteristics of diet in the main group do not get worse as students get older.

References

Brown, T., Summerbell, C.A. (2008). A systematic review of school-based interventions that focus on dietary intake and physical activity levels to prevent childhood obesity: an update to the obesity guidance produced by the NICE. Obesity Reviews, 10:110-141.

Bullen,K (2004). Changing Children's Food and Health Concepts: A Challenge for Nutrition Education. Education and Health, 22 (4):51-55. http://sheu.org.uk/x/eh224kb.pdf

Dani, J., Burrill, C. and Demming-Adams, B. (2005).The remarkable role of nutrition in learning and behavior. Nutrition and Food Science, 35 (4):258-263.

Drobizheva L.М. (2003).Value of health and culture of unhealthy living in Russia. Research of the Institute of Sociology of the Russian Academy of Science, 3: 505.

James,P.(1998). Food is a public health issues. British Medical Journal, 332:505.

Gilligan, P., Manby, M., Gibson, D.,Hodgkinson, A. (2012).Healthy Heroes: Improving Young Children's Lifestyles In Lancashire; an evaluation of a challenge based schools' programme. Education and Health, 30 (4): 89-93. http://sheu.org.uk/x/eh304mm.pdf

Hackett,A., Gibbon,M., Lamb,L .(2003). Eating habits of children in Liverpool: a need for health education. Education and Health, 21 (1):3-8. http://sheu.org.uk/x/eh211ah.pdf

Kenkel, D. (1991).Health Behavior, Health Knowledge and Schooling, Journal of Political Economy, 99 (2):3-8.

Makeeva, A.(2008). About the formation of health culture of teenagers. Biology at school, 138 (1): 3-10.

Seaman, C., Woods, M.,Grosset, E.,(1997). Attitudes to healthy eating among Scottish school children. Health Education, 1: 9-15

Shilova, l. (2005). Teenagers and youth in Russia – perspective group for spreading of social diseases. Health and healthcare in the reality of market-driven economy. Moscow. Institute of Sociology of the Russian Academy of Science.

Sobel, J. , Stunkard, A. (1989).Socio-economic Status and Obesity: a Review of the Literature. Psychological Bulletin, 105: 260-271.

Sosunova, I., Alekseev, S.,(2003). Health, demography and social and ecological interests. Men’s health: sociological and humanitarian aspects and medico-biological aspects. Moscow. Institute of Technical Aesthetics

Turmer, S., (1997). Children’s understanding of food and health in primary classrooms. International Journal of Science Education. 3: 353-364

Vasilyeva O.S., Filatov F.R. (2001). Psychology of Health: Anchorages, Notions, Mindsets. Moscow. Published by “Academy”. (Vasilyeva O.S., Filatov F.R. Psikhologiya zdorovya cheloveka: etalony, predstavleniya, ustanovki. M.: Izdatelskiy Tsentr “Akademiya”, 2001. 352 s).

Wyatt, K.,Lloyd, J. (2013). Development of a novel, school located, obesity prevention programme, the Healthy Lifestyles Programme (HeLP). Education and Health, 31 (2):89-95. http://sheu.org.uk/x/eh312kw.pdf

Education and Health The journal, published by SHEU since 1983, is aimed at those involved with education and health who are concerned with the

health and wellbeing of young people. Readership is worldwide and in the UK include: primary; secondary and further education

teachers; university staff and health-care professionals working in education and health settings. The journal is online and open

access, continues the proud tradition of independent publishing and offers an eclectic mix of articles.

Contributors (see a recent list) - Do you have up to 3000 words about a

relevant issue that you would like to see published? Please contact the Editor

20 Education and Health Vol.33 No.1, 2015

C entral Bedfordshire Council (CBC) commissioned the Schools Health Education

Unit (SHEU) to run a survey in 2014 on children and young people’s perceptions of their health and lifestyles.

A sample of 3099 pupils from years 6, 8 and 10 years took part in the survey and results were compared to the CBC 2008 survey data as well as with wider SHEU data. These data helped to inform and drive projects in 2014/15 aimed at improving pupils’ health in Central Bedfordshire.

Results The results of the CBC survey were discussed

at an open event for PSHE leads and teachers who were given the opportunity to meet the children’s Public Health team, consider individual school data and discuss the implications for pupils. The summary data were also shared with key partners to inform their own policy decisions and priorities. For example, the survey was shared with the Bedfordshire Police Strategic Children and Young People Group which gave senior officers an opportunity to look at the results and determine if the Force’s education work was covering the needs of young people in Central Bedfordshire, The Force’s Children and Young People Development Officer and Schools Coordinator was tasked to promote the range of educational inputs on offer to schools to support them with a range of topics such as personal safety, online safety and bullying.

The good news stories Compared to the wider SHEU data, more

Central Bedfordshire pupils: Eat five or more portions of fruit and

vegetables each day

Report they do not smoke (an increase on 2008 data)

Say they never drink alcohol in year 6 and 8 (an increase on 2008 data)

Report they exercise hard during last week The challenges ahead

Comparisons of Central Bedfordshire Year 6, Year 8 and Year 10 results with wider SHEU data showed that Central Bedfordshire pupils are more likely to: Worry about more than one matter listed in

the survey Have low self esteem scores Feel their views are not listened to in school Sometimes feel afraid of going to school due

to bullying Feel less satisfied with their lives

It is known that adolescents (particularly young women) have higher rates of anxiety and depression than younger children, however when compared with the Central Bedfordshire 2008 survey results, pupils in 2014 are less likely to report they are satisfied with their lives. This downward trend is also reflected in wider SHEU data.

Development As a result of the 2014 survey data and in

response to other health drivers, Public Health implemented a number of new initiatives in

“The rising trend of self-esteem from 1997-2007 stopped in 2008, and the figures we are seeing for high self-esteem in 2013 are

generally lower now.

SHEU 2014

Sarah James is the Principal Public Health Officer for Children and Young People at Central Bedfordshire Council For communication please email: sarah.james@centralbedfordshire.gov.uk

Sarah James

Improving pupils’ health in Central Bedfordshire

21 Education and Health Vol.33 No.1, 2015

addition to existing programmes to improve the health and wellbeing of pupils in Central Bedfordshire. These are outlined below.

PSHE/ SRE Partnership Network

The Central Bedfordshire PSHE/ SRE Partnership network has been developed by Central Bedfordshire Public Health in collaboration with The Teaching School, service providers and commissioners to offer support and information to schools for their PSHE and SRE provision. Good quality PSHE and SRE are essential to developing the qualities and attributes pupils need to thrive as healthy individuals, enabling them to fulfil their potential in life.

The PSHE/SRE partnership network, which to date has over 130 members, was launched at an event on 16th October 2014 and was attended by over 60 PSHE leads and head teachers. The room buzzed as teaching professionals shared experience and ideas and took full advantage of the opportunity to engage with the 14 service providers who attended the event.

Attendees also heard talks from the School

Nursing Service about the support they can provide to schools. Such support includes offering general support with school’s PSHE curriculum and running weekly drop in sessions for years 7. Drop in sessions provide advice and support on issues such as emotional health and wellbeing; sexual health; reducing and stopping smoking; healthy weight; reducing misuse of drugs and alcohol and managing stress and anxiety at exam times. PSHE members also heard from the National PSHE Association offering a reduced membership rate exclusively for CB schools and from CBC’s Access and Referral Hub about the ‘one front door’ simplified referral pathway for individual children. Teaching professionals also

participated in workshop sessions and were asked about the barriers to delivery of the PSHE curriculum, the ways in which the PSHE/SRE network could best support schools and the topic areas of most concern. Feedback enabled the network to be shaped according to members’ needs, for example by responding to the need for support around pupils’ emotional wellbeing.

In February 2015, the Network received the first of a series of half termly PSHE/ SRE news letters providing further information and resources for schools. This issue focused on emotional wellbeing in children and young people and provided links to providers, as well as information, lesson plans and websites for further advice and guidance.

The Aspire Programme

‘Aspire’ is an evidence-based, early intervention programme commissioned by CBC that offers young people at risk of poor outcomes, including teenage pregnancy, small group support and individual coaching, with an emphasis on raising future aspirations. In the academic year 2012/13, the programme was delivered across 13 schools (both middle and upper) in high teenage pregnancy areas in Central Bedfordshire. All those who joined the programme were closely monitored over the year to measure the impact and outcomes of the intervention. Evaluation has shown that the Aspire programme has successfully reduced the risk factors for teenage pregnancy among those taking part in the programme.

New Sexual Health Website

Bedford Borough and Central Bedfordshire Public Health teams launched a new sexual health website across Bedford Borough and Central Bedfordshire.

The website has been developed for all ages to ensure that there is one point of contact for up to date information on local sexual health services, including: Brook, Terence Higgins Trust, Sphere Clinics (delivered by a number of GP Practices), Genito Urinary Medicine (GUM), Pharmacies and outreach workers within the local community. There is a clinic finder function which provides up to date detail on clinics running on every day of the week. Other

“I was really enthused by the pro-active approach being taken in Central Beds

regarding the welfare of young people and their education in areas that are so

important but not so high profile on the national curriculum.”

Chris Lee @ Ormiston Families

22 Education and Health Vol.33 No.1, 2015

features include information on contraception, Sexually Transmitted Infections (STIs), HIV, sexual dysfunction, pregnancy and sexual assault.

Tattoo and Piercing Safety Campaign

In January of this year, all schools and colleges with pupils aged 10 and above received a teaching resource pack on tattoo and piercing safety. The teaching pack was put together by the Public Health and Environmental Health departments of Luton, Bedford Borough and Central Bedfordshire Councils to assist teachers with their PSHE provision and specifically to explore the range of issues associated with tattooing and piercing, including health risks, safe choices and body image. As the resource is delivered, the return of prepaid feedback forms will evaluate its success and will inform future projects. A poster and media campaign has also supported the educational packs and has communicated the messages to a wider audience.

Excess weight resource pack for schools

As part of the work with the School Nursing Service and the National Child Measurement Programme, Public Health has developed a resource pack which was sent to all PSHE leads in schools and the School Nurses. The packs are intended to be used by teaching staff in PSHE lessons focusing on body image, bullying and self-esteem, and also by School Nurses in their weekly drop-in sessions if pupils require support and information around weight issues. The packs are being sent to schools to coincide with the weighing and measuring of Year 6 and Year R pupils and can be used with parents as well as individual pupils or groups. The excess weight packs support the work of the tattoo and piercing packs tackling body image and teachers’ highlighted issue of poor self-esteem.

Change4life Sugar Swaps Campaign

The Children’s Public Health team support ‘Change4life’ [C4L] and promote all campaigns that are publicised across the year. Through co-operative working, our schools and Children’s Centres are encouraged to sign up to C4L and promotions/information is also sent to the School Nursing Service and Health Visiting

Service. New community initiatives such as the new ‘Sugar Swaps’ campaign was supported for the first two weeks in January 2015 developing a display in a showcase shop window in one of the Council’s most deprived areas to raise awareness of the benefits of small changes.

Kick Ash Initiative

The Public Health Team in CBC have begun to deliver a prevention programme called ‘Kick Ash’. This programme is a Peer-led stop smoking programme for young people, with the aim of reducing their smoking prevalence. The Programme has a 3 Tier format:

Tier 1: All Schools commit and sign up to the Kick Ash Stop Smoking Policy, which extends from the national stop smoking policy.

Tier 2: Middle and Upper Schools deliver the Operation Smoke Storm Programme, which is a web-based learning package demonstrating the harms of smoking, with interactive sessions targeting year 7 and 8 students.

Tier 3: Upper Schools participate in the full Kick Ash Programme, which includes training volunteer Kick Ash Mentors on Smoking Cessation, Trading Standards and Communications. Once Mentors have been trained, they lead on activities within schools and academies in promoting Kick Ash Stop Smoking, and work with both PSHE leads and School Nurses to support students who may wish to quit, and also prevent younger students to begin smoking.

Several Upper Schools have signed up to the full Tier 3 Kick Ash Programme and Kick Ash Mentors are successfully delivering the Operation Smoke Storm sessions to younger students, benefiting both tutor and student.

As the Kick Ash Programme progresses, evaluation data will demonstrate the outcomes achieved. Smokefree Homes and Cars Project

The Smokefree Homes and Cars Programme has been nationally recognised since 2007 following the introduction of the smokefree regulations and in the run up to new legislation

“You would be mad not to support this exciting and worthwhile initiative”

PSHE Lead

23 Education and Health Vol.33 No.1, 2015

prohibiting smoking in cars. In Central Bedfordshire, the programme is currently being delivered by Public Health, working closely with Children Centres, Health Visitors and Community Health Assistants. All partners are trained to enable them to deliver the programme to young families, communicating the dangers of exposure and promoting the benefits of reducing exposure to second hand smoke. Families are encouraged to sign up to a promise of being smokefree at home or in the car. [New rules will come into force on 1 October 2015 making smoking in cars carrying children illegal.]

Young parents can also register online via the Central Bedfordshire website and commit to either a 3-month or 6-month pledge not to smoke in their home or car, with the aim of encouraging parents to quit smoking in the longer term.

Health and wellbeing information resource for vulnerable children and young people

Pocket health guides have been designed and distributed to all looked after children and young carers in Central Bedfordshire. The age specific key rings are designed with 5 leaves each delivering a different health message with relevant web links and telephone numbers providing appropriate information, help and support at any time. The messages cover a range of issues, including emotional wellbeing, healthy eating, smoking, alcohol and drugs, sexual health and safeguarding and are worded appropriately for the targeted age range. As an example, young people aged 16+ are prompted to access support and advice about relationship issues using specialist helplines and websites detailed on the reverse of the message.

Later in 2015, posters delivering the same age specific health messages will also be sent to

schools, colleges and community settings. Evaluations of the effectiveness and impact of the key rings will be carried out later this year. Support for the NSPCC Childline Schools Service

Public Health are supporting the NSPCC Childline Schools Service in their delivery of an initiative for years 5/6 which aims to ensure children have an understanding of abuse in all its forms, including bullying, how to protect themselves and how to get help. Several schools have signed up for the service and with continued and wider promotion it is hoped that more schools will engage in the coming months.

Future Plans As the new projects are implemented further

plans to improve the health of CB pupils are underway.

Children’s Workforce Conference

A one day partnership conference (Children’s Services and Public Health) on promoting emotional wellbeing and building resilience in children and young people is planned for March 2015. Attendees from the wider children’s workforce will hear presentations from academic and clinical professionals outlining the scale and importance of the issue. Specific topic areas such as drug and alcohol abuse in children, domestic violence and mental health issues in parents, online safety and teaching resilience will be covered in afternoon workshops, which will also be made available as stand alone sessions later in 2015/16.

Partnership working on Health and Educational Attainment

Research evidence shows that education and health are closely linked. So promoting the health and wellbeing of pupils and students within schools and colleges has the potential to improve their educational outcomes and their health and wellbeing outcomes .

In response to the 2014 Public Health England publication, The Link Between Pupil Health and Wellbeing and Attainment, and utilising data from the Central Bedfordshire SHEU survey, Public Health will be working collaboratively with the CBC School Improvement team and the School

Do you feel uncomfortable about a relationship and need

to talk to someone?

24 Education and Health Vol.33 No.1, 2015

Nursing Service to promote the document’s key themes and develop a clear plan for future joint working to raise levels of attainment:

The 2016 Health Related Behaviour and Perception Survey

Central Bedfordshire Public Health intends to commission the SHEU to undertake a more extensive survey in October 2015 with a focus on mental health and wellbeing. Work is underway in partnership with SHEU and local providers of mental health services to develop a targeted questionnaire with a robust promotional campaign to encourage a large number of schools to participate.

2015/16 Year 5 project

From Easter 2015, Public Health will be developing a programme in partnership with the School Nursing teams to be delivered in local schools to highlight issues around puberty, weight, self-image and self-esteem with Year 5 pupils. This is in response to the results of the health related behaviour survey and to guidelines from the National Child Measurement Programme recommending a more pro-active inclusive approach. The programme will begin in the summer term with Year 5 pupils, explaining why the NCMP takes place, how it works and what to expect after the weighing and measuring is completed and how the results will be communicated to parents. In the Autumn Term, when these pupils have moved up to Year 6, and before the weighing and measuring begins, Public Health plans to meet with parents at open evenings to explain the same process. The aim is to improve uptake of the programme, address parental concerns and provide support to families of under or

overweight children through their School Nurse and commissioned programmes.

A similar programme is also being planned for Reception year pupils and parents in 2016.

Reduction in self-harm and suicide prevention project

In response to growing concern around the number of young people self-harming, believed to be linked with an increase in cyber-bullying, Central Bedfordshire Public Health is working in partnership with Bedfordshire Police to develop a training package to be delivered in Middle and Upper schools. The training will include internet safety, advice/support and legislation aspect of self-generated images (sexting). The training will be promoted via the PHSE/SRE websites and is hoped to increase knowledge for professionals as well as for young people.

Conclusion Schools are important settings for health

promotion and prevention including their wider role in promoting pupil wellbeing. This can be achieved through an effective and high-quality PSHE and SRE programme and by ensuring that every child and young person has the right level of support to help them to maximise their full potential. When local services are informed by sound local data and can work in partnership with schools to meet needs of pupils in a holistic way, they are more effective and it is with this in mind that the project outlines above have been developed.

References

Twenge, J., & Nolen-Hoeksema, S. (2002). Age, gender, race, socioeconomic status and birth cohort differences on the Children’s Depression Inventory: A meta-analysis. Journal of Abnormal Psychology, 111, 578-588.

Public Health England. (2014). The link between pupil health and wellbeing and attainment .A briefing for head teachers governors and staff in educational settings. London, PHE. https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/370686/HT_briefing_layoutvFINALvii.pdf

“Pupils with better health and wellbeing are likely to achieve

better academically”

Public Health England 2014

SHEU Schools and Students Health Education Unit

The specialist provider of reliable local survey data for schools and colleges and recognised nationally since 1977.

For more details please visit http://sheu.org.uk