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Background: Most adult smokers started smoking in their teenage years, which increases the risk of nicotine dependence. In Denmark, there is a high prevalence of youth smoking among students in Vocational Education and Training (VET). However, reducing and preventing smoking in this group is a major challenge. This article presents a needs assessment aimed to explore factors sustaining legitimacy of smoking in VET schools and consider the measures needed to prepare VET schools' implementation of smoking reduction and prevention interventions., Methods: Participant observations were conducted in four VET classes representing three VET schools in Denmark with a duration of four days each. Individual, semi-structured interviews were conducted with teachers, managers, and a student advisor, as well as four focus groups with a total of 20 students. Interviews were audio-taped, transcribed, and the data material was analyzed following Malterud's systematic text condensation., Findings: Factors that helped sustain legitimacy of smoking in VET schools included a positive and normalized attitude towards smoking at home and among friends, an understanding of smoking as an integral and expected practice in VET professions and schools, a perceived reliance on smoking as an icebreaker in new social relations and as a pedagogical tool, and smoking as a habit and a means to deal with boredom and stress relief., Conclusions: The factors sustaining legitimacy of smoking in VET schools are reciprocal and call for smoking reduction and prevention intervention efforts which consider and address social influence, habitual behavior, and psychological needs, as well as changes at the policy level., (© 2024. The Author(s).)

Intersectoral partnerships constitute a central approach in health promotion. By combining different perspectives, knowledge and resources from different sectors, partnerships are important for addressing complex health problems. When successful, intersectoral partnerships create synergy, which is suggested to be a proximal outcome that links partnership functioning to health effects. Nonetheless, partnerships are also difficult and time-consuming and may result in conflicts, hostility and power struggles. Such antagonist outputs are expected to produce negative results. However, conflicts may also be a source of valuable learning. This article explores the relationship between conflict and synergy in health promotion partnerships. The empirical material is derived from an evaluation of a 4-year Danish government partnership program. Data consist of survey data collected from 35 partnerships and in-depth qualitative case studies of 10 partnerships. The analysis was inspired by realist evaluation. The qualitative data were coded, and cases written up. Cross-case analysis was conducted and triangulated with survey data. Surprisingly, disagreements and conflicts of interests between partners were common and associated with synergy creation. Moreover, the partnerships' experiences of synergy were often linked to their attribution of differences rather than to common goals or value congruences. The study identifies that a potential for synergy lays in the productive confrontation between partners different perspectives. Moreover, a key mechanism enabling productive conflicts was inclusive dialog, in which the partners' differences were valued, and all voices were included. The study thus builds on the existing synergy literature and adds nuance to the understanding of conflicts in health promotion partnerships., (© The Author(s) 2021. Published by Oxford University Press. All rights reserved. For permissions, please email: journals.permissions@oup.com.)

Much public health research has devoted attention to the question of how interventions aimed at reducing health inequalities can access so-called "hard-to-reach" populations. This work has generally reflected an instrumentalist approach, which implies the preexistence of particular target groups characterized by specific public health problems. The key research interests are to find ways to effectively alleviate health inequalities and to identify the best ways to intervene to address disparate health problems among certain groups of people. Based on ethnographic research with public health officers in four Danish municipalities, this article turns the issue on its head by examining how public health officers gain access to intervene in practice and, as part of this process, define and delineate target groups and public health problems. Through detailed descriptions of two ethnographic cases, we develop the argument that public health interventions carry with them moral differentiations that may contradict the overall intention of reducing health inequalities. We adopt a theoretical perspective developed by Lakoff and Collier, suggesting that public health interventions can be understood as "regimes of living." This leads us to the conclusion that the practices of gaining access result in the production of unforeseen target groups and new moral configurations where the value of health becomes linked to other types of value, most importantly economic value. For public health officers, the complicated issue of gaining access to intervene is not simply a matter of finding practical solutions; it also defines and delineates the scope of public health itself.

Intersectoral partnerships have the potential to co-produce 'synergistic' solutions to complex public health problems, exceeding what any single organization acting alone might achieve. Synergy requires shared decision-making and equitable co-construction by partners. However, many partnerships struggle to realize such synergistic potential. Building on the Bergen Model of Collaborative Functioning, this study offers insights for optimizing partnership synergy by examining interactions between 'inputs' to the partnership-shared mission, and partner resources. Specifically, we introduce the concept of 'dependency structure' to draw attention to how these input interactions shape the balance of power and hence the potential for shared decision-making and co-construction. Findings are based on qualitative data from 10 intersectoral, health promotion partnerships in Denmark, including 27 interviews, 10 focus groups, partnership documents and meeting observations. We identified eight distinct types of 'input resources', which were important in shaping the potential balance of power between partners in more or less productive ways. However, the dependency structure that materialized-and its synergistic potential-was contingent on how these inputs interacted with the partnership mission. Our findings suggest a well-developed shared mission serves three functions-(i) foregrounding a common purpose, (ii) aligning individual partner's self-interests and (iii) enabling action. The extent to which partnerships developed a shared mission serving all three functions influenced realization of a balanced dependency structure in which collaborators recognized their interdependencies, in turn promoting shared decision-making. To ensure the greatest potential for synergy, early and ongoing discursive processes to co-develop the partnership mission were particularly important., (© The Author(s) 2023. Published by Oxford University Press. All rights reserved. For permissions, please email: journals.permissions@oup.com.)

This commentary discusses the interesting and surprising findings by Hagen and colleagues, focusing on the role of the public health coordinator as a Health in All Policies (HiAP) tool. The original article finds a negative association between the employment of public health coordinators in Norwegian municipalities and consideration of a fair distribution of social and economic resources between social groups in local policymaking and planning. The commentary contemplates whether this surprising negative association should be interpreted as a failure of implementation, as suggested by the authors, or whether it might be the theory of change that has failed. On this basis, it is suggested that the very notion of HiAP could be flawed by the assumption that health should function as an overarching aim across government sectors. Potentially, the social determinants of health (SDH) might be more efficiently addressed by means of sectoral action by the corresponding sectors, emphasizing equity rather than health., (© 2018 The Author(s); Published by Kerman University of Medical Sciences. This is an open-access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.)

It is well-established that population health is influenced by a multitude of factors, many of which lie outside the scope of the health sector. In the public health literature it is often assumed that intersectoral engagement with nonhealth sectors will be instrumental in addressing these social determinants of health. Due to the expected desirable outcomes in population health, several countries have introduced Health in All Policies (HiAP). However, whether this systematic, top-down approach to whole-of-government action (which HiAP entails) is efficient in changing government policies remains unclear. A systematic evaluation of HiAP is therefore much needed. Lawless and colleagues present an evaluation framework for HiAP in their article: "Developing a Framework for a Program Theory-Based Approach to Evaluating Policy Processes and Outcomes: Health in All Policies in South Australia." This work is an important endeavor in addressing this problem (of uncertainty as to whether HiAP is effective) and represents an essential contribution to the HiAP literature. Nonetheless, in the spirit of encouraging ongoing reflection on this topic, we wish to highlight some challenges in the presented framework, which may pose difficulties in operationalization. We find that the evaluation framework faces two main limitations: its unclear causal logic and its level of complexity. We argue that in order to function as a tool for evaluation, the framework should be explicit about the mechanisms of change and enable us to trace whether the assumed causal relations resulted in changes in practice. Developing manageable evaluation frameworks, albeit simplified, may then be an important part of cumulating the theoretical insights aspired in theory-based evaluation. On this basis, we highlight how HiAP processes and healthy public policies respectively involve different mechanisms, and thus argue that different program theories are needed., (© 2018 The Author(s); Published by Kerman University of Medical Sciences. This is an open-access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.)

Aims: This paper examines the role of organizational structure within government(s) in attempts to implement intersectoral action for health in Danish municipalities. We discuss the implications of structural reorganization and the governance structures that are established in order to ensure coordination and integration between policy sectors., Methods: The paper is based on 49 interviews with civil servants from health and non-health sectors of 10 municipalities. Based on participants' experiences, cases have been described and analyzed in an iterative process consulting the literature on Health in All Policies and joined-up government., Results: Continuous and frequent processes of reorganizing were widespread in the municipalities. However, they appeared to have little effect on policy change. The two most common governance structures established to transcend organizational boundaries were the central unit and the intersectoral committee. According to the experiences of participants, paradoxically both of these organizational solutions tend to reproduce the organizational problems they are intended to overcome. Even if structural reorganization may succeed in dissolving some sector boundaries, it will inevitably create new ones., Conclusions: It is time to dismiss the idea that intersectoral action for health can be achieved by means of a structural fix. Rather than rearranging organizational boundaries it may be more useful to seek to manage the silos which exist in any organization, e.g. by promoting awareness of their implications for public health action and by enhancing the boundary spanning skills of public health officers.

Background: For more than 30 years policy action across sectors has been celebrated as a necessary and viable way to affect the social factors impacting on health. In particular intersectoral action on the social determinants of health is considered necessary to address social inequalities in health. However, despite growing support for intersectoral policymaking, implementation remains a challenge. Critics argue that public health has remained naïve about the policy process and a better understanding is needed. Based on ethnographic data, this paper conducts an in-depth analysis of a local process of intersectoral policymaking in order to gain a better understanding of the challenges posed by implementation. To help conceptualize the process, we apply the theoretical perspective of organizational neo-institutionalism, in particular the concepts of rationalized myth and decoupling., Methods: On the basis of an explorative study among ten Danish municipalities, we conducted an ethnographic study of the development of a municipal-wide implementation strategy for the intersectoral health policy of a medium-sized municipality. The main data sources consist of ethnographic field notes from participant observation and interview transcripts., Results: By providing detailed contextual description, we show how an apparent failure to move from policy to action is played out by the ongoing production of abstract rhetoric and vague plans. We find that idealization of universal intersectoralism, inconsistent demands, and doubts about economic outcomes challenge the notion of implementation as moving from rhetoric to action., Conclusion: We argue that the 'myth' of intersectoralism may be instrumental in avoiding the specification of action to implement the policy, and that the policy instead serves as a way to display and support good intentions and hereby continue the process. On this basis we expand the discussion on implementation challenges regarding intersectoral policymaking for health.

Action on the social determinants of health (SDH) through intersectoral policymaking is often suggested to promote health and health equity. This paper argues that the process of intersectoral policymaking influences how the SDH are construed and acted upon in municipal policymaking. We discuss how the intersectoral policy process legitimates certain practices in the setting of Danish municipal health promotion and the potential impact this can have for long-term, sustainable healthy public policy. Based on ethnographic fieldwork, we show how the intention of intersectoriality produces a strong concern for integrating health into non-health sectors to ensure productive collaboration. To encourage this integration, health is often framed as a means to achieve the objectives of non-health sectors. In doing so, the intersectoral policy process tends to favor smaller-scale interventions that aim to introduce healthier practices into various settings, e.g. creating healthy school environments for increased physical activity and healthy eating. While other more overarching interventions on the health impacts of broader welfare policies (e.g. education policy) tend to be neglected. The interventions hereby neglect to address more fundamental SDH. Based on these findings, we argue that intersectoral policymaking to address the SDH may translate into a limited approach to action on so-called 'intermediary determinants' of health, and as such may end up corrupting the broader SDH. Further, we discuss how this corruption affects the intended role of non-health sectors in tackling the SDH, as it may impede the overall success and long-term sustainability of intersectoral efforts., (© The Author 2016. Published by Oxford University Press. All rights reserved. For Permissions, please email: journals.permissions@oup.com.)

The work function of indium tin oxide (ITO) substrates was modified with phosphonic acid molecular films. The ITO surfaces were treated prior to functionalization with a base cleaning procedure. The film growth and coverage were quantified by contact angle goniometry and XPS. Film orientation was determined by reflection/absorption infrared spectroscopy using ITO-on-Cr substrates. The absolute work functions of nitrophenyl- and cyanophenyl-phosphonic acid films in ITO were determined by Kelvin probe measurement to be 5.60 and 5.77 eV, respectively.

Although the etiology of human breast cancer is unknown, certain epidemiological parameters such as risk of breast cancer development. Concurrent, retrospective and prospective studies have shown that one particular component of benign breast disease -- epithelial hyperplasia, may be responsible for the increase in risk. Several classification have been devised for epithelial hyperplasia of the human breast using light microscopy. By scanning electron microscopy epithelial hyperplasia in ducts has several patterns: focal hyperplasia, simple columnar bridging, complex bridging and solid hyperplasia. Although these patterns may be seen in non-cancerous ducts in both malignant and non-malignant cases, alterations in microvillus structure and number have only been seen to date in malignant cases.