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Background: Implementation of Health Promoting School (HPS) programs can be challenging due to the dynamic school context. Navigating between program fidelity and adaptation, as well as integrating the program, is essential for successful implementation, and consequently, for program effects. As part of an evaluation study in the Netherlands, this study aimed to develop a measurement instrument that differentiates schools according to fidelity, adaptation, and integration of HPS implementation. Methods: This study presents the development and psychometric evaluation of the 28-item HPS Implementation Questionnaire, covering 7 dimensions: adherence, dose, participant responsiveness, quality of delivery, program differentiation, adaptation, and integration. The questionnaire, to be filled out by school employees, was developed for primary, secondary, secondary vocational, and special needs education, in close collaboration with experts (n = 54) in school health promotion. Results: Semi-structured interviews aimed at dimension clarification resulted in a list of 58 items. Items were revised, combined, and/or removed based on quantitative and qualitative feedback by the evaluation study's Community of Practice, 2-round expert consultation, and pre-tests. Psychometric evaluation (n = 535 schools), consisting of calculating Cronbach's a and confirmatory factor analysis (CFA), confirmed internal consistency ([alpha] > 0.72) and the 7-dimension framework. Conclusion: The brief yet comprehensive HPS Implementation Questionnaire offers possibilities for research into HPS implementation in various educational sectors and contexts, as well as self-monitoring by individual schools. This study provides first evidence for internal consistency and validity of the questionnaire.

Objectives: Loneliness has been associated with unhealthy behavior, poorer health, and increased morbidity. However, the costs of loneliness are poorly understood. Methods: Multiple sources were combined into a dataset containing a nationally representative sample (n = 341,376) of Dutch adults (18+). The association between loneliness and total, general practitioner (GP), specialized, pharmaceutical, and mental healthcare expenditure was tested using Poisson and Zero-inflated negative binomial models, controlling for numerous potential confounders (i.e., demographic, socioeconomic, lifestyle-related factors, self-perceived health, and psychological distress), for four age groups. Results: Controlling for demographic, socioeconomic, and lifestyle-related factors, loneliness was indirectly (via poorer health) associated with higher expenditure in all categories. In fully adjusted models, it showed a direct association with higher expenditure for GP and mental healthcare (0.5 and 11.1%, respectively). The association with mental healthcare expenditure was stronger in younger than in older adults (for ages 19–40, the contribution of loneliness represented 61.8% of the overall association). Conclusion: Loneliness contributes to health expenditure both directly and indirectly, particularly in younger age groups. This implies a strong financial imperative to address this issue. [ABSTRACT FROM AUTHOR]

Young adults determined five needs which must be met to transition to adulthood: support, housing, study and work, income, and well-being. This study aimed to identify and describe subgroups of young adults and determine to what extent they meet the needs for independence, and to assess relations between subgroups and demographic characteristics. We conducted secondary data analysis of a population-based questionnaire, which included 2291 young adults (M age = 20.8 years, 71% female) living in South Limburg, the Netherlands. We adopted a person-centred approach, that is, latent class analysis, and identified four classes: Thriving (39%), Lacking support and well-being (29%), Widely struggling (18%) and Financially challenged (14%). Females and non-university students/graduates had higher odds of being members of the least thriving classes. Future research should focus on how support and cumulative disadvantage affect later life outcomes. We should broaden community, educational and institutional support systems to encourage and sustain meaningful relationships. [ABSTRACT FROM AUTHOR]

This paper investigates whether encouraging children to become more physically active in their everyday life affects their primary school performance. We use data from a field quasi-experiment called the Active Living Program, which aimed to increase active modes of transportation to school and active play among 8- to 12-year-olds living in low socioeconomic status (SES) areas in the Netherlands. Difference-in-differences estimations reveal that while the interventions increase time spent on physical activity during school hours, they negatively affect school performance, especially among the worst-performing students. Further analyses reveal that increased restlessness during instruction time is a potential mechanism for this negative effect. Our results suggest that the commonly found positive effects of exercising or participating in sports on educational outcomes may not be generalizable to physical activity in everyday life. Policymakers and educators who seek to increase physical activity in everyday life need to weigh the health and well-being benefits against the probability of increasing inequality in school performance.

INTRODUCTION Due to a continuing international trend of decentralization of public health policies, local governments are given an increasingly important role in tobacco control. The process of developing local-level tobacco control policies is an underexplored topic. This study uses grant applications as a data source to gain insight into the planning, development and proposed implementation of local tobacco control policies by regional public health departments in the Netherlands. METHODS Grant applications of 24 regional public health departments were analyzed using the second stage of the rational policy cycle, a four-stages policy model about the decisions made by local policy makers during the policy process. We coded the applications with open and axial coding. RESULTS Public health departments formulated four main goals for tobacco control: adding tobacco control policies to existing local policy documents, creating smokefree (child) environments, developing and improving access to smoking cessation care, and participating in media campaigns. Public health departments often specify tobacco control aims and involve partners in reaching these aims. However, the grant applications lacked information about implementing these tobacco control policies. CONCLUSIONS The information on implementation strategies and process evaluation, as well as the (evidence-based) legitimation for the policy choices, needs improvement. Under the current conditions, which include the brief explanation the departments received, an unclear mandate, insufficient funding, and local restricting factors such as time and knowledge, significant contributions to tobacco control policy cannot be expected from local governments. [ABSTRACT FROM AUTHOR]

Background: Although outdoor smoking bans at school are becoming important, it remains unclear whether successful implementation is feasible and what conditions promote it. Therefore, this study evaluates the implementation process by identifying important factors. Methods: Interviews were held with directors of 24 secondary schools that had decided to implement an outdoor school ground smoking ban, to identify important factors during implementation. Additionally, observations were made before and (about 4 weeks) after implementation to evaluate adherence to guidelines. Data were analyzed using a thematic approach. Results: During implementation, the following items were important--smoking ban (e.g., guidelines), school (e.g., policy, enforcement, environmental factors, resources, etc), and external factors (e.g., social environment). Four schools were unable to implement the ban, 20 schools implemented the ban but student adherence was low, and at 4 schools, staff members still smoked on school grounds. Conclusions: Although implementation is feasible, there are challenges. Schools need to apply a phased/dynamic process with ample lead time and clear communication of the policy. Directors should deal with offenders by strictly enforcing the ban and helping them stop smoking. This study offers information to help institutes implement an outdoor smoking ban to further protect adolescents from the harm of smoking.

Many children in the Netherlands do not adhere to dietary guidelines. Therefore, the Healthy School (HS) program stimulates healthier dietary intake of students through schools. However, evaluating the effectiveness of school health promotion in improving dietary intake is challenging due to the influence of contextual factors. Qualitative Comparative Analysis (QCA) considers these contextual factors. Therefore, we performed a QCA to examine which (combinations of) contextual factors contribute to the healthier dietary intake of students during school hours in primary schools (approximate age range children 4–12 years) and secondary schools (age range 12–18 years) when implementing the HS program for nutrition. Data were collected mainly through interviewing school staff and a school-level questionnaire in fifteen primary schools and twelve secondary schools. We included five factors for primary schools: implementation of the HS program for nutrition, degree of implementation, socioeconomic status, parental support, and student support. For secondary schools, we included school environment instead of parental and student support. For primary schools, the best results were obtained if the HS program for nutrition was implemented in high socioeconomic status schools with a combination of high implementation, parental support, and student support. Findings indicate that if secondary schools have an impeding environment and low socioeconomic status, implementation of the HS program for nutrition can result in healthier dietary intake. [ABSTRACT FROM AUTHOR]

Background: RealFit is a 13-week weight-reduction programme for adolescents. This study investigated the programme's long-term effectiveness regarding the psychological outcomes of self-esteem and food craving. Methods: The study had a quasi-experimental design. Body mass index, self-esteem and food craving were assessed at baseline (T[subscript 0]), immediately after RealFit (T[subscript 1]), and after five months (T[subscript 2]) and one year (T[subscript 3]) of follow-up. Control participants (n = 32) were overweight adolescents who received no treatment. Results: Comparison between the intervention (n = 86) and control groups showed a significant difference for the self-esteem domain of global self-worth (1.63; 95% confidence interval: 0.28 to 2.99) in favour of the intervention group. The differences regarding overall self-esteem and the physical appearance domain showed a trend towards improvement. No significant difference was found for food craving. Conclusions: Taking all results and limitations into account, it may cautiously be concluded that RealFit has beneficial long-term effects on some domains of self-esteem, but no substantial effect on food craving. The appropriate duration and delivery of cue-exposure sessions in groups of overweight adolescents to decrease food craving should be investigated to further improve the RealFit intervention.