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BACKGROUND School environments providing a wide selection of physical activities and sufficient facilities are both essential and formative to ensure young people adopt active lifestyles. We describe the association between school opportunities for physical activity and socioeconomic factors measured by low-income cutoff index, school size (number of students), and neighborhood population density. METHODS A cross-sectional survey using a 2-stage stratified sampling method built a representative sample of 143 French-speaking public schools in Quebec, Canada. Self-administered questionnaires collected data describing the physical activities offered and schools' sports facilities. Descriptive and bivariate analyses were performed separately for primary and secondary schools. RESULTS In primary schools, school size was positively associated with more intramural and extracurricular activities, more diverse interior facilities, and activities promoting active transportation. Low-income primary schools were more likely to offer a single gym. Low-income secondary schools offered lower diversity of intramural activities and fewer exterior sporting facilities. High-income secondary schools with a large school size provided a greater number of opportunities, larger infrastructures, and a wider selection of physical activities than smaller low-income schools. CONCLUSIONS Results reveal an overall positive association between school availability of physical and sport activity and socioeconomic factors.

The purpose of the research was to explore the associations between the characteristics of schools’ vicinity and the risk of sugar sweetened beverage (SSB) consumption in elementary students. Findings exposed an important variation in student’s SSB consumption between schools. Schools with a lower socioeconomic status or in a densely built environment tend to have higher proportion of regular SSB drinkers. These characteristics of the school’s vicinity partly explained the variation observed between them. We estimated that a student moving to a school with a higher proportion of SSB drinkers may increase his/her chances by 52% of becoming a daily consumer. Important changes in dietary preferences can occur when children are in contact with a new social environment. Findings also support the idea that dietary behaviors among children result from the complex interactions between biological, social, and environmental factors.

ObjectiveA school environment that encourages students to opt for food with sound nutritional value is both essential and formative in ensuring that young people adopt healthy eating habits. The present study explored the associations between the socio-economic characteristics of the school environment and the school food environment.DesignA cross-sectional survey was conducted in 2008–2009. Descriptive and bivariate analyses were performed on data from public primary and secondary schools.SettingQuebec, Canada. The school food offering was observed directly and systematically by trained research assistants. Interviews were conducted to fully describe food offerings in the schools and schools’ child-care services.SubjectsA two-stage stratified sampling was used to build a representative sample of 143 French-speaking public schools. The response rate was 66·2 %.ResultsThe primary and secondary schools in low-density areas were more likely to be located near diners (primary:P=0·018; secondary:P=0·007). The secondary schools in deprived areas were less likely to have a regular food committee (P=0·004), to seek student input on menu choices (P=0·001) or to have a long lunch period (P=0·010). The primary schools in deprived areas were less likely to have a food service (P=0·025) and their meal periods were shorter (P=0·033).ConclusionsThe schools in areas with lower socio-economic status provided an environment less favourable for a healthy diet. From a public health perspective, the results of this analysis could assist policy makers and managers to identify actions to support the creation of favourable school environments.

Food insecurity is steadily increasing in developed countries. Traditional interventions adopted to tackle food insecurity, like food banks, address the urgent need for food. By contrast, alternative interventions, such as community gardens and kitchens, are oriented towards social integration and the development of mutual aid networks. The objective of this paper is to examine whether the populations served by traditional and alternative interventions in food security differ according to measures of vulnerability. We studied newly registered participants to food security interventions. Participants were selected from a random sample of food security community organizations in a two-stage cluster sampling frame. The categorizing variable was participation in a community organization providing either traditional interventions or alternative interventions. Seven measures of vulnerability were used: food security; perceived health; civic participation; perceived social support of the primary network, social isolation, income and education. Regression multilevel models were used to assess associations. 711 participants in traditional interventions and 113 in alternative interventions were enrolled in the study. Between group differences were found with respect to food insecurity, health status perception, civic participation, education and income, but not with respect to social isolation or perceived social support from primary social network. Traditional and alternative food security interventions seem to reach different populations. Participants in traditional interventions were found to have less access to resources, compared to those in alternative interventions. Thus, new participants in traditional interventions may have higher levers of vulnerability than those in alternative interventions.

Objective To describe how and why nutritionists implement and strategize particular program operations across school contexts. Design Instrumental case study with empirical propositions from Actor-Network Theory (ANT). Data derived from interviews with interventionists and observations of their practices. Setting Seven primary schools from disadvantaged Montreal neighborhoods. Participants Six nutritionists implementing the nutrition intervention in grades 4 and 5. From 133 nutrition workshops held in 2005/06, 31 workshops were observed with audio-recordings. Intervention(s) Little Cooks – Parental Networks aims to promote healthy eating behaviors through engagement in food preparation and promotion of nutrition knowledge. Phenomenon of interest The program-context interface where interventionists’ practices form interactively within a given social context. Analysis Coding inspired by ANT. Interview analysis involved construction of collective implementation strategies. Observations and audio-recordings were used to qualify and quantify nutritionists’ practices against variations in implementation. Results Nutritionists privileged intervention strategies according to particularities of the setting. Some such variation was accounted for by school-level social conditions, individual preferences and nutritionists’ past experiences. Conclusions and implications Implementation practices are strategic and aim to engage educational actors to achieve intervention goals. These results challenge implementation frameworks centered on purely technical considerations that exclude the social and interpretive nature of practice.

This narrative systematic review explored (1) how neighbourhood interventions promote positive youth development (PYD) and (2) the role of context for these interventions. We asked: How do neighbourhood interventions become effective in promoting PYD for adolescents aged 12–18 years? Articles (n = 19) were analyzed using a framework integrating standards of health promotion evaluation and elements of the ecological systems perspective. First, results highlight the key characteristics of interventions that promote PYD. An intervention’s atmosphere encouraging supportive relationships and an intervention’s activities aiming to build skills and that are real and challenging promoted PYD elements including cognitive competences, confidence, connection, leadership, civic engagement, and feelings of empowerment. Secondly, this review identified facilitators (e.g. partnerships and understanding of the community) and constraints (e.g. funding and conflicts) to an intervention’s integration within its context. Results regarding interventions’ characteristics promoting PYD confirm findings from past reviews. Our findings indicate that context is an important element of effective interventions. This review encourages future evaluations to analyze the role of context to build a better understanding of its role.

Objectifs : Cette etude vise a produire une evaluation intermediaire des effets de l'intervention nutritionnelle « Petits cuistots - parents en reseaux »; elle est fondee sur un ensemble de mesures des effets du programme, dont 1) les connaissances, les attitudes, les habiletes et l'experience a l'egard de la nutrition, de l'alimentation et de l'art culinaire chez les enfants et 2) la participation parentale et/ou familiale a l'ecole. Participants: Un total de 388 eleves de 5 e annee (participants) et de 6 e annee (non-participants). Lieu: L'evaluation du programme nutritionnel a eu lieu dans les sept ecoles primaires participantes. Les ecoles etaient toutes situees dans des quartiers defavorises de Montreal. Intervention: Le volet « Petits cuistots » est un atelier nutritionnel anime par des dieteticiennes communautaires. Chacun des huit ateliers annuels presente un aliment particulier et un theme nutritionnel avec une recette pour faire l'experience de cuisiner et de deguster ensemble. Les enseignantes participent a l'atelier et assurent la gestion de la classe et le soutien au programme. Le volet « Parents en reseaux » invite les parents a assister aux ateliers nutritionnels et offre des activites parentales et familiales additionnelles liees aux themes des ateliers nutritionnels (p. ex., repas collectifs ou visites chez des producteurs agricoles locaux). Resultats: Le programme a eu certains effets sur la connaissance de la valeur nutritive, de la production et de la transformation des aliments; sur l'attitude et l'experience quant au fait de gouter des aliments nouveaux ou moins connus; et sur la perception de la capacite a cuisiner. Les familles dont les enfants ont participe au programme ont eu un niveau de participation plus eleve aux activites scolaires que les familles des eleves qui n'ont pas participe au programme. Conclusions: Notre evaluation montre certains effets potentiels du programme sur diverses mesures intermediaires des effets et met ainsi en evidence une intervention prometteuse en vue de promouvoir les capacites nutritionnelles.

AIM: To show that schools achieving higher examination pass and lower truancy rates than expected, given that their pupil populations (high value-added schools) are associated with a lower incidence of smoking among pupils (13-14 years). DESIGN: Value-added scores for schools were derived from standardized residuals of two regression equations predicting separately the proportion of pupils passing high school diplomas and the half-days lost to truancy from the socio-economic and ethnic profiles of pupils. The risk of regular smoking at 1- and 2-year follow-up was examined in relation to the value-added score in a cohort of 8352 UK pupils. Random-effects logistic regression was used to adjust for baseline smoking status and other adolescent smoking risk factors. SETTING: A total of 52 schools, West Midlands, UK. PARTICIPANTS: Year 9 pupils aged 13-14 years (n = 8352) were followed-up after 1 year (n = 7444; 89.1% of original cohort) and 2 years (n = 6819; 84.6% of original cohort excluding pupils from two schools that dropped out). MEASUREMENTS: Regular smoking (at least one cigarette per week). FINDINGS: Schools with high value-added scores occurred throughout the socio-demographic spectrum. The odds ratio (95% confidence interval) for regular smoking for a 1 standard deviation increase in the value-added measure was 0.85 (0.73-0.99) at 1-year and 0.80 (0.71-0.91) at 2-year follow-ups. Baseline smoking status did not moderate this. CONCLUSIONS: Schools with high value-added scores are associated with lower incidence of smoking. Some schools appear to break the strong link between deprivation and smoking. Understanding the mechanisms could be of great public health significance.

ObjectivesTo describe patterns of dietary behaviours specific to low quality snacking, fruit and vegetable, and fast food consumption during the transition from childhood to adolescence and to examine how these behaviours are associated with tendencies towards dietary restraint and the occurrence of overweight and obesity in mid-adolescence.DesignA 5-year follow-up of self-reported eating. Hierarchical linear modelling was utilised to explore the relationship between dietary changes and body mass index (BMI) and dietary restraint while controlling for physical activity and smoking.SettingThe sample was derived from students participating in the Quebec Heart Health Demonstration Project, and represents rural, suburban and inner city youths.SubjectsA sample of 561 girls and 627 boys in the fourth, sixth, seventh and ninth grades.ResultsOverall the sample was characterised by a decrease in fruit and vegetable consumption and increase in low quality snacking, and a decrease in fast food consumption over the 5-year follow-up. Dietary restraint and BMI were found to be associated with dietary behaviour. Lower than average dietary restraint was associated with a lower frequency of fast food consumption and greater increase in low quality snacking over the 5-year period. Higher than average dietary restraint was associated with lesser frequency of low quality snacking at baseline. Having a BMI in the obese range was associated with more frequent fast food consumption in the fourth grade and a more rapid drop in fast food consumption across the 5-year period.ConclusionsDietary behaviours are associated with the psychological construct dietary restraint and with weight status in this population of adolescents.

Objective: To determine whether value-added education is associated with lower risk of substance use among adolescents: early initiation of alcohol use (regular monthly alcohol consumption in grade 7), heavy alcohol use (>10 units per week) and regular illicit drug use. Design: Cross-sectional self-reported survey of alcohol and drug use. Analysis used two-level logistic modelling to relate schools providing value-added education with pupils’ substance use. The value-added education measure was derived from educational and parenting theories proposing that schools providing appropriate support and control enhance pupil functioning. It was operationalised by comparing observed and expected examination success and truancy rates among schools. Expected examination success and truancy rates were based on schools’ sociodemographic profiles. Participants: Data were collected across 15 West Midlands English school districts and included 25 789 pupils in grades 7, 9 and 11 from 166 UK secondary schools. Results: Value-added education was associated with reduced risk of early alcohol initiation (OR (95% CI) 0.87 (0.78 to 0.95)) heavy alcohol consumption (OR 0.91 (0.85 to 0.96)) and illicit drug use (OR 0.90 (0.82 to 0.98)) after adjusting for gender, grade, ethnicity, housing tenure, eligibility for free school meal, drinking with parents and neighbourhood deprivation. Conclusions: The prevalence of substance use in school is influenced by the school culture. Understanding the mechanism through which the school can add value to the educational experience of pupils may lead to effective prevention programmes.

Food insecurity is steadily increasing in Canada. The objective of this paper is to determine if food capacities and satisfaction of recently enrolled participants in food security interventions are associated with the intervention having either a traditional or an alternative type of approach. Participants having recently accessed traditional (n = 711) or alternative community interventions (n = 113) in the Montreal metropolitan area, Canada, were interviewed with a questionnaire. The categorizing variable was participation in a community organization providing either traditional interventions, aimed to help people cope with the urgent need of food, or alternative interventions, aimed at first assistance, in addition to the creation of long-term solutions such as social integration and skills development. Participants' food and nutrition-related capacities and food satisfaction are studied. Multilevel regression models were used to assess whether participants took part in a traditional or alternative interventions. These interventions do not reach the same population. Relative to participants in alternative food security interventions, participants in traditional interventions demonstrated less capacity for accessing information about food safety and healthiness, and perceived their diet as less healthy. Traditional food security participants also paid less attention to the nutritional properties of food and reported less satisfaction with quantity, variety and taste of the food they accessed. The reasons why individuals who may benefit the most from alternative interventions were unlikely to participate should be investigated. The potential that food security interventions may inadvertently reinforce social inequalities in health should be considered in future intervention research.

Background Despite the effects of food insecurity on health are well documented, clear governmental policies to face food insecurity do not exist in western countries. In Canada, interventions to face food insecurity are developed at the community level and can be categorized into two basic strategies: those providing an immediate response to the need for food, defined “traditional” and those targeting the improvement of participants’ social cohesion, capabilities and management of their own nutrition, defined “alternative”. Objective The objective of this study was to evaluate the effects of food insecurity interventions on food security status and perceived health of participants. Design This was a longitudinal multilevel study implemented in Montreal, Quebec, Canada. Participants were recruited in a two-stage cluster sampling frame. Clustering units were community organizations working on food insecurity; units of analysis were participants in community food security interventions. A total of 450 participants were interviewed at the beginning and after 9 months of participation in traditional or alternative food security interventions. Food security and perceived health were investigated as dependent variables. Differences overtime were assessed through multilevel regression models. Results Participants in traditional interventions lowered their food insecurity at follow-up. Decreases among participants in alternative interventions were not statistically significant. Participants in traditional interventions also improved physical (B coefficient 3.00, CI 95% 0.42–5.59) and mental health (B coefficient 6.25, CI 95% 4.15–8.35). Conclusions Our results challenge the widely held view suggesting the ineffectiveness of traditional interventions in the short term. Although effects may be intervention-dependent, food banks decreased food insecurity and, in so doing, positively affected perceived health. Although study findings demonstrate that food banks offer short term reprise from the effects of food insecurity, the question as to whether food banks are the most appropriate solution to food insecurity still needs to be addressed.

This work presents a theoretical framework in which health promotion and health education program implementation can be conceived as an open dynamic system. By tracing the evolution of an elementary school-based nutrition program from its conception to its recent form, we construct a program genealogy. Data were derived from two interviews and three historical documents from which historical events were identified and reconstructed in the form of a tree analogy. Data analysis ensued using concepts from the actor-network theory about social innovation. These concepts identified social and technical program attributes and situated them within a process which evolved over time, thus permitting the program's genealogy to appear. The genealogy was found to be influenced by the ways in which the involved actors interpreted the issue of food security, namely, as a professional issue, with a nutrition education response and as a social issue, with a community-building response. The interaction between the interests of the actors and the technical components of the program resulted in three temporal program iterations. The results highlight the important role played by the involved actors during program implementation and suggest the need to take these interests into consideration during all phases of program planning.

ObjectiveReported associations between socioeconomic status (SES) and obesity are inconsistent depending on gender and geographic location. Globally, these inconsistent observations may hide a variation in the contextual effect on individuals' risk of obesity for subgroups of the population. This study explored the regional variability in the association between SES and BMI in the USA and in Canada, and describes the geographical variance patterns by SES category.MethodsThe 2009-2010 samples of the Behavioral Risk Factor Surveillance System (BRFSS) and the Canadian Community Health Survey (CCHS) were used for this comparison study. Three-level random intercept and differential variance multilevel models were built separately for women and men to assess region-specific BMI by SES category and their variance bounds.ResultsAssociations between individual SES and BMI differed importantly by gender and countries. At the regional-level, the mean BMI variation was significantly different between SES categories in the USA, but not in Canada. In the USA, whereas the county-specific mean BMI of higher SES individuals remained close to the mean, its variation grown as SES decreased. At the county level, variation of mean BMI around the regional mean was 5 kg/m2 in the high SES group, and reached 8.8 kg/m2 in the low SES group.ConclusionsThis study underlines how BMI varies by country, region, gender and SES. Lower socioeconomic groups within some regions show a much higher variation in BMI than in other regions. Above the BMI regional mean, important variation patterns of BMI by SES and place of residence were found in the USA. No such pattern was found in Canada. This study suggests that a change in the mean does not necessarily reflect the change in the variance. Analyzing the variance by SES may be a good way to detect subtle influences of social forces underlying social inequalities.

Objectives To examine the independent influence of school economic deprivation, social fragmentation, and social cohesion on the likelihood of participating in no physical activity among students. Methods Data are from a large-scale longitudinal study of schools based in disadvantaged communities in Quebec, Canada. Questionnaires were administered every year between 2002 and 2008 among n = 14,924 students aged 12 to 18 from a sample of 70 schools. Cross-sectional and longitudinal analyses were conducted. Multilevel modeling was utilized to account for the clustering of students within schools. Schools were categorized as being low, moderate or high economic deprivation, social fragmentation and social cohesion. Those who indicated that they do no participate in any physical activity during the week were identified as being physically inactive. Results In baseline multilevel cross-sectional analyses, adolescents attending schools in the highest (compared to the lowest) levels of socioeconomic deprivation and social fragmentation were more likely to be physically inactive (OR = 1.33, 95% CI = 1.03, 1.72; and OR = 1.24, 95% CI = 0.98, 1.56, respectively). Conversely, students attending schools with the highest cohesion were less likely to be physically inactive (OR = 0.78, 95% CI = 0.61, 0.99). In longitudinal analysis, physically active students who attended schools with the highest social fragmentation were more likely to become physically inactive over two years (OR = 1.65, 95% CI = 1.09, 2.51). Conclusion The school socioeconomic environment appears to be an important contextual influence on participation in no physical activity among adolescents. Following adolescents beyond two years is necessary to determine if these environments have a lasting effect on physical activity behavior.

Research on adolescent well-being has shown that students with depression have an increased risk of facing academic failure, yet few studies have looked at the implications of adolescent depression in the process of school dropout. This study examined mediation processes linking depression symptoms, self-perceived academic competence, and self-reported achievement in 7th grade to dropping out of school in later adolescence. We followed 493 (228 girls and 265 boys) French-speaking adolescents from low-socioeconomic-status secondary schools in Montreal (Quebec, Canada) for 6 years. Almost 34% of participants dropped out of school during this period. Findings indicated that self-reported depression symptoms in 7th grade increased the risk of dropping out of school in later adolescence. Structural equation modeling revealed that the predictive relationship between depression symptoms and school dropout was mediated by self-perceptions of academic competence. Current findings provide support for self-perceptions of competence as mediational processes in the relationship between adolescent depression symptoms and early school leaving.

Describing pathways of school graduation and dropout in Canada is no simple task. Canada is a confederation of ten provinces and three territories, each responsible for their educational structure and curriculum, from pre-school to post-secondary education, including technical and vocational education. There is no federal ­ministry of education, nor are there national standards for graduation qualifications, making it difficult to describe the educational system in Canada. Each province and ­territory is characterised by a unique geopolitical, socio-demographic, cultural, historical, linguistic, migration, labour and economic profile. Over time, these unique ­patterns have been incorporated into the structure, curriculum, assessment and accountability policies across educational jurisdictions (Council of Ministers of Education Canada [CMEC], 2008).

It has been acknowledged for several decades that programs interact with context. The nature of this interactivity, and how it defines a program, has not been adequately addressed. We view this lacuna as a function of the dominant theoretical perspectives guiding knowledge of program operations. We propose the actor-network theory (ANT) and its conceptual apparatus, the sociotechnical network, as suitable for guiding the acquisition of general knowledge on program operations. We tested this proposition with an instrumental case study of health professional practices during the implementation of a nutrition program into an elementary school setting. Data collection and analysis were guided by the ANT. Data were derived from semistructured interviews completed with six health professionals (nutritionists). Analysis procedures focused on the nutritionists' collective representation of the microprocesses by which they aimed to build a sociotechnical network of alliances with educational stakeholders. Findings identified nutritionists as preoccupied with three overarching goals during the implementation of the nutrition program, whereby goals were found to take form interactively with the interests of the program participants (primarily students) and stakeholders (primarily teachers). Nutritionists strategically translated program components as a means of negotiating with participants and stakeholders. The findings of this study support the theoretical proposition that program implementation is a process of expanding a sociotechnical network. Beyond simply reaffirming that programs do indeed adapt to context, we interpret this adaptation through the lens of a social theory that suggests why and how adaptation is an inevitable component of program implementation. Refereed/Peer-reviewed

There is much more to evaluation than collecting, analyzing, and interpreting scientific data in order to compare the outcomes of vious treatments. For the past 40 years, method-related discussions in the field of program evaluation have evolved to include models and reflections on the complex and multiple roles associated with the practice of evaluation. In fact, for Shadish, Cook, & Leviton, (1991), the knowledge basis which pertains to the practice of evaluation must consider issues related to the evaluator’s roles as well as to the design of evaluation. Thus, evaluation practice requires both the methodological and technical competencies for systematic inquiry, in addition to a whole set of interpersonal and negotiation skills, identified by Brown (1995) as ranging from pedagogical to political. Conceiving evaluation as a practice, as we do in this collection of essays, is based upon the premise that evaluators are more than good and rigorous scientists, implementing empirical inquiry devices to study programs and interventions. While there is clearly more to the evaluator’s role than data-related activities, how do these two aspects of practice which are inherently part of program evaluation, come together and build knowledge of evaluation practice? To address this question, we propose revisiting the teleological, epistemological and ontological foundations upon which evaluation roles are defined. Consistent with the orientation of this book, we define evaluators’ roles vis-avis a program as framed by one’s evaluation practice. We suggest that evaluation practice does not however simply represent a repertoire of roles from which the evaluator may (more or less) arbitrarily choose from in order to define themselves and their evaluation activities (i.e. their methodological tool kit). In this chapter we argue that the evaluator’s role vis-a-vis programs stakeholders and the approach taken to identify, describe, and measure a program and its effects, form an evaluator’s practice, which is consistent and coherent across the contexts of their work. We will also argue that a practice, like a paradigm, constitutes an organized rationality (Crozier & Friedberg, 1977) common to groups of individuals that allow

The Kahnawake Schools Diabetes Prevention Project (KSDPP) is an ongoing participatory research and intervention project aimed at the primary prevention of type 2 diabetes. Formally initiated in 1994 with strong community support, KSDPP provides a fertile opportunity to learn about how a community came to identify the need for preventive action on a health problem such as diabetes. The purpose of our study was to describe the various conditions in the community of Kahnawake, which gave rise to its mobilization for the prevention of type 2 diabetes. Qualitative data consisted of 12 individual interviews and one focus group with key community members and health professionals living and/or working in the community of Kahnawake, along with historically relevant documents. The data collection and analysis procedures of the grounded theory method were applied. Results describe a preceding phase to formal KSDPP implementation, triggered by returning research results on the community prevalence of type 2 diabetes. This phase of 'legitimizing diabetes as a community health issue' is characterized by a shift in the perceived preventability of diabetes among community members; from a problem that was to be lived with to a problem that was to be prevented. The shift in perceptions was facilitated by the context in the community, described by structural developments, cognitive and relational elements. In addition to reaffirming the critical importance of utilizing lay knowledge during the planning of a health promotion intervention, our study has uncovered some of the key conditions through which individuals in the community came to participate in the identification and planning of a diabetes prevention project.