Lasse Kannas

The importance of the social environment for physically active lifestyle — results from an international study

Physically active lifestyles are regularly associated with improved health and quality of life. Differences in lifestyles in society can partly be understood through the differences in the social and physical environment. This study examines the relationships between reported physical activity, and the extent of perceived support for physical activity in the physical and policy environment (e.g. facilities, programmes and other opportunities), and in the social environment. The data for the study come from a cross-cultural health policy study called MAREPS. In total, 3342 adults, 18 years or older, from six countries (Belgium, Finland, Germany, The Netherlands, Spain, Switzerland) were interviewed via telephone. Respondents were categorised as active or inactive according to self-reported physical activity. Social environmental factors and physical and policy environmental factors were also assessed. The analysis of the data was informed by social cognitive theory, although the study was not originally designed for this purpose. Sixty-eight percent of females and 70% of males were active. The proportions of active and inactive varied by countries to a great extent. The strongest independent predictor of being physically active was social environment. Those who perceived low social support from their personal environment (i.e. family, friends, school and workplace) were more than twice as likely to be sedentary compared to those who reported high social support from their personal environment. Specific knowledge of the programmes and actions for physical activity and sport was also a strong predictor of being active. A supportive physical and policy environment was not associated with participation in physical activity as strongly as had been anticipated. The variation between countries was stronger predictor of being active than the physical and policy environment variables. This study generates the hypotheses and raises the questions that in a preliminary way, there appears to be some relationships between aspects of physical and social environment and physical activity participation. However, future research is needed to refine and clarify this.

Self-reported physical activity, public health and perceived environment: results from a comparative European study.

STUDY OBJECTIVE The focus of physical activity promotion is moving from methods for increasing health enhancing physical activity on the individual level to higher level strategies including environmental and policy approaches. Scientific inquiry, traditionally related to individual-based strategies, requires adaptation and refinement when environmental and policy changes become more relevant. The objective of this study is to investigate the significance for behaviour and health of community-based environments that encourage physical activity. DESIGN AND SETTING The article presents data and results from a cross sectional comparative survey of the general population in six European countries (Belgium, Finland, Germany (East and West), Netherlands, Spain, Switzerland). Specifically, the relation between perceived community-based opportunities for physical activity, self reported physical activity, and self rated health status is investigated. PARTICIPANTS Representative samples of general populations (adults 18 years or older). Overall response rate: 53.5%. Sample sizes realised: Belgium: n = 389; Finland: n = 400; Germany (East): n = 913; Germany (West): n = 489; Netherlands: n = 366; Spain: n = 380; Switzerland: n =406. MAIN RESULTS Analyses show that best opportunities are reported by people who are lightly to moderately physically active. Peoples self rated health is moderately, but significantly associated with both perceived opportunities, and physical activity itself. These predictors interact in that especially for women, the health impact of physical activity is more pronounced in case of good opportunities. CONCLUSIONS The paper shows the potential of opportunities within residential and community environments with regard to physical activity, both for behaviour and health. Opportunities may enable the population, especially women, to develop an active lifestyle, and thus improve their health. Future studies with objective indicators for physical activity related environments should test the findings that are based on perceptions.

Oral Hygiene Habits of 11-year-old Schoolchildren in 22 European Countries and Canada in 1993/1994

This study is part of the Cross-National Survey on Health Behaviour in School-aged Children-a WHO Collaborative Study, which started in 1982. The aim of the study was to describe the oral hygiene habits (toothbrushing and flossing) of 11-year-old schoolchildren in 22 European countries (Austria, Belgium, the Czech Republic, Denmark, Estonia, Finland, France, Germany, Greenland, Hungary, Israel, Latvia, Lithuania, Northern Ireland, Norway, Poland, Russia, Scotland, the Slovak Republic, Spain, Sweden, and Wales) and Canada. The data were collected from standardized anonymous questionnaires in school classrooms during the 1993-1994 school year. At least 1300 schoolchildren, representing the whole country, participated in the study in each country. Oral hygiene habits were analyzed according to gender, age, country, school performance, and family economy. The children brushed most favorably in Sweden, Denmark, Germany, Austria, and Norway (83-73% brushed twice a day). More-than-once-a-day toothbrushing was especially uncommon (from 26 to 33%) among boys in Finland, Lithuania, Russia, Estonia, and Latvia. Toothbrushing frequency differed significantly according to school performance in Canada, the Czech Republic, Scotland, Poland, Northern Ireland, and Wales and between different socio-economic groups in Northern Ireland, Wales, the Czech Republic, Scotland, Poland, and Russia. Use of dental floss was rare. In general, flossing was less frequent among boys than among girls. Daily flossing was most common among Canadian adolescents (25%). In conclusion, there are considerable differences in toothbrushing frequency among children in European countries.

Perceived tiredness among adolescents and its association with sleep habits and use of psychoactive substances.

This study investigated the variation in perceived tiredness among 11, 13 and 15‐year‐old Finnish adolescents (n=4187). Additionally interrelationships between sleep habits, use of psychoactive substances (alcohol, tobacco and coffee) and perceived tiredness among 15‐year‐olds were examined. This study is part of an international, WHO‐coordinated survey of school childrens health and lifestyle (the HBSC Study). In Finland, research data represented the whole country. The data were collected in March–May 1994. Pupils responded anonymously to a standardized questionnaire during a class period. Subjective tiredness was very common and increased with age among adolescents. Perceived tiredness on at least four school mornings a week increased from 24 to 35% among boys and from 16 to 34% among girls. Feeling tired more often than once a week increased from 20 to 37% in girls and from 24 to 50% in boys. Structural equation models showed that interrelationships between three factors – sleep habits, use of psychoactive substances and perceived tiredness – were statistically significant. For these three factors the two remaining factors explained 24% of the variance of perceived tiredness among boys and 20% among girls, and the two remaining factors explained 42% (16%) of the variation in sleep habits. For the variance of the use of psychoactive substances sleep habits and perceived tiredness explained 26% (12%). Subjective tiredness is strongly age related; this together with the use of psychoactive substances and sleep habits regulate adolescents’ daily life and well‐being.

Test-retest reliability of selected items of Health Behaviour in School-aged Children (HBSC) survey questionnaire in Beijing, China

BackgroundChildrens health and health behaviour are essential for their development and it is important to obtain abundant and accurate information to understand young peoples health and health behaviour. The Health Behaviour in School-aged Children (HBSC) study is among the first large-scale international surveys on adolescent health through self-report questionnaires. So far, more than 40 countries in Europe and North America have been involved in the HBSC study. The purpose of this study is to assess the test-retest reliability of selected items in the Chinese version of the HBSC survey questionnaire in a sample of adolescents in Beijing, China.MethodsA sample of 95 male and female students aged 11 or 15 years old participated in a test and retest with a three weeks interval. Student Identity numbers of respondents were utilized to permit matching of test-retest questionnaires. 23 items concerning physical activity, sedentary behaviour, sleep and substance use were evaluated by using the percentage of response shifts and the single measure Intraclass Correlation Coefficients (ICC) with 95% confidence interval (CI) for all respondents and stratified by gender and age. Items on substance use were only evaluated for school children aged 15 years old.ResultsThe percentage of no response shift between test and retest varied from 32% for the item on computer use at weekends to 92% for the three items on smoking. Of all the 23 items evaluated, 6 items (26%) showed a moderate reliability, 12 items (52%) displayed a substantial reliability and 4 items (17%) indicated almost perfect reliability. No gender and age group difference of the test-retest reliability was found except for a few items on sedentary behaviour.ConclusionsThe overall findings of this study suggest that most selected indicators in the HBSC survey questionnaire have satisfactory test-retest reliability for the students in Beijing. Further test-retest studies in a large and diverse sample, as well as validity studies, should be considered for the future Chinese HBSC study.

Health promotion profile of youth sports clubs in Finland: club officials' and coaches' perceptions.

SUMMARY The purpose of this article is to examine the current health promotion orientation of youth sports clubs in Finland in view of the standards created previously for the health promoting sports club (HPSC). Ninety-seven youth sports clubs participated, and 273 sports club officials and 240 coaches answered the questionnaires. To describe clubs health promotion orientations, an HPSC index was created. The HPSC index was formulated on sub-indices by factor analysis. The sub-indices were: policy, ideology, practice and environment indexes. The results indicate that youth sports clubs are fairly health promoting in general. On average, the clubs fulfilled 12 standards for HPSC out of 22. Every fourth club was categorized as higher health promoting (≥ 15 fulfilled standards), and every third as lower health promoting (<11 fulfilled standards). The variation between clubs was wide. The clubs that had been recognized as exemplary and hence certified by the Young Finland Association were more likely to recognize health promotion than non-certified clubs (OR = 2.36, p = 0.016). The sports club officials were twice as likely to evaluate their clubs as higher health promoting than the coaches (OR = 2.04, p = 0.041). Under the sub-indices, ideologies were recognized best, others less. These findings indicate that minority of the youth sports clubs have realized health promotion comprehensively as a part of their activities. There is a lot of need for development, especially in the area of health promotion policies and practices. The instruments used proved valid and reliable and can therefore be recommended for international use.

A review of settings-based health promotion with applications to sports clubs.

Sports clubs have a long and traditional history in many countries, yet they remain underdeveloped and underutilized settings for health promotion. Leisure time settings, in general, have been in minor role among settings-based health promotion initiatives. Current health concerns in western countries, such as sedentary lifestyles and obesity, have aroused a need to expand health promotion to include also settings with greater potential to reach and engage children and adolescents in more vigorous activity. To develop these alternative, most often non-institutional, settings to the level of the established ones, it is important to review what has been done, what has been accepted and what is known from research, theory and practice to have contributed to health. Given that settings approaches have been implemented with diverse scope and without close cooperation between different initiatives, the first aim of this paper is, on the basis of a review of commonly used theories and practices, to propose a mutual definition for the settings approach to health promotion. The second is to examine the applicability of the theoretical basis to youth sports club settings. Sports clubs are used as a reflective setting when reviewing the traditional ones.

How Comprehensive School Students Perceive their Psychosocial School Environment

The aim of this study was to describe students’ perceptions of their psychosocial school environment and to examine the associations between such perceptions and students’ perceived school performance. Our analyses were based on data from the Health Behaviour in School‐Aged Children 2006 study, involving responses by Finnish students from grades 7 and 9. The results indicated that students’ perceptions of their school environment were fairly positive, but that a remarkably large proportion of the students reported negative attitudes towards school. School engagement, school strain, and teacher‐student relations were found to be the most influential predictors in the psychosocial school environment regarding perceived school performance; as were the grade and educational aspirations out of the selected background factors. The findings imply that despite good academic achievement in Finnish comprehensive schools, there is still a need to improve students’ school engagement and their satisfaction with school.

Determinants of health policy impact: a theoretical framework for policy analysis.

SummaryThis paper addresses the role of policy and evidence in health promotion. The concept of von Wright’s “logic of events” is introduced and applied to health policy impact analysis.According to von Wright (1976), human action can be explained by a restricted number of determinants: wants, abilities, duties, and opportunities. The dynamics of action result from changes in opportunities (logic of events). Applied to the policymaking process, the present model explains personal wants as subordinated to political goals. Abilities of individual policy makers are part of organisational resources. Also, personal duties are subordinated to institutional obligations. Opportunities are mainly related to political context and public support. The present analysis suggests that policy determinants such as concrete goals, sufficient resources and public support may be crucial for achieving an intended behaviour change on the population level, while other policy determinants, e.g., personal commitment and organisational capacities, may especially relate to the policy implementation process. The paper concludes by indicating ways in which future research using this theoretical framework might contribute to health promotion practice for improved health outcomes across populations.

Measuring child and adolescent health literacy: a systematic review of literature

Purpose – A systematic review of literature was conducted to compile, analyse and describe the methodology and measurement of childhood/adolescent health literacy.Design/methodology/approach – Six online databases (ERIC, PubMed, CINAHL, Biomed Central, Web of Science and Sports Discuss) were systematically searched to identify English language, peer‐reviewed articles, published between 1980 and April 2011, which reported on the measurement of health literacy in a population under the age of 18. The search identified 16 articles to be included in the final review, from which, data were systematically extracted in order to answer four review questions concerning several aspects of the method and effectiveness of the completed studies.Findings – The majority (n=13) of the studies described the use of newly developed measurement tools and enquiry methods. The majority (n=14) assessed health literacy via task performance as opposed to examining self‐reported health literacy. Thirteen health topics and nine dis...