Vesa Saaristo

From childhood socio-economic position to adult educational level – do health behaviours in adolescence matter? A longitudinal study

BackgroundOur interest was in how health behaviours in early and late adolescence are related to educational level in adulthood. The main focus was in the interplay between school career and health behaviours in adolescence. Our conceptual model included school career and health-compromising (HCB) and health-enhancing (HEB) behaviours as well as family background. Two hypotheses were tested: 1) the primary role of school career in shaping educational level in adulthood (an unsuccessful school career in adolescence leads to HCB and not adopting HEB and to low educational level in adulthood); 2) the primary role of health behaviours (HCB and not adopting HEB in adolescence leads to a school career with low education in adulthood).MethodsMailed surveys to 12 to18 year-old Finns in 1981–1991 (N=15,167, response rate 82%) were individually linked with the Register of Completed Education and Degrees (28 to 32-year-olds). We applied structural equation modeling to study relations of latent variables (family SEP, family structure, school career, HCB, HEB) in adolescence, to the educational level in adulthood.ResultsStandardized regression coefficients between school career and health behaviours were equally strong whether the direction was from school career to HEB (0.21-0.28 for 12–14 years; 0.38-0.40 for 16–18 years) or from HEB to school career (0.21-0.22; 0.28-0.29); and correspondingly from school career to HCB (0.23-0.31; 0.31-0.32) or from HCB to school career (0.20-0.24; 0.22-0.22). The effect of family background on adult level of education operated mainly through school career. Only a weak pathway which did not go through school career was observed from behaviours to adult education.ConclusionsBoth hypotheses fitted the data showing a strong mutual interaction of school achievement and adoption of HCB and HEB in early and late adolescence. Both hypotheses acknowledged the crucial role of family background. The pathway from health behaviours in adolescence to adult education runs through school career. The interplay between behaviours and educational pathways in adolescence is suggested as one of the mechanisms leading to health inequalities in adulthood.

Quality of the contraceptive service structure: a pilot study in Finnish health centre organisations.

Objectives To evaluate the quality of the contraceptive service structure in health centre organisations (HCOs) in western Finland and to establish whether the characteristics of the HCOs are associated with the quality measured. Methods Survey data were collected from all HCOs in a university hospital area in western Finland (N = 63). Quality was evaluated using a score of ten indicators. Associations between the score and the characteristics of the HCOs were studied using rank correlation analysis and a multivariate ordered logit model. Results Among 51 HCOs yielding complete data for the evaluation, the quality score ranged from 3 to 10, the mean being 5.8. From 25 variables studied, ‘a chief nursing officer or leading nurse engaged in the HCO’ (p = 0.001) and ‘an appointed person responsible for management of health promotion’ (p = 0.006) were found to be associated with a good score in the rank correlation analysis, and they also remained significant in multivariate analysis (Odds Ratio [OR] = 11.5, 95% confidence interval [CI] 2.3–56.5 and OR = 5.9, 95% CI 1.6–21.5, respectively). Conclusions In the majority of the HCOs involved, the quality of service structure was rated average, but there was much variation between the HCOs. The results of the multivariate analysis emphasise the importance of good management of services.

Tobacco Use Documenting Policy and Its Association With Pupils’ Smoking and Their Perception of the Enforcement of School Smoking Bans in Finland

Finnish national data sets on schools (N = 496) and pupils (N = 74,143; 14–16 years) were used to study whether a systematic documenting policy for the violations of school smoking bans was associated with pupils’ smoking and their perceptions on the enforcement of smoking bans. Attending a school with a systematic documenting policy was associated with perceptions that smoking is prohibited and restrictions monitored, with lower levels of smoking in the vicinity of the school during the school day, but not with smoking prevalence. Findings suggest that a consistent documenting policy could be an effective tool for reducing pupils’ smoking in schools.

Access to a school health nurse and adolescent health needs in the universal school health service in Finland

Universal school health services are expected to offer similar, needs‐based services to all students across schools, service providers and students’ socio‐economic statuses and health needs. This study investigates access to school health nurses in Finland. The objectives were to study the differences in access to school health nurse between service providers, schools, students’ characteristics and school health nurse resources. Access was examined through a nationwide School Health Promotion study, which is a self‐reporting, voluntary and anonymous survey for 8th and 9th graders (15 to 16‐year old, N = 71865). The ethical committee of the National Institute for Health and Welfare has approved procedure for the School Health Promotion study. Data on school health nurse resources and service providers were obtained from the national database (534 schools; 144 service providers). Multilevel logistic regression was used. Of the pupils, 15% of girls and 11% of boys reported difficult access to a school health nurse. The number of adolescents who reported difficult access ranged between service providers (0%–41%) and schools (0%–75%). Students with lower socio‐economic background, poorer well‐being at school, lack of support for studying and greater health needs reported difficult access more often. School health nurse resources were associated with difficult access only among boys, when resources were under the national recommendations. These findings raise concern about equality and unmet health needs in school health services.

The comparative and objective measurement of health promotion capacity-building: from conceptual framework to operationalization:

The aim of this study was to analyse and test a theoretical generic health promotion capacity-building framework with empirical data on primary health care. The framework consists of seven dimensions: commitment, management, monitoring and needs assessment, resources, common practices, participation and other core functions. The data were collected in 2014 from all the health centres in Finland, of which 156 (99%) submitted their data. The data were scored by the quality of activities on a scale from 0 to 100, where 100 stands for desirable quality. Individual indicators were nested into subdimensions, which in turn were nested into the dimensions of the theoretical framework. Variables were clustered using the dimensions and subdimensions as initial partitions. The internal consistency of dimensions and subdimensions was tested with standardized Cronbach’s alpha both before and after the clustering analysis. The results showed that although the internal consistency of the dimensions was high in the initial classification, it is possible to get even more consistent dimensions. The internal consistency of the initial classification varied from 0.62 in participation to 0.93 in common practices. In the clustering analysis, 45 out of 203 indicators were assigned to a dimension different from the initial partition. The biggest gain in internal consistency was achieved in the subdimension of systematic mass communications by relocating two indicators. This study suggests that it is possible to assess the health promotion capacity-building of organizations in a coherent way with comparable and objective indicators. These analyses also show that the number of indicators can be reduced. It would be interesting to see how the framework works in other governmental structures or political contexts.

TEAVIISARI - A TOOL FOR BENCHMARKING SAFETY PROMOTION AND INJURY PREVENTION ON LOCAL LEVEL

Background In Finland, municipalities are responsible for promoting the health and welfare of their residents. Safety promotion and injury prevention are an integral part of health promotion on various fields of municipal action. Description of the problem Until the launch of TEAviisari, a nationwide benchmarking tool for the management, planning and evaluation of health promotion capacity building (HPCB), there has been very little accurate and comparable nationwide information on health promoting activities in different sectors in Finnish municipalities. Results Aiming to make measures taken by local authorities visible and to provide information on actions that promote better public health on local level, TEAviisari is based on a generic HPCB framework. The framework consists of seven dimensions: commitment, management, monitoring and needs assessment, resources, common practices, participation and core functions. Safety and injury related topics covered in TEAviisari include but are not limited to prevention of home and leisure accident injuries, inspection of health and safety at schools, home-school collaboration to promote safety, prevention and monitoring of accidents and injuries at school, compiling a local safety plan, evaluating older person’s housing safety and having expertise on health and safety technology and assistive devices. The results show that differences between municipalities and schools exist in all topics. The data can be viewed on municipal level or on various geographical or administrative levels. Data for single schools are shown with the permission of the school. Conclusions TEAviisari shows that it is possible to assess the HPCB of municipalities, serving as a tool for the local government while making it transparent to the residents. Web-based user interface provides a quick access to relevant, interpreted information for decision-makers. TEAviisari is free of charge and available at http://teaviisari.fi in Finnish, Swedish and English.