School Manchester Sven Bremberg

527 views

Published on

jan norton

Published in: Health & Medicine
0 Comments
0 Likes
Statistics
Notes
  • Be the first to comment

  • Be the first to like this

No Downloads
Views
Total views
527
On SlideShare
0
From Embeds
0
Number of Embeds
3
Actions
Shares
0
Downloads
9
Comments
0
Likes
0
Embeds 0
No embeds

No notes for slide
  • 45 min
  • School Manchester Sven Bremberg

    1. 1. Children and adolescents: health protective factors in education <ul><ul><li>Sven Bremberg </li></ul></ul>
    2. 2. Education and health Health education Health behaviour Health
    3. 3. Problems with the educational approach to adolescent public health <ul><li>Few school education programmes demonstrate behaviour effects: alcohol, tobacco, drugs, nutrition, exercise </li></ul><ul><li>Individual behaviour is determined by social context </li></ul><ul><li>Low long term stability of health behaviours during adolescence </li></ul>
    4. 4. Educational approach to adolescent sexual health <ul><li>Systematic reviews of RCT:s </li></ul><ul><li>Behaviour effects (contraceptive use) </li></ul><ul><li>DiCenso 2002 </li></ul><ul><ul><li>7 studies, pooled estimate: males ns, females ns. </li></ul></ul><ul><ul><li>1 study in favour of controls in males </li></ul></ul><ul><li>Bennett 2005 </li></ul><ul><ul><li>10 studies, 5 in favour of intervention </li></ul></ul><ul><ul><li>2 studies in favour of controls in females </li></ul></ul>
    5. 5. Public health policy Economy Life chances Lifestyle - environment Health QoL General politics Social policy Public health policy Health promotion Health care Upstream Downstream
    6. 6. Swedish national public health targets <ul><li>Mainly structural targets focusing institutions </li></ul><ul><li>11 targets approved by the parliament in 2003 </li></ul><ul><li>Structural targets </li></ul><ul><ul><li>Democracy - participation </li></ul></ul><ul><ul><li>Economic and social security </li></ul></ul><ul><ul><li>Positive conditions during childhood and adolescence </li></ul></ul><ul><ul><li>Healthier working life </li></ul></ul><ul><ul><li>… </li></ul></ul><ul><li>Some downstream targets </li></ul><ul><ul><li>Reduced use of tobacco and alcohol </li></ul></ul><ul><ul><li>… </li></ul></ul>
    7. 7. Determinants of U-5 female child mortality rate in 118 nations - t-values. Total model R2=0.79 (Safaei 2006)
    8. 8. Effects of education on adult health - a natural experiment (Spasojevic 2003) <ul><li>Compulsory schooling was extended in Sweden from 7 to 9 years; decided at municipal level, 1950 - </li></ul><ul><li>Men born 1945-1955. Health 1981-91 - control for SES </li></ul><ul><li>One extra year of schooling: 19% less risk of ill health, 12% less obesity </li></ul>
    9. 9. Effects of education on adult health -other natural experiments (Feinstein et al 2006) - effects demonstrated on <ul><li>Mortality </li></ul><ul><li>Hospital care </li></ul><ul><li>Management of chronic diseases </li></ul><ul><li>Depression </li></ul><ul><li>Smoking </li></ul><ul><li>Physical activity </li></ul>
    10. 10. Determinants of adolescent health Alcohol, tobacco Mental health Obesity Unsafe sex
    11. 11. Literacy Levels by Physical, Mental or Other Health Conditions – USA (Quantitative) Percent Level NALS, p. 44, 2002 Health Problems Mental or Emotional Problems Long-term Illness
    12. 12. Competences include abilities …(after Martha Nussbaum) <ul><li>to solve problems </li></ul><ul><li>to attach to other people </li></ul><ul><li>to take part in social life </li></ul><ul><li>to reflect critically </li></ul><ul><li>to form a concept of what is good </li></ul><ul><li>… </li></ul>
    13. 13. Association between mortality and cognitive ability at age 10 in men born in Malmö 1928, hazard ratio, crude and adjusted for parental income and class (Lager 2008) Table 1. Cognitive ability and mortality. Men (n=834, 349 deceased) Remains Crude Adjusted for parents’ income 1933 Adj. for parents’ income 1933 and parents’ class 1938 Hazard Ratio Confidence Interval Hazard Ratio Confidence Interval Hazard Ratio Confidence Interval Highest quartile 1.00 Reference 1.00 Reference 1.00 Reference Second highest quartile 1.40 1.00-1.95 1.29 0.92-1.81 1.31 0.93-1.84 Second lowest quartile 1.56 1.13-2.17 1.44 1.04-2.01 1.48 1.07-2.07 Lowest quartile 1.95 1.42-2.69 1.67 1.21-2.32 1.72 1.23-2.40
    14. 14. Competences and physical health - longitudinal studies <ul><li>Good mental ability in childhood is associated with </li></ul><ul><ul><li>Longer lifespan </li></ul></ul><ul><ul><li>Less CVD </li></ul></ul><ul><ul><li>Less severe illness at 30-39 yrs of age </li></ul></ul><ul><ul><li>( Whalley 2001 ), ( Hart 2003 ), ( Osler 2003 ), ( Deary 2004 ), ( Kuh 2004 ), (Batty 2005, in press) ( Martin 2004 ) </li></ul></ul>
    15. 15. Competences and mental health - longitudinal studies <ul><li>Good mental ability in childhood is associated with </li></ul><ul><ul><li>Less behaviour problems </li></ul></ul><ul><ul><li>Less depression and anxiety </li></ul></ul><ul><ul><li>Less suicide </li></ul></ul><ul><ul><li>( Schonfeld 1988 ), ( Hinshaw 1992 ), (Farrington i Rutter 1995 ), ( Sternberg 2001 ) and ( Fergusson 2005 ). ( Pianta 1989 ), ( Cederblad 1995 ), (Batty 2005) ( Fergusson 2005 ) </li></ul></ul>
    16. 16. IQ change 1942-1992 in five countries. Raven tests Flynn 1999
    17. 17. Education and health Health Ability to adapt Competencies
    18. 18. Time sequence for problematic health behaviours (after Roe) Year 1 Year 4 Year 7 Year 10 Antisocial behaviour/depression Problematic health behaviour School failure
    19. 19. Emphasis on health promotion or effective schools - municipalities in Stockholm county (Guldbrandsson 2005) <ul><ul><li>Effective schools </li></ul></ul><ul><ul><li>Health promotion </li></ul></ul>
    20. 21. Potential contribution to schools from the health sector <ul><li>Programmes that facilitates learning </li></ul><ul><li>Programmes with direct effects on health or determinants of health </li></ul><ul><li>Programmes with demonstrable effects </li></ul>
    21. 22. Measures for schools proposed by the Swedish National Institute of Public Health <ul><li>Social and emotional training (SET) </li></ul><ul><li>Prevention of bullying </li></ul><ul><li>Aggression preventive programmes </li></ul><ul><li>Programmes based on cognitive psychology </li></ul><ul><li>Local quality assurance programmes using both educational and health data </li></ul><ul><li>Parental support programmes </li></ul>
    22. 23. Effects of SET in Botkyrka grades 4-9 controlled trial (Kimber 2008) Variable Effect size Body image 0,48 Psychological well-being 0,33 Aggressiveness 0,33 Bullying 0,39 Alcohol (grade 7-9) 0,26 Narcotics (grade 7-9) 0,23
    23. 24. Prevention of bullying <ul><ul><li>Olweus’ model </li></ul></ul><ul><ul><li>Three controlled trials </li></ul></ul><ul><ul><ul><li>40% reduction </li></ul></ul></ul><ul><ul><li>Four levels </li></ul></ul><ul><ul><ul><li>Students </li></ul></ul></ul><ul><ul><ul><li>Teachers </li></ul></ul></ul><ul><ul><ul><li>Headmasters </li></ul></ul></ul><ul><ul><ul><li>Parents </li></ul></ul></ul>
    24. 25. Programmes preventing behaviour problems including aggression in the classroom: effect at follow up (Wilson 2007)
    25. 26. ACT - a preventive programme based on cognitive psychology <ul><li>Third generation CBT programme </li></ul><ul><li>Year 10-12 students - 3*3 hours (Livheim, 2006) </li></ul><ul><li>Reduced anxiety after 2 years </li></ul>
    26. 27. Quality assurance programmes at school <ul><li>Local school </li></ul><ul><li>/municipality level </li></ul><ul><li>Aggregated data 1: educational achievement </li></ul><ul><li>Aggregated data 2: health data from the school health service </li></ul>
    27. 28. Family support in Sweden: history 1940 1970 1990 2000
    28. 29. Structured methods for parents of children age 3-9 years, based on methods like PMT, COPE etc. adapted for universal use in Sweden… <ul><li>Parental groups </li></ul><ul><li>Starting with videotaped problem situations </li></ul><ul><li>Modelling </li></ul><ul><li>Role play </li></ul>
    29. 30. Education and sexual health Sexual health Ability to adapt Competencies
    30. 31. www.fhi.se

    ×