Mental health promotion and socio-economic disadvantage: lessons from substance abuse, violence and crime prevention and child health

Issue addressed: Mental health promotion aimed at populations with low socio-economic status (SES) may benefit by investigating prevention strategies that effectively address related child and adolescent problems.
Methods: Evidence from a number of literature reviews and program evaluations was synthesised. First, the impact of SES on development from childhood to adulthood is considered in light of research on substance
abuse, violence, crime, and child development problems. Second, evaluations of interventions are reviewed to identify those that have shown outcomes in research studies (efficacy) or in real-world settings (effectiveness) in reducing developmental problems associated with low SES. Low SES is measured in different ways including low levels of education and/or income or definitions that combine several variables into a new indicator of low SES.
Results: Factors associated with low SES are also associated to varying extent with the development of violence and crime, substance abuse and child health problems. Interventions that address underlying determinants of low SES show strong efficacy in decreasing adolescent crime and violence and effectiveness in improving child health outcomes. Although there is limited efficacy evidence that substance abuse prevention can be effectively addressed by targeting low SES, programs designed to improve educational pathways show some efficacy in reducing aspects of adolescent substance use.
Conclusion: Mental health promotion strategies can draw on the approaches outlined here that are associated with the prevention of child and adolescent problems within low SES communities. Alternatively, such interventions could be supported in mental health promotion policy as they may assist in preventing related problems that undermine mental health.

Health promotion and health education in schools : trends, effectiveness and possibilities

This report involved an extensive literature review as well as discussions with ten leading school health and traffic safety education researchers and practitioners. The findings of the report show that despite health promotion and health education activities occurring in all Victorian schools, school health related initiatives could be improved by focusing on cognitive outcomes and involving appropriate components of Health Promoting School (HPS) framework. Providing teachers with professional development and utilising interactive resources that complement the curriculum is also important. The report recommendations outline ways to improve the Health Promotion and Health Education and provide a potential framework for delivering TSE provision in schools.

MAKINGtheLINK : a school-based health promotion programme to increase help-seeking for cannabis and mental health issues among adolescents

Aim: There is increasing concern regarding the use of cannabis among adolescents, especially given recent evidence highlighting its link with later mental disorders. Encouraging young people with mental health or drug issues to seek professional help is an important early intervention strategy; however, adolescents are typically reluctant to do so and instead turn to their peers for help. Peers may not have the skills or knowledge required to assist their friends to access professional help. This paper describes the development and evaluation of MAKINGtheLINK, a school-based health promotion programme that promotes help-seeking behaviour for mental health and cannabis use issues among young people.

Methods: The MAKINGtheLINK programme was piloted with 182 Year 10 students at a secondary school in Melbourne, Australia. Forty teachers received the MAKINGtheLINK staff professional development session.

Results: The delivery of the MAKINGtheLINK programme was found to be both acceptable and feasible within a school setting. Students and teachers described it as a fun, engaging, helpful and important programme. Students reported increased confidence and awareness of how to seek help for themselves or a friend, and teachers indicated increased confidence and awareness of how to assist students to seek help for cannabis use and/or mental health problems.

Conclusions: MAKINGtheLINK was successfully implemented within the school curriculum. We believe this is the first school-based programme that specifically focuses on facilitating professional help-seeking for cannabis use and mental health problems among young people, and demonstrates that utilizing peer models for help-seeking is a valuable resource for early intervention initiatives.

Quantitative evaluation in health promotion : What's the difference?

This is the third in a series of articles on quantitative evaluation in health promotion written by Damien Jolley for the Health Promotion Journal of Australia. The first of these articles, published in the December 2000 issue, discussed the ideas behind sample surveys and how they can be used to improve evaluation of health promotion initiatives.1 The second, in the April 2001 issue, discussed confidence intervals in more detail and presented some strategies for computing confidence intervals for population percentages, both manually and using appropriate computer software. 2

`This was a great project!`: reflections on a `successful` mental health promotion project in a remote Indigenous school

Issue addressed: The complexities encountered in an Indigenous community when a white project support team assisted a school (Bwgcolman on Palm Island, Queensland) to implement MindMatters, a centralised, national project aiming to promote the psychosocial health of young Australians through the development of a comprehensive, school- based mental health promotion program. Approach: The MindMatters consortium offered pilot schools curriculum materials, professional development for staff, funding and ongoing support at a local level in return for their participation in the project. The support team flew to the island on two occasions to provide support. Conclusion: Whether or not MindMatters constituted a community project at Bwgcolman is debatable. Nevertheless, the project at Bwgcolman was considered a 'success' by key players since initial aims identified by the school were tangible (eg, professional development, curriculum development) and met in a way that the school could take ownership of. Additionally, behavioural management policy was implemented in a manner that was cognisant of a history of coercive relations with Indigenous communities. So what?: It is important in the telling of the success story at Bwgcolman that even though MindMatters endeavoured to be culturally sensitive, it was nevertheless a centralist mental health promotion program. Future mental health promotion initiatives need to be aware that the approach of the support team in attempting to hand back some community control at the local level may have played a role in the school succeeding.

Healthy nature healthy people: 'contact with nature' as an upstream health promotion intervention for populations

Whilst urban-dwelling individuals who seek out parks and gardens appear to intuitively understand the personal health and well-being benefits arising from `contact with nature', public health strategies are yet to maximize the untapped resource nature provides, including the benefits of nature contact as an upstream health promotion intervention for populations. This paper presents a summary of empirical, theoretical and anecdotal evidence drawn from a literature review of the human health benefits of contact with nature. Initial findings indicate that nature plays a vital role in human health and well-being, and that parks and nature reserves play a significant role by providing access to nature for individuals. Implications suggest contact with nature may provide an effective population-wide strategy in prevention of mental ill health, with potential application for sub-populations, communities and individuals at higher risk of ill health. Recommendations include further investigation of `contact with nature' in population health, and examination of the benefits of nature-based interventions. To maximize use of `contact with nature' in the health promotion of populations, collaborative strategies between researchers and primary health, social services, urban planning and environmental management sectors are required. This approach offers not only an augmentation of existing health promotion and prevention activities, but provides the basis for a socio-ecological approach to public health that incorporates environmental sustainability.

Impact evaluation of a five-day short course in health promotion: workforce development in action

Issue addressed: This paper reports on impact evaluation of a series of five-day Short Courses in Health Promotion that have been delivered to more than 2,000 people since 2002 as part of a statewide workforce development strategy.

Methods: A triangulated mixed methods research design was selected for the evaluation. Data were collected through a mail survey, key informant interviews, focus groups and organisational case studies. Stakeholder and participant involvement were central to the evaluation.

Results: Organisational change emerged as a key theme. Impacts of the short course were felt in relation to health promotion practice and on organisational capacity to conduct health promotion, while the development of confidence and skills of participants to engage in collaborative opportunities was a not unexpected, but important, benefit of the course.

Conclusions: A short course is effective if attention is given to quality delivery, adult learning methods, participant involvement, appropriate targeting, good planning, and adequate funding. However, respondents commonly report the need for organisational change in order for health promotion practice to be embedded into organisations and for practitioners to be supported in their efforts to re-orient services towards health promotion.

Global priority setting for Cochrane systematic reviews of health promotion and public health research

Background: Systematic reviews of health promotion and public health interventions are increasingly being conducted to assist public policy decision making. Many intra-country initiatives have been established to conduct systematic reviews in their relevant public health areas. The Cochrane Collaboration, an international organisation established to conduct and publish systematic reviews of healthcare interventions, is committed to high quality reviews that are regularly updated, published electronically, and meeting the needs of the consumers.

Aims: To identify global priorities for Cochrane systematic reviews of public health topics.

Methods: Systematic reviews of public health interventions were identified and mapped against global health risks. Global health organisations were engaged and nominated policy-urgent titles, evidence based selection criteria were applied to set priorities.

Results: 26 priority systematic review titles were identified, addressing interventions such as community building activities, pre-natal and early infancy psychosocial outcomes, and improving the nutrition status of refugee and displaced populations.

Discussion: The 26 priority titles provide an opportunity for potential reviewers and indeed, the Cochrane Collaboration as a whole, to address the previously unmet needs of global health policy and research agencies.