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The purpose of this paper is to investigate whether university students' smoking behaviour is associated with higher levels of stress and depression directly, or indirectly, via the mediation of coping, personal beliefs and social support.

The study design involves a cross‐sectional survey. Structural equation modelling was employed to explore the relationships between smoking behaviour, stress and depression via the mediating effects of coping resources, personal beliefs and social support.

The higher the stress and depression levels, the more likely the respondents' were to adopt disengagement coping strategies and to engage in smoking behaviour. Stress was not found to have a significant direct effect on smoking behaviour when depression, active coping abilities and social support were included as mediators in the model. Thus, if stress is high yet coping skills are also high and personal beliefs are anti‐smoking, the likelihood of smoking was low.

Disengagement coping strategies significantly increased the likelihood of smoking when stress heightened depression level. However, stress did not independently increase the chance of smoking when active coping and social support were moderating the effects of depression on smoking behaviour. Personal beliefs also acted as an independent contributor to increase the likelihood of smoking when pro‐smoking beliefs were held by individuals. Overall, this study suggests that personal coping strategies and personal beliefs, with social support, are important protective mechanisms through which stress and depression influence smoking behaviour.

Health promotion programmes to encourage smoking cessation should therefore include measures to encourage young adults to adopt active coping strategies (e.g. exercise, recreational activities) to make interventions effective in reducing smoking rate.

This study identifies important mechanisms that underpin smoking behaviour among university students. The results provide evidence that supports the resilience perspective that personal coping resources, personal beliefs and protective factors, such as social support, are important factors either to lead people to adopt smoking behaviour, or to decrease the likelihood of smoking.

Successful implementation of Health Promoting Schools (HPS) depends on putting the model in the schools’ context for both health improvement and school improvement. HPS can only be effective if the change can be sustained over an extended duration. The purpose of this paper is to discuss development of the HPS process by University Research Centre in Hong Kong, resulting in an award scheme, where no additional resources were initially provided by the authorities.

The team adopted a step-by-step approach starting with capacity building of key stakeholders and comprehensive needs assessment, leading to development of a system of evaluation and monitoring and establishment of a “Healthy School Award” system. The system was built on data derived from several different sources and made use of qualitative and quantitative information and were intended to be used to guide practice and actions for improvement.

Schools measured their own performance against established school and student health profiles. The validated system of evaluation and monitoring led to a Healthy School Award scheme for participating schools with “accredited” and “award” designations. The award system evaluated six key HPS areas and identified exemplars of HPS as resource schools to form a strong network.

HPS can be regarded as new paradigm of schooling rather than an add-on programme.

HPS can be regarded as new paradigm of schooling rather than an add-on programme. The advantage of an academic institution masterminding the development process lies with their strength in education and research, building on the professionalism of school educators in health promotion and developing evidence-based HPS practice.

This paper discusses an approach for addressing the key factors associated with initiation of innovation and management of change in an education setting. The involvement of both higher education and an award scheme can act strong catalysts to drive change, resulting in a strong evidence base with and results demonstrating effectiveness, which then led to government support.

The purpose of this paper is to improve adolescents’ nutrition knowledge and to examine the effect of interventions component to improve adolescents’ nutrition knowledge.

The study design was multi-factorial with repeated measures, at two points in time, of dependent samples from three schools, which were randomly selected from 15 middle schools in Miyun County, Beijing, and then randomly assigned to control school or intervention school. The instrument for baseline survey was a 14-item and for follow-up survey was a 26-item, self-administered, structured questionnaire, designed in Chinese.

Students’ nutrition knowledge improved significantly in intervention schools after intervention compared with controls. The extent to which students felt that peer support activities were helpful and that what they learned in class about nutrition was helpful, was related to their resultant level of nutrition knowledge.

To the authors’ knowledge there have been no previous studies which explore the effect of specific intervention components on levels of nutrition knowledge among adolescents.

The purpose of this paper is to assess whether the school-based nutrition programme using the health-promoting school (HPS) framework was effective to improve parents’ knowledge, attitudes and behaviour (KAB) in relation to nutrition in rural Mi Yun County, Beijing.

A cluster-randomised intervention trial design was employed. Two middle schools were randomly selected and assigned to either the intervention school using the HPS framework (HPS School), or to the Control School, in Mi Yun County, Beijing. From each school 65 parents of seventh-grade students were randomly selected to participate in the study. Nutrition-related KAB were measured at pre- and post-intervention surveys with the same instrument. The nutrition intervention last for six months.

The school-based nutrition intervention using the HPS framework was effective in increasing parents’ nutrition knowledge; however, it had no statistical significant impact on improving parents’ attitudes towards nutrition and their eating behaviours.

The intervention appeared to be inadequate from the point of view of its impact on parents in terms of content, form and frequency.

Future school-based nutrition promotion programmes using the HPS framework should focus more on parents, providing them with a more informative, participative and interactive, and frequent intervention.

There is very limited published research focusing on the effect of the school-based nutrition promotion programmes using an HPS framework on parents’ nutrition-related KAB. Although, the improved KAB in relation to nutrition among parents is essential to promote young people’s nutrition and healthy eating behaviours.

The purpose of this paper is to describe activities used to initiate health promotion in the school setting.

Description of successful pilot Health Promoting School (HPS) initiatives in Canada and Uganda and the validated measures central to each program. Evaluation methodologies: quantitative data from the tools used complimented by descriptive/qualitative methods.

Previously validated tools/methodologies used include: The World Health Organization (WHO) growth charts for comparison of children ' s height, weight, head circumference, and BMI against multi-ethnic standards; a 24-h dietary recall instrument to assess dietary diversity as a proxy measure of nutritional adequacy; urine analysis to evaluate baseline renal function and the effect of supplemental hydration; “photo-voice” to aid discussion of personal and community issues of concern; “role play” to promote dialogue and promote social competence; and fitness training. Each activity can combine the “curriculum content” and “healthy practices” components central to HPS concepts. All activities engaged more than 95 percent of pupils enrolled, generated positive responses, and had the potential to impact behaviors and promote health.

All the activities are inexpensive and straightforward to initiate, offer schools interested in health-promotion-driven education a broad range of potential “entry points” that can be matched to the interests/challenges of individual communities, and use validated methodologies aiding objective evaluation.

These activities foster a community empowerment (“bottom up”) approach, but are also relevant for policy makers exploring HPS to address disease prevention through lifestyle change (“top down” approach). Engagement of communities and ultimately their “ownership” of the HPS initiative have been achieved with these entry point activities.

The purpose of this paper is to examine the role of two higher education institutions in the Western Cape, South Africa, and how their initiatives and collaboration brought about a particular health promoting schools (HPS) program in a resource poor setting. The aim of this paper is to reflect on the importance of the role that external systemic actors and stakeholders can play in the process of designing and implementing HPS programs in resource poor settings.

In this paper a complex systems approach is employed to describe two different participatory methods of engagement with HPS by higher education institutions. On the one hand, engagement took place in terms of a formal and funded project, directed at the organizational level of the school, with capacity building as its aim. On the other hand, engagement was initiated informally (as part of a service-learning project) via collaboration with the formal project, directed at the individual level of learners in the school.

In recognizing the complex nature of planning and implementing HPS programs, the paper demonstrates that HPS approaches could benefit from engaging with resources outside the ambit of institutional health and educational policies and structures.

By acknowledging the systemic nature of implementing HPS strategies, novel collaborations emerge as a result. The paper highlights the important role that external stakeholders such as higher education institutions play in creating and sustaining tailor-made HPS programs for schools based in resource poor settings.

The purpose of this paper is to explain the rationale and potential for the WHO health promoting schools (HPS) to improve children ' s oral health, and describe validated quantitative methodologies and qualitative approaches to measure program impact.

Critical discussion of the impact of poor oral health and potential for school-based educational intervention, and evaluation methodologies used by the authors.

Using HPS to improve oral health is relevant because dental caries and gingivitis/periodontitis negatively impact children ' s health and quality of life worldwide. WHO has called for effective community-based oral health promotion programs; intervention is simple and low cost; robust evaluation measures exist – the decayed missing filled teeth index and change in cavity rate allow quantitative comparison of oral health status; and questionnaires document changes in knowledge, practices, diet, health-related quality of life, and pain.

Poor oral health is a major health issue. Established measures to improve oral hygiene offer an achievable, low-cost HPS entry point; the “knowledge” and “healthy practices” components central to the WHO HPS model are tried and tested and multiple potential benefits are documented. Poor oral health is a non-stigmatized issue, hence intervention is readily accepted, and effective evaluation tools provide evidence of program effect over a short (two to three years) timeframe.

Oral health promotion is more affordable and sustainable than the cost of traditional restorative treatments especially in middle- and low-income countries. Success with oral health leads to confidence for expansion of HPS activities to address other health issues relevant to the school community.

The purpose of this paper is to respond to food insecurity and environmental sustainability through school food gardens in Johannesburg, South Africa.

Permaculture is a method of organic agriculture where the garden design maintains a stable and productive ecosystem, mimicking natural processes and thereby creating a more natural and sustainable environment. Organic permaculture food gardens were established and integrated with the curriculum at two schools over the course of one year. A nutrition study of dietary intake and assessment of dietary diversity score was undertaken with a sample of 68 children.

Permaculture food gardens can contribute to children ' s physical, mental, and emotional health and can be a resource for teachers and learners. To achieve sustainability, practical and cultural challenges must be addressed.

The project was implemented at only school sites, findings may not be applicable to all schools in all settings. This assessment was conducted after one year of implementation, impacts, and sustainability would be best assessed after three years. Conclusions are therefore based both on this case study and on the wider literature.

When implementing a school food garden there must be long-term support and mentoring for school staff.

The value of a school food garden goes beyond the provision of nutrition and addressing food insecurity. Participation in gardening can increase students’ interactions with the natural world, and contribute to skills development, academic achievement, and well-being.

This paper informs discussion and practice related to school food gardens’ influence on holistic health and broader educational benefits. It is of relevance to health promotion and education practitioners, school garden developers, and funders.

The purpose of this paper is to understand how a Canadian intervention based on a professional development (PD) model did or did not influence schools’ capacities to absorb a Healthy School (HS) approach into their operations. This study is the second part of a research project: previously published results regarding this research provided a detailed description of the PD model and highlighted the relevance and effectiveness of PD in improving actors’ HS-related knowledge and practices. The present paper focuses on the organizational impact of such PD intervention.

The design was based on a realist evaluation approach, which helps to elicit a theory explaining how an intervention leads to particular outcomes. A multi-site case study of three schools with pre- (T ₀) and post- (T ₁) intervention comparison was adopted. Multiple qualitative methods were used to capture how the changes were achieved by collecting data from various stakeholders involved in the intervention.

The PD model tested reinforced the schools’ capacities to absorb this type of initiative. For one of the capacities examined, “exploitation”, i.e., the ability to incorporate and maintain the initiative into schools operation, the evidence was less apparent. In congruence with the realist evaluation, the results are rendered in the form of a contextualized intervention theory identifying the links between the PD and the mechanisms that were likely necessary to explain what led to the changes in “absorptive” capacities (which refers to the capabilities of schools to acquire and assimilate HS knowledge, and also to transform and exploit them, in the context).

The refined theory, based on empirical findings, can enable facilitators and practitioners to gain a deeper understanding of the action mechanisms shown to be determining in the success of HS implementation.

The purpose of this paper is to measure prevalence and predictors of mobile phone access and use among adolescents in Soweto, South Africa.

The current study was an interviewer-administered, cross-sectional survey among adolescents 14-19 years living in a hyper-endemic human immunodeficiency virus (HIV) setting in South Africa.

Of 830 participants; 57 per cent were female. The median age was 18 years (IQR: 17-18). Mobile phone access was high (91 per cent). Almost half of participants (42 per cent) spent more than five hours daily using their mobile phones. Two-thirds (62 per cent) had access to the internet, most (84 per cent) accessed the internet via their mobile phones. Mobile phone access was more likely amongst Sotho language speakers (aOR: 2.87, 95 per cent CI: 1.30-6.36), those living in formal housing (aOR: 3.55, 95 per cent CI: 1.97-6.42) and those who reported heterosexual orientation (aOR: 2.37, CI: 1.35-4.16).

This study substantially contributes to the literature about mobile phones usage and patterns among school-going adolescents in Soweto, South Africa.