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Poster abstracts.

Poster abstracts.

Poster abstracts.

Safety education directed at parents of pre-school children may be an important tool in reducing injuries of pre-school children at home. However, many studies on educational programmes directed at parents have shown little evidence of success in terms of changes in parental safety behaviour and childhood injuries. These programmes may have been affected, among other factors, by a typical kind of 'programme failure' due to a lack of empirical information on at-risk behaviour and the deterinants of that behaviour prior to the educational development of programmes. We tried to get an indication of the extent to which previous safety educational programmes had grounded their activities on an empirical basis. Therefore, a review of literature was carried out on empirical studies on (i) parental safety measures-the form of parental safety behaviour that is supposed to be very important in preventing injuries to pre-school children-and (ii) the behavioural determinants of those safety measures. It appeared that information on these topics is scarce and this suggests that previous programmes may indeed have suffered from such programme failure. Recommendations are made for enlarging the body of knowledge essential for the development of effective safety education directed at parents of pre-school children. Finally, some recommendations are presented for safety practitioners.

In opdracht van het ministerie van Welzijn, Volksgezondheid en Cultuur heeft het Nederlands Instituut voor Praeventieve Gezondheidszorg (NIPG-TNO) de Preventiegids vervaardigd, met een overzicht van de Nederlandse preventieprogramma's.1 Deze gids is in eerste instantie bestemd voor een aantal beroepsgroepen in de eerstelijnsgezondheidszorg en basisgezondheidszorg: huisartsen, verloskundigen en medewerkers van de jeugdgezondheidszorg. Daarmee is nuttig gebruik door anderen in de preventieve gezondheidszorg zeker niet uitgesloten. Bij het opstellen van de gids is een aantal controversen in de preventieve gezondheidszorg aan het licht gekomen, die in 4 artikelen in dit tijdschrift zullen worden besproken. Dit artikel is het eerste van deze reeks, die als doel heeft het losmaken van discussie over zin en onzin van deze preventieve maatregelen.

BACKGROUND: Weight gain prevention (WGP) among adults who are overweight is an important target in the prevention of obesity. However, little is known about the process from WGP as a goal to successful weight-management. The present study aimed to: (i) gain more insight into this process; (ii) identify cognitive predictors of intention for WGP; and (iii) examine WGP as a potential predictor for the intention to change weight-related behaviours [dietary intake (DI) and physical activity (PA)] and specific action planning. METHODS: In this cross-sectional study, overweight adults [n = 510; body mass index 25-30 kg m(-2); mean (SD) age 48 (9.5) years; 30.8% male] completed an online questionnaire, assessing goal intention for WGP, behavioural intention for DI and PA, planning for change in DI and PA and socio-cognitive correlates. Ordinal regression analyses were used to analyse the data. RESULTS: In 89% of the sample, (parts of) the proposed sequence from goal intention (for WGP), behavioural intention (for DI/PA) and planning (for DI/PA) was observed. Attitude, social norm and perceived control towards WGP, and perceived weight status and risk perception, were associated with intention for WGP. Behaviour-specific perceived control and preferences were more strongly associated with intention to change DI or PA and planning for change than intention for WGP was. CONCLUSIONS: Intention for WGP is important in the process toward weight-management because, for most people, intention for WGP precedes behavioural intention, which precedes planning. Intention for WGP is associated with behavioural intention but behaviour-specific factors are the strongest correlates of behavioural intention and planning.

Objective: In November 1993, Dutch health authorities advised that women planning a pregnancy should take folic acid in the periconceptional period to reduce the risk of fetal neural tube defects. In the autumn of 1995 a national campaign was organized to inform women and health care professionals in a systematic way. Methods: We assessed the awareness and behaviour of women at their first or second antenatal visit in two surveys in the spring of 1994 and the autumn of 1995, in order to evaluate the impact of non-systematic information during that period, and to collect baseline data to evaluate the effect of the national folic acid campaign. The two surveys were carried out in the north and the west of The Netherlands. Results: The proportion of women who had heard of folic acid increased from 28% to 78%. The proportion that used folic acid during any period in pregnancy increased from 7.8% to 26%. The proportion that took folic acid tablets during the whole of the recommended period increased from 0.8 to 4.4%. In the group of women wits did not take folic acid, the proportion who did 'not like to use anything during pregnancy' decreased, as did the proportion who did 'not think it is useful'. Conclusion: In The Netherlands, non-systematic information about periconceptional folic acid use has already led to significant changes in awareness and behaviour before the start of the national folic acid campaign.

Doel. Vaststellen in hoeverre huisartsen kennis hebben van de foliumzuurcampagne door het Voorlichtingsbureau voor de Voeding, een positieve houding hebben ten aanzien van het gebruik van foliumzuurtabletten door zwangeren en feitelijk voorlichting geven over foliumzuur. Opzet. Transversaal, beschrijvend. Plaats. Regio Midden-Brabant, Achterhoek, Randstad en Noord-Nederland. Methode. Naar 300 aselect gekozen huisartsen werd in 1996 een schriftelijke vragenlijst gezonden. Deze bevatte vragen over kennis, houding en handelwijze met betrekking tot het gebruik van foliumzuur door vrouwen met een zwangerschapswens en een niet-verhoogd risico voor het krijgen van een kind met een neuralebuisdefect. Resultaten. De respons was hoog (81). De meeste huisartsen waren op de hoogte van de landelijke voorlichtingscampagne over foliumzuur (87), maar 18 vond dat hij of zij onvoldoende geïnformeerd was over de voorlichtingscampagne en (of) het foliumzuuradvies. De helft van de huisartsen vond het gebruik van foliumzuurtabletten door vrouwen die zwanger willen worden belangrijk, terwijl tweederde vond dat het de zwangerschap medicaliseert. De meeste huisartsen dachten dat schuldgevoelens kunnen ontstaan bij zwangere vrouwen die geen foliumzuurtabletten hebben gebruikt (82). Desondanks adviseerde 64 om foliumzuurtabletten te gebruiken en schreef 63 zelf een recept uit indien een vrouw daar om vroeg. Van de huisartsen rapporteerde 75 dat zij het gebruik van foliumzuurtabletten zelf ter sprake brachten bij vrouwen met vermoede zwangerschapswens, hoewel de meesten meldden dat zij dit ook wel eens vergaten (58). Het percentage huisartsen dat soms of altijd foliumzuurtabletten ter sprake bracht bij een anticonceptieadvies na de bevalling of vrouwen met een zwangerschapswens adviseerde foliumzuurrijke voeding te kiezen, lag veel lager (respectievelijk 29 en 37). Conclusie. Hoewel een groot deel van de huisartsen potentiële problemen signaleerde, werkte de meerderheid actief mee aan het bevorderen van foliumzuurgebruik door vrouwen met een zwangerschapswens.

This article compares data on the use of alcohol and cannabis, collected in a study on adolescent sexuality in 1995 with data collected in a similar study, five years earlier. Furthermore, data are presented concerning XTC use in 1995. Data were collected by means of written questionnaires, administered in class by school doctors and schoolnurses. The 1990 sample and the 1995 sample may both be considered as highly representative for the population of pupils in secondary education in those years. Data from 17576 pupils were available for analysis. In testing, small differences between the two samples were controlled for by using logistic regression in which both time of measurement and the relevant demographic variables (sex, age group, type of education and ethnic origin) were entered into the analysis simultaneously. The percentage of pupils who ever drank alcohol in 1995 and 64%, compared to 54% in 1990, a highly significant increase. Among pupils who ever drank, the frequency of alcohol use, also, had risen: in 1995 68% of these pupils drank alcohol at least once a week, compared to 64% in 1990. This difference is significant, too. The percentage of pupils who ever used cannabis increased from 7% to 16%, again a highly significant difference. Frequency of cannabis use among those currently using did not increase significantly between 1990 and 1995. Three percent of all pupils ever used XTC; the percentage of those using at least once a week was 1%. These figures suggest a changing, more riskier life style, which might be related to an increase in other types of risk taking, for example with regard to sexual contacts, as described in Brugman et al (1995). Some people working in education and youth health care suggest an increase in the number of pupils who are not able to concentrate in class, due to drug abuse. A study focusing on problems and risks related to the use of alcohol and drugs among Dutch pupils in secondary education may therefore be deemed appropriate at this moment.

The objective of the study was to evaluate the effectiveness of a multifactor and multimethod community intervention programme to reduce falls among older persons by at least 20%. In a pre-test-post test design, self-reported falls were registered for 10 months in the intervention community and two control communities. After the pre-test registration, participants followed the intervention programme (Information and education, Training and exercise and Environmental modifications) for 14 months. All communities were situated in the Province of Friesland in the north of The Netherlands. The study ran from November 1999 to November 2002. The participants (intervention 1122; control 630) were aged 65 years and older and lived independently. There was no significant decrease in total falls, except outside the home, among women (odds ratio = 0.54, 95% CI = 0.30-0.98; p = 0.041). The multifactor intervention programme was not effective. The reduction of falls outside the home among women could be due to reduced outdoor physical activity.

Fat Watch was a four-year campaign carried out in cooperation with retailers and industry, aiming at a reduction of fat consumption by 10% among the Dutch population. Mass media and supermarkets were the main conveyers of the message. Supermarkets participated well in the first (53%) and in the third year (51%), but to a lesser extent in the second year (36%). Campaign awareness in the target group (household shoppers for food) was relatively high in the first year (60%), but dropped in the next two years (40% and 32%, respectively). Combined with prominent mass media messages and with promotional activities of food products by suppliers, supermarkets seem a good channel for dissemination of nutrition information. Fat Watch has proved that cooperation of governmental, industrial and retail organizations for several years with respect to nutrition education activities is possible in the Netherlands.

A systemic review resulted in a classification system to group the theories and models, referred to in 35 studies on education adn counseling children (0-27 y) about physical health

This study examines the factors that influence parents' decisions to have their children vaccinated under the Dutch National Immunisation Programme. A computer questionnaire was sent to 500 parents in 1999 (the response rate was 98.2%). The intention to vaccinate was most strongly determined by attitudes. The belief that vaccination is safe and the best way to protect children against infectious diseases positively influenced parents' attitudes. The idea that children receive too many vaccines simultaneously and that vaccination interferes with natural development had a negative effect on attitudes. Dutch parents believe that doctors only inform them about the benefits of vaccination and disregard possible drawbacks. Since attitudes did not appear to be the result of thorough deliberation, parents could easily be influenced by negative publicity about vaccination. Educational campaigns and practitioners' advice should provide complete information about all aspects of the question, enabling parents to make well-considered and therefore enduring decisions. © 2005 Elsevier Ltd. All rights reserved.

Background: Passive smoking is harmful to young children. A protocol has been developed to allow health care workers to communicate with parents about preventing passive smoking. The main message was to refrain from smoking in the presence of the child. The aim of the study was to assess the effectiveness of this education programme. Method: The prevalence of smoking in the presence of infants aged 0-10 months was compared before and after the implementation of the education programme. National samples of mothers completed questionnaires in 1996 (n=1,129) and in 1999 (n=2,534). Questions were asked about smoking in the living room in the presence of infants, and about parental smoking, and background characteristics. Results: The prevalence of passive infant smoking decreased from 41% to 18%. The adjusted odds ratio for passive infant smoking in 1999 compared to 1996 was 0.34 (0.26-0.44) when none of the parents smoked, 0.19 (0.14-0.27) when one of the parents smoked, and 0.30 (0.20-0.44) when both parents smoked. Conclusion: The implementation of this health education programme seems to have been very successful in reducing passive smoking in children. Implementation of similar health education programmes in other countries is recommended. Chemicals/CAS: Tobacco Smoke Pollution

Implementation studies are recommended to assess the feasibility and effectiveness in real-life of programmes which have been tested in randomized controlled trials (RCTs). We report on an implementation study of two evidence-based exercise and health education programmes for older adults with osteoarthritis (OA) of the knee of hip. Three types of primary health-care providers (n = 18) delivered the OA Knee programme (n = 20) and the OA Hip programme (n = 20), supported by programme manuals and implementation guidelines, in four regions. The outcome measures were pain and mobility. The Knee programme had OA knowledge and self-efficacy as additional outcome measures. Differences in outcome measures and background variables of participants were assessed between the RCTs and the implementation study. Positive effects (P < 0.05) were found for OA knowledge, pain and self-efficacy in the Knee programme (n = 157), and for pain in the Hip programme (n = 132). No effect was found for mobility. Effect sizes of the RCTs and the present study were comparable. Background variables did not explain the variance in the outcome measures. The outcomes of the previous RCTs and the implementation study were comparable, and indicated the ecological validity of the two programmes. The implications for nationwide dissemination and implementation in The Netherlands are discussed.

Objective: : The effectiveness of use of migrant health educators in the general practitioners' care for female migrants with psychosomatic problems was evaluated to contribute to the improvement of the care for these patients. Methods: : A randomised controlled trial (RCT) design was used. A total of 104 patients (75%) agreed to take part in the intervention study. The patients were from Turkish and Moroccan immigrant groups living in The Netherlands. The intervention group received counselling and education from the migrant health educators as adjuncts to the GPs' care. Special attention was given to the patient's cultural background, supporting the communication between GP and patient. The control group received regular treatment from their GPs. Results: : A significant improvement of perceived general health, psychological health and reported ability to cope with pain was observed among the intervention group. No effects were found for social support and the perceived burden of stressful life-events. Conclusion: : The patients' perceived health and coping abilities improved through the intervention as a whole. Not all outcome measures had been affected due to among others the diversity of physical and psychological complaints the patients suffered from, non-compliance and a perceived decrease of disability over time. Practice implications: : The intervention methods should be integrated in the patient care delivery for migrants in general practice. Further development of intervention methods to address the patients' social support is recommended. © 2007 Elsevier Ireland Ltd. All rights reserved.

Strategies to promote implementation of school-based health promotion (HP) programmes should be designed to suit determinants of implementation and continuation. This study explored determinants of completeness of teachers' implementation of a healthy diet promotion programme and of their intention to continue the programme. Strategies for promoting complete and continued implementation of school-based HP programmes should be designed to suit such determinants. Teacher logbooks were used to assess completeness. Additionally, the teachers completed questionnaires before and after implementation on user-, programme-, context- and dissemination strategy-related determinants and their intention to continue the programme in the next school year. Non-parametric tests and logistic regressions were used to assess baseline-posttest changes in determinants and differences in determinants between teachers with levels of completeness and of intention to continue the programme. Variability in teachers' completeness of using the programme was best predicted by their perception of relative advantage and compatibility of the intervention programme. Teachers' intention to continue could be explained by perceived personal benefits, their perception of programme outcome feasibility and on subjective norm from students. Our explorative study indicates that HP professionals should target various user-, programme- and context-related determinants in their implementation strategy to improve completeness of programme implementation and continuation. Close collaboration with the users and members of the target group during the programme development phase is essential.

The article describes the dissemination and implementation of the Aging Well and Healthily (AWH) program in the Netherlands. In the period 1997-1999 this process was monitored by means of telephone interviews with 263 participants, 28 peer educators, and 13 organizers. The program participants were mainly physically active and relatively healthy people in their mid 70s. The peer educators were in their late 50s. The overall satisfaction with the content and delivery of the AWH program was good; 13% of the participants enrolled in related local sports activities. In total, the AWH program was run 57 times, which did not meet the target of 50 times a year. Different factors could have negatively influenced dissemination. In the first place, the organization of the program was perceived to be complex and not compatible with the values of the organizations that were to implement the program. Also, 3 national implementation partners had organizational problems of their own. The results were used to design a new social marketing strategy, which appears to be successful.

Background. Most school health education programs focus on a single behavioral domain. Integrative programs that address multiple behaviors may be more efficient, but only if the elements of change are similar for these behaviors. The objective of this study was to examine which effective elements of school health education are similar across three particular behavioral domains. Methods. A systematic review of reviews of the effectiveness of school-based health promotion programs was conducted for the domains of substance abuse, sexual behavior, and nutrition. The literature search spanned the time period between 1995 and October 2006 and included three databases, websites of review centers and backward search. Fifty-five reviews and meta-analyses met predetermined relevance and publication criteria and were included. Data was extracted by one reviewer and checked by a second reviewer. A standardized data extraction form was used, with detailed attention to effective elements pertaining to program goals, development, content, methods, facilitator, components and intensity. Two assessors rated the quality of reviews as strong, moderate or weak. We included only strong and moderate reviews in two types of analysis: one based on interpretation of conflicting results, the other on a specific vote-counting rule. Results. Thirty six reviews were rated strong, 6 moderate, and 13 weak. A multitude of effective elements was identified in the included reviews and many elements were similar for two or more domains. In both types of analysis, five elements with evidence from strong reviews were found to be similar for all three domains: use of theory; addressing social influences, especially social norms; addressing cognitive-behavioral skills; training of facilitators; and multiple components. Two additional elements had positive results in all domains with the rule-based method of analysis, but had inconclusive results in at least one domain with the interpretion-based method of analysis: parent involvement and a larger number of sessions. Conclusion. Five effective elements of school health promotion were found to be similar across the three behavioral domains examined (substance abuse, sexual behavior, nutrition). An integrative program that addresses the three domains seems feasible. The five elements are primary candidates to include in programs targeting these behaviors. © 2009 Peters et al; licensee BioMed Central Ltd.

Purpose – The purpose of this paper is to evaluate the effects of the Dutch “Skills for Life” programme on students’ health behaviours, bullying behaviour and suicidal ideation. Design/methodology/approach – The effectiveness of the “Skills for Life” programme on health behaviour outcomes was evaluated at three points in time in using a cluster randomized controlled study design with a follow-up of 20 months. In total, 27 schools and 1,394 students were included. Findings – The programme was judged to be well implemented in just under half of cases. The outcome results for the experimental group (EG) compared with controls present a complex picture at the three different time points used for evaluation. There was a clearly positive effect on levels of alcohol consumption and a clearly negative effect on smoking across time. There was a mixed picture over time for suicide ideation and for bullying including sexual bullying (although the prevalence rates for bullying were low and thus results should be treated with caution). There were generally more positive impacts on students with lower educational levels including less suicidal ideation and less bullying. Research limitations/implications – Limitations were the dropping out of several schools during the study and the low level of fidelity of the curriculum. Social emotional learning (SEL) programs can be part of a health promoting school framework but should be more tailored to disadvantaged school populations. Originality/value – The findings indicate that students with a less optimal starting position, when it comes to health related behaviours, benefit most from a SEL programme. This indicates that schools with disadvantaged school populations could benefit most from a Health Promoting School approach.