Stephanie Chambers

Background: The current means-tested Free School Meals (FSM) policy aims to provide nutritious meals to children from disadvantaged backgrounds. This study evaluated the effectiveness of the UK secondary school FSM policy on fruit and vegetable (FV) intake, diet quality, nutrient intake, and food insecurity. Methods: A cross-sectional study was conducted in 34 UK secondary schools, (England (n=17), Northern Ireland (NI) (n=17)), with varying FSM uptake in those eligible and registered. Dietary intake was assessed using Intake24 dietary recalls; diet quality (Diet Quality Index for Adolescents (DQI-A)) and food security (Child Food Security Survey Module). Multilevel linear regression examined associations between school-level FSM uptake and the primary outcome, FV intake. Secondary outcomes included diet quality, school FV intake, meeting ‘5-a-day’ FV recommendations, energy and nutrient intakes, and food security. Model covariates included school-level (rurality, gender mix, location) and individual-level factors (gender, relative age, deprivation, ethnicity, English as an Additional Language, Special Educational Needs, FSM status). Findings: A total of 1,678 students aged 11-12 and 14-15 years (NI n=823; England n=855) participated. Mean FSM registration and uptake were 39% and 73% respectively. After adjustment for covariates, a 10% increase in FSM uptake was associated with a 0.11 portion/d mean increase in FV intake (95% CI 0.01, 0.20; p=0.02); a 22% increased odds of meeting FV recommendations (OR=1.22 95% CI 1.05, 1.42) and a 0.8 unit mean increase in DQI-A score (95% CI 0.13, 1.47). FSM uptake was not significantly associated with food security .Interpretation: Increased school-level FSM uptake was associated with marginal improvements in FV intake and diet quality, but not food security in UK secondary school students. Strengthening FSM participation and the nutritional quality and attractiveness of school food could enhance uptake, broaden access to healthier options, and support better diet quality among secondary school students.

Background: Most children attend early childhood education care settings (ECEC settings), commonly known as nurseries in the United Kingdom. ECEC settings provide opportunities to improve health through improved nutritional quality and physical activity for young children. There is evidence from the US that the NAPSACC intervention improves nutrition and physical activity in ECEC settings. We adapted NAPSACC for the UK and investigated its fidelity, acceptability and sustainability within a multi-centre trial. Methods: Embedded process evaluation within a 12-month cluster randomised controlled trial with 52 ECEC settings (25 intervention and 27 control). The NAPSACC UK intervention comprised two six-month cycles of nutrition and activity self-assessment, staff workshops and goal setting, supported by public health practitioners. Data included: observations during training and workshop delivery, questionnaires to practitioners and ECEC setting staff; 11 interviews with practitioners who delivered the intervention, 11 ECEC setting managers, 5 commissioners, and two focus groups with the research team. Document analysis of self-assessment and goal setting forms was undertaken. Thematic analysis was conducted with both deductive and inductive codes, a coding framework and triangulation across data sources. Results: Three-quarters (19/25) of intervention ECEC settings implemented the NAPSACC intervention across one cycle. Only 40% implemented a second cycle, mainly due to delays in scheduling staff workshops caused by sector-wide staffing challenges. ECEC setting managers valued the opportunity to reflect on practice and the support offered by the practitioner. ECEC setting staff highly rated the workshops and valued support given by public health practitioners. 83% of nutrition and 70% of physical activity goals set by the ECEC settings were achieved (fully or partially) and self-assessment scores increased, with greater gains for ECEC settings implementing two cycles. ECEC setting managers planned to maintain the changes made but varied in their intention to continue self-assessment and goal-setting processes. Conclusions: Despite sector-wide staffing challenges, we saw high engagement from ECEC settings in self-assessment and setting goals to improve child nutrition and activity. However, future development and use of NAPSACC UK need to be considered in the context of a lack of measurable impact on objective measures of child health and the significant challenges of staff capacity and time. Trial registration: ISRCTN33134697, 31/10/2019.

Community arms of professional football clubs have become key third-sector players in mitigating health and social inequalities. This paper examines the factors affecting their capacity for delivering social and public health programmes in the community setting. Semi-structured interviews were conducted with 24 community staff members from the community arms of 22 professional football clubs and one non-professional club. This provided the basis for an interpretive thematic analysis which led to the development of three themes: ‘from football club community departments to charitable arms’, ‘the reach of community programmes’, and ‘challenges and opportunities of delivering social and public health programmes via community football club arms’. Charitable status has created more funding opportunities, enabling community arms to better prioritize community needs. The expanding reach of community programmes delivers social and health benefits to children, adults, and older adults (65 and over) from diverse cultural and socioeconomic backgrounds. However, numerous challenges and opportunities were reported as affecting community arms’ capacity to deliver these programmes. Safeguarding is a challenge, but partnerships offer an opportunity to address it. Co-dependency with the football club presents both challenges and opportunities for community arms. Staffing and facilities, funding applications and reporting on programmes, were all identified as challenges. Our findings highlight eight key recommendations specific to areas of oversight in the community arms of football clubs, including professional development, partnership working, board members, resourcing, funding, programme reporting, and conflicts of interest.

More than 100 children per day in the UK experience the death of their parent before the age of 18. Parentally-bereaved young people (PBYP) face considerable hardships including detrimental health and wellbeing outcomes across their lifespan. This study's aim was to explore the lived experience of PBYP in the UK to understand their experiences and needs. Nine semi-structured interviews were conducted with young people aged 18-25 in Scotland. Thematic analysis was carried out using the Dual Process Model (DPM) as an exploratory lens. Four themes were identified: grief experiences, cumulative stressors, valued support, and coping mechanisms and management strategies. The themes reflected the DPM's components: loss-orientation, restoration-orientation and oscillation, but the DPM was not fully able to account for the wider social and interpersonal contextual factors discussed. The article proposes further research to explore extensions to the DPM to account for these factors. Practice recommendations include improved bereavement protocols, education for peers and educational staff, and bereavement support interventions.

The aim of this review is to highlight the key issues in relation to food insecurity among children and young people living in Scotland. It provides an overview of the current context of food insecurity more generally within the UK and specifically in Scotland. Food insecurity has risen in Scotland evidenced through responses to national surveys and the dramatic increase in households relying on emergency food provision. Food insecurity is highest among young people, single parent families and single men. The key drivers of food insecurity include insufficient income, welfare reform, food inflation and geo-political events. Evidence suggests that food insecurity is negatively related to sufficient nutritional intake, and the implications for physical and mental health are profound. Policy actions implemented to mitigate the impact of food insecurity on children and young people include the introduction of the Scottish Child Payment, food voucher schemes, free school meals, and holiday food provision. Further evidence is required to evaluate the success of these policies in reducing or mitigating food insecurity. The review concludes by considering the ways in which a rights-based approach to food might benefit children and young people living in Scotland, and argues that wider systemic change is required.

Leisure and health are human rights that apply to both children and adults. Leisure can enhance health and enable people to participate fully in leisure activities. One of children’s main opportunities for leisure is during school holidays. Little previous research has focused on this time in children’s lives. This paper presents a review of the literature surrounding school holidays, providing a critique of educational and public health approaches that focus narrowly on children’s future outcomes that may be associated with how they spend their time during these leisure periods. It argues that a more sociological understanding, rooted within child-centred approaches to leisure, provides the opportunity for children’s agency, participation and citizenship to be investigated more fully.

Background: Policymakers in many low- and middle-income countries do not prioritize oral health and are inadequately informed about the burden of oral and maxillofacial problems, their connection with systemic health and the possible threat to human life. In Africa, the absence of oral health policies is a key problem contributing to increased oral disease burden, health workforce shortage, and inadequate oral health service provision. Context-relevant policies and research to determine needs and monitor progress are key components in eradicating oral health inequalities. This paper focuses on the work of Malawi to follow the direction of travel outlined at the 2021 World Health Assembly by developing its first National Oral Health Strategy and Implementation Plan. Methods: A case study approach examined the processes followed by Malawi to develop its National Oral Health Policy, launched in April 2022. The aim was to understand how oral health policy is being developed within the context of an African country. Specifically, the objectives were to identify how oral health policy was being developed in Malawi and the contributors to the development of that policy. Qualitative data were collected from semi-structured interviews (n=8) of purposively selected key informants from the Malawi National Oral Health Policy Taskforce team involved in the policy creation. Data were analyzed in the thematic areas within the Health Policy Triangle of actors, context, processes, and content. Results: The policy development process was guided by Malawi’s Ministry of Health and involved a diverse group of actors, both local and international. The funding of the policy development process by the Scottish Government and Borrow Foundation provided critical support. Five groups of stakeholders have conducted the relevant background investigations and written the Oral Health Policy: international development partners, academics, policy experts, dental practitioners, and civil society organizations. The partnership skill-sharing and well-managed dynamics of the group, together with the reliable funding base, all contributed to a successful outcome. Conclusions: A multisectoral approach was used. Malawi is uniquely placed in its oral health policy development, having a solid stakeholder base (local and international) and resources to support the policy development and, partly, its implementation.

Child and adolescent mental health and wellbeing (MHWB) have received greater attention in recent years due to increases in mental ill health and reports of decreasing subjective wellbeing. The School Health and Wellbeing Improvement Research Network (SHINE) was established to create a national infrastructure to support Scottish schools to collect and use health and wellbeing (HWB) data to inform school improvement action planning. This study aimed to evaluate a pilot of SHINE’s provision of school-level HWB data reports from the Health Behaviour in School-aged Children survey and their impact on school action planning. Using a qualitative case study design, we collected data in four local authorities across Scotland via pupil and school staff focus groups (n = 23 groups), and from interviews with senior leaders, school SHINE Leads, other relevant school-level stakeholders, local authority (LA) HWB and data leads (n = 30 interviews). Data analysis was supported using Normalisation Process Theory as a guiding framework. Implementation was at an early stage. Participants indicated that the data reports were an accessible and valuable source of local information to support the improvement agenda. SHINE’s expertise supported the lack of research capacity and strengthened HWB data literacy skills in schools. At the point of interview, data reports had not been shared widely within the school community, but there was some limited use of the reports to inform action planning around HWB. Through close working and further engagement with schools, SHINE has the potential to support them to deliver national commitments to improving HWB. Scottish schools are required to support young people’s health and wellbeing (HWB). Schools must demonstrate a robust framework of self-evaluation to understand pupils’ HWB needs and find ways to support them. The School Health and Wellbeing Improvement Research Network (SHINE) was set up to support Scottish schools to better understand the HWB needs of pupils and make more effective use of HWB data. In SHINE’s initial pilot phase, schools were given reports of findings from a survey of some of their pupils. This study asked schools and local authorities what they thought of these reports and whether they had used them to inform school improvement. Schools were enthusiastic about receiving reports with their own school’s data. They liked the format and content of the reports. However, at the time of interview, only a few schools had used the reports to make changes within the school. Some limitations of the data reports were identified. They believed however that SHINE’s expertise was valuable and were enthusiastic about the potential of network membership. SHINE will continue to develop in response to this study’s feedback.

Background: Unhealthy diets are a leading contributor to obesity, disability and death worldwide. One factor cited as contributing to rises in obesity rates is the pervasive and ubiquitous marketing of unhealthy foods and beverages (F&Bs) across a variety of mediums, such as sport sponsorship at both professional and amateur levels. Despite increased academic attention on the detrimental impacts of sport sponsorship within the obesogenic environment, this has not been matched by legislative action. One explanation may be the way that F&B corporations’ sport sponsorship is framed within policy debates. Framing is the deliberate ways in which (often contested) issues are presented in communication. This paper examines how sport sponsorship by F&B corporations is framed through media reports. Methods: This study employed a mixed methods content and framing analysis. First, we conducted a quantitative newsprint content analysis (n = 234). This then informed and directed a thematic framing analysis of a sub-set of articles (n = 54) that specifically associated sport sponsorship by F&B corporations with obesity and childhood obesity. Results: The findings suggest that two competing frames are evident within newspaper coverage: 1) public health and 2) industry. The public health frame rejects the sponsorship of sport by High in Fat Sugar and Salt (HFSS) product corporations in particular, calling for such sponsorship to be restricted or banned. The industry frame characterises sponsorship of sport as a form of corporate social responsibility, positioning industry as good moral actors and part of the solution to childhood and adult obesity. These frames are evident across other Unhealthy Commodity Industries (UCIs) policy debates. However, the prominence of industry actors within the sample is potentially indicative of their discursive power within this space, particularly with their emphasis on the financial maintenance of sport as well as encouraging physical activity, contributing to the lack of regulatory development of sport sponsorship by F&B corporations. Conclusions: The findings of this study are particularly useful for public health organisations who seek regulatory change, as it may provide further insight into countering industry framing practices, raising the salience of regulation of sport sponsorship and thus increasing the likelihood of regulatory development that seeks to improve population health.

Background During COVID-19 restrictions in England in spring 2020, early years settings for young children were closed to all but a small percentage of families, social contact was limited and play areas in parks were closed. Concerns were raised about the impact of these restrictions on young children's emotional well-being. The aim of this study was to explore parents' perceptions of young children's emotional well-being during these COVID-19 restrictions. Methods We interviewed 20 parents of children 3-4 years due to begin school in England in September 2020. Interviews were conducted via telephone (n = 18) and video call (n = 2), audio-recorded and transcribed verbatim. Interviews focused on childcare arrangements, children's behaviour and transition to school. A sample of transcripts were coded line by line to create a coding framework, which was subsequently applied to the remaining transcripts. Coded data were then analysed using a nurture lens to develop themes and further understanding. Results Participants were predominantly mothers (n = 16), White British (n = 10) and educated to degree level (n = 13), with half the sample living in the highest deprivation quintile in England (n = 10). Five were single parents. Three themes developed from nurturing principles were identified: creating age-appropriate explanations, understanding children's behaviour and concerns about school transition. Parents reported that their children's emotional well-being was impacted and described attempts to support their young children while looking ahead to their transition to primary school. Conclusions This study is one of the first to examine in-depth perceptions of COVID-19 restrictions on young children's emotional well-being. The longer term impacts are not yet understood. Although young children may be unable to understand in detail what the virus is, they undoubtedly experience the disruption it brings to their lives. The well-being of families and children needs to be nurtured as they recover from the effects of the pandemic to allow them to thrive.