Knowledge Matters Jan-Mar, 2011This is a featured page

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Canada's monthly school health report from the Canadian Association for School Health
Volume 5 Issue 5 (Jan-Mar, 2011)
Featuring: Recent Canadian School Health Research: Are we Making the Shift or Retracing our Steps?

Canadian research and renewed activities in our national Communities of Practice (CoP’s) are the big items in this edition of Knowledge Matters, our quarterly report on school health promotion in Canada. With the support from the Public Health Agency of Canada, the Mental Health Commission of Canada and Health Canada, CASH is now able to support more activities in several of its CoP’s in the coming months. See below for the details. We are also pleased to follow up the April 2010 and December 2010 issues of Knowledge Matters which identified several Canadian SH research articles in 2009-10 and promised more for this issue. In particular, we are pleased to offer an assessment of Canadian research in 2009-2010, with a review to determine how many of the 106 Canadian articles and how many of the 132 relevant CIHR funded projects are making the shift towards an ecological and systems-based approach.

Changed Frequency, Call for Papers for this magazine Knowledge Matters,

Our 2500+ readers will note that we are now moving to a quarterly format for the publication of this report. We have struggled to produce a monthly version without the funding we used to receive from the Canadian Council on Learning. People who are interested in receiving the news on a monthly basis can still do so by “watching” the archives page in our web site, When you are watching a selected page, the web site automatically sends you an email alert when that page is changed, which we will do each month. (You will need to be a member of that wiki-based web site (no cost, no spam) and you will need to adjust the controls in your profile once you have signed into the site so that you are watching that page.) We send out an email to everyone when we post the issues of Knowledge Matters in the web site, but the quarterly review of Canadian news, research and reports will now be more retrospective.
If you are a real newshound and like instant gratification, you can follow us on Twitter at: We post Canadian items in that account several times a week. We are also posting international news, research and resource items on the welcome pages for some of our Communities of Practice. Go to these pages for the latest on these selected topics: sexual health, mental health and substance abuse prevention.

Our readers may have also noticed that we are now calling for papers to be included in this newsletter. We hope to move gradually to more of a magazine format. In 2011, CASH will be opening up this feature article space in the monthly report to others who wish to communicate with the over 2500 professionals and organizations who are on this email list. We will be looking for articles of about 1200-1500 words. We are hoping to receive submissions that include:
  • fact-based commentaries on different issues in or aspects of school health, safety, environmental or social development
  • summaries of what we know and need to know about those issues and aspects
  • case studies or practice-based stories in local agencies and communities
Send your submissions to

Use our Widget to Post the Latest SH News on Your Web Site
Widget for CSHTweets
The Canadian Association for School Health uses a Twitter account to share Canadian news stories, research and resources. We keep it factual, professional and brief. If you have a Twitter account, you can join others in “following” us as we post clippings of the various items with convenient web links back to the original source. Go to:

To feed those items (tweets( into that account, we follow several Canadian journals and watch for Canadian studies or researchers in many others as well as monitor the Canadian news, web sites and social media outlets. Now, through the use of a “widget” available for Twitter accounts, you can have those postings displayed in a window on your web site.

Post the Latest CSH News on Your Web Site Using our Widget Displaying the latest “Tweets” from our Twitter News/Research Feeds

We are pleased to offer this innovative method to add the latest Canadian news, research and resources as a window on your own web site. Promote traffic to your site while cooperating with the Canadian Association for School Health. To do this, we are “syndicating” or sharing the items that CASH posts on its Twitter account called CSHTweets. Here is what the widget looks like when placed on your web site. We can customize the text, size, colours and number of items displayed according to your needs.

The web site programming code shown in the text box in this document posted on our web site can be pasted into your web site, thereby creating an updated listing of the latest tweets or posts made to that Twitter account.

Contact the web technical staff in your organization. They will know how to copy and paste the code into a frame on a page of your choosing on your web site

If you have questions or need help, contact

PS We encourage others to post their announcements into that same Twitter account. Feel free to post your news on the shared "CSH Tweets" account on Twitter. Simply go to, sign in as user "cshtweets`, password `cash-aces and post your news. Those tweets and other items are subsequently posted on the CSH web site through posting updates directly onto our School Health Blog

Canadian School Health Knowledge Network News

Three Webinars/Web Meetings on Sexual Health Promotion
Our Community of Practice on School Sexual Health promotion is hosting three webinars on (1) Understanding the Nature and Prevalence of Sexual Health of Canadian Youth(May 26, 9:00 am PT), (2)Teacher Education & Development in Health, Personal and Social Development Education (Including Sexual Health) June 8, 9:00 am PT and (3)Towards an Updated Comprehensive Model of School Sexual Health Promotion(June 21, 1:00 pm PT).(Theseweb meetings will feature panel discussions among experts from Canada and other countries as they answer participants questions and engage everyone in discussions)For more information and to register for these free web activities, go to:

Five Webinars/Web Meetings: Implementation Issues School Mental Health
A similar series of panel-based web meetings will be held on implementation and capacity issues in school-based and school-linked mental health promotion. Inter-ministry cooperation and leadership, inter-agency coordination, capacities & capacity-building, Evidence-based Implementation Models and Maintaining Fidelity to Evidence-based Programs or Approaches in the face of Complexity and Other Challenges. This series will start in June. Watch for the dates and times at:

Four Year Knowledge Exchange Program in Substance Abuse Prevention
CASH is pleased to be working with the Council on Drug Abuse and the International School Health Network in providing knowledge development and exchange associated with a national peer-based program being developed and expanded in schools in three jurisdictions. The KE program will include a series of webinars, web meetings and online discussions.

CASH Conference November 28-29, 2011 in Montreal
Our annual conference, which normally is held in the Spring of each year, will be organized on November 28-29, 201 at the Queen Elizabeth Hotel in Montreal. We are pleased to be partnering with the Institute for Public Health in Quebec, as part of their Journeés annuelles de la santé publique (JASP), the International Union for Health Promotion and Education (IUHPE) and the International School Health Network. CASH is represented on the international planning committee Fran Perkins of the Ontario Healthy Schools Coalition. The theme is New Understandings, Better Integration, Sustainable and Equitable Actions. Link to the web site here.
Sign Up & Sign In: We are continuing to transfer the email contacts lists over to our professional networking web site at Agencies, organizations and individuals will be able to control the email they receive from this wiki-based web site through their own profiles. (This occurs by "watching" or "unwatching" selected pages). As well, they will be able to use the tools on the web site to interact with others and receive RSS feeds from the daily blog of SH news.

CASH Leads PHAC Discussions on Knowledge Exchange
On May 26, 2011, CASH Executive Director Doug McCall will be presenting our report that maps out the web-based KE activities of many national organizations, federal departments and agencies and universities for the Canadian Best Practices Portal and Initiative. A wiki-based web site has been developed to assist in the project. This web site contains information on the KE activities of over 50 national organizations at:

Canada Bucks the Trend with Expanded SH Activities
Several new developments within Canada are indicating expansion and strengthening of school health promotion in Canada. These include:
  • recent well-attended provincial SH conferences in Manitoba, Alberta and BC
  • emergence of SH research centres or activities at several universities including UPEI, U Ottawa, UNB, U de Montreal, Waterloo, U Alberta and SFU.
  • Celebration of the Third Annual Healthy School Day (on Environmental health issues) reflects a growing awareness about sustainable development issues
  • national funding for school projects in physical activity/nutrition, obesity, substance abuse, mental health
  • the use of small SH school grants and recognition programs in Ontario and Manitoba
  • expansion of the HBSC survey to include sampling in all provinces and across the territories
These welcome Canadian events run counter to some disappointing events in England, where the SH program has been dismantled and in the US, where the SH program at CDC has been divided into two parts that correspond to two major health issues.

Highlights of Canadian Research & News Stories from January-March 2011

With our change to a quarterly format for this newsletter, we will be highlighting selected events over the past three months. Go to the archive of monthly postings
for all of the items.

Highlights From January 2011

  • The Public Health Agency of Canada decided to ease physical-fitness guidelines
  • Several news stories followed the controversy about wifi in schools. Edmonton schools moved ahead with WiFi technology
  • On Jan 24, the federal government Renewed Health Warnings on Cigarette Packages
  • School health services in Ontario were criticized in a review. See this blog post that calls it a mess (Toronto Star)
  • A small Canadian study found Schools participating in Ontario’s “Healthy Schools” program had better school oral health outcomes
See all of the postings for January here
Highlights from February 2011

  • The Trillium Foundation will fund an Ontario Project Studying sustainable strategies for safe schools
See all of the postings for February here.
Highlights from March 2011

  • New Brunswick Ministers indicated more efficiencies(budget cuts) are being sought in Health & Ed Ministries
  • A study reported that earlier hitting in hockey leads to spike in kids' concussions
  • The FPT Ministers’ ‘national dialogue’ on obesity falls short for health advocates
  • The FPT policy Curbing Childhood Obesity: An Overview of the FPT Framework to Promote Healthy Weights
See all of the postings for March here

Feature Article
: Recent Canadian School Health Research: Are we making the Shift or Retracing our Steps? By Doug McCall, Executive Director, Canadian Association for School Health

This article presents and discusses a list of published Canadian research studies (2009-10) as well as recently funded CIHR Research Grants (2010) to provide a preliminary assessment as to whether these recent works are making the shift to new ecological approaches to school health promotion. This preliminary assessment indicates that Canadian research is beginning to consider these new approaches but the majority of studies published and funded in this time frame continue to follow traditional pathways and methods.

In determining the criteria for assessing whether the research studies were making the shift towards an ecological approach, we used a report on a 2004-05 CIHR project (McCall & Doherty, 2004) that developed an international research agenda for school health promotion as our operational definition of a new paradigm for school health research. This agenda is based on a national email survey, literature reviews, two Canadian workshops and an international seminar. It presents an ecological and systems-based approach to the promotion of health, safety, social development and sustainable development through schools. It also presented a list of concerns and major research/knowledge development issues that should be addressed in the future.

The International School Health Network has developed a more complete explanation of this ecological and systems-based approach in its World School Health Encyclopedia. In this approach, researchers and practitioners pay more attention to concepts such as local context, system, organizational and professional capacities, implementation processes and sustainability rather than testing a particular program in controlled and often somewhat artificial circumstances.

The recently published studies considered here were identified by scanning the contents of over 150 journals published on health promotion, safety, social development and education as well as a review of the 2010 research grants and awards from the Canadian Institutes for Health Research. The Canadian articles reviewed here were selected from a database maintained by the International School Health Network which publishes the School Health Insider, a multi-source information service tracking research, news, web sites, presentations and professional uses of social media. The school-related 2010 grants were selected originally from a list published on the CIHR web site. A previous issue of this newsletter published a list of school-related projects, awards and knowledge translation events. This list was used for this review.

Articles and funded CIHR projects were initially identified for review only through their titles and authors, so we extend our apologies if we missed or misunderstood any studies. We would be pleased to add them to the updated list of published Canadian articles found on the web site. As well, because of the human and library resources available to us at this time, we relied only on the abstracts of brief articles that appear in peer reviewed journals or on the brief project descriptions provided on the CIHR web site. Further, we recognize that there drawing a clear demarcation line between new and old approaches to school health promotion is somewhat simplistic.
However, our preliminary results do clearly indicate that majority of recent Canadian studies are not yet making the shift towards an ecological and systems-based approach. In this sampling, 83 published articles and projects/awards reflected the new approach, while 155 projects were retracing traditional routes in describing health problems and using controlled trials that have proved most often to be unsustainable in the real world of education, public health and other systems.

Further, many of the published articles reflecting the ecological approach were not reporting on studies but were actually analyses and arguments for using the new approaches and studying the newer concepts. As well, many of the CIHR projects that we noted as reflecting the new approach were actually meeting grants and graduate student awards that were developing research agendas and avenues of inquiry rather than reporting on research that had been completed.

More assessments are clearly warranted but this preliminary assessment does sound a warning bell in respect to our collective will to truly reform our approaches to school health promotion in order to walk the talk about ecological approaches. For researchers, this article can indicate some promising directions for new research. For research funders, this article suggests that some new criteria for funding applications should be considered. For practitioners, officials and policy-makers, this article could encourage them to ask the research system to move forward on explaining the complex, real world factors that limit the sustainability and implementation of better programs.

Here are the two groupings of research we have developed for this preliminary analysis.

Research Reflecting
Ecological/ Systems-based Approach
Number of articles (2009-10) and CIHR 2010 funded projects
Research Reflecting
Traditional Program Approach
Number of articles (2009-10) and CIHR 2010 funded projects

Respecting and working within complex, ecological, systems-based factors from the outset, recognizing that open, adaptive systems will eventually modify any intervention (general overview)

  • One article
  • Two CIHR projects
Descriptive studies of the prevalence and nature of health and social problems
  • 27 articles
  • Ten CIHR projects
Understanding how complex interactions between macro, meso and micro environments interact with family, school and student characteristics to initiate or support behaviours, attitudes and beliefs

  • Five articles
  • Three CIHR projects
Identifying and describing correlations between various social influences, populations and conditions and health behaviours or health status (especially low SES, race, aboriginal status)
Identifying single and multiple intervention that can address underlying social and economic disadvantages
Correlating specific health behaviours and conditions to underlying social and economic determinants
  • 17 articles
  • 31 CIHR projects (many on aboriginal communities/ students)
Identifying the means to achieve basic health literacy for all, Understanding the correlation between basic health literacy and basic education/dropouts.
  • Four articles
  • One CIHR project
Defining the minimal (rather than optimal) health education outputs for over 25 health/social topics that are necessary to achieve basic health knowledge/skills that are sufficient for behaviour change when linked with services and other supports

Moving back to properly planned health/personal-social development curricula with evidence-based scope and sequence and a defined and realistic set of minimum learning outcomes

Finding ways to replace family studies/home economic/ family life curricula and learning which have largely disappeared from schools

Finding ways to shift attention in PE curricula towards broad participation/ enjoyment rather than competition and motor skill development

  • One article
Studies or assertions on how improved knowledge, skills, attitudes can lead to healthier behaviours

Studies or assertions showing the benefits of positive health behaviours or the personal, social and economic burden of negative health behaviours or diseases

Development of issue specific instructional programs

Studies correlating the absence of a disease with improved academic performance of students

  • One article
Describe how other relatively new concepts about socially learned and similar factors will affect the development of behaviours, including personal assets, resilience, normative beliefs, stigma that discourages help-seeking and encourages discrimination, connectedness to trusted adults, positive peers and schools
  • Two articles
  • Four CIHR projects
Descriptions and assertions about what should be known about and skills directly related to specific health and social issues. These usually describe the personal knowledge, attitudes and skills required to affect behaviour to avoid risk or health problems (deficits) and are packaged as separate instructional programs
Starting with an analysis of the local context and identifying issues and populations of concern, then selecting programs to address them
  • Seven CIHR projects (using Community-Based research techniques in small studies)
· Evaluating the impact of single or specific programs interventions in random, controlled trials (usually with externally funded resources)
  • Eight articles
  • 12 CIHR projects
Understanding how regular practices, norms and customs in the school (recess, lunch hours, grade/school organization, transitions between levels of schooling, student promotion/failing practices, student recognition practices, student events such as proms and dances, policies on student suspensions, attitudes towards gender and minority cultures/races, all affect health and development.
  • Five articles
  • Six CIHR projects
· Evaluating the impact of a RCT-evaluated program in replicated trials in different contexts or on sub-populations
  • Eight articles
  • 12 CIHR projects
Doing more cost-benefit and cost-effectiveness studies to identify short and long term savings or realistic options within current budgetary limits
  • One article
Understanding of the physical features, and facilities affect health and learning, including school size, transportation routes, school grounds, facilities and transportation for after school programs, air quality, natural light, environmental hazards, clean water, etc
  • One article
  • One CIHR project
Doing multi-level analyses and correlations, narrative reviews and other qualitative studies that explain why and how interventions are successful or sustained in schools
  • One CIHR project
Doing systematic reviews and meta-analyses of the impact of a program in several studies
  • Five CIHR projects
Describing the conditions and capacities necessary to sustain and institutionalize multiple intervention approaches and programs across several systems. These include baseline costs such as staffing ratios and operating budgets as well as operational capacities such coordinated ministry and agency policies, assigning coordinators at all levels, workforce development, ongoing knowledge exchange, regular monitoring and reporting on health learning and behaviours/knowledge/skills as well as system policies and programs, formal and informal mechanisms for cooperation, strategic issue management and explicit planning for sustainability
  • Ten articles
  • 19 CIHR projects (mostly were meeting grants discussing knowledge exchange strategies or setting research agendas on specific topics)
Evaluating the impact of multi-intervention programs on a single or limited number of related health/social issues
  • Six articles
  • One CIHR project
Developing and using implementation theories and models to explain program adoption
  • Two articles
Determining if fidelity affects program impact and how fidelity can be maintained
  • Two CIHR projects
Using organizational development, management and similar theories to understand and explain how system structures and system characteristics (openness, loose coupling among layers in systems, professional bureaucracies, working across multiple systems) interact to support healthier schools, agencies and ministries Using behavioural theories to understand how individuals are influenced by their social environments, how they contemplate and adopt certain behaviours and how programs can increase their knowledge, skills, attitudes and ultimately selected health behaviours
  • Six CIHR projects
Achieving a deeper understanding of the primary functions of schools, the work lives/professional norms of educators and other professionals and how health/social and other agencies can integrate their concerns within the priority educator concerns and constraints
  • Two articles
  • Three CIHR projects
Determining if teacher training has an impact on program implementation and program impact
  • One article
  • Four CIHR projects
Understanding how a variety of largely unstudied mechanisms work in SH promotion, including how to coordinate interventions at the inter-ministry, inter-agency and inter-professional levels ·
Seeking ways to measure changes in the physical, social and policy/program environments

Seeking ways to measure and monitor system, organizational and professional capacities
  • Two articles
Discussion of measurement methods for assessing the presence of disease, deficits, disabilities etc within a population
  • Two articles
  • Two CIHR projects
Strengthening and increased use of new research methods including multiple method studies, narrative inquiry, practice-based identification of research topics, more analysis and sharing of survey and administrative data sources
  • 12 CIHR projects (mostly small scale studies or awards top grad students using CBR methods with designated sub-populations)
  • 36 articles
  • 47 CIHR projects
  • 70 articles
  • 85 CIHR projects

Discussion and Recommendations

Although this preliminary review is limited in scope and methodology, this convenient sampling of recent Canadian articles and funded grants shows that the majority (roughly two-thirds) of current research in school health promotion is still following traditional pathways of describing health and social problems, amplifying their importance to overall health and suggesting targeted, controlled trials of specific interventions to prevent those problems. On the positive side, there appears to be an increased level of interest reflected in articles, meeting grants and graduate student awards in ecological approaches to school health promotion.

This preliminary assessment can be improved and extended by a more extensive review of the published articles in the 150 journals that are monitored for other purposes (ie an information service). Further, obtaining the full journal articles and details of the CIHR grants would enable for more in-depth analysis of their contents. Perhaps a dialogue with the researchers to confirm the assessments would be possible as well as productive in other ways.

As well, using a simple demarcation line between “new and old” approaches is not sufficient to capture different facets and even spinoff examinations from several studies, so a multi-dimensional analysis would likely be more effective.
Further, since Canada is a small part of the research community worldwide, a broader view that captures research from other countries would be even more valuable.

Notwithstanding the above, this assessment strongly suggests that the research agendas of funding agencies, government departments and major research programs should be reviewed in the light of this little, blinking warning light. Decades of research documenting the prevalence and importance of single health behaviours and conditions, many studies of controlled trials of interventions on those problems and more reviews, systematic reviews and reviews of reviews have been done without yet answering fundamental questions about the capacities required to sustain such interventions in the real world of open, adaptive and complex systems. Let’s hope that Canadian can truly move in that direction in the near future.

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