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WORLD HOSPITAL DIRECTORY
Health Care Management Medical Health Promotion International - current issue
<span class="paragraphSection"><div class="boxTitle">Abstract</div>Sedentary lifestyles among urban young adults are a growing public health concern, contributing to the rise in chronic diseases worldwide. Factors such as neighborhood walkability and access to amenities play a critical role in promoting physical activity among young adults. However, the specific ways urban environments influence active lifestyles vary and are context-dependent. This study explores how urban assets shape the active living experiences of young adults in a physical activity-friendly neighborhood in Seoul, South Korea. It addresses how these features support active lifestyles in a dense, competitive, and culturally complex urban environment. Twenty-six young adults residing in the study area, selected through purposive sampling, were recruited between September 2022 and May 2023. Using a spatiotemporal qualitative design, experiential, spatial, and temporal data were collected through in-depth interviews, cognitive mapping, and 24-hour activity tracking. The data were analyzed using generic qualitative analysis—a flexible approach to identifying patterns in qualitative data—and overlay analysis to integrate insights on how urban assets interact with young adults’ active lifestyles. Young adults perceive active living as a self-directed pursuit, balancing personal growth and social engagement within a compact urban environment. Urban assets, including parks, fitness centers, and walkable streets, are key enablers. However, young adults also perceive psychological pressure to maintain an active lifestyle in a competitive urban setting. This study highlights the need for urban environments that promote physical activity while considering the unique challenges of young adulthood. Public health policies should ensure equitable access to urban assets, supporting young adults’ active lifestyles.</span>
<span class="paragraphSection"><div class="boxTitle">Abstract</div>Cooking meals at home is often recommended as a strategy to consume a healthy diet and avoid ultra-processed foods and unhealthy dietary patterns. However, cooking has traditionally been a highly gendered activity, and as food environments, economies, and social norms evolve globally, understanding of cooking behaviors in different contexts is needed. We analyzed repeated cross-sectional data from 135 countries from the 2018–22 Gallup World Poll (<span style="font-style:italic;">n</span> = 638 192). We conducted unadjusted and adjusted negative binomial regression models, overall and stratified by gender, to estimate differences over time and by five food system typologies in the mean number of days cooking and eating lunch and dinner at home per week. Across most food system typologies, mean number of days cooking but not eating meals at home gradually increased between 2018 and 2019, peaking in 2020 (among females) and 2021 (among males) and then declined in 2022, trending towards prepandemic levels. Adjusted for covariates, participants from emerging and diversifying food systems cooked meals at home 13% (95% CI: 1.10, 1.16, <span style="font-style:italic;">P</span> < .001) more compared to participants in rural and traditional food systems. Compared to males, females cooked meals at home 214% more frequently (<span style="font-style:italic;">P</span> < .001). Across the globe, COVID-19 shifted cooking behaviors and exacerbated preexisting gender disparities in frequency of cooking meals at home. Future research is needed to better understand the role of cooking behaviors in the nutrition transition at global, national, and local levels.</span>
<span class="paragraphSection"><div class="boxTitle">Abstract</div>Educational materials about human papillomavirus (HPV) vaccination must be easy to understand and must support recommended behaviors regardless of readers’ health literacy levels. The purpose of this study was to evaluate the understandability, actionability, and comprehensiveness of HPV vaccination educational materials in Japan. From August to September 2023, we obtained HPV vaccination educational materials from the central government, local governments, and websites. We assessed the understandability and actionability of the materials using the Patient Education Materials Assessment Tool for Printed Materials (PEMAT-P), Japanese version. We also evaluated the comprehensiveness of the content. Ratings of understandability, actionability, and comprehensiveness were compared by material type and source. We evaluated 164 eligible materials. The mean understandability and actionability of all materials were 60.5% (standard deviation [SD] = 12.5) and 42.0% (SD = 20.5), respectively. Many materials lacked definitions of medical terms, clear explanations of numbers, content summaries, explicit steps of action, and the use of visual aids to improve understanding and actionability. The mean comprehensiveness score was 73.5% (SD = 14.7%). A few materials included all the necessary information content. The highest understandability score and actionability score were for local government mailings, and the highest comprehensiveness score was for academic materials. Most Japanese HPV vaccination educational materials were insufficiently understandable and actionable. Such materials need to be improved, especially regarding the use of numbers, medical terms, and visual aids. In terms of content, the importance of vaccination before sexual debut and the benefits of vaccination for men should be emphasized.</span>
<span class="paragraphSection"><div class="boxTitle">Abstract</div>This study constructed the Healthy Aging Index (HAI) and identified its associated factors, using two waves of nationally representative data on the Vietnamese older persons in 2019 and 2022. HAI was constructed with 22 variables reflecting various domains of healthy aging, and its measurement ranged from 0 to 100. Descriptive statistics and multivariate Tobit regressions were conducted. We found that the overall HAI scores were relatively high in 2019 and 2022 (84.05 and 83.71, respectively), indicating that the Vietnamese older persons were relatively healthy. More advanced age, being women, living with at least a child, living with a spouse, being more affluent, having higher educational level, receiving social welfare benefits, performing household chores, and utilization of healthcare services were associated with the overall HAI scores as well as each factor of HAI scores. This study also discussed policies that can be designed to enhance well-being of older persons in Vietnam, including the investment in higher educational training, lifelong learning programs for older adults, increasing pension and social welfare benefits together with enhancing healthcare delivery for vulnerable groups, and the development of an integrated care model combining health and social care.</span>
<span class="paragraphSection"><div class="boxTitle">Abstract</div>Salutogenesis and sense of coherence can buffer the effects of external threats such as stigma, discrimination, and emergencies. Lesbian, gay, bisexual, trans, and queer (LGBTQ+) communities globally face discrimination, prejudice, and victimization. Understanding salutogenesis and sense of coherence among LGBTQ+ people could improve policy and health promotion responses and reduce the impact of these stressors on LGBTQ+ people’s health. This scoping review addressed the following question: To what extent has salutogenesis, either qualitatively or through measurement of sense of coherence, been explored among LGBTQ+ populations globally? Systematic searches of five databases identified 448 unique sources: 413 were excluded through title and abstract screening, and 18 by full-text screening. Of the 17 included studies, 14 were quantitative, two qualitative, and one mixed methods. Studies recruited participants from 11 high-income countries. Two-thirds (11) recruited participants only from within the LGBTQ+ community and six had more broadly based samples. The studies sampled a diverse range of subpopulations and subgroups from a variety of contexts limiting generalizability. The quantitative measure of sense of coherence most often used was the SoC-13 (<span style="font-style:italic;">n</span> = 7), however, heterogeneity in the results reporting prevented quantitative synthesis. The limited evidence suggests that sense of coherence may be lower in LGBTQ+ populations than in comparison groups of cisgender heterosexuals, at least in some contexts, and is related to measures of wellbeing and discrimination. Further research is needed to understand how sense of coherence and its dimensions influence, and is influenced by, LGBTQ + people’s life experiences and resources and their responses to external stressors.</span>
<span class="paragraphSection"><div class="boxTitle">Abstract</div>Unhealthy dietary behaviour is associated with several adverse health outcomes. However, individual dietary choices aren’t solely the function of personal habits and are influenced by various environmental factors. This study aimed to identify the social determinants of dietary behaviours in a priority Australian community. We utilized community listening to explore the priority community members’ narratives and experiences about the determinants influencing their dietary behaviour. Those determinants were then categorized under the lens of the Socio-ecological Model. The suburb of Inala; a low socioeconomic, multiethnic community in Southwest Brisbane, Queensland, Australia was selected to listen to the voices of community members, health professionals, social workers, teachers, and community service providers. Researchers listened to hundreds of stories from 168 community members throughout the project. Participants identified personal interest in healthy eating, knowledge of healthy food and preparation; and time constraints for healthy food preparation, which were subsequently categorized under individual-level (microsystem) determinants of dietary behaviour. Family support, parental influence, and commitments were identified as other determinants that were categorized under social-environment level (mesosystem) determinants. Availability of fresh fruits and vegetables and ubiquity of fast-food outlets were the other factors identified, which were listed under physical-environment (exo-system) determinants; and finally, cost of living, inculturation, and dissatisfaction with health practitioners were identified and categorized under policy-level (macrosystem) determinants. The complex relationship between personal, sociocultural, and environmental factors with dietary behaviour presented in this study highlights the need for multi-component and culturally tailored initiatives to enable healthy eating in priority communities.</span>
<span class="paragraphSection"><div class="boxTitle">Abstract</div>Children face new and growing threats to their health and well-being, including rising rates of non-communicable diseases and mental health disorders linked to the influence of commercial determinants of health and climate change, among other issues. Yet despite their right to participation established under the United Nations Convention on the Rights of the Child, children are rarely invited to participate in global health processes meant to benefit them, whether by selecting priorities, designing policies and programming, advocating for their adoption or evaluating their implementation or impact. We call for greater involvement of children in global health initiatives, particularly those designed to benefit them, and lay out five principles to structure such engagement: (i) respect for children’s right to participation, (ii) protection of children’s safety and well-being as a foremost concern, (iii) age-appropriate interactions, (iv) reasonable inclusivity, and (v) transparency and accountability towards child participants. We provide practical recommendations for engaging with older children based on our experience with the Youth Advisory Board of the Children in All Policies 2030 initiative, which included 22 children aged 13–18 from 17 countries who provided input across all areas of our work. Finally, we show the benefits of engaging with children for organizations, the impact they seek to achieve, and child participants themselves.</span>
<span class="paragraphSection"><div class="boxTitle">Abstract</div>Higher levels of parental health and digital literacy are associated with better health knowledge and therefore better health outcomes for their children. There is currently no research evaluating the impact of parental digital and health literacy on children’s participation in sport. This cross-sectional study aimed to investigate the effect of parental digital and health literacy on the sport participation of their children and included parents of children aged 6–18 years, categorized into a sport-participating group (<span style="font-style:italic;">n</span> = 201) and a non-participating group (<span style="font-style:italic;">n</span> = 116). Parents completed a questionnaire assessing demographic characteristics, internet and mobile phone usage for health-related purposes, and their children’s level of sport participation. Additionally, they were administered the Digital Literacy Scale and the Health Literacy Scale. The total, technical, and social dimension scores of the Digital Literacy Scale were significantly higher in parents of children participating in sport (<span style="font-style:italic;">P</span> < .05). Similarly, the total score on the Health Literacy Scale, as well as the subscale scores for accessing/obtaining, understanding, and processing/appraising health-related information were significantly higher in the sport-participating group (<span style="font-style:italic;">P</span> < .05). Furthermore, a significant correlation was observed between the total scores of the Digital Literacy Scale and the Health Literacy Scale (<span style="font-style:italic;">P</span> = .001, <span style="font-style:italic;">r</span> = 0.412). These findings indicate that parents of children engaged in sport have significantly higher digital and health literacy levels. Enhancing parental digital and health literacy may play a crucial role in promoting children’s participation in sport. Interventions aimed at improving parental digital and health literacy could positively impact children’s sport-related health outcomes.</span>
<span class="paragraphSection"><div class="boxTitle">Abstract</div>People with chronic health conditions tend to look for information from a range of sources. Although information online is accessible, the quality varies and articles in scientific journals are not written for a general audience. Given this, plain language summaries (PLSs) may be a useful source of information, especially for people with chronic medical conditions. PLSs contain reliable information that is written in plain, easy-to-understand language. We investigated the health information-seeking behaviour of consumers with chronic health conditions and sought to understand what they see as important in a PLS with respect to content, design and structure, and the labels used. We conducted semi-structured focus groups and interviews with 19 participants from 6 countries, all with a chronic medical condition. Using reflexive thematic analysis, we developed four themes: (i) ‘Accessing information in a competitive landscape of health information’; (ii) ‘I really don’t see the patient in this at all’; (iii) ‘Co-design should be meaningful, not tokenistic’; and (iv) ‘A way forward: Approach PLSs with creativity’. Participants highlighted the importance of PLS labels, the need for actionable content, and the recommendation to vary the reading level depending on audience needs. The results of this study suggest that PLSs produced with consumer input could elicit PLSs that better meet audience needs, focusing on information that is actionable, accessible, and written with useful content that is detailed but still respectful of the reader. Consequently, PLSs could become a more useful source of reliable information, particularly for people with chronic health conditions.</span>
<span class="paragraphSection"><div class="boxTitle">Abstract</div>There have been increasing calls for cultural safety training in recent years, but it is not a new concept. We outline the developmental process used to create an intensive online Indigenous cultural safety training led by Indigenous Peoples. We describe the process and framework developed with the Indigenous Content Committee for creating this online program that includes 24 hours of content, and the final course structure and administration. The objective of the cultural safety course was to address systemic anti-Indigenous racism with a focus on improving culturally sensitive communication, effective collaboration, and respectful community engagement among students, staff and faculty in medicine, nursing, social work, public health, and education. Evaluations of the course outcomes have been reported in detail elsewhere, but the course was positively received and participants demonstrated increased knowledge, understanding, and feelings of responsibility. The course design that resulted from this process was reported to be impactful on participants personally and academically, but it must be recognized that cultural safety is a lifelong journey and should not end here.</span>
<span class="paragraphSection"><div class="boxTitle">Abstract</div>Fuelled by the tobacco industry, commercial tobacco use is a major cause of preventable morbidity and mortality among Aboriginal and Torres Strait Islander peoples. Preventing adolescent smoking initiation is critical to reducing uptake. Understanding individual, social, and environmental factors that are protective against smoking can inform prevention strategies. We analysed data from adolescents 12–15 years and their caregivers from Wave 11 (2018) of the Longitudinal Study of Indigenous Children (LSIC). Poisson regression was used to calculate adjusted prevalence ratios (PR) of never smoking in relation to individual, social, and environmental factors adjusted for age and remoteness. Never smoking was reported by 81.3% of adolescents. Half (51.3%) of those who had ever-smoked had smoked in the last year. Never smoking was significantly associated with peer never smoking, no substance use (including e-cigarettes), positive family and school environments, no boredom, no trouble with police, and no family experiences of racism. Never smoking prevalence was twofold among adolescents who had never (versus ever) tried e-cigarettes (PR = 2.10; 95%CI: 1.41, 3.14). Fostering positive social relationships, discouraging substance use, and eliminating racism and discrimination are important in preventing adolescent smoking, offering some protection against the exploitative practices of the tobacco industry. Culturally safe structural supports and comprehensive approaches to individual, social, and environmental wellbeing are required to prevent smoking and promote wellbeing.</span>
<span class="paragraphSection"><div class="boxTitle">Abstract</div>In the Australian population, a substantial number of people consume alcohol, tobacco, and other drugs (ATODs). As most people who use ATOD are employed, the workplace is an environment through which ATOD primary and secondary preventive health interventions can be implemented. However, resource allocation can be informed by research that determines priority industries and occupations, as indicated by the prevalence of ATOD use, numbers of users, and likelihood of use (i.e. adjusted odds ratios). A secondary analysis of the 2022–23 Australian National Drug Strategy Household Survey was conducted to assess risky alcohol consumption, current smoking, and illicit drug use (past 12 months) across different industries and occupations. There were 16,281 participants for industry analyses and 17,247 participants for occupation analyses. Survey-weighted estimations of the number and prevalence of individuals who consumed ATOD were performed, followed by a series of survey-weighted logistic regression analyses to identify industries and occupations associated with increased likelihood of ATOD use. Across all substances, the industries with the highest prevalence of ATOD use were mining, construction, and accommodation and food services, while occupations with the highest estimated prevalence were technicians and trades workers and labourers. Conversely, health care and social support, along with construction, exhibited the highest estimated number of ATOD users. The adjusted regression models revealed substantial variation in the industries and occupation types associated with heightened likelihood of ATOD use. This study provides important evidence for prioritizing industries and occupations most likely to benefit from ATOD interventions.</span>
<span class="paragraphSection"><div class="boxTitle">Abstract</div>School food programs have been shown to support the nutrition of children and their long-term health outcomes in tandem with reducing nutritional inequities experienced by low-income, food insecure, and racialized populations. Understanding the specific needs and outcomes of these equity-deserving groups is crucial when enhancing program implementation and participation in school food programs. A scoping review of equitable, diverse, and inclusive considerations for school food programs was conducted on Canadian and American peer-reviewed and grey literature. The search strategy identified 18 peer-reviewed publications and three grey literature reports that supported the creation of five themes to be explored for school food programs: universal access, food preparation and delivery, sociocultural food preferences, partner involvement, and equitable nutrition. Analysis revealed that while literature surrounding these themes is developing, they serve as a crucial starting point for further research and consideration of the enhancement of school food programs. These themes can support the delivery of a program that is accessible to all students, accommodates their individualized needs, and is free of stigma.</span>
<span class="paragraphSection"><div class="boxTitle">Abstract</div>Understanding parental decision-making during complementary feeding is essential for designing effective interventions that address deviations from nutritional recommendations and support optimal growth and development. However, there is no consensus on the key factors shaping the characteristics of complementary feeding, particularly in Africa, Asia, and Latin America. In this context, the present work aimed to identify factors influencing parental decision-making on what foods to offer their child during complementary feeding in Uruguay, a Latin American country. Semi-structured interviews with 21 parents of children aged 6 to 15 months were conducted. Interviews were audio-recorded, transcribed verbatim, and analyzed using qualitative content analysis, integrating inductive and deductive coding approaches. Several deviations from national and international complementary feeding recommendations were identified, including limited dietary diversity, focus on soft textures, delayed introduction of nutrient-dense foods like meat, and early introduction of ultra-processed dairy products high in sugar, such as yogurt and dairy desserts. A multifaceted range of factors influencing parental feeding practices during the complementary feeding period were identified. Health-related goals played a central role in parents’ decisions about which foods to offer during complementary feeding. However, insecurity, misconceptions about food healthiness, fears of adverse health outcomes, and economic constraints often led to deviations from nutritional recommendations. In addition, parental decisions were also shaped by the external food environment and macro-level factors, such as the health system, childcare centers, and social norms. These findings underscore the need for comprehensive, multifaceted approaches to improve complementary feeding practices, extending beyond simply enhancing parental knowledge.</span>
<span class="paragraphSection">Medical Research Council10.13039/501100000265MC_UU_00022/2Chief Scientist Office of the Scottish Government Health Directorates10.13039/100014589SPHSU17Cancer Research UK10.13039/501100000289PPRCTAGPJT\100003</span>
<span class="paragraphSection"><div class="boxTitle">Abstract</div>Spending time in and connecting with nature has been shown to have positive benefits across multiple health outcomes, including for children and youth. Growing in popularity, nature prescriptions are recommended by health providers, social providers, and educators to spend more time in nature. The health and well-being benefits from nature prescription programs hold great potential for children and youth. However, a key evidence gap remains on how nature prescriptions occur in practice in pediatric healthcare, social care, and education, including barriers and facilitators to the implementation of nature prescription programs. The purpose of this scoping review was to explore the barriers and facilitators to the implementation of nature prescription programs for child and youth health. Peer-reviewed, original studies published in English were systematically searched in six databases using search terms focusing on nature prescriptions and child and youth health. Following the recommendations of Arksey and O’Malley (2005), two reviewers independently screened 2111 titles and abstracts, 38 records were screened in full text, and 10 studies were included. Thematic analysis was conducted following Braun and Clarke’s (2022) guidelines. Three themes were developed from thematic analysis: (i) safety considerations, (ii) materials, resources, and support, and (iii) program features. The results of this review can be used to guide future nature prescription program implementation strategies for child and youth health.</span>
<span class="paragraphSection"><div class="boxTitle">Abstract</div>Participatory interventions, such as art therapy and group activities, have been shown to promote healthy aging. However, the effectiveness of shared reading among older adults requires further evidence. The aim of this systematic review was to explore the impact and effectiveness of shared reading groups in slowing cognitive impairment, improving social interaction, promoting psychosocial well-being, and enhancing functional aspects among older adults living in the community. The selection criteria included studies published in English after 2000 focusing on individuals aged 60 and above and examining the benefits of shared reading. The studies also included participants with cognitive or psychiatric conditions who were independent. Seven databases were queried for this research. A total of 11 articles met the inclusion criteria. A descriptive analysis of the included studies revealed the tools used to measure the impact of interventions on outcomes and the key results obtained. Despite variability in methodology and outcomes, the results showed that group activities can improve self-rated health and reduce depressive symptoms in older adults. Interventions that include reading as a form of cognitive stimulation enhance communication skills, contribute to well-being, improve quality of life, reduce loneliness, and increase social engagement. Shared reading has positive effects on satisfaction with social relationships and community support. The findings suggested that shared reading groups represent a promising, non-pharmacological intervention for promoting psychological health, well-being, and social interaction. This review gathers existing literature and highlights the need for further studies to explore the effectiveness of this approach and to improve its implementation.</span>
<span class="paragraphSection"><div class="boxTitle">Abstract</div>Childhood is a period of significant formative development where knowledge, skills, and capacities for adequate health literacy are acquired, particularly within school settings. The new <span style="font-style:italic;">Curriculum for Wales</span> (CfW), phasing in from September 2022 for learners aged 3–16 years, places statutory focus on health and well-being and school-level curriculum design, providing unprecedented opportunities to empower children as agents in making health-enhancing decisions. Designing, tracking, and evaluating impacts of the CfW on children’s health literacy requires scalable monitoring tools; however, research efforts have focused on adolescent populations. This national-scale scoping and pilot study, the first to explore children’s health literacy in Wales, piloted the <span style="font-style:italic;">Health Literacy for School-Aged Children</span> (<span style="font-style:italic;">HLSAC-5</span>) within the existing nationwide <span style="font-style:italic;">Health and Attainment of Pupils in Primary EducatioN</span> (<span style="font-style:italic;">HAPPEN-Wales</span>) health and well-being survey to examine the health literacy of children aged 8–11 (<span style="font-style:italic;">n</span> = 2607) and explore associations between health literacy and health behaviours. Children’s health literacy was categorized as low (22.6%), moderate (50.4%), and high (27.0%). Multinomial logistic regression analyses suggest high health literacy compared to low health literacy was associated with higher sleep [relative risk ratio (RRR): 1.08, 95% CI 1.01–1.15], higher weekly physical activity (RRR: 1.13, 95% CI 1.03–1.25), fewer sedentary days per week (RRR: 0.89, 95% CI 0.81–0.99), and higher health-related well-being (RRR: 1.35, 95% CI 1.27–1.44). This study offers a sustainable measure of pre-adolescent children’s health literacy and health behaviours and tracking of CfW impacts. This enables efforts to be tailored to <span style="font-style:italic;">person-centred</span> (understanding children’s health literacy needs), <span style="font-style:italic;">place-based</span> (examining specific organizational health literacy context within schools and CfW design), and <span style="font-style:italic;">policy-focused</span> approaches (re-energizing health literacy within current/emerging policies in Wales including the CfW).</span>
<span class="paragraphSection"><div class="boxTitle">Abstract</div>Individuals experiencing suicidality at work may face complex disclosure decisions, involving assessing the risks versus benefits of disclosure or non-disclosure. This study aimed to identify barriers and enablers to disclosing suicidality in workplaces and to explore the responses, support, and accommodation needs for workers experiencing suicidality. We conducted semi-structured interviews with a purposive sample of 30 working adults who reported experiencing suicidality at work and may or may not have disclosed. Using reflexive thematic analysis, we constructed four themes: (i) stigma and discrimination are fears realized, (ii) leaders should address psychosocial hazards, (iii) there’s a price to pay when considering revealing and protecting social identities, and (iv) having safe people and safe systems would help. The study findings indicate that creating more compassionate and empathetically supportive workplaces may help address some of the barriers to disclosure of suicidality, including potentially decreasing stigma and discrimination and addressing psychosocial hazards that act as barriers to disclosure. Considering the role of identity by applying a socioecological lens that includes understanding the role of social identity, belongingness, culture, and marginalization may help to increase understanding of suicidality disclosure decision-making in workplaces. The findings further indicate a need to implement multi-layered systems-level approaches for workplaces to be better equipped to support workers who experience suicidality.</span>
<span class="paragraphSection"><div class="boxTitle">Abstract</div>This article explores the intersection of financialization and the commercial determinants of health (CDoH), with a focus on Australian food systems. While existing research highlights the food industry’s role in shaping dietary patterns and health outcomes, the financial sector’s influence on food systems governance remains underexamined. By investigating key actors in food systems investment policy and practice and the types of power they wield, this study contributes to a growing body of literature on CDoH. We conducted 22 semi-structured interviews with financial (e.g. investment banks and assets managers) and non-financial (e.g. food industry, government, and civil society) actors in Australia. Applying Moon’s expanded power typology, we examined how financial and non-financial actors influence food systems investment, the disruptive potential of the financial sector on established power dynamics, and implications for the healthfulness of food environments. Our results identified economic power as the foundation of influence, but network and expert power were seen as critical, especially for financial actors to get deals done. Financial actors, including the ‘responsible investment’ sector, were perceived as potentially disrupting traditional power dynamics dominated by transnational food companies. Financial norms and practices manifested differently among different actors and areas of food systems. Governments were viewed as largely absent, with calls for them to articulate a clear investment policy vision to guide healthier food systems. This study provides novel insights into financial sector involvement in food systems, the disruption of traditional power dynamics, and opportunities for healthier food systems while also raising risks for increased market concentration through financialization.</span>
<span class="paragraphSection"><div class="boxTitle">Abstract</div>Adolescents and young adults in the USA face significant sexual health challenges. Immigrant and refugee youth are particularly vulnerable due to barriers such as cultural silence around sex, contraception stigma, and knowledge gaps in sexual health. This pilot study explored the potential of a choose-your-own-adventure (CYOA) story intervention to address reproductive and sexual health disparities and enhance prevention engagement among immigrant and refugee youth in Central Ohio. We conducted semistructured interviews with 32 immigrant and refugee young adults recruited through a community organization. The interviews explored the impact of CYOA stories on participants’ understanding of dating and sexual health and identified key design features and player experiences that contribute to the intervention’s effectiveness. Interviews were audio-recorded, transcribed, and analyzed using thematic analysis. Participants (<span style="font-style:italic;">n</span> = 32) were predominantly female (87.5%) and aged 18–25 years. The CYOA intervention significantly improved understanding of sexual health through engaging scenarios that simulated real-life interactions and decision-making processes. The intervention’s inclusive design and interactive elements were pivotal in enhancing understanding, though minor technical and navigational issues were noted as areas for improvement. Realistic scenarios, peer interaction, and customization features were particularly effective in promoting engagement and learning. The CYOA format is a promising tool for sexual health promotion among immigrant and refugee youth. Carefully designed interactive stories can significantly improve young adults’ understanding and communication regarding sexual health.</span>
<span class="paragraphSection"><div class="boxTitle">Abstract</div>In 2021, the World Health Organization issued its first global strategy on digital technologies and health, calling on member states to develop their own national digital health strategies. However, the normative tools that guide the development of these strategies do not prompt member states to consider how broader political factors, such as law and policy, governance, and civic engagement, could shape health outcomes in the digital age. The digital gender divide, algorithmic biases linked to race, transnational private sector actors, and more must be thoroughly addressed in future digital health strategies. Experiences from the global HIV response have demonstrated that it is possible to do this, by mobilizing diverse government and non-governmental actors to systematically assess and act to strengthen the legal and political environment for health. This essay draws on the HIV response to critically engage with recent literature on the digital determinants of health, proposing an approach to analyzing broader political determinants of health, including commercial determinants of health, and other laws, policies, governance, and civic engagement relevant to digital health strategies. By rendering visible the role of politics, governance, and civic engagement in digital health, strategies can be tools to mobilize broad collaborations and advocacy that creates an enabling environment.</span>
<span class="paragraphSection"><div class="boxTitle">Abstract</div>The tobacco industry manipulates cigarettes to provide sensory cues that mislead people who smoke. We assessed the effectiveness of health warnings (HWs) focussed on the impact of misleading product attributes, including filter ventilation, menthol, and roll-your-own tobacco, which were called Product Attribute HWs. Australian adults who smoke (<span style="font-style:italic;">n</span> = 2544) were randomly assigned to view: control medication warnings; new Standard HWs with smoking harm images; Product Attribute HWs; or Product Attribute HWs plus a video. At baseline, participants were exposed to seven condition-specific warnings (+ video for those in the Product Attribute HWs + Video condition), then they were potentially re-exposed to one warning daily for 7 days (+ up to six video viewings). Participants (<span style="font-style:italic;">n</span> = 1414) were followed-up at 8 days. Compared to controls, exposure to Product Attribute HWs elicited: greater increases in concern when inhaling smoke with misleading favourable (e.g. smooth) and unfavourable (e.g. harsh) sensory cues; greater knowledge of industry manipulation; greater self-centric and industry-centric negative emotions; higher product-specific smoking dissonance; and a higher likelihood of past-week rumination about HWs. Compared to Standard HWs, Product Attribute HWs elicited greater knowledge of product manipulation and industry-centric negative emotions, but similar self-centric negative emotions and past-week rumination about warnings. Only the Product Attribute HWs + Video condition resulted in greater discussion and online information-seeking about warnings. Product Attribute HWs that challenge long-standing myths fostered by tobacco companies yield many similar outcomes to Standard HWs but also provide unique beneficial outcomes. Nations should consider including Product Attribute HWs in their suites of tobacco HWs.</span>
<span class="paragraphSection"><div class="boxTitle">Abstract</div>Unhealthy food and drink marketing exposure to children is known to influence children’s dietary choices and the World Health Organization recommends governments protect children from the marketing of unhealthy commodities. This study aims to explore and synthesize children’s unhealthy food and drink marketing exposure in New Zealand. A systematic search strategy was undertaken following the PRISMA guidelines. Eight databases were searched for studies from inception to January 2024 on marketing exposure of unhealthy food and drink to children aged 2–17 years. A deductive coding analysis was used, with codes sourced from a modified coding framework developed using a diagram sourced from the ASEAN and UNICEF (2023) report. The diagram demonstrates the pathway from marketing exposure to unhealthy food- and drink-related diseases. A total of 1019 studies were screened for eligibility. Forty-five studies met the inclusion criteria—five qualitative, 34 quantitative and four mixed-method studies. The results are presented in a narrative review format. Findings demonstrated children’s exposure to unhealthy food/drink marketing is ubiquitous with clear links to dietary preference and consumption. To improve child health now and over the life course, unhealthy food/drink marketing needs to be subjected to greater restriction with enforceable legislation to protect children from exposure to unhealthy marketing, breaking the chain from exposure to ill health.</span>
<span class="paragraphSection"><div class="boxTitle">Abstract</div>Underemployment is an increasingly persistent and pervasive feature of contemporary labour markets and there is some evidence to suggest that underemployment is an important social determinant of health and well-being. However, the evidence base has tended to focus on hours-based underemployment more than others like skills-based underemployment. Moreover, the gendered dimensions of underemployment remain under-researched despite evidence to suggest that women are more likely to be underemployed. Drawing on 21 annual waves (2002–22) of data from the Household, Income, Labour Dynamics in Australia survey, this longitudinal study employed Mundlak modelling to examine the association between two forms of subjective underemployment and mental health in working-age (25–64 years) Australians (<span style="font-style:italic;">n</span> = 18,285). Underemployment was operationalized in two ways: (1) hours-related underemployment; and (2) skills-based underemployment. Mental health was assessed using the MHI-5 scale. All models were stratified by gender. Results suggest that hours-related underemployment has a more negative effect on women’s mental health while skills-related underemployment has a more negative effect on men’s. Theoretically, this article highlights how subjective forms of underemployment are like unemployment, acting as a stressor for mental health because they partially deprive workers of the benefits of full employment. This study provides robust longitudinal evidence of the detrimental impact of underemployment on the mental health of working-aged Australians, highlighting how inadequate forms of work have negative health consequences. Thus, greater effort from both governments and employers is needed to implement policies and programs that help workers reach their capacity to mitigate against the negative health effects of underemployment.</span>
<span class="paragraphSection"><div class="boxTitle">Abstract</div>Mental health concerns are increasing for postsecondary students and often exceed supportive capacity. Research highlights the importance of mental health literacy (MHL) training for educators; few studies have evaluated a program designed to improve it. The purpose was to assess the impact of a two-session, virtual workshop offered 10 weeks apart for postsecondary educators on MHL and self-efficacy to recommend mental health resources to students. Content was co-created and delivered in collaboration with the university’s Student Health and Wellness department. Validated questionnaires were used to assess MHL, self-efficacy, and psychological well-being before and after each session. Open-ended questions were posed following the second session to explore experiences. Educators at the host institution who did not enrol were invited to complete the same quantitative measures to serve as comparative data. Seven participants attended both workshops and were included in the analysis. Scores for MHL and self-efficacy increased following each session and were highest following the second, revealing medium and large effect sizes, respectively. Post-workshop MHL and self-efficacy scores were higher for workshop attendees compared to their institutional counterparts (<span style="font-style:italic;">n</span> = 28). Positive experiences (e.g. group camaraderie, improved empathy and understanding, workshop utility) were noted qualitatively. Findings suggest that this type of virtual workshop may be valuable for equipping educators with knowledge and self-efficacy to enhance student mental health. Postsecondary wellness centre partnerships should be considered to facilitate reach of mental health education and resources. Involving educators who have direct contact with students can foster a whole campus approach to mental health.</span>
<span class="paragraphSection"><div class="boxTitle">Abstract</div>Continuous quality improvement (CQI) has become a widely accepted approach to optimize health services while lowering healthcare costs (Quintuple Aim) and has expanded from clinical interventions to health promotion. Retail food environments (e.g. hospital cafeterias, cafes) are of interest given the increased adoption of healthy eating policies and interventions to influence diet (e.g. price, promotion, placement and product). However, there is a lack of understanding of what organizational and policy processes are necessary to implement CQI for health promotion in healthcare. This research uses a qualitative multiple exploratory case study design to explore the barriers and facilitators of CQI for health promotion in healthcare retail food environments. This research occurred in a healthcare setting with an organizational Healthy Eating Policy applicable to staff, patients and visitors. We collected semi-structured interview data with 12 healthcare staff working in Nutrition & Food Services in a Canadian provincial health authority from January to June 2023. We used directed content analysis to analyze the data. We used the Inside out model to interpret cross-cutting organizational barriers and facilitators. Four cases of quality improvement interventions (Plan-Do-Study-Act (PDSA) cycles) were identified. Barriers included expertise to interpret nutrient criteria, lack of data, conflicting benchmarks (e.g. finance and health), third-party vendors, past negative experiences, and a lack of time to monitor and evaluate. Facilitators included an organizational Healthy Eating Policy, understanding community context, local knowledge, partnerships with researchers and leadership. This study revealed how overarching policies, accompanied by organizational support, facilitated quality improvement and engagement in CQI but also created barriers to routine practice and sustainability of health-promoting interventions.</span>
<span class="paragraphSection"><div class="boxTitle">Abstract</div>Indigenous people represent 6% of the world’s population and, over time, this population has faced different negative consequences, including those related to health. Health literacy is a variable that can help reduce the health-related harm faced by Indigenous people, since low health literacy has been considered a public health problem. The aim was to review the literature on sociodemographic and health-related factors associated with low health literacy among Indigenous people. To do this, we conducted a systematic review following the recommendations of the PRISMA Statement and approved by PROSPERO (CRD42024591888). A total of seven articles make up the results of this review. The findings show that the low health literacy of Indigenous people is associated with sociodemographic characteristics (e.g. older age, male gender, lower income and educational level) and health-related aspects such as having more than one chronic condition, low perception of COVID-19 risk, low chance of cancer screening, poorer glycemic control, eating behavior, self-monitoring of blood glucose and knowledge about diabetes and difficulty in understanding health information (e.g. medication labels). Although the number of articles selected for this review was small, it should be noted that they all presented a low risk of bias. Sociodemographic and health factors are associated with low health literacy among the Indigenous population. The findings demonstrate the importance of planning public policies to promote health and especially health literacy among this neglected population.</span>
<span class="paragraphSection"><div class="boxTitle">Abstract</div>Misinformation has been identified as a major threat to society and public health. Social media significantly contributes to the spread of misinformation and has a global reach. Health misinformation has a range of adverse outcomes, including influencing individuals’ decisions (e.g. choosing not to vaccinate), and the erosion of trust in authoritative institutions. There are many interrelated causes of the misinformation problem, including the ability of non-experts to rapidly post information, the influence of bots and social media algorithms. Equally, the global nature of social media, limited commitment for action from social media giants, and rapid technological advancements hamper progress for improving information quality and accuracy in this setting. In short, it is a problem that requires a constellation of synergistic actions aimed at social media users, content creators, companies, and governments. A public health approach to social media-based misinformation that includes tertiary, secondary, and primary prevention may help address immediate impacts, long-term consequences, and root causes of misinformation. Tertiary prevention to ‘treat’ this problem involves increased monitoring, misinformation debunking, and warning labels on social media posts that are at a high risk of containing misinformation. Secondary prevention strategies include nudging interventions (e.g. prompts about preventing misinformation that appear when sharing content) and education to build media and information literacy. Finally, there is an urgent need for primary prevention, including systems-level changes to address key mechanisms of misinformation and international law to regulate the social media industry. Anything less means misinformation—and its societal consequences—will continue to spread.</span>
<span class="paragraphSection"><div class="boxTitle">Abstract</div>The emergence of vaping represents a novel phenomenon, highlighting its distinctive role within contemporary society. Nevertheless, the comprehensive understanding of the cultural significance and social norms associated with vaping remains incomplete. This scoping review aimed to report the perspectives, motivations, and experiences of adolescents and young adults (10–25 years) engaging in the use of nicotine vapes. Peer-reviewed primary research published in English from 2003 to February 2024 was identified using the databases PubMed, Scopus, CINAHL, and PsycINFO. Qualitative studies reporting on the perspectives, motivations, and experiences of adolescents and young adults who currently engage in nicotine and tobacco vape use were included. Thematic analysis revealed three key themes in adolescents and young adults vaping: understanding and reasons for vaping, the challenges of addiction and withdrawal, and varied responses from families and caregivers. Adolescents and young adults are often introduced to vaping by peers and siblings, drawn by the desire to fit in and the appealing flavours. Despite awareness of potential health risks, addiction makes quitting difficult, leading to intense cravings and withdrawal challenges. Families show a spectrum of responses, from ignorance to reluctant acceptance, indicating a need for better awareness and intervention strategies to address adolescent vaping. Establishing a withdrawal pathway for vaping is imperative as an intervention strategy to address the prevalence of vaping among adolescents and young adults.</span>
<span class="paragraphSection"><div class="boxTitle">Abstract</div>Food marketing plays a substantial role in shaping adolescent diets, having wide-ranging ramifications for health behaviours and outcomes throughout the life course. Yet, there remains a dearth of research about how outdoor advertising as a specific channel of food marketing affects purchasing behaviours. We examine self-reported purchases made at retail food outlets by adolescents as it relates to the availability of outdoor food and beverage advertising around each participant’s home, school, and along the journey to and from school. We also consider the impacts of sociodemographics and consumption attitudes on purchasing, as compared to the geographic availability of outdoor advertising. Data are drawn from a survey completed by 545 adolescents in 2018 across four secondary schools in the Middlesex-London region of Ontario, Canada. The availability of outdoor advertising in the home and school environment is marginally correlated with self-reported purchases made at fast food, table-based, grocery, and variety retail outlets. However, consumption attitudes, cultural background, and gender are significantly correlated with purchases, with substantially larger effect sizes. The overall results were consistent between estimating the availability of outdoor advertising in the immediate area surrounding the home and along the journey to and from school. There is considerable health promotion policy interest in regulating outdoor advertising around child-serving locations. However, scarce health promotion resources would be better allocated to educational programming that addresses the substantial role of consumption attitudes in affecting adolescent purchasing behaviour, as compared to the considerably weaker impact of outdoor food advertising observed in our analysis.</span>
<span class="paragraphSection"><div class="boxTitle">Abstract</div>This article explores the impact of digital transformation on sexual and reproductive health promotion from an interdisciplinary perspective, focusing on the implications of rapidly evolving policy landscapes for the Australian health promotion workforce. We draw on 29 key informant interviews and workshops with 18 current sexual and reproductive health professionals (aged 18–29). Both groups were invited to reflect on how digital and data literacies are currently understood and applied within the Australian sexual and reproductive health promotion sector. Interviewees shared concerns related to digital and data literacy, equity, and the challenges of integrating digital technologies into health practice. Findings highlight the need for strategic approaches that shift focus away from individual literacies towards broader organisational capabilities. These capabilities include: an understanding of digital policy and platform governance (e.g. in relation to social media content moderation); an understanding of how health consumers and service users currently utilise digital systems to support sexual health and wellbeing; and an understanding of the ways digital equity and data justice can be undermined or advanced in organisational settings. We conclude with recommendations for enhancing workforce digital and data capabilities and integrating DDoH into health promotion policy and practice to improve health equity. Significantly, we conclude that dedicated resources and training are needed to address the complexities of DDoH in the sexual and reproductive health context.</span>
<span class="paragraphSection"><div class="boxTitle">Abstract</div>The World Health Organization and public health experts are calling for urgent restrictions on the online marketing of unhealthy food. The harmful effects of exposure to advertising for ‘unhealthy foods’, including discretionary foods high in fat, salt or sugar, particularly for children, has prompted a proposed policy action in Australia to prohibit all online unhealthy food marketing. We used a novel data donation infrastructure, the Australian Ad Observatory, to create a dataset of 1703 ads promoting top-selling unhealthy food brands that had been placed by 141 different advertisers on 367 individual Australians’ Facebook feeds. We used this dataset to identify any targeting of unhealthy food ads towards young people (18–24), investigate harmful marketing practices by four of the top advertisers (KFC, McDonald’s, Cadbury and 7-Eleven); and demonstrate how online advertising may be made observable and accountable. We find indications that young people (18–24), especially young men, are being targeted by unhealthy food, especially fast food, ads. We also find that unhealthy food brands use potentially harmful marketing strategies to appeal to children, young people, parents and the broader community, including cartoon characters, and associations with popular sports and greenwashing. The policy implications of our findings are that a broad prohibition on all forms of unhealthy food advertising online is desirable to protect not only children but also young people and the broader community. Such a prohibition will go one step towards addressing the commercial and digital determinants of health caused by harmful industries’ use of online automated advertising.</span>
<span class="paragraphSection"><div class="boxTitle">Abstract</div>This study aimed to investigate young people’s exposure to and perceptions of e-cigarette advertising to co-produce an advocacy video. This focus on e-cigarette marketing and its targeted appeal to young people comes at a crucial juncture, as policymakers in the UK and Scotland channel considerable efforts into shaping new regulations in response to these concerns, such as banning disposable e-cigarettes. The research to co-design a video was conducted with 33 young people aged between 12 and 16 living in the Central Belt of Scotland. The research comprised four stages: workshops, photo elicitation, focus groups and video development. Young people expressed concerns regarding the potential health effects of e-cigarettes, the ubiquity of e-cigarette advertising and products seemingly directed at young people, and the use of e-cigarettes among their peers. While none of our participants identified themselves as e-cigarette users, and all were below the age of 18, some mentioned seeing targeted advertisements for e-cigarettes online. These concerns were also reflected in participants’ contributions to the video production process. Our findings highlight that young people feel overly exposed to e-cigarette advertising and they identified aspects of these adverts (including the use of vibrant colours and flavour variations) that they felt were designed to appeal specifically to young people. These findings suggest the need for stronger legislation to protect young people from the advertising and marketing of e-cigarettes. Further research might also usefully contribute to understanding counterarguments and marketing from public health advocates to limit the appeal of e-cigarettes to young people.</span>
<span class="paragraphSection"><div class="boxTitle">Abstract</div>To bridge the gaps of mental health service in Malaysia, we developed a digital intervention protocol (RELATE-ME) aiming to restore social connectedness and well-being during the COVID-19 pandemic lockdown. Co-designed with a cross-disciplinary panel, we integrate principles of digital mental health, support group modality, psychoeducation elements, and community engagement into a 2-week online group program. To validate the protocol, we trained three community health workers (CHWs) to facilitate a briefer version of RELATE-ME with two groups of participants (six elders and six youths) in suburban Malaysia. After 4 days, they were interviewed regarding the feasibility and acceptability of this program. The interview transcripts were coded by the research assistant through an inductive-deductive method. Results showed that the majority of the participants reported the relationship with CHWs and peers as a motivator to sustain their engagement and it took time to build trust with each other. They appreciated the engaging group contents (e.g. relaxing and pleasant activities), sharing of their peers and skill-building lessons (e.g. learning of goal setting, stress management and relationship building). However, they faced the challenge of time constraints, family duties, low English literacy and digital literacy, especially among the elderly group. This finding suggested that RELATE-ME is a feasible protocol to increase social connectedness and well-being in the suburban area of a middle-income Asian country like Malaysia. Its effectiveness could be further enhanced through capacity building of CHWs, translating all contents into local languages and implementation in a physical setting.</span>
<span class="paragraphSection"><div class="boxTitle">Abstract</div>Digital food marketing (DFM) of unhealthy foods and beverages (high in saturated fats, sugar and salt) to children and young people influences brand recall, recognition, purchase intentions and attitudes, and increases consumption of unhealthy foods and beverages. Understanding children’s and parents’ awareness of, and attitudes toward, such marketing is crucial for developing health-promoting advocacy and policy solutions. This registered systematic scoping review synthesized literature on children’s, young people’s and parents’ attitudes and awareness of DFM. A structured search of Medline, PsycInfo, Academic Search Complete (Ebscohost), Scopus and CINAHL was conducted. Inclusion criteria were peer-reviewed studies focused on children (<18 years), young people (<24 years) or parents, published after 2000, examining attitudes or awareness of online marketing of food or non-alcoholic beverages. Data were extracted and charted in Excel. Forty studies were included for synthesis. Studies of children/young people (<span style="font-style:italic;">n</span> = 31) show varying levels of awareness regarding DFM on social media and other digital media. While some understand social media marketing tactics, others struggle to recognize ads. Preferences lean towards influencer marketing and ‘native’ advertising styles. There is limited evidence on parents’ views (<span style="font-style:italic;">n</span> = 9 studies), but these suggest low parental awareness of digital marketing tactics targeting children, and unclear opinions on regulation. Overall, the findings suggest a need for a versatile, trans-disciplinary research and advocacy agenda to capture the complex and rapidly evolving digital marketing landscape, enhance critical digital literacies (including power inequalities) for both children and parents, increase knowledge-sharing and advocacy, and develop regulatory policies.</span>
<span class="paragraphSection"><div class="boxTitle">Abstract</div>Marketing of tobacco and vape products is effective at recruiting new users; yet, little is known about children’s online exposure to such material. This research aimed to develop a methodology for assessing children’s exposure to, and engagement with, online tobacco and vape marketing. This pilot study used data from the innovative Kids Online Aotearoa Study in which 156 11–13-year-olds from schools in the Wellington region of Aotearoa New Zealand used Zoom teleconferencing software to record real-time, screen-shared internet use for four consecutive days. We developed a coding framework to analyse the nature and extent of exposure to tobacco or vape marketing and applied it to a strategic subset of children’s (<span style="font-style:italic;">n</span> = 16) data. Twenty-one instances of tobacco or vape marketing were identified from 12 participants; four participants had no identified exposures. The findings show that children are exposed to such marketing online, despite legislation that should protect them; these insights improve understanding of the online marketing environment and may help to support global health promotion efforts in tobacco and nicotine control given the borderless nature of the online world. The Kids Online Aotearoa tobacco and vape marketing methodology and coding framework enables the direct assessment of children’s exposure to online tobacco and vape marketing and is a valuable research tool to monitor and provide evidence to inform social and political action to protect children from online harm.</span>
<span class="paragraphSection"><div class="boxTitle">Abstract</div>Children’s engagement with smartphone-based (online) gaming content is rapidly increasing. There appears to be no existing objective evidence of children’s exposure to this content captured in real time. Evidence on preteens’ smartphone-based gaming is especially scarce. This study aimed to objectively explore the nature and extent of preteens’ exposure to smartphone-based gaming content. Sixty-six children aged 11–13 years from 16 schools in the Wellington region of New Zealand used Zoom video teleconferencing software to record real-time, screen-shared internet use for 4 consecutive days. On average, children recorded 164 minutes each over the 4-day study period. Recordings were coded for gaming content by activity, using game applications and watching gaming content using social media. Game application characteristics were also recorded. Of every online hour recorded, 28.6% showed gaming content—using game applications (18%) and watching (10.7%). Male and low-deprivation children recorded more gaming content as part of their screen-shared internet use than female and high-deprivation children. Game application time comprised gameplay (56.6%), non-gameplay (43.4%), and included advertising 16.4% of the time. Most games were ‘Advergames’ [games including advertising (85.7%)], were free-to-play (98.4%), and included in-game purchases (87.3%). One-quarter (25.5%) included ‘Random Items’ (e.g. loot boxes) as part of these purchases, and 28.6% allowed users to interact with other users. While ‘playing’ using smartphone game applications, children are exposed to highly commercialized contexts that include manipulative design features, adult themes and advertising. Children, who are most vulnerable to online harms, must be protected in accordance with the United Nations Convention on the Rights of the Child.</span>
<span class="paragraphSection"><div class="boxTitle">Abstract</div>Adolescents globally are calling for high-quality digital services to support and improve their health and well-being. Digital technologies are playing an increasing role in healthcare and whilst today's adolescents have been exposed to digital media since birth, there are unique challenges to their use that must be considered. This review aims to synthesize the literature on adolescent health promotion in the digital era. It provides evidence from adolescent perspectives and identifies that community-based and ‘digital only’ settings hold scope for further research to advance the field. The article recommends that when working with adolescents to develop digital health promotion tools, we should look to use youth engagement frameworks that are relevant to their context. Secondly, it demands stronger governance over digital media to protect adolescents, whilst allowing safe digital access. Finally, it demonstrates how listening to adolescents may help to address the emerging digital determinants of health and avoid exacerbating health disparities. Adolescents are powerful advocates to make global change. Stakeholders across research, policy and practice should examine how they incorporate adolescent voices to drive change in health promotion in the digital era.</span>
<span class="paragraphSection"><div class="boxTitle">Abstract</div>The progressive increase in youth use of social media can have implications for health. This study explores how school professionals working with health promotion (HP) position their practices at the intersection between the challenges and potential opportunities posed by social media. Empirical data were produced from seventeen semi-structured interviews with various school professionals from state-funded and private schools in Sweden where HP is a shared responsibility among many professionals including nurses, psychologists, special educators, principals and teachers. Data were analysed using reflexive thematic analysis. The analysis was informed by practice theory. Three themes were generated: (i) navigating an ambiguous terrain of professional practice; (ii) reconfiguring HP practice in relation to student social media use and (iii) social media as resources for HP. The findings indicate that school professionals are reconfiguring HP practice around the increased challenges invoked by students’ social media use but are also aware that social media can be fruitfully operationalized in school HP. Professional attempts at harnessing the health-promoting potential of social media are limited to individual initiatives, possibly in relation to a lack of clear policy directives that inform actions and assign responsibilities where social media are concerned. School professionals recognize a need for professional learning to keep abreast of students’ highly dynamic use of social media. The study underscores the need for professional development but argues that this development needs to be grounded in a comparable institutional one, for example by reformulating and updating policies to be more professionally supportive.</span>
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