The results of this review provide opportunities for action across multiple system levels to ensure synergy and coordinated action toward SNP goals to foster the creation supportive nutrition environments for children.

Health-promoting schools (HPS) is an effective approach to enhance the health and well-being of children and youth, but its measurement remains a challenge considering contextual differences across school environments. The purpose of this study was to qualitatively explore the physical features of the school environment through photographs of schools that had implemented an HPS approach compared with schools that had not. This study used a descriptive approach, wherein physical features of the school environment were distilled through visual images and qualitatively analyzed. School environment data were collected from 18 elementary schools (10 HPS, 8 comparison schools) from a school board in rural Nova Scotia (Canada). Evaluation assistants captured photographs of the physical school environment as part of a broader environment audit. Overarching themes included the promotion, access and availability of opportunities for healthy eating and physical activity, healthy school climate and safety and accessibility of the school. The photographs characterized diverse aspects of the school environment and revealed differences between schools that had implemented an HPS approach compared with schools that had not. There were increased visual cues to support healthy eating, physical activity and mental well-being, and indications of a holistic approach to health among schools that implemented an HPS approach. This research adds to understanding the environmental elements of HPS. The use of photographic data to understand school environments provided an innovative method to explore the physical features of schools that had implemented an HPS approach.

Health Promoting Schools (HPS) is a whole-school approach that shapes the conditions necessary to support student health and well-being. Youth engagement is recognized as key to HPS implementation, yet research related to the involvement of youth voice in school health promotion initiatives is limited. The purpose of this study was to understand youth perspectives on HPS and school youth engagement. Ten youth (grades 9–10, ages 14–16) were trained as peer researchers using a Youth Participatory Action Research approach. The peer researchers interviewed 23 of their peers (grades 7–10, ages 12–16) on perspectives related to HPS and school youth engagement. All interviews were audio-recorded, transcribed and data were analysed using inductive ‘codebook’ thematic analysis. Themes related to a healthy school community were mapped onto the pillars of HPS: (i) Social and Physical Environment, (ii) Teaching and Learning, (iii) Partnerships and Services and (iv) School Policies. Participants placed more importance on the social and physical environment of the school including respect, inclusivity, supportive relationships and the design of spaces. Key factors for youth engagement were: (i) safe and supportive spaces, (ii) passion and interest, (iii) using their voice, (iv) power dynamics, (v) accessibility and (vi) awareness. With recognition that youth engagement is a crucial part of HPS, this work provides relevant and applicable information on areas of the healthy school community that are important to youth, and if/how they are meaningfully engaged in school decision-making.

Objective Bullying and its potential consequence for poor mental health constitutes a public health concern, yet there is a dearth of longitudinal studies examining the topic. This study examines the temporal relationship between childhood bullying behaviours (being a victim, being a bully, or being a bully and a victim) and physician-diagnosed internalizing disorders over a 7-year timespan. Methods Data from the 2003 Children's Lifestyle and School performance Study (CLASS), a population-based health survey of grade 5 students in Nova Scotia, Canada were linked to administrative health-care records to examine the relationship between bullying behaviours and services where a physician diagnosis of an internalizing disorder (ID) was received. Negative binomial regression analyses were conducted to examine this relationship. Results Of the 4694 participants, 33.3% reported being involved in some form of bullying behaviour and 24.1% had a service where a physician diagnosis of ID was given over a 7-year timespan. Compared with children who reported not being involved in bullying behaviours, children who reported being a victim of bullying had a higher rate of subsequent physician-diagnosed ID services (IRR = 1.38, 95% CI = 1.11, 1.70). Children who reported being a bully had a lower rate of ID services (IRR = 0.67, 95% CI = 0.46, 0.99), while there was no difference for those who reported between being a bully and a victim (bully-victim) with respect to ID services. Conclusion Bullying behaviours should be considered a serious public health issue due to their high prevalence in school environments and detrimental effects on the mental health of adolescents.

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