Diet contributes to a large proportion of preventable deaths and diseases. Adolescence is a period during which diet may particularly evolve, and therefore represents an opportunity to develop long-lasting healthy dietary behaviours. However, dietary habits are particularly subject to social variations, which may lead to social inequalities in health. Tackling them requires public health actions based on a comprehensive approach of social determinants at this life stage. This doctoral thesis aimed to examine socioeconomic and sociocultural disparities in dietary habits among adolescents, using the repeated cross-sectional Health Behaviour in School-aged Children (HBSC) surveys conducted in French- and Dutch-speaking Belgian schools. The three specific objectives of this aim were: (i) to study the socioeconomic disparities in dietary habits of adolescents from different migration status; (ii) to determine trends in dietary disparities between 1990 and 2014; (iii) to estimate disparities in dietary habits according to the socioeconomic and migration status at both individual and contextual levels. Firstly, different socioeconomic disparity patterns according to the migration status were observed, with narrower disparities in 1st-generation immigrants than among natives, highlighting the major role of cultural influences in immigrant populations. Secondly, the long-term trend analyses emphasised increasing disparities for healthy foods and decreasing disparities for unhealthy foods. In addition, when the consumption of a food group increased overall, disparities decreased, and vice-versa. Finally, the multilevel analyses showed that individual and school disparities were independently associated with food consumption frequencies. Furthermore, this observational assessment revealed the weak relationships between nutrition policy in schools and dietary habits. Note that in the Brussels-Capital Region, native adolescents were at higher risk of unhealthy dietary behaviours than immigrants, but the risk of unhealthy behaviours tended to be higher when, in the school, the socioeconomic index decreased, and the proportion of immigrants increased. Overall, our analyses underlined the need to include, in addition to the socioeconomic factors, cultural components in public health actions aimed at addressing social inequalities in adolescent diet, in a multicultural context such as Belgium. Support to schools, with a greater emphasis on those disadvantaged in order to prevent increased inequalities, is needed to develop a consistent and effective nutrition policy. Finally, further studies are needed to better understand the mechanisms behind dietary disparities among adolescents, particularly those related to their migration status and broader socioeconomic environment. / Doctorat en Santé Publique / info:eu-repo/semantics/nonPublished

The Health Promoting School (HPS) is s a model that advances both the health and learning needs of students. Yet there is a lack of consensus on student indicators that reflect a HPS or a coherent understanding of what a HPS represents amongst various stakeholders. The goal of this research was to establish indicators of student health and wellbeing associated with policies and practices in schools, and to further our understanding of health promoting schools. The research proceeded in three phases. The first phase established a relationship between student health and academic achievement. The second phase examined the associations amongst student health and wellbeing and student and school-level factors. The third phase involved case studies of two schools in Ontario to examine the organisational and structural elements associated with achieving a HPS, and the mechanisms by which these elements support student health and wellbeing. The association between students’ self-rated health and their academic achievement found in the first phase provides a platform for advancing the health promoting school agenda in Canada at the research and policy levels. Subsequent findings established an association between the environment and disciplinary climate in schools, and the school’s academic and socioeconomic standing to student health and wellbeing outcomes. These findings also suggest overlapping effects of schools and neighbourhoods on students’ health and wellbeing, implying that school health promoting efforts will be more successful when partnered with efforts within neighbourhoods and communities. Finally, the case studies suggest that embracing a HPS philosophy that addresses students’ emotional and physical wellbeing may help support students’ overall learning. Findings, presented in an implementation model of a HPS, emphasise key action areas that need to be addressed when implementing HPS initiatives and enhancing the capability of the education system to improve the health and learning of students. / Thesis (Ph.D, Education) -- Queen's University, 2009-10-05 13:45:06.342

Med en socialkonstruktivistisk och sociokulturell ansats, studeras skolkuratorers uppfattning om och erfarenhet av grundskoleelevers psykiska hälsostatus samt skolkuratorernas definieringar av psykisk hälsa/ohälsa. Studien problematiserar att det rapporteras från återkommande enkätstudier att mer än varannan grundskolelev uppger sig ha återkommande psykosomatiska symptom vid minst två tillfällen i veckan, samtidigt som knappt nio av tio grundskoleelever uppger sig ha gott eller mycket gott psykiskt välbefinnande. Mer än varannan grundskolelev lider av psykisk ohälsa är utgångspunkten i den offentliga debatten. Empirin består av intervjuer med skolkuratorer vilka inte delar den bild av grundskolelevers psykiska hälsostatus som utmålas i den offentliga debatten. Allmängiltiga definitioner av psykisk hälsa/ohälsa finns inte, vilket bidrar till delade meningar råder bland forskare, myndigheter, politiker, media, etcetera om vad begreppen innebär. Utifrån studien kan slutsatser dras att definitionsförvirring, otillräckliga mätinstrument och brist på hänsyn till samhällsutvecklingen bidrar till en missvisande bild av grundskolelevers psykiska hälsostatus.