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The Society for Public Health Education's Youth and School Health website is dedicated to supporting health educators and other professionals by providing contemporary resources and information on topics related to youth and school health.
The engagement of health care practitioners is a vital component of comprehensive NCD control programs as they are routinely engaged in risk factor reduction. These practices require health practitioners to be trained to identify risk factors, provide information and counseling and refer patients to supportive community resources.
The health behaviours adopted by clinicians themselves can have a significnat effect on their support of and use of counselling and referral strategies. Currently, training programs for medical students that include tobacco cessation programs and routine screening for healthy and active living are rare.
The high prevalence of NCDs suggests that medical and nursing schools will need to incorporate screening and prevention into their curricula in the future. Training practicing clinicians on screening for risk factors and providing advice regarding lifestyle changes appears relatively straightforward. Obtaining buy-in from practitioners was straightforward, as the recommendation for the trainings was endorsed from the Ministry of Health, Mexico City. In an ideal world, clinicians would screen all patients who come into their care for the risk factors for NCD.
Link data from intake forms and routine physician-patients interactions to computerized reminder systems or electronic medical records (where applicable) to facilitate counseling, the use of referral networks within the health care system and to connect individuals to resources and support systems within the community. Behavioural risk assessments should be conducted on every patient, otherwise a section of the community may be overlooked. Incorporate questions about tobacco use into standard protocol during physician-patient interactions. Routinely screen for and record smoking status (current, former, never) for every patient at each visit. Urge every smoker to quit - all current smokers should be provided clear, strong, personalized advice to stop smoking. Provide clinical advice that links smoking to a patient's illness or reason for visit in order to build a stronger incentive for smokers to quit and maintain abstinence.
Assess readiness to quit, ask every smoker if he or she is interested in quitting smoking in the next 30 days.
Evaluate the degree of individual motivation - provide personalized advice to quit and refer them to the required resources, treatment, and cessation options. Based on the stage of a patient's readiness and level of commitment, provide counseling, pharmacotherapy and instructional guidance. Address relapses; evaluate the use of pharmacotherapy and ask for a recommitment to total abstinence.
The case study below shows an example of a clinical form that includes standard information and has been modified to include additional fields to capture information about three risk factors for NCD. An example of a recent intervention in China to reduce salt intake includes providing a set of small plastic spoons to patients that are sized to provide the appropriate daily dose of salt, sugar, and oils. The case study below presents an example of how to incentivize clinicians to participate in tobacco cessation programs. The Taiwanese Smoking Cessation Outpatient Services program reimburses clinicians for providing tobacco cessation interventions.
In a further case study below an example is provided that shows  how physicians engaged in NCD screening and health education can be pivotal players in community NCD intervention implementation. The Green Prescription in New Zealand is an innovative scheme targeting physically inactive people who are receiving or seeking primary health care.
Step 2: Agreed goals are prescribed to the patient on green paper, and passed on to the local sports foundation or patient-support person to facilitate adoption of more healthy and active lifestyles.
Clinicians should be provided with the appropriate training and resources so that they can conduct screening, engage in counseling and provide treatment in a culturally-appropriate and sensitive manner. Competition from the academic curriculum means that mandatory classes end by the time students are in high school. The WHO (WHO, 2007) has created a series of resource manuals providing guidelines for health education in schools (see resources).
The WHO Information Series manual on tobacco provides a comprehensive school based health program that may be easily adapted to include health education messages about unhealthy diet and physical inactivity  (Cruijsem et al, 1998). Providing students with resistance and refusal skills for peer pressure and providing insight regarding the behaviour and marketing of the tobacco industry, such as manipulative marketing by tobacco companies that portraying tobacco use as cool, modern, Western and mature. The report compared school-only interventions and school + community interventions that were primarily multi-media based, and recommended combined approaches when targeting young people (Flay, 2007).
The dose of health education programming affects outcomes, with studies showing that this can begin with kindergarten children aged under 5 years. Level of knowledge of detrimental health effects of each behaviour, and knowledge of health promoting behaviours. Schools themselves are responsible for setting policies and practices to create smoke-free environments and to encourage healthy eating and physical activity, and teachers and staff should act as role models (Cruijsem et al, 1988). The case study below describes PROJECT SHOUT, a school-based tobacco control intervention aimed at 7th and 8th graders, used by several communities to bring about substantial reductions in tobacco use among youth and adolescents, particularly within school settings but also within the wider community. Project SHOUT (Students Understanding Others Understand Tobacco) developed at San Diego State University has been shown to reduce tobacco use in young people.
8th Grade: Each student received 4 phone calls from trained undergraduate counselors– phone calls involved sharing resources and information around refusal skills training, tobacco news and tobacco cessation and links to a local free cessation help line. 9th Grade: 5 newsletters with information about tobacco control events, legislation, research, the tobacco industry, and cessation tips were mailed to students and parents. 11th Grade: 50% of students received 2 more newsletters focused on tobacco companies' marketing tactics, information on city, state or national legislation regarding tobacco, cessation advice and second-hand smoke and 1 phone call discussing the ban of smoking in public places.
C.Low resource requirements The initiative is low-cost and requires 17 hours of training per staff member for the classroom sessions and phone components.
People of working age spend much of their time at work, and workplaces are not always conducive to healthy lifestyles. It is time and cost-efficient and to leverage existing resources and efforts by identifying and adopting available materials and resources.
Most of these organizations have materials available for distribution and dissemination that can be directly downloaded from their websites, and they may have local staff persons who would be willing to come into the community and talk about NCDs.
The case studies below provide examples of leveraging resources from existing organizations and resources to implement community programs. Using a variety of educational tools: Educating for healthy lifestyle change comes in various forms including textual materials, lectures, counseling, word-of-mouth and media campaigns (Health Communications Unit, University of Toronto, 2000).
Educating agents of change in community venues: Educate and train persons who can support the message of healthy lifestyle behaviour and influence other contacts.
Leveraging other community activities: Capitalizing on the importance of health, information and educational messaging about NCDs and prevention can be coupled with a variety of other community activities, and is often welcomed.
The establishment of accessible screening programs in the community improves early detection and can be an effective strategy for NCD prevention and reduction. Decide on metrics: Use local clinical screening and counselling protocol if they exist (Strong et al, 2005). Ensure that screening practices are specific to the group or specific segment of the population e.g.
In addition to benefiting the individual, screening programs can also serve as a strategy for obtaining useful data on the population.
Mass media campaigns can increase recruitment into screening and health education programs, and act as a voice for the community regarding risk-promoting conditions and in advocating for change. DO: Specify why to incorporate recommendation into daily life "Cut it out -- Smoking causes lung cancer!
A one-size fits all approach is not viable in influencing the perceptions and behaviour of diverse communities and population (CDC, 2009; United States Department of Health and Human Services, 2006). The NHS (2004) recommends that a diverse range of media are used and that non-traditional outlets are explored such as smaller grass-roots organizations, outreach efforts to community centres, churches and healthcare facilities be considered. Consider leveraging partnerships and collaborations to design health education materials that can be promoted by media outlets (CDC, 2009; NHS, 2004).
Ensure that media messaging is supplemented with other types of outreach including that from clinicians, schools, parents and community leaders.
Aside from the medium of communication, the structure and framing of a message can have an influence on how it is perceived by the viewer. Create a Healthy Community Calendar that is made available in local newspapers, on radio stations, local TV channel, electronically on community bulletin board, via emails or a community flyer that is available at accessible points e.g.

VERB™ It's what you do is a national scale social marketing campaign coordinated by the CDC that utilizes social marketing theory and commercial marketing strategies to design and execute interventions to increase and maintain physical activity among 'tweens' (children aged 9–13). The steps used in the development of the VERB media messages described in the above case study provide a practical example of the use of formative assessment in the development of media messages.
Artinian NT, Fletcher GF, Mozaffarian D, Kris-Etherton P, Van Horn L, Lichtenstein AH et al. Promotion Practice and Research: Strategies for Improving Public Health ed DiClemente RJ, Crosby RA, Kegler MC. The Community Health Education (CHE) offered by LCMS Mercy Medical Teams is just as important as the clinical work that we provide.
Community Health Education focuses on preventing disease and injury, improving health, and providing lasting results. Because the MMT program works with our local Lutheran church partners, there is a permanent presence in the community after the team leaves, continuing to share the love of Christ and promote good health.
CHE can be as simple as a health fair which offers resources on several topics during the course of an afternoon, or can be more involved, offering workshops and classes over the course of a weekend or several weeks.  Separate programming can be provided for children while their parents are participating. Although the needs of each community are unique, some of the most common things that we teach are prenatal care, dental hygiene, and prevention of specific diseases like malaria or diabetes.
Because each culture is unique, lesson plans are adapted for the context and culture of the participants. Tracy Quaethem serves as manager for LCMS Life and Health Ministries, working with Mercy Medical Teams and parish nurses. Note: LCMS leader blog articles express the personal experiences and views of our ministry staff and have not been subjected to the LCMS doctrinal review process. Rural Education, Awareness and Community Health (REACH) was established to respond to the heightening levels of sexual harassment evident in South Africa’s rural farming communities. REACH was co-founded by Joanie Fredericks, Executive Director, and Claudia Lopes, Training and Counselling Director, in response to a study on sexual harassment conducted by Fredericks in 2003. Despite the hype and promises made by government and civil society following the launch of the study, Fredericks notes that subsequently there was a very distinct lack of programmes and absence of support services that addressed and assisted rural farming communities in their plight against these social problems. In response to the great need that this lack of programmes and services inspired, Fredericks and Lopes established REACH in February 2005. True to her RootsAs the youngest daughter of a farm worker in Grabouw in the Western Cape, Fredericks grew up to be one of the first women forklift drivers in the area.
Despite numerous attempts to gain support from her female counterparts, Fredericks was continuously faced with women who were indifferent to her situation.
Since then, Fredericks has worked for the Sexual Harassment Education Project (SHEP), assisting the organisation to establish an office in rural Western Cape. In the period between 2003 and 2005, she also worked for the Centre for Rural Legal Studies, as well as the Public Health Department and Industrial Health Research Group at the University of Cape Town as a researcher and research assistant. Fredericks’s first hand experience with sexual harassment combined with her strong background in research has greatly influenced her philosophy for REACH. In light of her philosophy, Fredericks appraises South Africa’s key development challenges within the context of financial constraints facing the development sector. Empowering Rural Farming Communities Amongst other things, the organisation’s main objectives are to provide training and raise awareness about sexual harassment and sexual violence on farms, establish counselling and legal support services on farms, and conduct research into factors contributing to sexual harassment and sexual violence.
Since its inception, REACH has gradually made headway towards realising its main objectives in the farming communities of the Western Cape. The organisation also embarks on campaigns and advocacy activities to ensure adequate policy and legislative framework to address these problems. South African Rural Women’s Day This year’s campaign was attended by 576 women and children from the Western Cape.
Fredericks maintains that prior to the establishment of this event, there were very few platforms that allowed rural women the opportunity to air and share their views constructively. During the event, REACH launched a research report titled, ‘Sexual Harassment on Farms: Is it really a problem’, which focused on the prevalence of violence against women and children on farms. Pushing Forward Irregardless of Challenges Although REACH only has a modest annual budget of R860 000, Fredericks maintains that there is still scope for growth for the organisation.
Despite current financial constraints, Fredericks is optimistic that in the near future the organisation will broaden out into all the rural areas of the Western Cape, with the ultimate goal of branching out nationally and even internationally. 27After the Party: 21 Years of Electoral Democracy – What Does South Africa’s 2016 Local Government Elections Hold for the Future? To date, most work in this area has been done with tobacco cessation; only recently has the importance of clinical interventions for unhealthy diet and physical inactivity become more apparent. Ultimately, this training should be embedded within the training curriculum for all health professionals, with the result that NCD prevention, detection and surveillance becomes part of the standard training. Clinicians who smoke, are obese, eat unhealthy foods and who are physically inactive may not be interested in encouraging healthy living. Only 39% of medical schools report tobacco-focused modules in their teaching programs, with fewer programs in LMICs compared to high-income countries (Richmond et al., 2009).
All community health clinics providing services to residents in the intervention area received this training. To date, most work in the area of screening and assessment has been done in the field of tobacco use and an expert panel has published a series of recommendations (Fiore et al., 2000). In the case of paper files, a system of noting NCD risk factors through the use of color-coded stickers on the chart or intake log may help serve as reminders. Studies have found diaparities in are when all pateints are not asked consistently about smoking status.
Pharmacotherapy, in conjunction with counseling and community support programs, has been found to be particularly effective for smokers with medical conditions, individuals smoking fewer than 10 cigarettes a day, pregnant and breastfeeding women who smoke and adolescent smokers (Kenford and Fiore, 2004).
Additional screening questions on risk factors should be based on the amount of time a clinician has to spend with each patient, and may not be collected at every visit, but it is recommended that the risk factor screening occur at each annual visit. Some people may not been aware of the constituents of a healthy life and others may have the knowledge but lack the resources to effect behaviour change. Other size spoons can be available for high-risk patients who may need smaller spoons to reflect a more restricted diet. The program is aimed at promoting physical activity via recommendations from a primary care professional to leverage public perception around doctors'prescriptions that have symbolic and authoritative meaning. The prescription entails 3-4 months of both phone calls and 1:1 meetings in conjunction with communal support groups for about 6 months (New Zealand Ministry of Health 2010). Adopting this approach can facilitate patient behaviour change towards a healthier lifestyle, increase patient satisfaction and improve adherence (Artinian et al, 2010). Providing students with information is not sufficient, this knowledge should be supplemented by social skills and problem-solving strategies that can support young people in rejecting unhealthy behaviours and overcoming barriers to health (Cruijsem et al., 1998). Individual states have the option to decide how many credits of physical education (PE) and health education will be needed for students to graduate from high school. A comprehensive, school-wide program is desirable, but other strategies for integrating a series of lessons into the school curriculum have also proved successful.
Parents and the community as a whole also have a role to play, as school-based health education is more effective if the messages are reinforced by family members and community groups. Project SHOUT delivers 18 sessions taught by college undergraduates to 7th and 8th graders and includes a classroom-based component along with telephone-and newsletter-based boosters during the 9th grade year.
There is evidence that work place health initiatives are a strategic investment for industry, as addressing improving health and wellness has been linked to increased worker productivity, reduced absenteeism and the return on investment and health cost savings are high (Bending et al, 2008; Goetzel and Ozminkowski, 2008). Handouts of health education materials can be provided at community meetings and events, local clubs, health fairs and churches. These may be people at the point of contact, such as restaurant waiters and fast food cashiers who can suggest healthy options from menus. Various types of medical screening programs exist, here the focus is on population-based screening events that can be used to identify those at risk of NCDs such as cancer, diabetes, heart disease and obesity. The protocol should specify the information to distribute (oral and text materials) and the available community resources for appropriate referral. Additionally, community-wide media campaigns support the messages encountered during screenings and health programs and can support individuals in maintaining healthy behaviours.
Media messaging through print, electronic and social networking, contributes to information about particular diseases, risk factors or behaviours and bridges the gap between a prompt for change and its impact as a preventative measure for NCD (Randolph and Viswanath, 2004). Make It Clear and Simple: All messages should be simple and concise presenting why or how to adopt a recommendation to change knowledge, attitudes, beliefs or behaviours.
For example, the theme of active living or healthy communities can include messages of eating more local, fresh produce instead of processed foods and committing to increased physical activity as a community.

Make It Memorable: Place a strong emphasis on design principles(The Health Communication Unit at the Centre for Health Promotion, 2000). It is important to consider how different groups communicate with their peers by text messaging, social networking websites or through other media. Partnerships can include schools, hospitals, community centres, members of the food industry and food retail outlets and public agency representatives from departments of sport, recreation, education, health and culture and tourism. Imagination has been found to affect the impact of the message, "If one can easily imagine the outcome of noncompliance with exercise behaviour (e.g.
VERB used a three-step process, drawing on qualitative methods, mainly focus groups and interviews to develop its advertising messages. An effective media campaign requires the following components: 1) theoretical basis of the message, 2) the use of formative development assessments, 3) the intensity of message broadcast and 4) an appropriate enough time period to ensure message penetration (Brinn et al, 2010). School policy framework: implementation of the WHO global strategy on diet, physical activity and health. Diet and lifestyle recommendations revision 2006: a scientific statement from the American Heart Association Nutrition Committee.
Leading by example: The value of worksite health promotion to small and medium size employers. The Influence of Family and Culture on Physical Activity Among Female Adolescents From the Indian Diaspora.
Through education, many conditions and diseases can be prevented, decreasing the need for medical care and improving the health of our partners. CHE is individually tailored for each location to meet the unique challenges of that particular place. Any topic can be addressed using CHE, including community development, physical health, relationships, and Christian living. Believers are meeting together, and are sharing Christ with their neighbors in word and deed.
Health improves, and God is glorified as a result of the solutions created and owned by the people, not programs delivered from the outside. Readers are encouraged to leave questions in the comment section or consult their pastor with any queries related to this content. After three years as a forklift driver facing constant sexual harassment with no respite, Fredericks decided to resign, but resolved that she would come back to change people’s perspectives of sexual harassment. While working for SHEP, Fredericks produced the research study which informed the establishment of REACH. She notes that, “The non-profit sector has become too much like business because of the need for sustainability.” Fredericks bemoans that the lack of financial resources within this sector has resulted in the development sector being more profit driven rather than passion driven.
In line with this, REACH launched a South African Rural Women’s Day campaign on 12 August 2006.
Fredericks delightedly notes that the event was, “Absolutely fantastic and mind-blowing.” She highlights this campaign as a turning point for rural women and their issues within farming communities in the Western Cape. She does not foresee REACH closing down due to inadequate funding, instead she highlights that in its first year REACH did not have any official funding but the organisation persevered.
Providing support to improve their health, especially tobacco cessation, is recommended as the first line of action as they will be morel ikley to provide advice to their patients if they themselves are successful (Smith et al, 2007). For example, in Taiwan, patients that tended to receive more advice and support to stop smoking were male, older, daily cigarette users, had previously attempted to quit, preceived themselves as having poor health and were more aware of the benefits of smoking cessation services. Nurses or other health care professionals can be trained to provide counselling or offer group support.
Pharmacotherapy is not always be feasible and is beyond the resources of many health care system and there is a lack of knowledge among health care providers of the benefits of this approach (Kenford and Fiore. For example, a healthy 50-year old adult may receive a salt spoon that holds 6g salt while a 50 year old with high blood pressure may receive a smaller spoon. Clinicians are trained to conduct a brief 6-minute counseling session based on the 5 As  and to prescribe appropriate medication to assist patients in quitting. The prevalence of patient interventions increased significantly when reimbursements for conducting interventions increased to $11 for a short period.
Insurance plans do not cover smoking cessation medications, but the government provides a subsidy for such medications –with low-income patients receiving a greater subsidy. It is important for clinicians to develop 'cultural lenses' that will allow them to view the world and their patients according to the traditions and culture of the patient. Outreach programs through parents, sport, recreation and community groups can promote healthy living and enforce restrictions to tobacco products. The approach uses a combination of health education and follow-up to engage young people and the community in taking ownership of the issue of tobacco control. Computerized internet programs can be used for risk identification, stage-related education, targeted advice and referrals (WHO, 2009). People who have jobs that require 1:1 contact with clients, such as hair stylists, may also be good communicators for health information. Publicize the resources extensively, including distribution to medical offices, other health care facilities and community messengers.
Although there is still debate over the value of some types of population-based screening efforts (e.g. All these organizations can be involved with adapting health education materials so that they can be utilized in different settings, to ensure maximum reach and efficacy. The calendar can include opportunities for healthy and active living sponsored by different organizations including activities such as lectures, yoga classes, support groups for tobacco cessation, walking clubs, tai chi sessions, farmers markets, fruit and vegetable cart schedule and cooking demonstrations.
With the help of LCMS Health Ministry, church and community leaders identify the challenges in their area, and a plan is developed to address these needs. Participants are involved in the learning process, taking ownership of the solutions that they create.
The purpose of the session is not to transfer knowledge from the trainer to the participants, but to involve participants in creating solutions that they will own and implement. Each lesson ends with the Bible, relating the behaviors and solutions learned to the Word of God. Once the community has the knowledge, they become the teachers, offering classes and support to others. This annual campaign aims to explore social issues faced by rural women and also ways in which communities can invest in the empowerment of rural women. This approach can be applied to other areas e.g improving thier diet and increasing exercie by offering group support, incentives and follow-up. In contrast, younger, less frequent, female smokers received less support (Chang et al, 2010). For many individuals, culturally-specific foods are closely linked to tradition, cost, knowledge and religious values.
Parental engagement through school-based and outreach programs can support long-term change (Lagarde et al, 2008).
Regardless of whether participants were low, medium, or high exercisers, 'hard to imagine' symptoms resulted in worse attitudes than 'easy to imagine' symptoms,"(Berry and Carson, 2010). CHE is reproducible; after the team leaves, our church partners continue the programming, reaching far beyond our initial connections.
The leader guides the discussion by involving participants in reaching their own conclusions and providing solutions that fit their community. Each contribution is valued and respected, and the leader presents knowledge as a participant rather than an expert. Culture influences what we eat, how we prepare our food, how frequently we eat, when we eat and our use of seasonings such as salt, sugar and spices.
Food choice can be affected by acculturation (adopting different food cultures) and substitution (replacing elements of local food culture) (Story et al, 2002). Results were used to assess design elements that were confusing, controversial or misleading, and make the materials stylistically and content-wise more effective in terms of message transmission to the target audience.

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