BackgroundThe negative consequences of peer-victimization on children and adolescents are major public health concerns which have been subjected to extensive research. Given all efforts made to analyze and estimate the social and health consequences of peer-victimization, the adolescents’ own experiences and understandings have had surprisingly little impact on the definition of bullying. Therefore, the aim of the current study is to explore adolescents’ definitions of bullying.MethodsA questionnaire study (n = 128) and four focus group interviews (n = 21) were conducted among students aged 13 and 15. First, gender and age differences were analyzed with respect to what behaviors are considered bullying (questionnaire data). Second, analysis of what bullying is (focus group interviews) was conducted using qualitative content analysis.ResultsThe adolescents own understanding and definition of bullying didn’t just include the traditional criteria of repetition and power imbalance, but also a criterion based on the health consequences of bullying. The results showed that a single but hurtful or harmful incident also could be considered bullying irrespective of whether the traditional criteria were fulfilled or not. Further, girls and older students had a more inclusive view of bullying and reported more types of behaviors as bullying compared to boys and younger students.ConclusionsThe results of the current study adds to the existing literature by showing that adolescents consider the victim’s experience of hurt and harm as a criterion for defining bullying and not only as consequences of bullying. This may be of special relevance for the identification and classification of bullying incidents on the internet where devastating consequences have been reported from single incidents and the use of the traditional criteria of intent, repetition and power imbalance may not be as relevant as for traditional bullying. It implies that the traditional criteria included in most definitions of bullying may not fully reflect adolescents’ understanding and definition of bullying. Assessments of bullying behaviors that ask adolescents to strictly adhere to the traditional definition of bullying might not identify all adolescents experiencing peer victimization and therefore not provide estimates of prevalence rates reflecting adolescents’ own understanding of bullying.

Schools are recognized worldwide as settings for health promotion, and leadership has a bearing on schools' ability to be health promoting. School managers have a great influence on what is prioritized in school, which in turn affects students' school performance and health. There is lack of research into school managers' views on health promotion, and what they consider to be central to health promotion. The aim was therefore to examine school managers' views about what health promotion in schools include. An explorative design, qualitative content analysis, was performed. In-depth interviews were conducted with all 13 school managers of a middle-sized municipality in central Sweden. The analysis had both manifest and latent content and three categories: 'Organization and Collaboration', 'Optimize the arena' and 'Strengthen the individual', and 10 subcategories emerged. The theme, 'Opportunities for learning and a good life', describes the latent content of these categories. Taking into account the views of school managers are important because these views help form a more complete picture of how school managers work with health promotion and what is needed to enhance health promotion to improve students' opportunities for learning and a good life. The Ottawa Charter for Health promotion is thereby transformed into practice.

Examining children's opinions is requested and promoted by the UN convention on the Rights of the Child. The findings contribute to the field by showing how school satisfaction and social relations might be improved, if the child perspective is considered in the planning of health promotion activities in school.

Aim A beneficial classroom climate is vital for school achievements, health, well-being, and school satisfaction. However, there is little knowledge as to how the classmate characteristics and class composition are related to the level of a perceived messy and disorderly classroom climate and whether the estimated relationships vary between different groups of children. The aim of the study was to explore the relationship between classmate characteristics as well as class composition and children's perceived classroom climate. Method Data from a cross-sectional survey administrated in 71 classes including 1,247 children in a mid-sized Swedish city were used. The analyses were conducted using multilevel models. Results A class with a higher proportion of girls was associated with a lower likelihood of perceiving the classroom climate as messy and disorderly. Moreover, a higher proportion of immigrant children in a class was associated with a perception of a messier and disorderly classroom climate among non-immigrant children, but not among immigrant children themselves. Conclusion Classmate characteristics and class composition deserve more research attention and can be important considerations when aiming to improve the classroom climate and children's well-being in general.

Summary To examine whether a public health project to reduce problem behavior in schools and improve the classroom climate, undertaken among eight secondary schools in a municipality in Sweden, was accompanied by favorable changes in the school environment over time. Data were collected from ninth grade students (aged 15–16 years) at three different time points: the year before the project began (2005), during the project (2008) and when the project finished (2011). Changes in the school environment, measured as damage, littering, noise and classroom disorder, were compared between the project municipality and a comparison group of other municipalities in the same county, using multinomial logistic regression analysis. Descriptive comparisons were made between the schools within the project municipality. The school environment improved significantly from 2005 to 2011 in the project municipality compared with the other municipalities. The school environment was improved in all schools within the project municipality. The biggest improvements took place in two schools which systematically worked with one program incorporated into the school schedule. This study demonstrates that it may be possible to improve the school environment by implementing health programs. Further studies based on experimental designs are required in order to confirm the potential and efficiency of school health programs.

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AimTo investigate school nurses’ experiences of health-promoting work to prevent stress in Swedish adolescents.Materials and methodsSwedish school nurses (n = 225) responded to a web survey with open-ended questions. The results were subjected to a qualitative content analysis.ResultsSix categories were identified from the analysis: (1) Knowledge of body and soul, (2) Identifying stress and ill health, (3) Collaborative working within/outside school, (4) Make yourself (i.e., school nurses) visible to the students, (5) Support students’ learning, and (6) Tools for stress management. One of the most important themes in preventing and counteracting stress in school-aged children and adolescents was promoting healthy living habits. That school nurses were easily accessible and visible were important for them to identify stress as early as possible. The close collaboration with the school health care team and building relationships with the students were emphasized. The stress in adolescents was largely linked to schoolwork and performance anxiety. To counteract this, the dialogue with the teachers was important to increase their knowledge of mental health problems and stress and influence the scheduling of school exams.ConclusionThe study contributes to increased knowledge in the field and provides concrete strategies for how school nurses can work to counteract stress in students.

The aim of this study was to investigate school nurses’ perspectives on students’ health during the COVID-19 pandemic in Sweden in 2021. A cross-sectional survey design was used with school nurses (n = 225) working in schools in Sweden from elementary to upper secondary levels. The Clausson School Nurse Perception Questionnaire was used with two additional questions about the COVID-19 pandemic. The school nurses rated students’ physical health as very good or good in 78% of the cases and their mental health as very good or good in 64%. There was also a negative trend in mental health during the pandemic, especially among girls. School nurses working in vulnerable areas (i.e., areas with a high proportion of immigrants and those receiving financial assistance) rated students’ physical and mental health significantly worse compared other areas.