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Summary Availability of health-promoting interventions (HPIs) may vary across schools serving students with different socioeconomic backgrounds. Our objectives were to describe social inequalities across elementary schools in: (i) level of importance that school principals attribute to 13 common health-related issues among students in their school; (ii) availability of HPIs within their school addressing eight health topics and (iii) (mis)alignment between perceived importance and HPI availability. Data were collected in telephone interviews with school principals in a convenience sample of 171 elementary schools (59% of 291 schools contacted). Schools were categorized as serving very advantaged, moderately advantaged or disadvantaged students. Principals reported how important 13 health issues were among students in their schools and provided data on HPI availability for 8 health issues, 4 of which required school action under government mandates. Higher proportions of principals in schools serving disadvantaged students (36% of all 171 schools) perceived most health issues as important. The mean number of HPIs in the past year was 12.0, 12.1 and 11.7 in schools serving very advantaged, moderately advantaged and disadvantaged students, respectively. Only availability of mental health HPIs differed by school deprivation (60, 43 and 30% in very, moderately and disadvantaged, respectively). Although most schools offered oral health HPIs, dental problems were not perceived as important. Smoking was perceived as not important and smoking-related HPIs were relatively rare (9%). Given rapid evolution in public health priorities, (mis)alignment between perceived importance of specific health issues and HPI availability in elementary schools warrants ongoing reflection.

Introduction School-based health-promoting interventions (HPIs) aim to support youth development and positively influence modifiable lifestyle behaviours. Identifying factors that contribute to or hinder the perceived success of HPIs could facilitate their adaptation, improve implementation and contribute to HPI sustainability. The objective of this study was to identify factors in three domains (school characteristics, characteristics of the HPI and factors related to planning and implementing the HPI) associated with perceived success of HPIs among school principals in elementary schools. Methods Data were drawn from Project PromeSS, a cross-sectional survey of school principals and/or nominated staff members in a convenience sample of 171 public elementary schools in Quebec, Canada. School board and school recruitment spanned three academic school years (2016–2019). Data on school and participant characteristics, HPI characteristics, variables related to HPI planning and implementation and perceived success of the HPI were collected in two-part, structured telephone interviews. Descriptive statistics were used to characterize schools and study participants. Twenty-eight potential correlates of perceived HPI success were investigated separately in multivariable linear regression modelling. Results Participants generally perceived HPIs as highly successful. After controlling for number of students, language of instruction, school neighbourhood and school deprivation, we identified five correlates of perceived success, including lower teacher turnover, higher scores for school physical environment, school/teacher commitment to student health, principal leadership and school being a developer (vs. adopter) of the HPI. Conclusion If replicated, these factors should be considered by HPI developers and school personnel when planning and implementing HPIs in elementary schools.

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BACKGROUND:The context in which school-based health-promoting interventions are implemented is key for the delivery and success of these interventions. However, little is known about whether school culture differs by school deprivation. METHODS:Using data from PromeSS, a cross-sectional study of 161 elementary schools in Québec, Canada, we drew from the Health Promoting Schools theoretical framework to develop four measures of health-promoting school culture (i.e., school physical environment, school/teacher commitment to student health, parent/community engagement with the school, ease of principal leadership) using exploratory factor analysis. One-way ANOVA with post-hoc Tukey-Kramer analyses was used to examine associations between each measure and social and material deprivation in the school neighborhood. RESULTS:Factor loadings supported the content of the school culture measures and Cronbach's alpha indicated good reliability (range: 0.68-0.77). As social deprivation in the school neighborhood increased, scores for both school/teacher commitment to student health and parent/community engagement with the school decreased. IMPLICATIONS FOR SCHOOL HEALTH POLICY, PRACTICE, AND EQUITY:Implementation of health-promoting interventions in schools located in socially deprived neighborhoods may require adapted strategies to address challenges related to staff commitment and parental and community involvement. CONCLUSION:The measures developed herein can be used to investigate school culture and interventions for health equity.

Introduction Les interventions de promotion de la santé (IPS) en milieu scolaire visent à soutenir le développement des jeunes et à influencer positivement les comportements modifiables liés au mode de vie. La détermination des facteurs qui contribuent au succès perçu des IPS ou l'entravent pourrait faciliter leur adaptation, améliorer leur mise en œuvre et contribuer à leur durabilité. Cette étude a pour objectif de déterminer ces facteurs dans trois domaines (caractéristiques de l'école, caractéristiques de l'IPS et facteurs liés à la planification et à la mise en œuvre de l'IPS) associés au succès perçu des IPS auprès des directeurs d'écoles primaires. Méthodologie Les données ont été tirées du projet PromeSS, une enquête transversale menée auprès des directeurs d'école ou de membres du personnel délégués dans un échantillon de commodité de 171 écoles primaires publiques du Québec (Canada). Le recrutement des commissions scolaires et des écoles s'est déroulé sur trois années scolaires (2016 à 2019). Les données sur les caractéristiques de l'école et des participants, les caractéristiques de l'IPS, les variables liées à la planification et à la mise en œuvre de l'IPS et le succès perçu des IPS ont été recueillies lors d'entretiens téléphoniques structurés en deux parties. Des statistiques descriptives ont été utilisées pour caractériser les écoles et les participants à l'étude. Vingt-huit corrélats possibles du succès perçu des IPS ont été étudiés séparément, dans un modèle de régression linéaire multivariée. Résultats Les participants ont généralement perçu les IPS comme étant très réussies. Après ajustement pour le nombre d'élèves, la langue d'enseignement, le quartier de l'école et de la défavorisation scolaire, nous avons relevé cinq corrélats du succès perçu, à savoir un taux de rotation plus faible du personnel enseignant, des scores plus élevés pour l'environnement physique de l'école, l'engagement de l'école et du personnel enseignant envers la santé des élèves, le leadership du directeur d'école et le fait que l'école développe l'IPS (au lieu de l'adopter seulement). Conclusion Si ces facteurs sont reproduits dans le cadre d'autres études indépendantes, les concepteurs des IPS et le personnel scolaire devraient en tenir compte dans le cadre de la planification et de la mise en œuvre des IPS dans les écoles primaires.

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