Preventing Stress among High School Students in Denmark through the Multicomponent Healthy High School Intervention—The Effectiveness at First Follow-Up

Abstract

Stress is a widespread phenomenon and young people especially are experiencing high levels of stress. School-related factors are the most frequently self-reported stressors among adolescents, but few interventions have targeted the school environment. This study evaluated the effectiveness of the Healthy High School (HHS) intervention on stress at a 9-month follow-up. The study included 5201 first-year high school students (~16 years) in Denmark. Participating schools were randomized into the HHS intervention (N = 15) or control group (N = 15). Baseline measurements were conducted in August 2016 and the follow-up was conducted in May 2017. The intervention was designed to promote well-being (primary outcome) by focusing on physical activity, meals, sleep, sense of security, and stress (secondary outcomes). The intervention comprised: structural initiatives at the school level; a teaching material; peer-led innovation workshops; and a smartphone app. The 10-item Perceived Stress Scale was used to measure stress. Intervention effects on perceived stress were estimated using an intention-to-treat approach with multiple imputations of missing data and multilevel general linear regression modelling. A total of 4577 students answered the baseline questionnaire. No statistically significant difference was found in stress between students at intervention and control schools at the follow-up (mean score: 16.7 versus 16.7, adjusted b = 0.42, 95%CI: −0.16;1.00). The HHS Study is one of the first large randomized controlled trials targeting school environmental stressors. Potential implementation failures and the failures of the program theory are discussed.

Teaching methods for critical thinking in health education of children up to high school: A scoping review

“…Most studies conducted in Europe concerned lifestyle, including both nutrition and/or physical activity interventions [ 7 , 9 , 11 , 22 , 24 , 46 , 91 , 97 , 103 , 106 , 109 , 126 , 134 ], public health [ 8 , 12 , 13 , 29 , 47 , 88 , 101 , 105 , 139 ], and psychoactive substance use [ 7 , 15 , 48 , 51 , 84 , 114 , 122 ]. Four papers concerned somatic health [ 22 , 30 , 97 , 125 ] and five–mental health [ 68 , 97 , 99 , 109 , 113 ]. Only two educational intervention addressed sexual health [ 28 , 115 ].…”

“…Half of the studied interventions were preceded by teachers’ training (57 articles, 50%) and/or peer leaders training (13 articles, 11%). Only every third intervention provided pupils with additional materials, such as booklets [ 22 , 32 , 74 , 77 , 102 , 124 ], handouts [ 49 , 78 , 117 ], audiovisual materials [ 20 , 74 , 90 , 99 , 107 , 115 ], textbooks [ 84 , 85 , 130 ], recipes [ 57 ] newsletters [ 28 , 46 ], exercise book [ 129 ], and student guide [ 111 ].…”

“…Typically, the practice-oriented methods were dedicated to developing either cognitive skills and emotional regulation or manual abilities and physical fitness. The former was used when fostering the skills of goal setting [ 77 , 85 , 87 , 100 , 137 ], decision-making [ 12 , 25 , 27 , 29 , 46 , 61 , 70 – 72 , 74 , 76 , 77 , 80 , 84 , 85 , 89 , 97 , 102 , 111 , 120 , 123 , 126 , 134 – 136 , 138 ], stress management [ 85 , 99 ], peer pressure resistance [ 21 , 61 , 80 , 85 , 95 ], emotions regulation [ 85 , 89 ], peaceful conflict resolution techniques [ 29 , 111 , 139 ], differentiating healthy from unhealthy practice [ 11 , 92 , 123 , 134 , 135 ], assertiveness [ 87 , 111 ], as well as values clarification and/or self-monitoring [ 46 ,…”

“…This social dynamic was used in educational interventions across countries for over 40 years. A peer-to-peer approach was applied in 54 tested interventions [ 8 , 10 , 14 – 17 , 21 – 23 , 26 , 28 , 29 , 31 , 32 , 46 , 48 , 55 , 57 , 58 , 61 , 62 , 80 , 81 , 85 , 86 , 90 , 92 , 93 , 95 , 98 , 99 , 102 , 106 , 110 , 112 – 114 , 117 , 119 , 127 , 128 , 131 , 133 , 136 , 137 , 139 , 140 ], either as a main or complementary teaching strategy. With peer-to-peer method as the main strategy, selected pupils typically participated in training for peer leaders and offered workshops, prepared presentations, or moderated discussions with other pupils [ 15 – 17 , 31 , 55 , 57 , 58 , 62 ,…”

“…The application of teaching methods was typically supported by internet search [ 11 , 13 , 22 , 50 , 60 , 66 , 73 , 75 , 97 , 100 , 102 , 103 , 105 , 108 , 115 , 122 , 131 , 132 ], creating presentations [ 20 , 22 , 29 , 30 , 46 , 47 , 54 , 74 , 111 , 140 ], communicating or analyzing social media [ 7 , 8 , 11 , 13 , 17 , 20 , 30 , 31 , 108 , 122 ], using applications, both those generally available, i.e. interactive web-based quiz and those developed for the intervention [ 12 , 88 , 91 , 99 , 102 , 106 , 110 , 115 , 118 ], or computer games [ 84 , 103 , 107 , 111 , ...…”