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Education and Health Published by SHEU since 1983

Volume 31 Number 4, 2013

ISSN 2049-3665

An evaluation in UK schools of a classroom-based physical activity programme - TAKE 10! ®: A qualitative analysis of the teachers' perspective Paul Gately, Claire Curtis and Rachel Hardaker SHAHRP: School Health and Alcohol Harm Reduction Project – Developments in Australia and the UK Nyanda McBride, Michael McKay and Harry Sumnall Adolescent gambling via social networking sites: A brief overview Mark D. Griffiths Food for thought Leila Harris Charlton Manor’s Food Journey Tim Baker and Nicholas Shelley Teaching cooking at Ashton Vale Primary Glyn Owen British adolescents’ experiences of an appearance-focussed facial-ageing sun protection intervention: a qualitative study Alison Leah Williams, Sarah Grogan, Emily Buckley and David Clark-Carter SRE - Not yet good enough: Can scripts bridge the training gap? David Evans

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Education and Health

SHEU publications

David McGeorge

‘Education and Health’ is published by SHEU, an independent organisation, providing research, survey and publishing services to those concerned with the health and social development of young people. SHEU incorporates the Schools Health Education Unit, founded in 1977 by John Balding. The address for all correspondence is: SHEU, 3 Manaton Court, Manaton Close, Matford Park, Exeter EX2 8PF Many publications can be viewed online or purchased from SHEU e-mail:


(e-mail: Welcome to the fourth issue for 2013. We continue with the proud tradition of independent publishing and offer an eclectic mix of articles. Contributions come from those working with young people and we welcome the interest from around the world. Developments in open access publications mean that articles from this journal are available in most places where there is Internet access. The journal, published since 1983, is aimed at those involved with education and health who are concerned with the health and wellbeing of young people. Readers, in the UK, come from a broad background and include: primary, secondary and further education teachers, university staff, and health-care professionals working in education and health settings. Readers outside of the UK share similar backgrounds. The journal is also read by those who commission and carry out health education programmes in school and college. Articles focus on recent health education initiatives, relevant research findings, materials and strategies for education and health-related behaviour data.

Contributors (see a recent list)

Do you have up to 3000 words about a relevant issue that you would like to see published?


The archive of Education and Health articles is also online. Please visit this weblink: I look forward to your company in the next issue.

The Young People series Large numbers of young people, between the ages of 10 and 15 years, respond to over 100 questions about their health-related behaviour. SPECIAL OFFER FOR SCHOOL LIBRARIES

We have available a 145 page pdf, for library use Young People into 2013 [£20] that includes: Bookmarks to each section with links to each page with external links to relevant websites about young people's health and wellbeing. There is also the facility to print the black and white publication. SEE EXAMPLE PAGES Free resources

Topics include:- Planning PSHE in your school; Research news about young people’s health and wellbeing; Literature search resource; Young People Reports into health and wellbeing; and more.


Schools and Students Health Education Unit

The specialist provider of reliable local survey data for schools and colleges and recognised nationally since 1977. "The survey reports have been used to inform commissioning at specific commissioning groups. They are also being used within our Extended Schools Clusters and to inform The Annual Public Health and the Joint Strategic Needs Assessment." Programme Manager - Young People For more details please visit TO SUPPORT YOUR WORK WITH YOUNG PEOPLE TRY SHEU’S FREE RESOURCES

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Dr Paul Gately is Professor of Exercise and Obesity at Leeds Metropolitan University and Director of MoreLife (UK) Ltd. Claire Curtis is the Research Manager and Rachel Hardaker is the former Programme Development Coordinator at MoreLife (UK) Ltd. For communication, please email:

Paul Gately, Claire Curtis and Rachel Hardaker An evaluation in UK schools of a classroom-based physical activity programme - TAKE 10! ®: A qualitative analysis of the teachers' perspective


he increasing prevalence of obesity among adults and children is a major public health concern both nationally and internationally (UK Department of Health 2008 and 2011a; WHO, 1997). Within the UK, it has been anticipated that 25% of children aged 2-15 will be obese, and 30% overweight, by 2050 (Foresight, 2007). Obesity prevention strategies are clearly needed to stem these perturbing projections. Early childhood is thought to be one of the critical time periods for the development of obesity (Dietz, 1997), and therefore a pivotal time for obesity prevention efforts. It is thought that lifestyle behaviours that promote wellbeing and healthy body weight (i.e. increasing physical activity (PA) and reducing sedentary behaviours; Malina, 1996) that are established during this time are more likely to persist (track) into adulthood (Dietz, 2004), thereby decreasing the risk for obesity and other health conditions later in life. Engaging young people in PA is a key behavioural goal for obesity prevention. Schools are a particularly attractive and popular setting for the implementation of childhood obesity interventions. Moreover, teachers are thought to be in an ideal position to deliver these strategies and influence pupils’ attitudes and beliefs regarding health behaviours. Consequently, a number of research initiatives have been developed that aim to increase physical activity within a school setting using teachers as facilitators. One example of this is TAKE 10!, a classroombased programme that integrates 10-minute sessions of PA into primary school educational curriculum. More specifically, the programme provides teachers with age-group-specific physical activities to be completed within class

time that are linked to core subject area objectives. This programme, designed by the International Life Sciences Institute Center for Health Promotion (ILSI CHP), was first piloted in the United States in 1999. Since this time several articles have reported the outcomes of the TAKE 10! programme. A recently published review of studies examining TAKE 10! over the past 10 years highlights the feasibility of integrating movement within academic studies in elementary school classrooms. Furthermore, TAKE 10! has been shown to be particularly effective in helping students focus on learning and enabling improvement in PA levels (Kibbe et al., 2011). The purpose of this study was to add the teachers’ viewpoint, that has not been previously studied, to the existing literature. The implementation of the TAKE 10! Programme, with the UK schools National Curriculum, was explored using a qualitative analysis of the teachers' perspective.

Methods Participants Participants for the study included 8 teachers from the two schools in the Yorkshire region that were recruited to take part in the Take 10! intervention. Of these teachers, two taught year 3 (ages 7-8), two taught year 4 (ages 8-9), two taught year 5 (ages 9-10) and two taught year 6 (ages 10-11). The teachers varied in gender (4 females/4 males) and years of teaching experience (from 6 months – 37 years). All teachers received training in the TAKE 10! standardised format and were asked to deliver TAKE 10! sessions to the pupils in their class for a minimum of 3-4 times per week for one school

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year. However, post-study interviews revealed that the average number of times the TAKE 10! sessions were carried out was 1.5 times per week. Qualitative Data Collection Participants were interviewed using a semistructured format on three occasions throughout the school year (one interview per term). The interview guide focused on the teachers’ experience of implementing TAKE 10! While every effort was made to follow the proposed guides, the interviewer was mindful of Berg’s (2004) definition of the semi-standardized interview where questions are “typically asked of each interviewee in a systematic and consistent order, but interviewers are allowed the freedom to digress; that is, the interviewers are permitted (in fact, expected) to probe beyond the answers to their prepared standardized questions.” Therefore, some questions were posed in a different order depending on each individual interview. For example, some of the answers given by participants covered several questions and certain responses prompted the early insertion of later questions. The interview schedules encouraged the interviewees to tell their own story. All interviews lasted between 10-15 minutes and were audiotaped (with permission) and transcribed in their entirety. Consent and Ethical Approval Consent was obtained from all participants and ethical approval was obtained from Leeds Metropolitan University Research Ethics Committee. Qualitative Data Analysis Transcripts were analysed using the thematic analysis procedure described by Braun and Clarke (2006). Firstly, the data were read carefully to identify and code interesting features of the transcripts. Secondly, the different codes generated were sorted into potential themes and all data relevant to each potential theme were collated. Finally, the data were systematically reviewed to ensure that a name and clear definition for each theme were identified and that these themes worked in relation to the coded extracts.

Results The thematic analysis identified two overarching themes evident across all teacher transcripts, suggesting a consensus of opinions

from the two schools regarding the implementation of TAKE 10!, namely, 1) barriers and 2) benefits. These themes are described below: Barriers to Implementing TAKE 10! Overloaded Curriculum leads to Time Constraints There was agreement that the main barrier to implementing TAKE 10! was insufficient time to accommodate any extra activities into what they describe as “an already overloaded school curriculum.” One teacher describes the feeling echoed in most transcripts: “There just is not enough time in core subjects like English and maths, in an hour’s lesson, 10 mins is a long time. You only want to give the children an input of 15 mins but then if they have had 10 mins of TAKE 10! that’s 25 mins, and then you take into account drinks cause they are tired, and equipment set up and putting it away things like that, it becomes a half hour job.” This excerpt eloquently raises the frequently stated view that TAKE 10! takes more than 10 minutes which diverts what the teachers describe as “much needed time” away from actual teaching in those core fundamental subjects. In other words, the teachers did not view TAKE 10! as a further extension to their teaching or as another way to deliver the information in the core subjects. One teacher describes: “We are pushed for time as it is trying to cover all we need to in those core subjects.” However, when asked if more time would aid the implementation of TAKE 10!, the teachers responded that they would rather “fill it with more curricular-based activities” further highlighting the disconnect with the teachers seeing the value if TAKE 10! as a ‘curricularbased’ activity! The reasoning behind their preference to focus on core subjects became apparent throughout the interviews and will be discussed within the next sub-theme. The pressures, to maintain the overloaded curriculum, are increased by additional activities that are “squeezed” in. For example, the teachers spoke of periods when time constraints are exacerbated due to timetable changes: “It’s been just an absolute nightmare because of all the Christmas stuff – extra singing practices, longer assemblies….It’s been difficult enough to get through the lessons more than anything else.”

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The agreement between the teachers was, during these times when the lessons are disrupted and they are not in their usual routine, if something has to be compromised they would “unfortunately, trim the TAKE 10! down.” Other activities cited as causing interference to the timetable and limiting their core subject teaching time, (and limiting their ability to conduct TAKE 10!), were assessments (i.e. SATS), school trips, OFSTED, rehearsal, teachers’ strike, residentials, sports day, and charity events. Furthermore, TAKE 10! was not delivered when the teachers were off sick and there was a supply teacher covering or when the teacher was out of the class due to other commitments such as managerial duties. Teachers at one school explained how there have been a number of new initiatives put in place in their school that same year. One teacher described: “You have to fit in 10 mins of this and 10 mins of that and there is a limit of how many 10 mins you can fit in!” The general feeling among the teachers was for TAKE 10! to work there needs to be a “routine” and “structure” and an “uninterrupted” “normal” school week. It became evident that at each time-point that the interviews were conducted (i.e. each term) there appeared to be some event that further stretched the teachers’ ability to deliver the core curricular subjects and thus diverting the teachers’ time away from delivering TAKE 10! School Judged on Academic Achievement rather than Physical Health The major emphasis placed on teaching core subjects appeared to stem from the fact that the teachers, and their schools, are judged on how well their students perform in these key areas. The transcripts revealed an underlying pressure placed on the teachers to obtain good grades from their classes. Teachers commented: “we have to meet targets”; “we have the pressure of the curriculum and demands of standards, targets etc.”; “preparing for assessments have to take priority”; “We’re cramming in everything right now. There is a pressure to get all this done”; “Physical activity can’t take the place of the academic teaching that you need to do.” Furthermore, if certain children or their class in general, are behind in key areas such as

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maths or English, the teachers felt any extra time should be “best to spent getting the child up to speed on these and not engaging in ‘fun’ activities.” Such comments give the impression that the majority of teachers did not see the value of TAKE 10! as a tool to further embed learning in these subjects but rather takes time away from their teaching. One teacher remarked “some content cannot be adapted into a physical format.” Another said “In subjects like literacy, they need to master core skills like writing and to get pens on paper, not be jumping up and down!” Viewed as an Extra Demand This highlights a key criticism that the teachers shared about TAKE 10!, that is, its contents did not link to their school’s curriculum and the lessons they were teaching in a “meaningful way”. So, in order to deliver the sessions, the teachers were adapting the TAKE 10! session plans to fit what they had planned in that particular lesson. The teachers reported that they did not really use the manual provided much other than to gain some ideas as to the concept and then they planned their own sessions; “I didn’t always take the sessions straight from the pack, I have adjust them to fit what we are doing. I feel more confident with the ones I write myself”; “I have obviously modified some of the ideas in there but the content didn’t necessarily fit our curriculum all that well”; “It is all my own things because then it fits in with my teaching agenda. More time-effective than searching through the folder for links.” This acted as a considerable barrier to delivery for the majority of teachers. They explained: “It’s another planning task to have to do. Planning and prep time is taken up with planning and prep for core subjects. I don’t have the time for extra planning”; “I am up at 6am and get home at 6.45pm and have had a 10 min lunch break. How can I fit in extra time and have a good work-life balance?”; “To be honest it’s been an extra demand - It’s brainpower and thinking how can I do this today?” While the teachers agreed that TAKE 10! doesn’t easily fit with all lessons, the teachers utilised it most in maths. This teacher’s comment reflects the views of many: “It fits in nicely with maths and doesn’t take away from the

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content that they would be teaching already. It doesn’t add an extra task!” Conflict with Existing Physical Activity within School There were mixed views as to whether the teachers felt the children already did enough physical activity in their school day and whether initiatives like TAKE 10! are therefore not needed. The differences in opinions seemed to be directly related to whether the teacher saw themselves as a PE specialist or not, with those who advocated the need for more physical activity tending to be the former. The chosen schools were already engaging in other daily physical activity initiatives. It was these examples that the teachers would refer to in the defence of their argument that they didn’t see the need to do TAKE 10! as the children were getting extra activity through these schemes. “We already have this activity; we don’t need to do both!”; “I think we do enough physical activity already.” Constraints of Delivery Environment Another key barrier in the implementation of TAKE 10! was the delivery environment. Due to large class sizes (29-35 pupils), the teachers felt that the classrooms were not designed, sizewise, to accommodate some of the TAKE 10! activities. Furthermore, some were mobile classrooms which raised further problems; “There are health and safety implications of doing these activities in a mobile classroom with 34 kids especially with year 6 kids who are big kids”; “The walls are very thin in these classrooms so noisy activities can disrupt the class next door – noise and the shaking of room!” The majority of the teachers preferred to do TAKE 10! outside but with that came other issues: “The weather has been terrible so we’ve not been able to get out on the yard so space has been an issue”; “We could not go outside as year 6 were doing SATS and they were complaining we were making too much noise”; “When the weather’s bad and we can’t go outside - what I had planned doesn’t adapt to our small classroom so I end up not doing it”; “Outside is better but takes more time.” Benefits of Implementing TAKE 10! Enjoyment and Engagement of Pupils Generally, the response from the teachers was the majority of the children were eager to engage in TAKE 10! One teacher commented: “They like to get involved in anything that doesn’t involve sitting at their desks with a

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pen!” Another said: “You get the odd moan now and again but they do get on with it.” The children who engaged the most were those who were seen as the ‘active’ children. Conversely, the ones that “don’t like to get involved don’t generally engage in PE lessons either” or the children that “typically don’t have a good attitude to work.” It was also observed that boys tended to give more energy to the activities and the girls were inclined to be embarrassed or less confident. The teachers noticed that engagement in the TAKE 10! sessions were increased when the children were allowed to lead the sessions. One teacher described: “I think they enjoy it now they are planning it…They have more ownership, like when the other children are marching around telling them they are not doing it right that has a bigger impact than if it was me saying it. The children can get away with saying more things to get the other children moving more than I could!” Improvements as a Result of TAKE 10! Generally, when asked whether the teachers had noticed any differences in the children in their class as a result of TAKE 10! the majority commented “not really” or “no differences that they could say with confidence were directly as result of doing TAKE 10!” One teacher said: “It helps them to expend energy and get it out of their system but I am not sure what is making the difference as there are lots of other changes going on.” However there were some positive improvements reported such as: “There were 4 maths lessons that were unusually quiet. The group focused more”; “When the children have finished these sessions they are refreshed and ready to settle down and do work again”; “One or two children who have difficulty concentrating, I think they are concentrating a little better and more focused”; “They are more alert some of them. Engaged and awake. It helps to focus their attention again.” The majority of teachers felt that any differences from TAKE 10! are no different from when they have playtime or other short physical activity sessions. While for the majority of children TAKE 10! may infer positive benefits, there were a small proportion of the children for whom it had an opposite effect. “Some are calmer but it has the opposite effect on others – who get giddy and over-excited.” This leads to further disruptions in class.

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It is difficult to draw conclusions as to the effectiveness of TAKE 10! in deriving healthrelated benefits from participation. While the teachers aimed to deliver 4 sessions of TAKE 10! per week, on average they completed 2 sessions per week. This eventually dwindled to an average of 1 session per week at the third time interval. One teacher did comment “Because I haven’t been doing it consistently or regularly enough I can pin point any specific differences in the children from doing TAKE 10!” Strengthens Learning Another positive benefit from delivering TAKE 10! was that it seemed to strengthen learning in certain children. For example: “Some of the ones who don’t normally engage in timetables really engage when we do it connected with activity. You’re not tricking them into doing it, you are just engaging them, stimulating them. So it does work”; “Some children may get the concept better or remember the information better by associating times tables with fun or activity. They can maybe physically see it and remember it, for example, visualise dividing half of the group up for fractions.”

Discussion A range of largely external factors relevant to the implementation of the TAKE 10! programme were reported. Teachers commonly reported being overloaded and that the Take 10! programme was like “extra work”. Some articulated that the resources were “big and bulky” and “not very user friendly” demonstrating the importance of understanding the local audience needs. Several teachers talked about the key targets in school being literacy and numeracy as well as attainment. It was felt the pursuit of these targets left little in the way of time for other activities like TAKE 10! Many comments by the teachers suggested that they felt pupils already participated in enough physical activity, with the use of PE and the “wake and shake” programme. A survey by the Department for Education (2010) showed that, in 2009/10, 55% of pupils participated in at least 3 hours of high quality PE per week and out of hours schools sports. These data question the attitudes of teachers that children get enough activity each day especially when the recommendation is for children to achieve at

least 1 hour a day of physical activity (Dept. of Health, 2011). At an individual level the question of perception vs. reality of physical activity in school pupils by teachers is important, as noted in a study by Corder (2010) which reported the differences in perceived vs. real levels of physical activity. The data showed that parents’ perceptions of activity levels were much greater than in reality. It should be acknowledged that it is difficult to determine whether pupils are ‘active enough’ as they do not spend all their time at school and that there is a lack of awareness of the necessary thresholds of unhealthy or healthy behaviours like physical activity. Other studies suggest that adults tend to overestimate their physical activity levels by as much as 48-61%, which demonstrates a general overestimation of physical activity levels for health benefits to be obtained (Sluijs, Griffin & Poppel 2007). This research does demonstrate that the perception vs reality gap for physical activity does exist and needs to be addressed across a range of groups including teachers and parents. In 2012, the UK targets for five hours of PE each week were removed by the government; this demonstrates a continued move towards greater degrees of autonomy in schools. However, it is clear given many of the attitudes of the teachers we worked with that the opportunities of pupils to engage in physical activity may be reduced even further with such changes. Despite the range of challenges that were presented, all teachers felt the children enjoyed the TAKE 10! sessions and felt they benefited from them. Some teachers reported observations of the positive impact on pupils’ learning capabilities through the TAKE 10! programme. These perceived benefits require further understanding and communication to teachers given the potential positive impact on pupils learning. With that being said, it was also interesting to note that in several statements made by teachers about the impact of TAKE 10! they appeared to acknowledge some benefits from the TAKE 10! sessions but they did not attribute all the positive elements they observed to the TAKE 10! session. However, they were unable to attribute the benefits to any other factors. It may be that the teachers have a

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narrow view of the impacts of physical activity and therefore felt it was not possible to attribute these outcomes to the Take 10! session. This demonstrates the importance of communication especially related to the objectives of the teachers, but also the contributions made by the TAKE 10! programme or regular participation in physical activity. It is unfortunate that the balance of positive and negatives associated with the TAKE 10! implementation from the teachers’ perspective is tipped towards the negative side. It appears that teachers saw value in physical activity; however the range of barriers presented could suggest physical activity has a lower degree of priority within the educational system as a whole, by individual schools and/or by teachers. Other potential issues include teachers’ confidence and competence delivering physical activity or the degree to which physical activity impacts on learning, for example some teachers’ comments imply that their expectations on the benefits to learning (particularly related to primary targets) will be limited. A study by Morgan and Bourke (2005) reported that primary school teachers possessed only moderate levels of confidence to teach PE and felt that they were ill-equipped following their teacher training. This demonstrates a major system issue which limits the foundational principles of physical activity promotion within the school curriculum. In addition, a review by Treadau and Shephard (2008) found that academic achievement was improved despite the extra time allotted to it. In contrast, they also found that more time in academic subjects did not improve academic achievements. Yu and colleagues (2006), however, did not find any relation between physical activity participation and school conduct. This further demonstrates the challenges of achieving the evidence necessary to support practices based on evidence rather than opinion, even those of teachers. A worrying observation was the cancelling or withdrawal of a TAKE 10! session for poor behaviour. Whilst evidence is limited on this issue, the National Association of Sport and Physical Education have published a position statement (2009), which suggests it is inappropriate to withhold physical activity as a form of punishment. Another comment

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demonstrates more worrying attitudes of some teachers about the value they attribute to physical activity “best spent getting the child up to speed on these and not engaging in ‘fun’ activities”. It is likely that these attitudes will send the wrong message to children and young people about the value and importance of physical activity.

Conclusion In summary, the teachers thought the ‘idea’ of TAKE 10! was worthy “in principle” saying “Theoretically, it would be good”. However, the overwhelming feeling was it is just not “practical” given the range of pressures that these teachers faced within their current role. A significant amount of work has gone into the development of the TAKE 10! programme to enable teachers to overcome many of the practical barriers they may face in implementing the programme. These include the development of user-friendly resources, training support and the inclusion of themes aligned to curricular subjects and themes so that the Take 10! activities complement learning. Some of the comments from teachers suggested they had not fully engaged in the training or the reviewing of the resources. Whilst it is accepted that modifications to the TAKE 10! programme can be made, the majority of the comments reflected educational system issues/barriers and a culture that suggests a low priority given to physical activity. It appears that the cultural challenges are very important factors to the effective implementation of TAKE 10! , this is despite comments from the teachers that many of the pupils enjoyed and benefited from the programme. It is unclear the degree to which more can be done as part of the overall programme delivery to facilitate the greater use of TAKE 10! in the UK without cultural changes in the educational system and primary school staff. Acknowledgements This work was funded by the International Life Sciences Institute (ILSI) Research Foundation and European branch. The authors received funding from the ILSI Europe Weight Management in Public Health Task Force. Industry members of this task force are listed on the ILSI Europe website at For further information about ILSI Europe, please email or call +32 2 771 00 14. The opinions expressed herein and the conclusions of this publication are those of the authors and do not necessarily represent the views of the ILSI Research Foundation, ILSI Europe nor those of its member companies.

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References Berg, B.L. (2004). Qualitative research methods in social sciences. 5th ed. Boston: Pearson Education. Braun, V. & Clarke, V. (2006). Using thematic analysis in psychology. Qualitative research in psychology, vol. 3, no. 2, pp. 77-101. Corder, K., Van Sluijs, E.M.F., McMinn, A.M., Ekelund, U., Cassidy, A., & Griffin, S.J. (2010). Perception Versus Reality – Awareness of physical activity levels of British children. Am. J. Prev. Med, vol 38, pp. 1-8. Daniels, R.S. (2006). ‘From Critical Periods for Abnormal Weight Gain in Children and Adolescents’, in Goran, S,M,I., Sothern, M,S,. (ed.) Handbook of Pediatric Obesity: Etiology, Pathophysiology & Prevention. Florida: Taylor & Francis Group. Department for Education (2010). PE and Sport Survey 2009/10, HMSO, London. Department of Health (2008). Healthy Weight Healthy Lives, HMSO, London. Department of Health (2011a). Call to Action: Obesity Strategy, HMSO London. Department of Health (2011b). Start Active, Stay Active A report on physical activity for health from the four home countries Chief Medical Officers. Department of Health. Dietz, W.H. (1997). Periods of Risk in Childhood for the Development of Adult Obesity — What Do We Need to Learn? J. Nutr., vol 127 no. 9, pp. 1884S-1886S. Dietz, W.H. (2004). Overweight in childhood and adolescence. N Engl J Med, vol 350, no. 9, pp. 855-857. Foresight (2007). Tackling obesities: future choices—project report. London: The Stationery Office. Kibbe, D.L., Hackett, J., Hurley, M., McFarland, A., Schubert, K. G., Schultz, A., & Harris, S. (2011). Ten Years of TAKE 10!: Integrating physical activity with academic concepts in elementary school classrooms. Preventive Medicine, vol 52, pp. S43-S50.

Malina, R.M. (1996). Tracking of physical activity and physical fitness across the lifespan. Res. Q. Exerc. Sport, vol 67, pp. S48–S57. Morgan, P, & Bourke, S. (2005). An investigation of pre-service and primary school teacher’ perspectives of PE teaching confidence and PE teacher Education. Asia-Pacific Journal of Health, Sport & Physical Education, vol. 52, pp. 7-13. Trudeau, F, & Shephard, RJ. (2008). Physical education, school physical activity, school sports and academic performance. International Journal of Behavioral Nutrition and Physical Activity, vol. 5 pp. 10. Van Sluijs, E., Griffin, S., Van Poppel, M. (2007). A cross sectional study of awareness of physical activity associations with personal, behavioural and psychosocial factors. Int J. Beh Nutr Phys Act, vol. 8, p. 4. Yu, C.C.W., Chan, S., Cheng, F., Sung, R.Y.T., & Hau, K. (2006). Are physical activity and academic performance compatible? Academic achievement, conduct, physical activity and self-esteem of Hong Kong Chinese primary school children. Educational Studies, vol. 32, pp. 331-341. National Association for Sport and Physical Education (2009). Position statement – Physical activity used as Punishment and/or Behavior Management. World Health Organisation (1997). Obesity: Preventing and managing the global epidemic. Report of a WHO consultation on obesity. Geneva. Switzerland

Education and Health The journal, published by SHEU since 1983, is aimed at those involved with education and health who are concerned with the health and wellbeing of young people. Readership is worldwide and in the UK include: primary; secondary and further education teachers; university staff and healthcare professionals working in education and health settings. The journal is online and open access, continues the proud tradition of independent publishing and offers an eclectic mix of articles.

Contributors (see a recent list) - Do you have up to 3000 words about a relevant issue that you would like to see published? Please contact the Editor


Schools and Students Health Education Unit

The specialist provider of reliable local survey data for schools and colleges and recognised nationally since 1977. "The (named) Children and Young People's Partnership has benefitted from the results of the SHEU survey locally for many years now, and we should like to continue to do so in future." Consultant in Public Health Medicine For more details please visit

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Dr Nyanda McBride is the Senior Research Fellow and Project Leader at the National Drug Research Institute, Curtin University, Western Australia. Dr Michael McKay is the STAMPP Co-ordinator and Dr Harry Sumnall is Professor in Substance Use at the Centre for Public Health, Liverpool John Moores University. For communication, please email: : :

Nyanda McBride, Michael McKay and Harry Sumnall SHAHRP: School Health and Alcohol Harm Reduction Project – Developments in Australia and the UK


he School Health and Alcohol Harm Reduction Project (SHAHRP) is an evidencebased programme that aims to reduce alcohol related harm in young people. The programme is a world first research study assessing the behavioural impact of classroom-based alcohol harm reduction on students' alcohol consumption and harm in alcohol use situations.

Early development The programme began in the late 1990s and involved secondary schools in Perth, Western Australia. Before developing and pre-testing the programme, project staff conducted extensive formative work, including talking about alcohol issues with young people, to ensure that activities were based on reality and relevant to young people (Farringdon et al., 2000; McBride et al., 2006). The programme is evidenced-based and incorporates findings from a systematic literature review of school drug education research (McBride, 2003), incorporates the experience of young people, and has been well tested in schools with students and teachers (McBride et al., 2006). The Australian SHAHRP study was conducted over a 32-month period, with earlier data collection at 8 and 20 months after the completion of each phase of the programme (McBride et al., 2004). Each assessment measured knowledge about alcohol, attitudes towards alcohol, total consumption, risky patterns of consumption, context of alcohol use, alcohol-related harms/risks associated with the student's own alcohol use, and alcohol-related harm/risks associated with other people's alcohol use (McBride et al., 2006; McBride et al., 2004). The evidence-based, classroom programme was conducted in two phases over a two year

period. The initial phase was implemented during the first year of secondary school (13 years old) when most students had not yet started to experiment with alcohol (McBride et al., 2006). It consisted of 17 skill-based activities conducted over 8-10 lessons (McBride et al., 2006). Phase 2, which was conducted the following year (when many young people had started to experiment with alcohol), consisted of 12 activities delivered over 5-7 weeks (McBride et al., 2006).

Activities The SHAHRP activities incorporate various strategies for interaction including delivery of utility information; skill rehearsal; individual and small group decision making; and discussions based on scenarios suggested by students, with an emphasis on identifying alcohol-related harm and strategies to reduce harm (McBride et al., 2006). Interactive involvement is emphasised, with two-thirds of activities being primarily interactive and another 15% requiring some interaction between students (McBride et al., 2002). Interactive involvement of students provides important practice in reducing harm associated with alcohol use and is a critical aspect of lessons using an evidence-based approach (McBride et al., 2006; McBride et al., 2004).

Programme components Teacher training Teacher training is conducted before each phase of SHAHRP. During Phase 1, teachers are provided with two days of training that gives an overview of the study behaviour outcomes, evidence-based components, and interactive modelling of each Phase 1 activity (McBride et al., 2006). Phase 2 training is conducted over two days for teachers new to the project. These

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teachers are briefed on the research aspects of the project and Phase 1 intervention activities during the first day of training (McBride et al., 2006). On day two, all teachers participate in interactive modelling of Phase 2 activities (McBride et al., 2006). Trainers who are experienced in interactive techniques are recommended as SHAHRP teacher trainers (McBride et al., 2006). Teacher manual The teacher manual provides specific written guidance for teachers. The manual includes detailed and structured lesson plans for eight 60-minute lessons in the first phase and five 50minute lessons in the second phase. Each lesson plan includes sample questions to help facilitate discussion and processing of activities and to focus on activity intention, coaching points to aid in the management of the activities, and background information about alcohol-related issues (McBride et al., 2006). Additional coaching points included in the teacher manual are based on feedback from teachers who have previously taught the programme (McBride et al., 2006; McBride, 2012). Student workbooks Student workbooks are available for each phase to stimulate and engage student's interest, provide information, encourage students to further explore issues and to record what they have learned as a way of consolidating practical activities (McBride et al., 2006). Qualitative results from the SHAHRP study show that students and teachers thought the books were appealing and great to use as reinforcement to the interactive activities (McBride et al., 2006). Trigger visual A Trigger Visual is used in Phase 2 of SHAHRP. The DVD features scenarios that young people may experience in alcohol use situations to prompt discussion about how to minimise the harms associated with alcohol use.

Results The results from initial Australian studies indicated an immediate effect in reducing the harm that young people experienced from their own drinking, and the harm they experienced from other people's drinking (McBride et al., 2004; McBride et al., 2000). Over the period of the study (from baseline to final follow-up 32

months later), students who participated in SHAHRP consumed 20% less alcohol, were 19.5% less likely to drink to harmful or hazardous levels, had 10% greater alcohol related knowledge, experienced 33% less harm associated with their own use of alcohol and 10% less harm associated with other people's use of alcohol than did the control group (who received regular alcohol education) (McBride et al., 2006; McBride et al., 2004). During the first and second phases of the programme, intervention students consumed 31.4% and 31.7% less alcohol (McBride et al., 2004). Differences in alcohol use were converging 17 months after the end of the programme. Intervention students were 25.7%, 33.8% and then 4.2% less likely to drink to risky levels from first follow-up onwards (McBride et al., 2004). This shows that direct classroom programmes are critically important to creating alcohol use change. However, the impact on harm reduction was maintained. The intervention reduced harm that young people experienced as a result of their own use of alcohol, with intervention students experiencing 32.7%, 16.7% and 22.9% less harm from first follow-up onwards (McBride et al., 2004).

Further developments SHAHRP targets a key issue affecting the health and wellbeing of young people and their communities, fosters knowledge, understanding and skills for decision making and teaches the application of problem-solving techniques to support healthy living. Between 2000 and 2009, over 70 international requests from policy makers, health and education practitioners and researcher resulted in replication of the study, requests for copyright release of programme materials, and the adoption of the programme in education and youth programs worldwide. The Australian SHAHRP study was replicated in Northern Ireland, starting in 2005, with the results reinforcing the behavioural findings of the Australian SHAHRP study (McKay et al., 2012). Independent replication of SHAHRP in another jurisdiction, and by a separate research group, provides stronger scientific evidence of the impact of SHAHRP on alcohol behaviours. The Federal de S達o Paulo in Brazil is also replicating the SHAHRP study. The research

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team has undertaken focus groups with young people to help ensure that the scenarios and situations in the SHAHRP manual and workbooks are culturally relevant to young Brazilians. The Brazilian research team have conducted baseline behavioural assessment and are currently supporting intervention schools in the teaching of Phase 1 of SHAHRP to Brazilian students. It is expected that SHAHRP will align with the Health and Physical Education learning area of the Australian Curriculum, to be implemented in schools in 2014, and in particular with the proposed strand: Personal, social and community health. The team at the National Drug Research Institute will provide a detailed document of SHAHRP’s alignment to the new Australian Curriculum on the website when the curriculum is released.

SHAHRP in Northern Ireland In Northern Ireland, the Public Health Agency funded SHAHRP as part of the Strategic Direction for Alcohol and Drugs 2006– 2011 because alcohol experimentation, more than any other drug, is widespread among young people. SHAHRP was chosen because it challenges young people to consider their behaviours regarding personal health and social responsibility. Michael McKay and a team of research colleagues at the University of Liverpool and Liverpool John Moores University, with the support of Nyanda McBride, developed the Northern Ireland SHAHRP content and design in order to adapt the programme for local schools. The initial study, a non-randomised longitudinal design with intervention and control groups, followed over 2,500 13 year-olds from 29 schools for 32 months, examining their knowledge of alcohol, attitudes towards alcohol, drinking habits and resultant behaviours. What was different in Northern Ireland from the study in Australia was the inclusion of two intervention groups. In one group the SHAHRP lessons were delivered by trained teachers, (as in Australia), while in the other the intervention was delivered by external facilitators; drug and alcohol education workers from a number of third sector agencies. A robust evaluation using latent class growth modelling found that those in receipt of

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SHAHRP (either from teachers or outside facilitators) reported significant, positive results (compared to those in the control group) with respect to impovements in alcohol-related knowledge, ‘healthier’ attitudes towards alcohol use, less alcohol-related harm, and perhaps most surprisingly considering the findings of previous prevention research, a lower consumption of alcohol at ‘last time use’. Furthermore, results showed a greater intervention effect for external facilitators compared to teachers; specifically the provision of SHAHRP by external facilitators was associated with a development of greater alcohol-related knowledge, ‘healthier’ attitudes, less harms, and a smaller growth in drinking than other conditions. The findings from the SHAHRP group included: 70% increase in knowledge about alcohol across time 73% increase in ‘healthier’ attitudes across time Findings from the control group, compared to the SHARP group, included: 30% increase in proportion of unsupervised drinkers across time 45% increase in self-reported harms resulting from their own drinking 63% increase in self-reported alcohol related harm associated with other people’s drinking SHAHRP is now delivered annually to 16,000 pupils in schools across Belfast and the South Eastern area.

SHAHRP in the UK In the UK, the National Institute of HealthPublic Health Research Programme has funded a randomised control trial (RCT) of SHAHRP with the addition of a parental component to be conducted in Scotland and Northern Ireland (2011-2015). This is being undertaken by a collaboration led by the Centre for Public Health at Liverpool John Moores University. STAMPP The trial will use the Northern Irish adaptation of SHAHRP, with the addition of a parental component designed to support parents in establishing family rules about substance use (an adapted form of an intervention delivered in the Netherlands (Koning et al., 2009). The combined treatment is called STAMPP (Steps Towards Alcohol Misuse

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Prevention Programme). A total of 105 High schools in Scotland and Northern Ireland have been randomised into intervention and control conditions and a total of 11, 300 participants have completed questionnaires at baseline and at T2 (following delivery of Phase one of the SHAHRP lessons). One set of schools will receive STAMPP, the other will receive their usual school alcohol education. Parents of the children who receive alcohol education as normal will not be invited to receive any type of intervention. Phases 1 & 2 Phase 1 of STAMPP is delivered when pupils are in year 10 (age 13-14), coinciding with the onset of alcohol use for many children, and phase 2 in year 11 (age 14-15), when alcohol use becomes more established. Phase 1 consists of six sessions (with 16 activities) and phase 2 consists of four sessions (with 10 activities). Each lesson incorporates skills-based activities and individual and small group discussions to emphasise the identification of alcohol-related harm and the development of harm reduction strategies. Interactive involvement is a key feature of the sessions. Parental component The parental component takes place over a single one hour long session and is aimed at parents/carers of intervention children. Parents are able to listen to the latest research findings regarding alcohol use by young people in the trial geographies and learn about some of the determinants of use. Through group discussion, parents are encouraged to agree upon, and set, authoritative rules on how alcohol will be dealt with in their home. Parents are reminded about the agreed rules a few weeks later though an information leaflet. Classroom intervention The classroom intervention is delivered by specially trained teachers in the current trial. Teacher training includes an introduction to the concepts involved in harm reduction, rehearsal of delivery of each of the sessions in that intervention phase, and awareness of raising of potentially difficult issues/areas around alcohol. Additionally, teachers will be provided with a support pack which includes detailed lesson plans, and alcohol information sheets. The parental component is delivered by trained prevention practitioners and takes place in the school or community setting.

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Schools and timetable Approximately 100 schools will take part in the research. Around 80 schools will be in Northern Ireland and 20 in Glasgow, UK. Fifty will receive STAMPP and fifty will deliver alcohol education as normal. The study started in November 2011 and lasts for 51 months. Phase 1 of the intervention began in Autumn 2012 and takes place across two annually delivered blocks of lessons. Changes in alcohol outcomes Based on previous work it is hypothesised that changes in alcohol outcomes associated with the classroom curriculum are mediated by changes in self efficacy, self regulation, and time perspective and orientation, whereby the skills developed in the sessions enable children to make more accurate decisions on the likely immediate short and long term consequences of different types of alcohol use, and to develop (and adhere to) personal and group strategies to reduce harm experienced by the recipients’ own and others’ alcohol use. These changes will be reinforced and supported by changes in family based skills.

Conclusion This article has briefly described the successful development of SHAHRP in Australia and in the UK. More details, about aspects of the process, can be found in the links below. SHAHRP’s harm reduction approach represents a change in paradigm to the field of alcohol education which has been dominated for many decades by the North American abstinence based approach. The success of SHAHRP lies in this change of paradigm but also in the critical inclusion of young people in the development and piloting of the program. The inclusion of young people in the formative development of the SHARHP intervention ensured that the program provided studentcentred activities and methodologies that are relevant and resonates with the young people who participate in the program. The SHAHRP studies have also identified key developmental phases of alcohol education provision in the school setting. These include an Inoculation phase provided immediately before the majority of young people are experimenting with alcohol, followed by an Early Relevancy phase when the majority of young people are starting to experiment with alcohol.

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The past and continued assessment of the SHAHRP harm reduction approach in international settings, and the application of the SHARHP program in school and other settings by education and health professionals has resulted in the body of work being awarded the 2013 Australian National Drug and Alcohol Award for Excellence in Prevention and Community Education. Acknowledgements The STAMPP trial is funded by the National Institute for Health Research Public Health Research (NIHR PHR) Programme (project number 10/3002/09). This article presents independent research funded by the National Institute for Health Research (NIHR). The views expressed are those of the author(s) and not necessarily those of the NHS, the NIHR or the Department of Health. This article has been edited by the authors and derived from a number of sources including: The National Drug Research Institute, Curtin University, Western Australia. SHAHRP website: Healthcanal: School alcohol project results in healthier and safer pupils. Nov. 2011. References Farringdon, F., McBride, N. & Midford, R. (2000). The fine line: Students perceptions of drinking, having fun and losing control. Youth Studies Australia, 19, (3), pp. 33-38. Koning, I.M., Vollebergh, W.A., Smit, F., Verdurmen, J.E., Van Den Eijnden, R.J., Ter Bogt, T.F., Stattin, H. & Engels, R.C. (2009). Preventing heavy alcohol use in adolescents (PAS): cluster randomized trial of a parent and student intervention offered separately and simultaneously. Addiction, 104, 1669– 1678. McBride, N. (2003). A systematic review of school drug education. Health Education Research Theory and Practice, 18, (6), pp. 729-742. McBride, N., Farringdon, F. & Midford, R. (2002). Implementing a school drug education programme: Reflections on fidelity. International Journal of Health Promotion and Education, 40, (2), pp. 40-50. McBride, N., Farringdon, F., Meuleners, L. & Midford, R. (2006). The School Health and Alcohol Harm Reduction Project. Details of Intervention Development and Research Procedures. National Drug Research Institute, Monograph 59., Perth, Western Australia. McBride, N., Farringdon, F., Stevens, C. & McKay, M. (2012). SHAHRP Refresh. Updating the School Health and Alcohol Harm Reduction Project. Final Report. National Drug Research Institute: Perth, Western Australia. McBride, N., Midford, R., Farringdon, F. & Phillips, M. (2000). Early results from a school alcohol harm minimisation study. Addiction, 95, (7), pp. 1021-1042. McBride, N., Farringdon, F., Midford, R., Meuleners, L. & Philip, M. (2004). Harm Minimisation in School Drug Education. Final Results of the School Health and Alcohol Harm Reduction Project (SHAHRP). Addiction, 99, pp. 278-291. McKay, M.T., McBride, N., Sumnall, H.R. & Cole, J.C. (2012). Reducing the harm from adolescent alcohol consumption: Results from an adapted version of SHAHRP in Northern Ireland. Journal of Substance Use; 17(2), 98-121. (see also http://

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Bibliography 2013 - McKay, M.T., Percy, A. & Cole, J.C. (2013). Consideration of Future Consequences and Alcohol Use among Northern Irish Adolescents. Journal of Substance Use, 18:5, 377-391 (doi:10.3109/14659891.2012.685793). McKay, M.T. & Cole, J.C. (2013). Adolescent drinking and adolescent stress: A domain-specific relationship in Northern Irish Schoolchildren. Journal of Youth Studies, 16, 237-256. McKay, M.T., Percy, A. & Cole, J.C. (2013). Present Orientation, Future Orientation and alcohol use in Northern Irish Adolescents. Addiction Research & Theory, 21(1), 43-51. 2012 - McKay, M.T., Percy, A., Goudie, A.J., Sumnall, H.R. & Cole, J.C. (2012). The Temporal Focus Scale: Factor Structure and association with alcohol use in a sample of Northern Irish school children. Journal of Adolescence, 35(5), 1361-1368. McKay, M.T. & Cole, J.C. (2012). The relationship between alcohol use and peer pressure susceptibility, peer popularity and general conformity in Northern Irish school children. Drugs: Education, Prevention and Policy, 19(3), 213-222. McKay, M.T., Cole, J.C., Sumnall, H.R. & Goudie, A.J. (2012). Framing Health Messages for Adolescents: Should we use Objective Time Periods, Temporal Benchmarks, or both? Journal of Youth Studies, 15(3), 351-368. McKay, M.T., Sumnall, H.R., Cole, J.C. & Percy, A. (2012). Selfesteem and self-efficacy: Associations with alcohol consumption in a sample of adolescents in Northern Ireland. Drugs: Education, Prevention and Policy, 19(1), 72-80. McKay, M.T., Ballantyne, N., Goudie, A.J., Sumnall, H.R. & Cole. J.C. (2012). "Here for a good time, not a long time”: DecisionMaking, Future Consequences and Alcohol Use among Northern Irish Adolescents. Journal of Substance Use, 17(1), 1-18. 2011 - Hale, D., Coleman, J. & Layard, R. A model for the delivery of evidence-based PSHE (Personal Wellbeing) in secondary schools. The London School of Economics and Political Science: London ISSN 2042-2695. 2011. McKay, M.T., Sumnall, H.R. & Cole. J.C. (2011). Teenage thinking on teenage drinking: 15- to 16-year olds’ experiences of alcohol in Northern Ireland. Drugs: Education, Prevention and Policy, 18(5), 323-332. McKay, M.T., Sumnall, H.R., Goudie, A.J., Field, M. & Cole, J.C. (2011). What differentiates adolescent problematic drinkers from their peers? Results from a cross sectional study in Northern Irish school children. Drugs: Education, Prevention and Policy, 18(3), 187-199. 2007 - McBride, N., Farringdon, F. & Kennedy, C. (2007). Research to Practice - Formal Dissemination of the School Health Harm Reduction Project (SHAHRP) in Australia. Drug and Alcohol Review, 26, (6), pp. 665-672. [RJ548] Abstract 2004 - McBride, N. (2004). School drug education: A developing field and one element in a community approach to drugs and young people. Addiction, 99, pp. 292-298. [RJ439] 2003 - McBride, N., Farringdon, F., Midford, R., Meuleners, L. & Phillips, M. (2003). Early unsupervised drinking - reducing the risks. The School Health and Alcohol Harm Reduction Project. Drug and Alcohol Review, 22, (3), pp. 263-276. [RJ394] Abstract 2002 - McBride, N. (2002). Systematic literature review of school drug education. National Drug Research Insititute. NDRI Monograph No. 5. Curtin University, Perth, Western Australia. ISBN: 1 74067 188 0 [M40] Abstract 2000 - McBride, N., Farringdon, F. & Midford, R. (2000). What harms do young Australians experience in alcohol use situations. Australian and New Zealand Journal of Public Health, 21, (1), pp. 54-59. [RJ321] Abstract McBride, N., Midford, R. & Farringdon, F. (2000). Alcohol harm reduction education in schools: Planning an efficacy study in Australia. Drug and Alcohol Review, 19, (1), pp. 83-93. [RJ284] Abstract 1999 - Farringdon, F., McBride, N. & Midford, R. (1999). School Health and Alcohol Harm Reduction Project: Formative development of intervention materials and processes. Journal of the Institute of Health Education, 37, (4), pp. 137-143. [RJ301]

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Dr Mark D. Griffiths is Professor of Gambling Studies and Director of the International Gaming Research Unit, Psychology Division, Nottingham Trent University. For communication, please email:

Mark D. Griffiths Adolescent gambling via social networking sites: A brief overview


n two previous issue of Education and Health, I have examined various issues surrounding the psychosocial impact of social networking among adolescents (i.e., Griffiths & Kuss, 2011; Kuss & Griffiths, 2011a). Most parents and teachers will be only too aware that the online social networking phenomenon has spread rapidly in the UK. However, one social networking activity that has only recently come into focus is gambling via social networking sites. Although the playing of gambling games for points (e.g., poker) have been popular for a number of years (Griffiths, 2010; Griffiths & Parke, 2010), a number of gaming operators are now using Facebook as a platform in which to offer gambling for real money (Griffiths, 2013). In August 2012, Facebook hosted a gambling game (Bingo Friendzy developed by Gamesys) that allowed users to win jackpots up to £50,000 of real money. In the UK, there are 31 million registered users of Facebook who are over 18 years of age (Griffiths, 2013). According to a market research study by Experian Hitwise, UK visitors have an average Facebook session time of 22 minutes. The study also revealed that a quarter of those visiting Facebook visit other entertainment website such as games and music, immediately after leaving the website (most of whom are adolescents and young adults). This shows gambling companies that there is a good market size to access and that users could be quite receptive to gambling on the site. Bingo Friendzy (at present only available in the UK) is now being followed by other gambling games including slot machine apps and sports betting. I was one of many who voiced concerns in the national press when Bingo Friendzy was launched. My main concern was that the game itself features cartoon characters similar to Moshi Monsters.

Having studied youth gambling and written two books (i.e., Griffiths 1995; 2002), I don’t believe gambling games should feature anything that might encourage children or adolescents to gamble. Although players have to be aged 18 years to play Bingo Friendzy, research has shown that adolescents regularly bypass the minimum age limits to have a Facebook profile simply by giving false information and/or with the help of their parents (Griffiths & Kuss, 2011; Kuss & Griffiths, 2011a; 2011b).

Social games I and some of my colleagues have argued previously that many social games played on social networking sites have gambling-like elements – even if no money is involved (Griffiths, Derevensky & Parke, 2011; Griffiths, Parke & Derevensky, 2012; King, Delfabbro & Griffiths, 2010). Even when games don’t involve money (such as playing poker for points on Facebook), they introduce youth to the principles and excitement of gambling (Griffiths & Parke, 2010). On first look, playing games like Farmville, may not seem to have much connection to activities like gambling but the psychology behind such activities are very similar (Griffiths, 2010). Companies like Zynga have been accused of leveraging the mechanics of gambling to build their gaming empire. One of the key psychological ingredients in both gambling (such as playing a slot machine) and social gaming is the use of operant conditioning and random reinforcement schedules. Basically, random reinforcement schedules in games relate to the unpredictability of winning and/or getting other types of intermittent rewards (Parke & Griffiths, 2007). Getting rewards every time someone gambles or plays a game leads to people becoming bored

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quickly. However, small unpredictable rewards leads to highly engaged and repetitive behaviour for those playing such games. In a minority of cases, this may lead to addiction to the game (Parke & Griffiths, 2010). Both gambling operators and social gaming developers can use intermittent and unpredictable rewards to get repeat custom.

Psychosocial impact The psychosocial impact of this new leisure activity has only just begun to be investigated by academic researchers in the gaming field. Social networking sites have the potential to normalise gambling behaviours as part of the consumption patterns of a non-gambling leisure activity, and may change social understandings of the role of gambling among young people (Griffiths & Parke, 2010). There is no money changing hands but teenagers – as noted above – are learning the mechanics of gambling and there are serious questions about whether gambling with virtual money encourages positive attitudes towards gambling in people (and young people particularly). For instance, does gambling with virtual money lead to an increased prevalence of actual gambling? Research carried out by Forrest, McHale and Parke (2009) demonstrated that one of the risk factors for problem gambling among adolescents was the playing of the ‘play for free’ gambling games on the Internet (games that are widespread on Facebook and other social networking sites). It has been argued, based on the available empirical literature, that it may be important to distinguish between the different types of money-free gambling being made available – namely social networking modes (on social networking sites) and ‘demo’ or ‘free play’ modes (on internet gambling websites). Initial considerations suggest that these may be different both in nature and in impact. For example, as Downs (2008) has argued, players gambling in social networking modes may experience a different type and level of reinforcement than those gambling in ‘demo’ mode on an internet gambling site. On some social networking sites, the accumulation of ‘play money’ or ‘points’ may have implications for buying virtual goods or services or being eligible for certain privileges. This may increase

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the value and meaning of the gambling event to the individual. Additionally, when considering the ‘flow’ and intention of individuals accessing such sites, it could be argued that individuals accessing money free gambling through social networking sites may be more likely to be induced or persuaded to play given that these website visitors’ primary intention may have been social interaction (i.e., the primary function of the website) as opposed to those playing in ‘demo’ mode where gambling is the primary function of the website. A 2011 national gambling survey of British adolescents (n=2739; aged 11-16 years) by Ipsos MORI reported that around one in seven children (15%) played free or practice gambling games in the past week, and that the most popular form of practice gaming was through Facebook. One in ten children (11%) said they had played free games on social networking website Facebook. The report also noted: “There may be some value in tackling children’s access to free online trial games. There is a clear link between playing free trial games on the internet and gambling for real money (online and offline). However, regulators will need to target a range of games and websites to monitor this effectively, as children report playing games on a wide variety of websites.”

Exploiting psychological principles I have already noted in previous writings (e.g., Griffiths, 2012) that observers have accused companies like Zynga of exploiting well-known psychological principles to increase their player base and to bring in new players from a demographic who may never have played games before (such as housewives looking after small children at home who might play poker or other quick play social games for 30 minutes while their child is asleep). However, that alone does not explain the success of Zynga games. Other features, such as stylish and appealing characters and graphics, and (what some might deem to be) aggressive viral marketing tactics, also appear to play an important part in the acquisition, development, and maintenance of social gaming behaviour (Griffiths, 2012).

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I have also argued that introduction of ingame virtual goods and accessories (that people willingly pay real money for) was a psychological masterstroke (Griffiths, 2012). In this sense, it becomes more akin to gambling, as social gamers know that they are spending money as they play with little or no financial return. They are buying entertainment and the intrinsic play of the game itself is highly psychologically rewarding.

Why pay real money for virtual items? The one question I am constantly asked (particularly by the media) in relation to social gaming is why people pay real money for virtual items in games like Farmville (or why people will pay real money to buy virtual money to play Zynga poker games). As someone who has studied slot machine players for over 25 years, the similarities are striking. Many of the hard core slots players I have interviewed claim they know they will lose every penny they have in the long run, and they are playing with money rather than for it (Griffiths, 2002). To me, this appears to be what social gamers do as well. Like slots players, they actually love the playing of the game itself. Money is the price of entry that they are willing to pay. Unlike those involved in social gaming, gamblers do at least have an outside chance of getting some of the money they have staked back. Therefore, allowing those who play social games the chance to actually get their money back (or gain more than they have staked) is why companies currently operating social games want to get into the pure gambling market. This extra dimension to social games could be a huge revenue generator (Griffiths, 2012). Those in the social gaming business believe that their games tap into some of the fundamental drivers of human happiness and give people pleasure, friendship, and a sense of accomplishment. Nicole Lazzaro, who has been interviewed in the mass media about gaming psychology, claims there are four elemental keys that determine game success. These are: (i) Hard fun (i.e., players having to overcome difficult obstacles to progress in the game in pursuit of winning)

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Easy fun (i.e., players just enjoying the game even if they don’t win) (iii) Altered states (i.e., players engaging in the game because it makes them feel good psychologically and changes their mood for the better) (iv) The people factor (i.e., players wanting to socially interact with others in the game). Put in the most basic form, Lazarro says the most successful games “will engage players’ curiosity, allow players to socialize with friends, challenge players to overcome obstacles to achieve goals and somehow relate to people’s lives in a meaningful way”.

Lines are beginning to blur Over the past year, the rapid growth of social media gaming has come to the attention of Great Britain’s Gambling Commission, particularly as the lines are beginning to blur between social gaming and gambling, and because online gambling operators and gambling software developers (e.g., Bwin, Party Gaming, PlayTech, etc.) are now positioning themselves for entry into the social gaming market, and vice-versa (e.g., Zynga). There have also been reports that virtual money can now be traded for real cash illegally. The Gambling Commission are particularly concerned about the lack of regulation where children and adolescents are concerned. This is also something I have written about extensively in the past few years in relation to gambling and video game convergence (e.g., Griffiths, 2008; 2011; King, Delfabbro & Griffiths, 2010). New types of social gaming and gamblinglike experiences that people of all ages are now being exposed to and raises various moral, ethical, legal and social issues (Griffiths, 2013). Given that most of the issues highlighted here are somewhat anecdotal, more empirical research is needed in these new online activities as the line between social gaming, non-financial forms of gaming, and gambling are beginning to blur. References Downs, C. (2008). The Facebook phenomenon: Social networking and gambling. Paper presented at the Gambling and Social Responsibility Forum Conference, Manchester Metropolitan University, Manchester.

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Forrest, D. K, McHale, I & Parke, J. (2009). Appendix 5: Full report of statistical regression analysis. In Ipsos MORI (2009) British Survey of Children, the National Lottery and Gambling 2008-09: Report of a quantitative survey. London: National Lottery Commission. Griffiths, M.D. (1995). Adolescent Gambling. London: Routledge Griffiths, M.D. (2002). Gambling and Gaming Addictions in Adolescence. Leicester: British Psychological Society/Blackwells. Griffiths, M.D. (2008). Digital impact, crossover technologies and gambling practices. Casino and Gaming International, 4(3), 3742. Griffiths, M.D. (2010). Gaming in social networking sites: A growing concern? World Online Gambling Law Report, 9(5), 1213. Griffiths, M.D. (2011). Gaming convergence: Further legal issues and psychosocial impact. Gaming Law Review and Economics, 14, 461-464. Griffiths, M.D. (2012). The psychology of social gaming. iGaming Business Affiliate, August/September, 26-27. Griffiths, M.D. (2013). Social gambling via Facebook: Further observations and concerns. Gaming Law Review and Economics, 17, 104-106. Griffiths, M.D. & Kuss, D. (2011). Adolescent social networking: Should parents and teachers be worried? Education and Health, 29:2, 23-25. Griffiths, M.D. & Parke, J. (2010). Adolescent gambling on the Internet: A review. International Journal of Adolescent Medicine and Health, 22, 59-75.

Griffiths, M.D., Parke, J. & Derevensky, J. (2011). Online gambling among youth: Cause for concern? In J.L. Derevensky, D.T.L. Shek & J. Merrick (Eds.), Youth Gambling: The Hidden Addiction (pp. 125-143). Berlin: DeGruyter. Griffiths, M.D., Derevensky, J. & Parke, J. (2012). Online gambling in youth. In R. Williams, R. Wood & J. Parke (Ed.), Routledge Handbook of Internet Gambling (pp.183-199). London: Routledge. Ipsos MORI (2011). Underage Gambling in England and Wales: A research study among 11-16 year olds on behalf of the National Lottery Commission. London: Author King, D.L., Delfabbro, P.H. & Griffiths, M.D. (2010). The convergence of gambling and digital media: Implications for gambling in young people. Journal of Gambling Studies, 26, 175-187. Kuss, D.J. & Griffiths, M.D. (2011a). Excessive online social networking: Can adolescents become addicted to Facebook? Education and Health, 29:4, 63-66. Kuss, D.J. & Griffiths, M.D. (2011b). Online social networking and addiction: A literature review of empirical research. International Journal of Environmental and Public Health, 8, 3528-3552. Lapuz, J. & Griffiths, M.D. (2010). The role of chips in poker gambling: An empirical pilot study. Gambling Research, 22(1), 34-39. Parke, J. & Griffiths, M.D. (2007). The role of structural characteristics in gambling. In G. Smith, D. Hodgins & R. Williams (Eds.), Research and Measurement Issues in Gambling Studies (pp.211-243). New York: Elsevier.

Education and Health The journal, published by SHEU since 1983, is aimed at those involved with education and health who are concerned with the health and wellbeing of young people. Readership is worldwide and in the UK include: primary; secondary and further education teachers; university staff and healthcare professionals working in education and health settings. The journal is online and open access, continues the proud tradition of independent publishing and offers an eclectic mix of articles.

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The specialist provider of reliable local survey data for schools and colleges and recognised nationally since 1977. "The survey reports have been used to inform commissioning at specific commissioning groups. They are also being used within our Extended Schools Clusters and to inform The Annual Public Health and the Joint Strategic Needs Assessment." Programme Manager - Young People For more details please visit TO SUPPORT YOUR WORK WITH YOUNG PEOPLE TRY SHEU’S FREE RESOURCES

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Leila Harris is a Senior Teacher based in North West London. For communication, please email:

Leila Harris Food for Thought


he British Nutrition Foundation survey highlighted that many children have a worrying lack of knowledge about where their meat and vegetables come from; “Cheese comes from plants and fish fingers are made of chicken”(British Nutrition Foundation, 2013) . The staggering and equally worrying findings behind the headlines were that 18% of primary school children believed fish fingers are made from chicken, while 29% think cheese comes from plants, 34% of five to eight year-olds and 17% of 8 to 11 year-olds believe pasta comes from animals and 10% of secondary school children believe tomatoes grow under the ground. Would free school meals make a difference? An evaluation of the free school meals pilot project found that it had a significant positive impact on attainment for primary school pupils at Key Stages 1 and 2, with pupils in the pilot areas making between four and eight weeks’ more progress than similar pupils in comparison areas (DfE, 2013). More recently, the development of the “School Food Plan”, (School Food Plan, 2013), by founders of Leon Restaurant and the Department for Education, led to an announcement that all pupils in Infant Schools in England will receive free school lunches from September 2014. Leon founder, Henry Dimbleby, said, “We do need to make packed lunch the less attractive option”, concluding that packed lunches were significantly less nutritious than a cooked meal. The new plan does not ban packed lunches, but the aim is that by providing a free, hot meal, standards will be raised. Previous research into the National School Fruit Scheme (Wells & Nelson, 2005), found that it produced short-term but not longer-term increases in fruit consumption in primary school children. However, total fruit consumption (including fruit juice) was higher for junior pupils than the infants. There was no

evidence to suggest that the provision of free fruit to infants affected their fruit consumption as junior school pupils. The apparent lack of effect of the scheme on junior pupils’ fruit consumption does not necessarily mean that benefits in later life will not be shown.

The Topic of Food in Schools Having worked with young adults and their families over the years, I have come to appreciate that the topic of food can be used for motivational purposes, uniting groups of people and celebrating our diverse community. Eating food satisfies our most basic human need for survival and in many cultures food is used for rituals as well as forming a central part of social occasions. I have always been very keen to ensure that young children are well educated about food, where it comes from and its nutritional value. Having worked in an Infant School, I have taken it for granted that children in the Foundation Stage and in Key Stage 1 have opportunities to visit farms, grow their own vegetables in ‘Growing Patches’ and tend the plants to harvesting. This work is often based on stories such as ‘Oliver’s Vegetables’ and children have opportunities to make fruit salads, fruit kebabs and soups. This form of learning in context and exploiting learning opportunities from first-hand experience ensure that the children are fully engaged with their learning by making links and inspiring genuine curiosity. Involving the children’s parents/carers in cooking activities is also useful as this can serve to promote the school’s work in an informal way, which the children recognise as being ‘special’ because it is delivered by a guest. The children’s personal identities may also be celebrated through the sharing of food from their community’s culture. In the past, I have done this by exploring ‘Bread from Around the

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World’. This project involved tasting different breads from various countries (such as baguettes, ciabattas, rotis, corn bread and so on). Working in such a diverse and multicultural school, this project supported all families’ cultures to be shared, valued and celebrated and the families were eager to come in to share food from their homeland as part of an International Food Tasting event. Schools often host after-school clubs for children and cooking clubs and allotment clubs have become increasingly popular. However, I believe that all children should be offered these learning opportunities and it is a practitioner’s responsibility to find ways to weave these opportunities into the curriculum. The Five-aDay Scheme provides a perfect opportunity for class discussions about how and where the fruits/vegetables are grown. All children are praised for trying fruits and vegetables that they may not have encountered before and in the past I have shared recipe ideas as part of family reading activities. Celebrations at school often lend themselves to the topic of food, such as Harvest Festivals held in the Autumn Term. Children are reminded about how food is grown, harvested and used in cooking, often delivered alongside the story of ‘The Little Red Hen’, which is a classic tale that can also be used to illustrate the process of baking bread, as well as conveying a moral about teamwork and the value of sharing and collaboration. I have further extended the idea about ‘Harvest Time’ by teaching older pupils about the harvest of the seas and exploring the concept of overfishing. Pupils are made aware of environmental/ecological concerns and how they can be ‘considerate consumers’, for example ensuing that they buy dolphin-safe tuna and fairtrade foods. Schools strive to support and encourage pupils to lead healthier lifestyles by making informed decisions about their foods. Roy Ballam, the Education Programme Manager at the British Nutrition Foundation, argues that schools require a national framework and guidance for food and nutrition education. As a teacher-practitioner, I am conscious that all lessons have a shared objective which can be differentiated for all pupils. I believe cooking activities can be integrated into the curriculum easily by teaching in a cross curricular style; e.g. writing instructions

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for a recipe and linking this with a food-based Design and Technology lesson; teaching weighing and using scales to measure ingredients or calculating the cost of a meal as part of a numeracy lesson so that children’s learning is contextualized in a real life, practical situation. There are several events held through the year for which schools can enrol free of charge. Through participating in National Healthy Eating Week events, children may be re-engaged with the origins of food, nutrition and cooking, so they grow up with a fuller and deeper understanding of food. This provides a way for schools to validate the work they are doing to educate pupils about where their food comes from, the importance of healthy eating and teaching essential life skills within a culinary context.

Tips for Practitioners Arrange for trips to local farms or allotments Try to find an area in the school grounds which may be used as an allotment and appoint children as monitors who are responsible for maintaining the area Talk to pupils during fruit times about where their fruit/vegetables have come from Provide children with gardening magazines, food-based stories and other reading materials with recipes Participate in national events and invite children’s families to support the work the school does (e.g. through International Food Tasting events, cooking sessions, etc. References British Nutrition Foundation. (2013). Cheese comes from plants and fish fingers are made of chicken. Last accessed 11/11/2013. healthyeatingweek Department for Education. (2013). Evaluation of the free school meals pilot: impact report. Last accessed 11/11/2013. School Food Plan. (2013). The School Food Plan. Last accessed 11/11/2013. Wells, L., & Nelson, M. (2005). The National School Fruit Scheme produces short-term but not longer-term increases in fruit consumption in primary school children. British Journal of Nutrition, 93, 537–542 Last accessed 11/11/2013 line&aid=918340&fulltextType=RA&fileId=S0007114505000681

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Tim Baker is the Headteacher and Nicholas Shelley is the gardener at Charlton Manor Primary School. For further information please call Charlton Manor Primary on 020 8856 6525 or email : or log on to the website:

Tim Baker and Nicholas Shelley Charlton Manor’s Food Journey


harlton Manor is a large inner-city primary school which is surrounded by a mix of social housing and some privately-owned housing. The school attracts its pupils from both areas. The children who attend the school come from a wide variety of backgrounds and have a range of experiences and expectations when they enter school. Some are prepared and ready for learning but a considerable number enter school neither socially or emotionally ready and unsure of what to expect, so find it hard to settle to the expectations of school life. Within the locality of Charlton Manor there is a high level of deprivation. Many children come from homes where either nobody works, has ever worked or is employed in a low paid job. The effect of which is that all too often expectations for their children are low. Many of the children live with one parent or carer as the relationship between their parents has broken down. The school has a large number of families entitled to free school meals for their children. In each year group, it ranges between 50% and 58% of the children; however, in the current Year 6 it stands at 74%. This level of deprivation puts the school into the highest percentile on the latest data analysis. Within close proximity to the school, there are several fast food shops that attract children and their families as they provide easy meals that children like and will eat. Local supermarkets are also frequently used to provide quick breakfasts for older children on their way to school. Charlton Manor attracts children from a number of ethnicities and there are currently 47 different languages spoken by children attending the school and their families. Nepalese is currently the most prevalent

language spoken after English. This initially has an impact on the school as a considerable number of children begin in the Nursery with little, if any English. However, these children then go on to make accelerated progress once they are secure in speaking and writing English. As Headteacher, I wanted to introduce the children to the outdoors in an educational way. The area does have parks and communal areas however these were also frequented by gangs. The children had nowhere to develop a growing space that would be safe. An area in the school had overgrown and was not being used. I was deputy at the time and wanted to start a garden that would support and enhance the children’s understanding of healthy eating.

Developing the outdoor area In 2004, I became the Headteacher and it was now that I started my first project, developing the outdoor area. I started by giving the children the footprint of the area on A3 paper and asking them to design a garden that they would like in the school. They looked at the area and then went to several gardens to get ideas. The plans were then collected and given to a landscape architect who produced plans incorporating many of the ideas. These plans are available to view on our website. The garden was then created and incorporates many educational features including a growing area, weather station, compost area, bees, chickens, wildlife area, pond, hide, workshop, greenhouse, stag beetle area as well as areas to sit for stories or instruction from the teacher or gardener. The children spend much time out in the garden which is used for literacy and numeracy as well as all the other subjects. I have also

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employed a gardener which is key to the success of the garden.

The gardener The following, written by the gardener Nicholas Shelley, desribes his role within the school. As gardener at Charlton Manor Primary School, my role falls into two distinct areas that both overlap and fit together. I am responsible for the school garden(s), any school produce and the chickens and bees. The second responsibility is in the education of pupils with regards to horticulture. The school garden encompasses the main garden, nursery garden, forest school and any other raised beds, trees and shrubs and indoor plants around the school. It also includes the school allotment at Woodlands Farm. Along with the bees and chickens these areas all need daily, weekly and monthly upkeep and chores. Depending on the time of year, the focus of time and effort on these areas can frequently change. Not only is the general appearance important, but also the safety within all of these areas is critical. Growing plants for the gardens and produce for the teaching kitchen and main dining restaurant (plus lessons) needs careful planning and care throughout the whole year. Whilst constantly improving my own experience and knowledge for this role, I also am involved in the education of the pupils in all types of horticulture. This can range from history of growing and food production to actually planting, sowing, growing and harvesting. How to look after the chickens and bees is also important. All this is achieved in small groups such as gardening after school clubs, beekeeping club, Gifted & Talented group or small class groups. Whole class lessons are regular and lunch-time sessions throughout the week. The aim is to include every pupil in the school and to ensure they have access to all gardening experiences during their time at school. As you can see, the role is unique and involves the gardener in all manner of activities.

The importance of the gardener in an effective school garden cannot be underestimated as it supports the development of lessons within the garden and allows access to learning activities all year round. Added to this, it enriches the children’s experience as the gardener is able to identify opportunities when teaching through other subjects such as History, Geography etc. To take this experience even further and gain a real understanding of food growing and eating we have built a kitchen so that children can cook with the produce they have grown.

‘Adopt a School’ As part of the ‘Adopt a School’ initiative, run by the Academy of Culinary Arts, we have had a chef visit several times to work with the children and also with the parents so that they can gain more cooking experience. The kitchen offers a great environment for children to cook wonderful foods but also to embed understanding of Literacy, Numeracy as well as other subjects in a practical way. In terms of behavior we find that children are very much engaged and besides the enthusiasm there are very few behavior concerns. The parents are also very keen to use the kitchen and increase their own skills so that they can provide a healthier diet for their children. We have run a parents and children growing and cooking club which was very well attended and led to an increase in school meal uptake. Parents are very interested in the healthy eating side of school and regularly discuss it.

Changed the attitude to food Charlton Manor has come a long way with food growing and cooking. It has changed the attitude to food within the school and continues to improve the children’s understanding of healthy eating and food growing. The school effectively uses issues within the food industry such as ‘Fairtrade’, ‘Food miles’, Organic versus GM, Local produce to support children’s literacy skills and cases for arguments as well as instructions for planting, looking after bees/chickens, plant care and report writing such as ‘How the chickens are doing?’ ‘How do bees make honey?’ ‘What is growing on the allotment?’ Added to this a wealth of opportunities for creating settings for stories.

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The school is currently working on the new curriculum and linking the learning to food as much as possible in all subjects. Charlton Manor Primary works very closely with Woodlands Farm Trust and has an allotment on which it grows a number of vegetables which are used within the teaching kitchen and the main kitchen. The children enjoy eating school dinners that contain their produce and also really enjoy using garden produce in the teaching kitchen. It is essential, at Charlton Manor, that we encourage healthy eating as much as possible and staff join children to eat their lunch in the dinner centre. The year 5 and 6 children are waiters in the kitchen and will ensure that water is served and cutlery is placed at the tables. Recently the school is working with Olivier Blanc and Charlotte Salt who have developed an app ‘Henri le Worm’. The app is designed to support children to understand and learn more about food growing and eating in a fun and engaging way. Also included in the app are 10 recipes from the world-renowned chef,

Raymond Blanc OBE and these are fun and easy to make. Year 1&2 are currently using the app in Literacy and Numeracy. They are really enjoying this and engaged in their learning.

The future What next for Charlton Manor? The next step is a community project that brings all the food growing and cooking together and supports the children during the time they aren’t at school. The children will have access to food growing and cooking during evenings, weekends and holidays. This will be supported by ‘Henri le Worm’, the character that children will be able to relate to and be familiar with as they work with the app during school time. Added to this, community groups will work with the children. Food growing and healthy eating has developed a positive ethos throughout Charlton Manor that not only helps to raise attainment but also provides an inclusive approach that supports the pupils and their families within the school.

Education and Health The journal, published by SHEU since 1983, is aimed at those involved with education and health who are concerned with the health and wellbeing of young people. Readership is worldwide and in the UK include: primary; secondary and further education teachers; university staff and healthcare professionals working in education and health settings. The journal is online and open access, continues the proud tradition of independent publishing and offers an eclectic mix of articles.

Contributors (see a recent list) - Do you have up to 3000 words about a relevant issue that you would like to see published? Please contact the Editor


Schools and Students Health Education Unit

The specialist provider of reliable local survey data for schools and colleges and recognised nationally since 1977. "The survey reports have been used to inform commissioning at specific commissioning groups. They are also being used within our Extended Schools Clusters and to inform The Annual Public Health and the Joint Strategic Needs Assessment." Programme Manager - Young People For more details please visit TO SUPPORT YOUR WORK WITH YOUNG PEOPLE TRY SHEU’S FREE RESOURCES

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Glyn Owen is taking a sabbatical from classroom teaching at Ashton Vale Primary School in North Bristol where he is the Healthy School co-ordinator. For further information please call 07906 633 167 or email :

Glyn Owen Teaching cooking at Ashton Vale Primary


s a Primary School teacher, for the last 15 years, I am very excited about the current high profile of nutrition and health within the school curriculum and the media as a whole. I started my career in the catering industry, before retraining as a teacher and starting at Ashton Vale Primary School in North Bristol, where I am the Healthy School co-ordinator and head up all the food projects. Over the last five years, I have also been involved with health education across Bristol; first as a speaker at the nutrition training sessions and then as a Healthy School Champion. In my Champion’s role, I visit other schools to advise on how to teach about a healthy diet and to help plan projects around healthy lunchboxes and cooking with children. For too long, teaching about health and other skills for life have been put on the back burner with a bigger emphasis being placed on formal subjects – the idea being that teachers were preparing pupils for vocations rather preparing them for life. With the “School Food Plan”, free school meals for 4-7 year olds and quality cooking/food education back on the curriculum and OFSTED* focussing more on health, things are moving in the right direction and there is a lot to celebrate, but it is not going to be easy. I speak as a classroom teacher, not a dietician or health expert, and I want to give the view from the frontline of getting children cooking and learning about a healthy diet.

Teaching cooking The new Design and Technology curriculum, (to be implemented in September 2014), is very clear on what children need to be taught about food and cooking. Key Stage 1 Pupils should explore and develop purposeful, practical skills in design and technology, taking advantage of local opportunities and the expertise of teachers. Pupils should be taught the basic principles of balanced eating and where food comes from, and should be encouraged to develop an interest in cooking.

Key Stage 2 Pupils should be taught about the major components of a balanced diet and how ingredients can be combined to prepare healthy meals. They should be taught basic cooking techniques and how to cook a variety of savoury dishes. In meeting these requirements, schools without access to a teaching kitchen, nearby kitchen or mobile kitchen may have to adapt the dishes and techniques they teach accordingly to the facilities available.

Key Stage 3 Pupils should be taught about the importance of nutrition, a balanced diet, and about the characteristics of a broad range of ingredients in choosing and preparing food. They should be encouraged to develop a love of cooking. They should be taught to cook a repertoire of savoury meals and become confident in a range of cooking techniques. In meeting these requirements, schools without access to a teaching kitchen, nearby kitchen or mobile kitchen may have to adapt the repertoire and techniques they teach accordingly to the facilities available. (Design and technology. Programmes of study for Key Stages 1-3. February 2013)

* Paragraph 49 of the School Inspection Handbook, updated for September 2013, says that inspectors will now observe pupils’ behaviour during lunchtime, including in the dining hall. They will also consider the food on offer and the atmosphere of the dining area. Ofsted’s subsidiary guidance for inspectors (paragraph 47) requires them to: - Consider how lunch time and the dining space contribute to good behaviour and the culture in the school, including by spending time in the lunch hall - Ask school leaders how they help to ensure a healthy lifestyle for their children and, specifically, whether their dietary needs have been considered .

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This is a far cry from the present curriculum, where teachers who feel passionate about children’s health try to shoe-horn nutrition in where they can, but the majority of children aren’t taught about it as it isn’t prioritised by schools (who can blame them), when OFSTED, at present, won’t be focussing on health education.

Teaching all subjects So, a fantastic new curriculum with clear criteria to be taught! This is all very well, but as a teacher I know that not all Primary School teachers are knowledgeable in nutrition or feel skilled as cooks. Totally understandable. Most Primary School teachers are expected to teach all the subjects from Literacy and Numeracy through to Music, Sex Education and Modern Foreign Languages. I have yet to meet any teacher who feels confident in all the subjects they teach and often there is support given by another expert in the school or through outside agency training. For example, I never feel confident in teaching P.E. and sport. I feel it is a vital lesson and in the past I have often felt guilty about not being able to give the children the knowledge and skills they need in this area. So, one way round this was having whole school training, where we have had experts coming in to train the teachers and give demonstration lessons. Another approach has been to have experts come in and teach the lesson while the teacher has their PPA release time. Both these approaches have meant the children have had some excellent, quality lessons in P.E. and sport. Wonderful, but it all costs money. Much of our P.E. and sport input in the last couple of years has been funded by direct government (pupil premium) funding and with this money earmarked for P.E. and sport it means this area has been expertly delivered. But we need to do the same for nutrition and food education. At Ashton Vale Primary, we have been delivering a quality food and nutrition curriculum for many years but that has been because I have been able to train the staff and advise whenever needed and we have also been blessed with some fantastic, unpaid volunteers. We have also been fortunate to work with agencies such as Bristol Healthy Schools and The Food for Life Partnership, but as budgets

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throughout the education world become tighter, what were free services now start to come at a cost. I believe that to deliver a quality food and nutrition curriculum funding also needs to be made available to schools, ring-fenced for food and nutrition education (just as it is for sport and ICT). Many teachers I talk too are also very wary of cooking because of a lack of facilities. They come to see Ashton Vale Primary, where we have a purpose built cooking room, and they feel that, because they don’t have such a facility, cooking is not possible in their school. Not so. When I first started teaching cooking in the school the cooking room didn’t exist. We used the carpeted (not ideal) support room and had a Baby Belling/2 hob/unreliable oven to work with along with a lucky dip of utensils. It wasn’t ideal but the lessons went on and we felt we were changing children’s lives.

Cooking room, suitable for eight children, at Ashton Vale Primary

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Are you confident cooks? Although we now have a cooking room, it only holds a group of 8 children and so without parent/volunteer cooks coming in (who must also be CRB-checked) cooking would only happens in afterschool clubs if we didn’t make use of the classrooms themselves to cook in. This is where the real panic can set in for a teacher who is an unconfident cook. Will I have to complete a health and safety analysis? How can I make sure they don’t get food poisoning? How can I let them use knives? Without knives how can they cook? The list goes on. But I promise, there are ways around it. With proper, easily followed procedures and correct training so the teachers/adults feel confident it is easy, and great fun, to have the whole class of 30 cooking at the same time. In fact, for our annual food festival it often happens that we have the whole school (200 pupils) cooking at the same time! And if you asked our teachers, “Are you confident cooks?”, a few would respond with nervous laughter. Hygiene The first hurdle to get through is the concern about hygiene. The typical classroom table is not ideal, hygiene-wise, as it often cracked or has joins where germs can linger. We have safely solved this problem by purchasing some heavy duty table cloths (from a well-known Swedish interior design store) which can be used as a hygienic work surface. These cloths get daily usage as table cloths in our school hall during lunch service, but sprayed with anti-bac spray and given an extra wash down they are fantastic for cooking on. Although the tables themselves are not hygienically ideal the height is normally perfect for that age of children to prepare food on. Table height is an area not often thought about when it comes to organising a cooking room, but cooking in that age group’s classroom the tables are perfect. Next, there is the worry about safety. Using a few simple checks (and common sense), it is easy to run a safe cooking session in a classroom.

Suitable recipes It is vitally important that teachers consider the age and existing skills of the class who are going to be cooking. If the only food they have prepared before in a classroom has been a

sandwich then there is no point in asking them to create a lasagne – you are planning for disaster! A good starting point for recipes is the Internet, where lots of organisations have healthy, tried and tested recipes available. These linksare a good place to start: -eating.html One vital lesson I have learned is that the pupils don’t have to cook a complete recipe from scratch each time. Teachers need to consider the skills they would like the children to learn in the lesson and then focus on these skills only. For example – If I wanted a Year 2 Class to make pizzas and I wanted to focus on the bread making element I would have the sauce and the vegetables prepared and cut up beforehand. That being said, if I wanted to make pizzas with a Year 6 Class, who have been cooking in the school throughout their school career, I would be asking them to cook the complete recipe as well as plan and choose the ingredients and equipment beforehand. When choosing a recipe to cook teachers should also consider the equipment used – as some equipment is obviously more difficult and possibly more dangerous than others. Does the recipe being planned involve cutting? That doesn’t have to mean using knives. Herbs can be safely snipped using blunt scissors, many vegetables can be ripped and soft fruits (such as bananas) can be cut using lollipop sticks. There are some excellent websites that give advice on which equipment is suitable for each age group and also a skllls progression so that it is easier to choose the skills the class can focus on. For example: I like to use the classrooms interactive whiteboard to show the recipe. This means that the class are all at about the same stage (helps to check everyone has understood each instruction and gives the teacher a chance to repeat / re demonstrate the instruction / skill). Also with younger pupils using lots of image on the screen help to show what exactly they need to do. Some PowerPoint recipes can be found here: -in-schools.html

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Suitable equipment It is so important that the equipment is correctly chosen for the children and that it is in good working order. Some equipment is actually more dangerous than you would think. In all my years of teaching cooking, I very rarely have seen an accident with a knife but almost every time I use graters with a group someone needs a blue plaster (despite me modelling the correct use and the safety steps). Also the equipment needs to be of a suitable quality and well maintained. A blunt knife is certainly going to be more dangerous than a sharp one as a blunt knife needs a lot of pressure to make it cut, leading to it being more likely to slip. I have found that it is worthwhile paying a little bit extra for equipment – rather than just the bargain basics lines available in supermarkets. If you have ever tried cooking pancakes in a paper thin, supposedly non-stick, frying pan you will know how frustrating it is. We wouldn’t ask children to draw a straight line using a buckled and dented ruler but often I have seen teachers expecting culinary success from children using equipment that even a highly skilled chef would find difficult to use.

Suitable training (for adults and pupils) When considering the recipe/skills to be taught teachers need to think about what skills need to be explained to make sure equipment is used safely. Most importantly, all of the adults working with the children need to be trained on the skills as well. I have found the easiest way of doing this is making sure all of the adult helpers are present as I teach the skill to the children (sounds obvious, but often adult helpers can disappear at this vital moment to come back in later without being safely trained).

I have learnt that 30 children and 5 adults all trying to see my hands as I demonstrate a chopping technique doesn’t work. It is much better to use videos or images from the Internet to demonstrate what you want the children to do. For examples, see the following links: siteId=14&sectionId=62&contentId=70

Suitable adult/pupil ratio To ensure the lesson runs safely teachers need to make sure there are enough adults in the room as well. This obviously depends on the age of the class (with Year 2, I tend to have 1 adult to each table of 4-6 children with me spare to move around and lead the session), and the existing skills of the children. Sometimes too many adults can cause problems as well (too many cooks…)

The future of cooking in schools The future of cooking in schools is certainly looking very promising and there is a real excitement amongst those working with food in schools. But, the average teacher is going to need support in delivering this curriculum. If cooking skills have not been passed down from parent to child in the last few generations, and cooking has not been consistently taught in schools for a few years, many teachers will be working in schools where no-one has experience of teaching cooking and children are not encouraged to cook at home. However, with support, our schools could be producing a new generation who know what a healthy diet looks like, have an understanding of where food comes from and possess the skills to cook for themselves and their family. That is exciting!


Schools and Students Health Education Unit

The specialist provider of reliable local survey data for schools and colleges and recognised nationally since 1977. "The survey reports have been used to inform commissioning at specific commissioning groups. They are also being used within our Extended Schools Clusters and to inform The Annual Public Health and the Joint Strategic Needs Assessment." Programme Manager - Young People For more details please visit TO SUPPORT YOUR WORK WITH YOUNG PEOPLE TRY SHEU’S FREE RESOURCES

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Dr Alison Leah Williams is Lecturer in Psychology, Staffordshire University. Professor Sarah Grogan is Professor of Psychology, Manchester Metropolitan University. Dr Emily Buckley is Principal Lecturer in Psychology and Professor David Clark-Carter is Professor of Psychological Research Methods, Staffordshire University. For communication, please email:

Alison Leah Williams, Sarah Grogan, Emily Buckley and David Clark-Carter British adolescents’ experiences of an appearance-focussed facial-ageing sun protection intervention: a qualitative study


he World Health Organization (WHO) suggests that recreational exposure to ultraviolet (UV) radiation, including exposure to the sun and a history of sunburn, are the primary causes of all melanomas, leading to skin cancer (WHO, 2012). Research has suggested that regular sun protection use, during the first 18 years of a person’s life, can reduce the risk of non-melanoma skin cancer by 78% (Jarrett, Sharp and McLelland, 1993; Severi et al., 2002). Dobbinson et al. (2008) suggest that few studies have targeted adolescents’ sun protection behaviours, and that previous interventions have typically used educational strategies which have been shown to have limited effect on sun protection behaviours. Appearance-related reasons to tan among adolescents are associated with greater intentions to sunbathe and fewer intentions to engage in sun protection behaviours (Asvat, Cafri, Thompson and Jacobsen, 2010). Thus, appearance-based interventions may be particularly useful in this population. Previous appearance-focussed studies on adolescents have used UV photography to show participants pre-existing damage to their skin (Olson et al., 2007; Olson et al., 2008). These studies have found promising results: for example, Olson et al. (2008) found that after viewing the underlying UV damage to their skin one-third of the adolescent participants, who had not previously intended to use sun protection in the next month, now intended to

use it. The current study was designed to investigate British adolescents' experiences of engaging in an age-appearance morphing programme. Participants were shown how their own faces would age with and without UV damage, and their experiences were recorded whilst viewing the images. Immediately after viewing the photographs, the participants took part in focus groups, where they were able to discuss their experiences of viewing the photographs. The intervention has been used with adults (Williams, Grogan, Buckley and Clark-Carter, 2012; Williams, Grogan, Buckley and ClarkCarter, 2013; Williams, Grogan, Clark-Carter and Buckley, 2013) with encouraging results, for example in terms of participants expressing intentions to increase their sun protection use in the future.

Method Design The study was qualitative, and used group sessions to collect the data. The authors felt that because of the nature of the intervention and the age of the participants, they would feel more comfortable taking part in the intervention in a group rather than individually, and previous research has found that data from groups were likely to be authentic, rich and informative because they mimic natural peer groups (Gough, Fry, Grogan and Conner, 2009).

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Software The intervention used APRIL® Age Progression Software. The software works by taking a photograph of a person’s face and then, using point detection for facial features, displays how the person is likely to age over the years from their current age until the age of 72. The images show the person’s face on the left of the screen as they may age without damage from UV exposure, if they have been protecting their skin, and on the right of the screen as their face may age with UV damage, if they have not been protecting their skin. This allows the viewer to compare the differences in their appearance for each age. Materials Materials utilised were a laptop computer installed with the APRIL® Age Progression Software, a digital camera and an audio recorder. Additionally, an outline protocol and a list of questions were also used. The list of questions was prepared prior to the sessions, and was derived from prior reading and discussions within the research team (for example, “Do you have any thoughts on these?”) Participants Sixty adolescents (30 males and 30 females) took part in the study: in ten groups, each with six participants. Six participants per group has been used previously in focus groups looking at sun protection behaviours with adolescents (for example, Potente, Coppa, Williams and Engels, 2010). It was decided to use adolescents between the ages of 11 and 14 years, as this is approximately the age when responsibility for sun protection use may be shifting from parents/caregivers to the adolescents themselves. For example, Berneburg and Surber (2009) suggest that whereas the extent to which parents protect their child is more likely to be the priority with infants, as children move into adolescence it becomes more important that they want to do this themselves. Participants came from ten classes from one school in Wales, UK. Five classes were school year 7 (aged 11 and 12), and five classes were school year 9 (aged 13 and 14). The mean age of participants was 12.58 (1.20), and 100% of the participants were Caucasian.

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Procedure The following procedure was carried out for each of the ten separate classes. Two months prior to the intervention taking place, the adolescents were given consent letters to take home. Parents/carers were asked to return the form if they did not consent to their child participating in the study (one parent/carer returned the form). For each focus group, simple randomisation was used to decide which participants took part in the session, with six participants being chosen at random (using random number sampling) from the school class register to take part, separating girls and boys in order to get equal numbers of each. The facilitator was a 24-year-old female PhD student. At the beginning of each session, the facilitator introduced herself to the group, and gave some background information about herself and the study. The facilitator then asked participants if they had any questions, and gave all participants a consent form to sign. The facilitator then carried out the intervention on each participant, by taking a photograph of each participant’s face, and uploading the photograph onto the software. The audio recorder was turned on, and the participants viewed the software, with their reactions and answers to the facilitator’s questions recorded. After each of the participants had been through this process, and seen themselves aged, the participants took part in a focus group to discuss their thoughts on the software and intervention. At the end of the sessions participants were given the debrief sheet, and it was reiterated that they could contact the facilitator should they have any queries or concerns. Data Analysis The audio-taped sessions were transcribed verbatim and analysed using thematic analysis, a method for identifying, analysing and reporting patterns within data (Braun and Clarke, 2006). All resulting data were analysed by both the first and second author. The authors chose to use inductive thematic analysis, due to its flexibility and theoretical freedom, along with its ability to create a rich and detailed account of data (Braun and Clarke, 2006). Analysis of the individual sessions and focus

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groups followed the six-phase process outlined in Braun and Clarke (2006).

Results Three key themes arose from the transcripts: 1. The Effects of UV Exposure on Facial Appearance 2. Comparing the Aged Photographs to Other Images 3. Inspired to Change Sun Protective Behaviours in the Future Figure 1 (below) shows the key themes and interlinking sub-themes. In the quotes below, (.) is used to indicate a pause of less than one second. After each quote, the participant’s pseudonym and age are included. The Effects of UV Exposure on Facial Appearance All of the participants (n = 60) were shocked at the visible effects of ageing on the skin on their face, using words such as “urgh” (n = 37) and “oh my God” or “oh God” (n = 35). The shock was directed at both the UV-aged and non UVaged photographs; however, once the participants had looked at both photographs in more detail, they were shocked at the difference that UV exposure had on their ageing. Participants reported that the photographs enabled them to see clearly the likely impact of UV exposure on the skin. All participants could see a difference between the UV-aged photograph and non UV-aged photograph, with the majority of participants feeling that the UVaged photograph looked more negative than the non-UV-aged photograph (n = 57).

Many of the participants used negative words, for example ‘horrible’ (n = 26) and ‘disgusting’ (n = 20), to describe how they felt their faces looked with UV-ageing. By using negative words to describe the UV-aged photographs, the participants were again emphasising that they did not like these images, and were concerned about the effect that UV exposure could have on their skin. Participants could see a difference in terms of number and depth of wrinkles, the amount of age spots, and the colour of the skin, between the two photographs: “When you don’t wear it [sun protection] it gives you a lot more /erm/ spots, your skin goes darker and you get a lot more wrinkles (.) it makes you look older” (Mason, age 14) Comparing the Aged Photographs to Other Images Participants compared themselves and each other to other images when looking at the aged photographs. This encompassed two subthemes: ‘Comparing Photographs to “Scary” Images’ and ‘Comparing Photographs to Older Family Members’. Comparing Photographs to ‘Scary’ Images - On viewing the photographs, many of the participants compared both their own photographs, and the other participants’ photographs, to socially agreed images of ugliness (n = 31), including zombies (n = 6) and witches (n = 5). The negative comparisons were directed towards the UV-aged photographs. The comparison to the negative images was linked with behaviour change, for example when discussing whether they thought that seeing the photographs would lead to them

Figure 1. The key themes that arose from the sessions, and the interlinking sub-themes

The Effects of UV Exposure on Facial Appearance

Comparing the Aged Photographs to Other Images

Comparing Photographs to ‘Scary’ Images

Inspired to Change Sun Protective Behaviours in the Future

Comparing Photographs to Older Family Members

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using more sun protection, Chris said: “Definitely (.) I don’t wanna look like the man on the “Up” movie [a 78-year old computeranimated man] like the old man (.) all wrinkly” (Chris, age 14) Comparing Photographs to Older Family Members On viewing the photographs, a number of participants expressed shock at their perceptions of resembling older family members in the aged images. This indicated that the participants were taking a personal view of the photographs. For example: “Urgh I look like my dad!” (Hugo, age 14) These comparisons also link to the selfrelevance of the photographs, showing that the participants experienced the images as similar to family members. This indicated that participants were not simply looking at the photographs and viewing them as unrealistic or invalid, but were viewing them as realistic projections of what they may look like. Inspired to Change Sun Protective Behaviours in the Future Some participants talked about wanting to change their UV exposure and/or sun protective behaviours after viewing the photographs, and seeing the difference in ageing between UV-exposure and non UVexposure. For example: “It’s made me want to use more sun tan lotion…yeah like plaster it on you before you go to school!” (Bruce, age 11) The difference between the photographs was the reason for participants wanting to practice safer sun behaviours, for example: “You don’t wanna look like the other person [UV-aged photograph] with all like spots all over you (.) and horrible skin” (Adam, age 14)

Discussion When looking at the benefits of safe UV exposure behaviours and sun protection use during a person’s early life, it is vitally important to develop effective interventions and strategies that encourage adolescents to develop safe UV exposure and sun protection behaviours which then develop into habits which stay with them throughout their adult life. The results of the present study suggest that appearance-based interventions hold some promise in this regard, at least with British adolescents, to encourage them to think about

the benefits of safe sun protection and UV exposure behaviours. Participants were shocked at the difference in their faces when they were UV-aged compared to non-UV-aged, with all of the participants expressing shock when viewing the aged photographs. The majority of participants preferred their faces aged without UV damage. Hevy et al. (2010) found that participants felt more vulnerable to developing wrinkles and age spots than to developing cancer. Interventions such as this may therefore be more effective than educational, health-focussed interventions for adolescents, because the damage caused by sun exposure is more selfrelevant and personal. The majority of participants reported that they felt motivated to change either their sun protection and/or their UV exposure behaviours after viewing the photographs. This is positive as it suggests that simply viewing the difference between the UV-aged and non UVaged photographs may have encouraged participants to think about making changes to their sun protection and/or UV exposure behaviours. The themes discussed applied to participants irrespective of their gender. Both the males and females were concerned about the effect of UVageing on their skin, and there were no differences in their reactions and concerns. Olson et al. (2007) found that the intervention effect was greater for girls, and work with adults has shown that women tend to be more concerned about ageing than men (Grogan, 2011), so it is interesting to note the results of the current study. Participants compared the photographs to older family members, which indicates that they felt that the images were self-relevant, as they were able to look at their aged faces and see that it was likely that as they got older they would start to look like older family members. This supports previous research, for example, Grogan et al. (2010) who found that seeing their own face convinced women that they were personally at risk of skin ageing through smoking. Additionally, research by the authors using the software on adults found that participants reported that seeing the effect of UV exposure on their own faces was useful, and some participants mentioned specifically that seeing

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other interventions with other people’s faces would not have the same effect on their sun protection or UV exposure intentions as seeing their own faces (Williams et al., 2012). Methodological / Interpretive Issues Participants in the present study were Caucasian British secondary school students aged 11 to 14, from the same school. This means that the findings can be generalised to other groups only with caution. Future Research It would be interesting to look at the effect of the intervention on participants with nonCaucasian skin types. Among non-Caucasians, melanoma is a higher risk for children than adults, and 6.5 percent of paediatric melanomas occur in non-Caucasians (Strouse et al., 2005). Implications for health promotion This intervention could be used in a school, for example during Personal, Social and Health Education lessons. It could also be used in a number of healthcare settings, for example, in a doctor’s waiting room whilst participants are waiting to be seen, or, in pharmacies, where adolescents could participate in the intervention while out shopping with their parents/carers. References Asvat, Y., Cafri, G., Thompson, J., & Jacobsen, P. (2010). Appearance-based tanning motives, sunbathing intentions, and sun protection intentions in adolescents. Archives of Dermatology 146(4): 445-446. Berneburg, M., & Surber, C. (2009). Children and sun protection. British Journal of Dermatology 161(3): 33-39. Braun, V., & Clarke, V. (2006). Using thematic analysis in psychology. Qualitative Research in Psychology 3(2): 77-101. Dobbinson, S., Wakefield, M., Hill, D., Girgis, A., Aitken, J.F., & Beckmann, K. (2008). Prevalence and determinants of Australian adolescents’ and adults’ weekend sun protection and sunburn, summer 2003-2004. Journal of the American Academy of Dermatology 59(40): 602-14.

Gough, B., Fry, G., Grogan, S., & Conner, M. (2009). Why do young adult smokers continue to smoke despite the health risk? A focus group study. Psychology and Health 24(2): 203-220. Grogan, S. (2011). Body Image Development in Adulthood. In Cash, T.F., and Smolak, L., (Ed). Body image: A handbook of science, practice, and prevention (pp 93-100). New York: Guilford Press. Hevy, D., Pertl, M., Thomas, K., Mahler, L., Craig, A., & Ni Chuinneagain, S. (2010). Body consciousness moderates the effect of message framing on intentions to use sunscreen. Journal of Health Psychology 15(4): 553-560. Jarrett, P., Sharp, C., & McLelland, J. (1993). Protection of children by their mothers against sunburn. British Medical Journal 306(6890): 1448. Olson, A., Gaffney, C., Starr, P., & Dietrich, A. (2008). The impact of an appearance-based educational intervention on adolescent intention to use sunscreen. Health Education Research 23(5): 763-769. Olson, A., Gaffney, C., Starr, P., Gibson, J., Cole, B., & Dietrich, A. (2007). SunSafe in the middle school years: A communitywide intervention to change early-adolescent sun protection. Pediatrics 119(1): 247-256. Potente, S., Coppa, K., Williams, A., & Engels, R. (2010). Legally brown: using ethnographic methods to understand sun protection attitudes and behaviours among young Australians ‘I didn’t mean to get burnt—it just happened!’ Health Education Research, 26(1): 39-52. Severi, G. (2002). Sun exposure and sun protection in young European children: an EORTC multicentric study. European Journal of Cancer 38(6): 820-826. Strouse, J., Fears, T., Tucker, M., & Wayne,. A (2005). Pediatric melanoma: risk factor and survival analysis of the surveillance, epidemiology and end results database. Journal of Clinical Oncology 23(21): 4735-41. Williams, A.L., Grogan, S., Buckley, E,. & Clark-Carter, D. (2012). A qualitative study examining women’s experiences of an appearance-focussed facial-ageing sun protection intervention. Body Image 9(3): 417-420. Williams, A.L., Grogan, S., Buckley, E., & Clark-Carter, D. (2013) Men’s experiences of an appearance-focussed facialageing sun protection intervention: A qualitative study. Body Image 10(2): 263-266. Williams, A.L., Grogan, S., Clark-Carter, D., & Buckley, E. (2013). Impact of a Facial-ageing Intervention versus a Health Literature Intervention on Women's Sun Protection Attitudes and Behavioural Intentions. Psychology and Health 28(9): 993-1008 World Health Organization. (2012). Ultraviolet Radiation and the INTERSUN Program. Available at: (accessed 16 October 2013).


Schools and Students Health Education Unit

The specialist provider of reliable local survey data for schools and colleges and recognised nationally since 1977. "The survey reports have been used to inform commissioning at specific commissioning groups. They are also being used within our Extended Schools Clusters and to inform The Annual Public Health and the Joint Strategic Needs Assessment." Programme Manager - Young People For more details please visit TO SUPPORT YOUR WORK WITH YOUNG PEOPLE TRY SHEU’S FREE RESOURCES

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David Evans is Chief Executive of the Health Behaviour Group and Apause. For further information please email : or visit the website for more detailed descriptors, evaluations, case studies and publications.

David Evans SRE - Not yet good enough: Can scripts bridge the training gap?


espite the much-vaunted success of the tenyear teenage pregnancy strategy, the recent National Surveys of Sexual Attitudes and Lifestyles (Mercer et al., 2013) shows that the UK still has the highest teenage pregnancy and STI rates in Western Europe. The same report (Wellings et al., 2013) suggests a link between teenage pregnancy and an insufficiency of classroom sex and relationships education (SRE), while, unsurprisingly, the 2013 OFSTED report, Not yet good enough: personal, social, health and economic education in schools points to the unsatisfactory nature of SRE teaching and learning in English schools. (OFSTED, 2013) Commissioned back in 2010 by the National Association of Head Teachers, the report, Sex and Relationship Education: Views from teachers, parents and governors highlighted the general inadequacy of training and resources in SRE (Durex, 2010), and recent cuts and restructuring in education and health spending will certainly not have improved the situation.

Mandatory SRE The above studies, and a vigorous group of lobbyists and media commentators, are pressuring government to establish mandatory sex and relationships education in the national curriculum. All make a strong case for more SRE in schools with the provision of specialist training; but training is expensive. Even if a teacher has just one day of training, free of charge, it will cost the school well in excess of £150 in supply cover. This paper sets out a case for systematically enabling teachers to learn how to facilitate effective SRE, as they go along, in the classroom, through the use of scripts. As a case study, it uses the methodology used in ApauseToo (Added Power and Understanding in Sex Education: Teacher Organised Option).

Specialist training in SRE

The logistics of specialist training in SRE requires some unpacking. Since there is minimal, if any, initial teacher training time dedicated to SRE, there are, broadly speaking, two routes an inexperienced teacher can get their SRE training. They can personally attend a series of training events, often earning some certification of Continued Professional Development (CPD) and take that expertise back in to their school and classroom. Or they can attend some in-house, school-based training and learn via a cascade system. This is usually delivered by the school’s specialist who also took the CPD route. One notable exception to this system is the Christopher Winter Project (CWP) where outside trainers mentor novice teachers as they teach the CWP curriculum. Notwithstanding these approaches, it seems that in a large proportion of schools, possibly the majority, teachers deliver SRE not by virtue of being trained but by dint of necessity - they are class tutors with a daily pastoral and administrative role. It is often they who are responsible for delivering some, or all of the PSHE that their tutor groups receive. They are not usually trained in SRE and consider their specialism lies in other, more ‘academic’ parts, of the curriculum.

Costs and benefits Given the expense of becoming a specialist teacher, we should consider costs and benefits. How much time does an average teacher spend teaching SRE in a year? If they deliver SRE as just one teacher in a cohort of class tutors, it could be three hours a year or less. So, it would be unfeasibly expensive training them to the point where they were specialists. In those, more enlightened, schools that have made a commitment to PSHE, the whole of SRE

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teaching is often carried out by a team of specialists who deliver across several year groups and to several classes from each year group. The initial investment in training, then, gives a good return in terms of student contact time with experienced practitioners. This positive return assumes that schools regularly timetable in a sufficiency of SRE lessons, and that teachers continue in their role in the team of SRE specialists. Increasingly, it appears that SRE is being pushed to the margins of the curriculum. Further, these specialist teams can easily be destabilised for various reasons such as the teachers of SRE being promoted, changing schools or being moved from that role. Once that team of specialists is disrupted; for example if, out of a team of four, one changes their job, then suddenly a replacement has to be found. In the current economic climate, with the paucity of local authority education services, will the replacement SRE teacher get the quality of training enjoyed by their predecessor? Doubtful. In this scenario, a quarter of all students will get an inferior SRE experience compared to the previous year. Whichever system a school uses in the provision of SRE, it is easy to see why the quality of SRE across the country is so often reported as being ‘patchy’.

Solution to widespread lack of adequate SRE With the unlikelihood of teachers getting enough specialist training in the foreseeable future, is there a solution to our widespread lack of adequate SRE? How might SRE provision look if resources were designed which enabled safe, comfortable and effective delivery by non-specialist teachers with minimal training and desirably overseen by a well trained PSHE teacher? Would children benefit from a more pragmatic approach? In devising its latest programme, the Apause team has set itself the challenge of creating scripted student workshops for all their exercises. At least initially, teachers ‘perform’ their role as SRE facilitators by reading from their scripts while the students perform their role as learners through interaction in small group tasks and preparing themselves for the ‘out loud’ part of the exercise where they report back, read a script, or share an answer for the benefit of the whole class. Teachers are in no

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way compelled to stick slavishly to the script, rather, it is part of a ‘scaffolded’ learning process. They can merely refer to it for specific phrases or instructions, or they can use the more schematic exercise plan which is also provided. Critically, teachers report that using a script or guideline does not hamper their engagement with the class and they quickly get used to the routine and grow in confidence. Effectively, teachers are learning or revising new methods of working as they go along.

Script construction Each learning resource is designed to be intuitive and ‘worked on’ and ‘worked out’ as part of a small group exercise which requires verbal interaction. Accordingly, the teacher’s script is carefully constructed to facilitate the effective deployment of the resources with a range of appropriate questions and lines of enquiry with a representative range of anticipated responses. Everybody knows that the lesson is going to be structured in this way, encouraging teacher confidence and student participation. It is highly democratic, giving every child the opportunity to actively participate in the small group exercises and contribute to group feedback to the rest of the class. It avoids the common pitfalls of classdiscussion-driven learning which can allow a vociferous few to dominate the proceedings and steer the subject matter into highly sensitive and possibly age-inappropriate areas, requiring specialist knowledge and exceptional competencies on the part of the teacher. The almost guaranteed outcomes of each session offer a high degree of transparency and accountability to senior management, parents and governors.

The challenge of SRE From a purely logistical perspective, it is easy to explain why SRE can be such a challenge to implement in schools, but there are other, more culturally deep-rooted, reasons why nonspecialist teachers can be reluctant to commit themselves to a thoroughgoing treatment of such a sensitive subject area. As a nation, we are highly ambiguous about acknowledging children’s sexuality. On the one hand, a highly sexualised teenage culture is in a reciprocal relationship with the world of fashion

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and the newsmedia, so that each can be seen to be dependent on the other and thereby constitute a thriving market economy. In contrast, there is widespread moral concern about the early sexualisation of our children, their exposure to pornography and hitherto unknown sexual practices (such as “sexting”) facilitated by social media. Furthermore, these positions are often conflated and confounded by public health agendas. As if all this isn’t complicated enough, discourses about sex and sexuality remain stubbornly taboo in our culture. So a teacher, novice in the area of SRE will, quite naturally, be apprehensive about facing a class of adolescents and tackling the subjects of say, “sexting” or the “benefits of mutual masturbation as opposed to full sex”.

Using scripts to teach effective SRE In what ways, one might ask, does the use of scripts alleviate some of these anxieties and impediments to *teaching effective SRE? In the first instance, it might be helpful to understand the nature of these ‘scripts’ and to establish in what sense they might not function strictly as scripts in the conventional theatrical understanding of the word. The scripts are probably more accurately thought of as being ‘descriptive’ rather than ‘prescriptive’ in that they are repositories of practices that have generally proved to be successful by other practitioners and in trial situations – albeit these practices are framed in a form of words that if simply read aloud off the page will perform effectively as a set of instructions, explanations or questions. Whilst this approach is expedient in the case of a novice teacher, in the hands of a more experienced or specialist teacher it is likely to be redundant. In such an instance, the experienced teacher can assess the small group activity resource and merely refer to the brief ‘plan’ or scan the script and use their own, more personalised, style of delivery. Enshrined in the repository of the script, though, are some extremely handy, and often hard-earned, models of good practice; for example, how to phrase lines of questioning that lead the learners to challenging conclusions, useful statistics around sexual risk, understandings about the prevalence, expectations and rights surrounding same sex relationships, vocabularies around masturbation

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and sexual pleasure, all of which can be difficult for a form tutor to come by in an unfamiliar and contentious subject area in which they are nonspecialist and that they may only engage with three times a year. Even more importantly, the exercises often focus on the emotional and socially-situated aspects of adolescent relationships and not merely on the procurement of medical facts. So, there is an interplay of the understandings the learners construct in the relative privacy of their small group exercises and the whole class feedback and lines of questioning the teacher uses in class discussion to confirm desirable normative expectations, for example that boys in a friendship group have a responsibility to ensure they and their peers always use condoms and know how to negotiate their effective use. One of the drawbacks of trying to codify such a complex set of learning experiences, and embed them in the Apause research practice of applying psychosocial theory, is that it is an extremely time-consuming process. It is not amenable to sudden changes in the reported sexual mores of adolescents and the latest phone app, all accompanied by outcries in the press for schools to do something about it. It is genuinely hard to develop resources that address the dangers of a phone app like ‘Snapchat’, or to talk with intellectual integrity about the harm done by pornography when the research evidence remains inconclusive.

Apause programme Possibly the Apause scripted method is most vulnerable to the criticism of being doctrinaire and not having been developed in direct response to the expressed, and localised needs of children, or in collaboration with them and their teachers. There is no denying that these are highly desirable practices, but to some extent Apause would contest those charges, in so far as many of the resources and methods were initially developed in small focus groups with young people and all have been piloted in classrooms with teachers and evaluated. Apause does not claim to be the perfect, all-inclusive curriculum, but does claim to provide a basic and robust programme that can be added to. This is in contrast to the fairly common situation where children may receive a ‘pick and mix’ set of lessons with no solid overall structure or predictable outcomes.

*Follow link for an example of a novice SRE teacher facilitating an exercise for the first time

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Apause has always been an advocate of highquality, specialist training for SRE; indeed, this was the basis of the positive evaluation by the National Foundation of Educational Research for its training. (Blenkinsop et al., 2004). The table below, taken from the NFER evaluation report (p.25), shows the response to the question, ‘Does the Apause approach to SRE differ from that previously used in your school?’. Table 3.5 How Apause differs from previous SRE Number of Schools Involvement of peers 44 Involvement of health professionals 34 More detailed/in-depth coverage 17 More interactive 16 Staff specifically trained 10 Better structure 5 Refreshing approach 5 Varied methods of delivery 4 SRE was not consistently delivered 4 SRE was incoherent 3 N = 92

Apause has for a long time put its name to campaigns to make SRE a mandatory part of the national curriculum. But given the lack of political will to acknowledge the importance of SRE, and its ‘Cinderella’ status in the curriculum, Apause remains committed to making available novel, low-cost, approaches which offer a population of young people a base-line entitlement of effective, well-

researched and evaluated SRE. Moreover, there is strong anecdotal evidence that, for many teachers and schools, Apause has offered a ‘point of departure’, a means of empowerment, giving them the confidence to progress on to developing their own curricula and resources. References Blenkinsop, S., Wade, P., Benton, T., Gnaldi, M., & Schagen, S. (2004). Evaluation of the APAUSE SRE Programme : NFER. Accessed 04/12/13. Durex. (2010). 'Sex and Relationship Education: Views from teachers, parents and governors'. Accessed 04/12/13. Mercer, C.H., Tanton, C., Prah, P., Erens, B., Sonnenberg, P., Clifton, S., Macdowall, W., Lewis, R., Field, N., Datta, J., Copas, A.J., Phelps, A., Wellings, K., & Johnson, A.M. (2013). 'Changes in sexual attitudes and lifestyles in Britain through the life course and over time: findings from the National Surveys of Sexual Attitudes and Lifestyles (Natsal)', Lancet, 382(9907), 1781-94. Accessed 04/12/13. Ofsted. (2013). Not yet good enough: personal, social, health and economic education in schools, No. 130065. Accessed 04/12/13. Wellings, K., Jones, K.G., Mercer, C.H., Tanton, C., Clifton, S., Datta, J., Copas, A.J., Erens, B., Gibson, L.J., Macdowall, W., Sonnenberg, P., Phelps, A., & Johnson, A.M. (2013). 'The prevalence of unplanned pregnancy and associated factors in Britain: findings from the third National Survey of Sexual Attitudes and Lifestyles (Natsal-3)', Lancet, 382(9907), 1807-16. Accessed 04/12/13.

Example from a script: The first part of it is read by a small group back to the class (actually, two or three do the reading and the other(s) feedback answers to the questions). The second part is how the teacher pulls together the exercise, moving the class towards the understanding that friends can be an important influence in whether people use condoms. 7) Special memories (Two boys or two girls) F1 F2 F1 F2 F1 F2 F1 F2

Good weekend? You stayed over didn’t you? Yeah great. Place to ourselves. Space to work it all out. You managed to get the condoms then? Thanks again for reminding me. But using condoms isn’t just like it says on the packet. How do you mean? Well first time it’s a bit of a game, - you know… too dark …leave them in your jacket, wrong way round, then you’re busting for the loo. Still got it sorted though. Yeah it was a laugh, we both had a go, talked about it. Made us stronger, really, more together. Overall, how would you say using a condom affected the relationship between Friend 2 and their partner? What sort of influence did Friend 1 have on Friend 2? What differences do the kind of friends a person has, make to their romantic relationships

Takes: 6 mins; 0 left “OK well done for reading them so well. First of all what would you say is the main message or theme in this story?” Á It looks at a relationship, Á more to using a condom than mechanics, Á friends can be supportive “What about friends, how useful are they in this situation?“ Á It depends on their attitude and how mature and responsible they are. Á If they have a good attitude and are responsible they can be very helpful in this situation. “Can you think of situations when friends aren’t helpful? Could you give an example?“ Á If a friend said condoms don’t feel good, or Á they don’t give good protection or Á that nobody uses them.

Education and Health Journal 31:4, 2013  

Open access journal for those concerned with the health and wellbeing of young people.

Education and Health Journal 31:4, 2013  

Open access journal for those concerned with the health and wellbeing of young people.