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Background Comprehensive School Health (CSH) is an internationally recognized framework that holistically addresses school health by transforming the school culture. It has been shown to be effective in enhancing health behaviours among students while also improving educational outcomes. Despite this effectiveness, there is a need to focus on how CSH is implemented. Previous studies have attempted to uncover the conditions necessary for successful operationalization, but none have described them in relation to a proven best practice model of implementation that has demonstrated positive changes to school culture and improvements in health behaviours. Methods The purpose of this research was to identify the essential conditions of CSH implementation utilizing secondary analysis of qualitative interview data, incorporating a multitude of stakeholder perspectives. This included inductive content analysis of teacher ( n  = 45), principal ( n  = 46), and school health facilitator ( n  = 34) viewpoints, all of whom were employed within successful CSH project schools in Alberta, Canada between 2008 and 2013. Results Many themes were identified, here called conditions, that were divided into two categories: ‘core conditions’ (students as change agents, school-specific autonomy, demonstrated administrative leadership, dedicated champion to engage school staff, community support, evidence, professional development) and ‘contextual conditions’ (time, funding and project supports, readiness and prior community connectivity). Core conditions were defined as those conditions necessary for CSH to be successfully implemented, whereas contextual conditions had a great degree of influence on the ability for the core conditions to be obtained. Together, and in consideration of already established ‘process conditions’ developed by APPLE Schools (assess, vision, prioritize; develop and implement an action plan; monitor, evaluate, celebrate), these represent the essential conditions of successful CSH implementation. Conclusions Overall, the present research contributes to the evidence-base of CSH implementation, ultimately helping to shape its optimization by providing school communities with a set of understandable essential conditions for CSH implementation. Such research is important as it helps to support and bolster the CSH framework that has been shown to improve the education, health, and well-being of school-aged children.

Background In 2005, we reported on the success of Comprehensive School Health (CSH) in improving diets, activity levels, and body weights. The successful program was recognized as a \"best practice\" and has inspired the development of the Alberta Project Promoting active Living and healthy Eating (APPLE) Schools. The project includes 10 schools, most of which are located in socioeconomically disadvantaged areas. The present study examines the effectiveness of a CSH program adopted from a \"best practice\" example in another setting by evaluating temporal changes in diets, activity levels and body weight. Methods In 2008 and 2010, we surveyed grade 5 students from approximately 150 randomly selected schools from the Canadian province of Alberta and students from 10 APPLE Schools. Students completed the Harvard Youth/Adolescent Food Frequency Questionnaire, questions on physical activity, and had their height and weight measured. Multilevel regression methods were used to analyze changes in diets, activity levels, and body weight between 2008 and 2010. Results In 2010 relative to 2008, students attending APPLE Schools were eating more fruits and vegetables, consuming fewer calories, were more physically active and were less likely obese. These changes contrasted changes observed among students elsewhere in the province. Conclusions These findings provide evidence on the effectiveness of CSH in improving health behaviors. They show that an example of \"best practice\" may lead to success in another setting. Herewith the study provides the evidence that investments for broader program implementation based on \"best practice\" are justified.

The health consequences of poor nutrition and sedentary lifestyles for overweight and risk for chronic diseases are generally well understood and are in fact the primary reason to implement policies to promote HEAL. However, less well known are the benefits of HEAL for learning and self-esteem. Physical activity for students has been demonstrated to have a positive effect on academic achievement (Fishburne, 2005; Tremblay, Inman, & Willms, 2000; Trudeau & Shephard, 2008), to lower stress levels (Fishburne, 2005; Trudeau & Shephard, 2008), to enable students to exhibit positive attitudes toward themselves, peers and school (Fishburne, 2005) and to increase self- esteem (Wang & Veugelers, 2008). Healthy eating has also been shown to have a positive effect on academic achievement and self-esteem (Alaimo, Olson, & Frongillo, 2001; Florence, Asbridge, & Veugelers, 2008; Powell, Walker, Chang, & Grantham-McGregor, 1998; Symons, Cinelli, James, & Groff, 1997; Tremblay et al., 2000; Trudeau & Shephard, 2008; Wang & Veugelers, 2008). Activities related to promotion of HEAL are herewith further justified to take place in schools as they improve learning and developmental outcomes among students. Les auteurs ont déterminé que ¿? surcharge pondérale et l'obésité juvéniles constituent d'importants problèmes de santé publique. Ik prêchent que même si les efforts de prévention mettent l'accent sur k promotion d'une saine alimentation et de modes de vie actif, très peu d'études examinent le degré d'appui que les intervenants accordent à k promotion d'une telle approche dans les écoles. Ils auteurs indiquent que parents et élèves soutiennent fortement k promotion d'une saine alimentation et de modes de vie actif à l'école et que cek peut aider à renforça les liens entre les secteurs de l'éducation etdek santé, y compris l'engagement conjoint des ministères de k Santé et de l'Education. Il concluent qu'un tel appui devrait favoriser k mue en oeuvre des politiques et programmes actuek et inspira l'ékboration d'autres politiques et programmes au profit de l'apprentissage etdek santé des élèves dans les années à venir.

Teachers are recognized as invaluable champions within school communities. This is especially true for school-based health promotion programs (Fullan, 1999; St Leger, 1998, 2000). However, there is a lack of understanding of teachers' perceptions of school-based health promotion, and specifically teachers' perceptions on the sustainability of these programs. Han and Weiss' (2005) concept of program sustainability refers to teachers' continued implementation of an intervention after initial resources have been withdrawn. Much research has focused on factors influencing program implementation, but less work has attempted to provide an integrated understanding of mechanisms that affect teachers' sustainability of these programs. Given the lack of evidence in this area, soliciting teachers' input is invaluable when examining and improving CSH programs. Therefore, the purpose of this study was to examine teachers' perceptions of the various factors affecting the sustainability of a CSH project taking place in the Canadian province of Alberta: the Alberta Project Promoting active Living and healthy Eating in Schools (APPLE Schools). Additionally, this study provides insight on a variety of considerations that may be helpful in improving the likelihood of project sustainability and future programming. APPLE Schools is a CSH intervention. This school-based health promotion intervention began in January 2008 when school health facilitators (SHFs) were placed full-time into ten Alberta schools. SHFs are key champions in each APPLE School that help to facilitate change in order to create a healthy school community. They do this in partnership with other key stakeholders in the school environment. APPLE Schools addresses healthy eating and physical activity in order to increase knowledge about healthy living for students, parents, teachers, and the school community and to ultimately improve students' health behaviours (Schwartz, Karunamuni, & Veugelers, 2010). The current study took place in April 2009, which was approximately 15 months into the intervention. In order to provide an understanding of the process, impact, and outcome of APPLE Schools, a variety of approaches are being used for evaluation. As part of this ongoing evaluation, teachers were interviewed due to their role as key stakeholders involved with APPLE Schools, and results have previously been presented on teachers' perceptions of implementation (Storey, Spitters, [Ceara Cunningham], Schwartz, & Veugelers, 201 1). However, for the purposes of this study, only the teachers' perceptions of the sustainability of the APPLE Schools project are presented. Les programmes de promotion de la santé en milieu scolaire, y compris l'approche de santé globale à l'école (SGE), gagnent en popularité à l'échelle du pays. Aux fins de l'approche de SGE, ies enseignantes et enseignants deviennent des intervenants clé qui jouent un rôle crucial dans l'instauration et le maintien de tek programmes. Malgré Wut, on ne sait pas toujours ce que les enseignants pensent de l'efficacité et de la viabilité des programmes de promotion de la santé à l'école. Cette étude visait à établir comment ces derniers percevaient les facteurs de viabilité associa à un projet de santé globale à l'école mu sur pied dans L· province de l'Alberta (Canada), /Alberta Project Promoting Active Living and Healthy Eating in Schools. L'étude a fait ressortir plusieurs éléments dont il faudra tenir compte à mesure que les efforts se poursuivront en vue d'améliorer L· qualité de teh programmes.

Comprehensive School Health (CSH) is an intervention approach that moves beyond classroom-based health education models to a more integrated approach of health promotion. However, the effectiveness of CSH approaches is inconclusive, and well-designed studies are critical to justify their broader implementation. CSH program elements also need to take into consideration the individual context of schools. This paper details the implementation of the Alberta Project Promoting active Living & healthy Eating in Schools (APPLE) project where interventions were tailored to ten elementary schools in Alberta, Canada. School Health Facilitators were placed in schools to implement customized health promotion strategies that acknowledge the unique needs and barriers to healthy living in schools. The primary goals of the project are to improve health behaviors among children and to increase the capacity to promote health-related behaviors in schools. The project will also contribute to the evidence base of the effectiveness of CSH.

Childhood obesity is a major public health challenge worldwide and has been linked to numerous health consequences. As such, promotion of health and prevention of disease is a priority. Comprehensive School Health (CSH) is recognized as a multilevel prevention strategy and has been shown to reduce overweight among students; however, there is a need to evaluate the process of implementation. Therefore, the purpose of this study was to examine teachers’ perceptions of the implementation of a CSH project, the Alberta Project Promoting active Living and healthy Eating in Schools (APPLE Schools). Participants were 45 teaching staff who took part in focus groups. Teachers identified students as central to APPLE Schools and themes that affected implementation included: building support; defining roles; leadership; embedding in school culture; and engaging stakeholders. Teachers were very supportive of APPLE Schools and had a clear sense of facilitating factors, barriers and solutions to enhance implementation.

Childhood obesity is a growing epidemic and has become a public health priority in developed countries [1,2]. Over the past few decades, prevalence rates of childhood obesity have tripled, with recent estimates indicating that 16.9% and 8.6% of children are obese in United States and Canada respectively [3-6]. Obesity negatively impacts a child’s self esteem andresults in diminished quality of life [7]. Moreover, children with high body mass index (BMI) often become obese adults, who are at increased risk of developing obesity-related diseases, such as type 2 diabetes, cardiovascular disease, and certain types of cancer, and place significant financial burden on healthcare systems [8-10].