Social inequalities in availability of health-promoting interventions in Quebec elementary schools

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