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BACKGROUND: Since the inception of the Youth Risk Behavior Surveillance System in 1991, all surveys have been conducted in schools, using paper and pencil instruments (PAPI). For the 2019 YRBSS, sites were offered the opportunity to conduct their surveys using electronic data collection. This study aimed to determine whether differences in select metrics existed between students who completed the survey electronically versus using PAPI. METHODS: Thirty risk behaviors were examined in this study. Data completeness, response rates and bivariate comparisons of risk behavior prevalence between administration modes were examined. RESULTS: Twenty‐nine of 30 questions examined had more complete responses among students using electronic surveys. Small differences were found for student and school response rates between modes. Twenty‐five of 30 adolescent risk behaviors showed no mode effect. CONCLUSIONS: Seven of 44 states and DC participated electronically. Because survey data were more complete; school and student response rates were consistent; and minor differences existed in risk behaviors between modes, the acceptability of collecting data electronically was demonstrated. [ABSTRACT FROM AUTHOR]

ABSTRACT BACKGROUND The Healthy, Hunger-Free Kids Act of 2010 ( HHKA) required schools to make changes to meals provided to children. Rural school districts have limited resources, with increased obesity rates and local food insecurity. In this study we sought to understand the perceptions of rural food service directors and the barriers to implementing the changes. METHODS Food service directors from rural school districts were invited to complete a semistructured telephone interview and online survey. A total of 51 respondents completed both, 6 completed only the online survey, and 16 completed only the telephone interview. Qualitative interview data were analyzed through open thematic coding; descriptive statistics were calculated for the quantitative data. RESULTS Food service directors mostly perceived the changes as negative, challenging, and burdensome. They believed that the changes resulted from concern about childhood obesity, which they did not view as a problem for their students. Diverse challenges were reported related to cost, preparation, and student preference. CONCLUSIONS Food service directors in isolated, rural areas need support to enhance understanding of HHKA requirements, build professional networks to learn from one another, and communicate with students, families, and other stakeholders. Future efforts should focus on changing perceptions and supporting directors in order to make implementation a success. [ABSTRACT FROM AUTHOR]

ABSTRACT BACKGROUND Computerized surveys present many advantages over paper surveys. However, school-based adolescent research questionnaires still mainly rely on paper-and-pencil surveys as access to computers in schools is often not practical. Tablet-assisted self-interviews ( TASI) present a possible solution, but their use is largely untested. This paper presents a method for and our experiences with implementing a TASI in a school setting. METHODS A TASI was administered to 3907 middle and high school students from 79 schools. The survey assessed use of tobacco products and exposure to tobacco marketing. To assess in-depth tobacco use behaviors, the TASI employed extensive skip patterns to reduce the number of not-applicable questions that nontobacco users received. Pictures were added to help respondents identify the tobacco products they were being queried about. RESULTS Students were receptive to the tablets and required no instructions in their use. None were lost, stolen, or broken. Item nonresponse, unanswered questions, was a pre-administration concern; however, 92% of participants answered 96% or more of the questions. CONCLUSIONS This method was feasible and successful among a diverse population of students and schools. It generated a unique dataset of in-depth tobacco use behaviors that would not have been possible through a paper-and-pencil survey. [ABSTRACT FROM AUTHOR]

BACKGROUND: Sexting is common among adolescents and is associated with numerous health risk behaviors and negative psychosocial constructs. This study examined the relationships between high school students' experiences with sexual violence victimization, dating violence victimization, and engagement in risky sexual behaviors with experiences of receiving sexts. METHODS: Cross‐sectional data from the 2014 to 2016 data from Pennsylvania Youth Risk Behavior. Participants were selected using an independent 2‐stage cluster sample design to produce a statewide population‐based sample. The pencil and paper surveys were conducted in school. Participants included 6734 Pennsylvania high school students in grades 9‐12. RESULTS: Overall, 29.0% of Pennsylvania high school students had received a sext, which varied by sex, race/ethnicity, school grade, and sexual identity. Students who engaged in sexual risk behaviors, experienced dating violence, or experienced lifetime sexual violence outside of the dating context had a significantly higher prevalence of receiving a sext than students who did not engage in those behaviors or have those experiences. CONCLUSIONS: Early screening and prevention efforts that include discussions about sexting behaviors may help prevent other negative outcomes, such as risky sexual behaviors and interpersonal violence. Addressing sexting in the education and health sectors may help to prevent other related harmful health and violence experiences during adolescence. [ABSTRACT FROM AUTHOR]

BACKGROUND: Return to learn (RTL) after mild traumatic brain injury (mTBI) presents unique challenges for school professionals. A multidisciplinary team approach is necessary yet training school professionals is logistically difficult. This paper describes an innovative pilot RTL program and its evaluation. METHODS: Utilizing the telehealth/telementoring program Project ECHO® (Extension for Community Healthcare Outcomes), this study utilized a multidisciplinary team of subject matter experts to deliver five 1‐hour sessions across 5 cohorts of school‐based professionals (total of 133 participants). The evaluation used a mixed‐methods approach of post‐session and post‐program participant surveys and post‐program participant focus groups. RESULTS: Participants who completed a post‐program survey reported statistically significant improvements in essential aspects of RTL knowledge and self‐efficacy. This included improvements in how to manage a student with an mTBI (44.8% to 86.9%), benefits of early return to school for students following mTBI (31.8% to 86.9%), and the importance of written RTL policies/procedures (55.1% to 97.1%). CONCLUSIONS: This study demonstrates that RTL training via a telementoring approach may be a positive and effective way to train school‐based professionals and improve knowledge and self‐efficacy, especially when attending face‐to‐face trainings are difficult. This model has the potential to produce programmatic and systematic improvements for RTL education. [ABSTRACT FROM AUTHOR]

BACKGROUND: Schools are important arenas for the promotion of critical health literacy (CHL) among adolescents. Key domains of CHL are information appraisal, understanding social determinants of health, and abilities to act on determinants of health. In this paper, we examine the psychometric properties of the Critical Health Literacy for Adolescents Questionnaire (CHLA‐Q). METHODS: A cross‐sectional survey study was performed at 5 schools in Norway. Respondents included 522 pupils aged 13‐15 years old. Confirmatory factor analysis (CFA) was conducted to examine the structural validity. Internal reliability was assessed using ordinal Cronbach's alpha. RESULTS: The estimated model had acceptable closeness of fit. Five of 6 scales displayed adequate internal reliability. CONCLUSION: The results indicate acceptable fit of the CHLA‐Q framework and that 5 of the 6 scales are applicable to inform future research and interventions. More research is needed on measurement of the second domain of CHL. [ABSTRACT FROM AUTHOR]

BACKGROUND: Ninety percent of smokers report having their first whole cigarette before the age of 19. Policies, such as youth access laws, are essential to prevent youth from becoming future smokers. In Canada, the Tobacco Act prohibits retailers from furnishing tobacco products to individuals under the age of 18. These laws can only be effective when retailers comply with them. This paper investigates the effect of retailer compliance on youth smoking behavior. METHODS: Data on individual smoking behavior in conjunction with provincial retailer compliance rates and cigarette prices for the years 1999–2005 were employed to examine the effects of retailer compliance on youth smoking participation and consumption. RESULTS: Both price and retailer compliance were significant predictors of smoking participation. A large portion of participants endorsed obtaining their cigarettes through social means. Price elasticity of demand for the overall sample was estimated to be −0.54. CONCLUSIONS: Consistent with previous literature, our results found that retailer compliance is an essential component to the successful implementation of youth access laws. Given that youth access laws and retailer compliance did not quell social access to cigarettes, there is an apparent need within schools and communities to reduce the social sale of tobacco products. [ABSTRACT FROM AUTHOR]

BACKGROUND: In this study, we examined nutrition‐related topics among adolescent students attending schools with different Indices of Community Socio‐Educational Advantage (ICSEA). METHOD: Participating students (N = 206) from 5 schools in Western Australia completed a paper‐based questionnaire on nutrition‐related topics. Frequencies and independent chi‐square tests were used to identify differences between sexes and school ICSEA. RESULTS: Of the participating students, 75% were interested in learning about 8 of 16 topics. We found statistically significant differences by sex (p <.01) for "Eating the right foods for preventing illness and disease," "Eating the right food for being active" among girls, and "Reducing food waste" among boys. We also noted differences by school ICSEA. CONCLUSION: Acknowledging sex and socioeducational differences in teaching and learning may help teachers to engage adolescent students in nutrition education. [ABSTRACT FROM AUTHOR]

BACKGROUND: Mode share is an important metric for active school travel programs. Common methods for measuring mode share include Hands Up surveys and family surveys, but these require teacher and parental involvement. We used these methods as part of an evaluation of a school‐based bicycle training program, and added a novel observational count approach. This paper compares mode share results across the 3 methods. METHODS: We collected data over 2015–2017 at 16 elementary schools. Our outcome of interest was mode share (walk, drive, and bicycle). RESULTS: We found variations in travel mode estimates between methods and across schools. Overall most school journeys were made by walking (55.7% by observational counts, 46.3% by Hands Up surveys, and 51.5% by family surveys) or car (42.5%, 51.4%, and 46.2%, respectively), and a small proportion by bicycle (1.8%, 2.3%, and 2.2%, respectively). At individual schools, Hands Up and family survey results were similar; there was less agreement between these and observational counts. CONCLUSION: School travel practitioners face pragmatic choices in data collection. Observational counts are a nonintrusive method suited for school‐wide travel patterns. Hands up and family surveys may be more appropriate for assessing differences between classrooms, ages, or family characteristics. [ABSTRACT FROM AUTHOR]

ABSTRACT: BACKGROUND: Significant proportions of young people experience body dissatisfaction, which has implications for psychological and physical well‐being. Lesson content and perceived competence may be important variables for the experience of body dissatisfaction, yet these have been underexplored in physical education. The aim of this cross‐sectional study is to identify the relationships between body dissatisfaction and perceptions of competence, and to explore whether body dissatisfaction depends on lesson content. METHODS: A paper‐and‐pencil questionnaire was completed by 446 (210 boys, 236 girls) 13‐ to 14‐year‐old pupils from 37 physical education classes. The questionnaire assessed body dissatisfaction and perceived competence in physical education. Lesson content was also recorded. Twenty‐nine of the classes were engaged in team activities, eg, ball games. Eight classes were engaged in individual activities, eg, fitness. RESULTS: Multilevel analysis identified a significant negative association between body dissatisfaction and perceptions of competence in physical education. Lesson content did not significantly predict variations in body dissatisfaction scores. CONCLUSIONS: Teachers should focus on enhancing pupils' perceptions of competence in physical education to support the development of body satisfaction. [ABSTRACT FROM AUTHOR]

ABSTRACT BACKGROUND Adolescent overweight and obesity are serious health risks, with prevalence varying by sociodemographic group. Studies link children's weight status and sex/race-ethnic differences with meeting recommendations for physical activity and diet. But, research examining the intersection of sociodemographic characteristics, behavior, and weight status is limited. This paper aims to identify sociodemographic differences in the association between adolescent weight status and meeting 6 national obesity-related recommendations. METHODS In 2011-2012, the Healthy Kids Colorado Survey was administered to all Denver high school students. Using descriptive and multivariate modeling, we examined subgroup associations between students' self-reported weight status and physical activity and diet. RESULTS Students (N = 6652) who met at least 1 recommendation were less likely to be at an unhealthy weight (OR = 0.87); also true for students who met at least 1 physical activity recommendation (OR = 0.80). However, the association varied across subgroups. The association between weight status and meeting at least 1 nutritional recommendation (OR = 0.91) was inconsistent across subgroups. Unexpected patterns also emerged in subgroup associations between meeting specific recommendations and weight status. CONCLUSIONS Identifying subgroup differences in meeting recommendations and the association with weight status is important in identifying high risk groups and improving policy and programs that target childhood obesity prevention. [ABSTRACT FROM AUTHOR]

ABSTRACT BACKGROUND Behavioral support may be effective in increasing physical activity (PA) in school settings. However, there are no data collection systems to concurrently record PA and behavioral support. This paper describes the development and validation of the System for Observing Behavioral Ecology for Youth in Schools (SOBEYS)-an instrument used with existing observation systems to record PA within a behavioral ecological context. METHODS In 2013, experts created a set of behavioral categories to record prompting and reinforcement of PA during a recreational school activity program. The school provided supervision and equipment for lunchtime PA, making it possible to assess both PA and behavioral support. The system was implemented in spring semester 2014 at 1 suburban junior high school (N = 1452; 48% girls, 74% Caucasian) in the western Unites States. RESULTS Following multiple field trials, the SOBEYS instrument recorded behavioral categories of visual and verbal prompting, verbal, and nonreinforcement by adults and peers, and token reinforcement. Construct validity and acceptable interobserver agreement (>90%; kappa between 0.22 and 0.94) resulted. CONCLUSION Trained SOBEYS users can accurately and reliably record the presence of behavioral support aimed at prompting and reinforcing PA in conjunction with established systematic observation instruments to record PA context and quantity. [ABSTRACT FROM AUTHOR]

ABSTRACT BACKGROUND With the rise in childhood obesity, school policies related to nutrition and physical activity have been written and implemented. In this paper, we present a model to evaluate the degree to which state legislation for school health policies are implemented at the school level. METHODS Using Washington, DC's Healthy Schools Act (HSA) and a self-report measure of the implementation of the HSA, we illustrate the process of developing a composite score that can be used to measure compliance with the provisions of the law. RESULTS We calculated elementary and middle school composite scores based on the provisions within the HSA. Schools have been successful in implementing nutrition provisions; however, more resources are needed for schools to achieve the minutes of health and physical education. We found statistically significant differences between public charter and traditional public schools on the implementation of the provisions of the HSA. CONCLUSIONS Understanding how schools are complying with school wellness policies is a next step to determining where additional resources or support are needed in order to support school-wide adoption of healthy policies. [ABSTRACT FROM AUTHOR]

ABSTRACT BACKGROUND This study describes the perceived impact of H1N1 influenza and the adoption of the recommended measures to address the pandemic in schools. METHODS A cross-sectional self-reported survey was conducted in 433 schools in Barcelona addressed to the school principal or the H1N1 influenza designated person. A descriptive analysis was performed, stratifying by educational level and type of school. A logistic regression analysis also was conducted. RESULTS Around 70% of the respondents reported that there had been H1N1 influenza cases among students, being this percentage significantly higher among those schools offering primary education (74.4%) (p < .05). The main measures (single-use paper towels, availability of sanitizer solutions and 15 minutes ventilation per day of enclosed spaces) were implemented in most of the centers. However, the correct adoption of the main measures took place in around 30% of the schools, being the percentage lower in those offering only secondary education (Odds ratio [OR]: 0.518; 95% confidence interval [CI]:0.272-0.986) and those located in medium (OR: 0.438, 95% CI: 0.234-0.811) or low socioeconomic status (SES) districts (OR: 0.321, 95% CI: 0.159-0.649). CONCLUSIONS Despite the climate of social alarm, the perceived impact of H1N1 influenza in most schools was moderate. In future potential threats, the educational level and the SES of the school should be considered, especially when measures requiring purchasing any product are recommended but not provided. [ABSTRACT FROM AUTHOR]

ABSTRACT BACKGROUND Schools are a key setting for childhood obesity interventions, yet nurses are not often included in delivering these interventions. The objective of this systematic review and meta-analysis was to examine school-based interventions involving nurses in a role beyond anthropometric measurement for effect on change in body measures. METHODS We performed a systematic review and meta-analysis of these papers. RESULTS The literature search produced 2412 articles. Eleven met inclusion criteria for the systematic review (4 randomized controlled trail [ RCT], 7 quasi-experimental) and 8 for the meta-analysis. None have been included in prior meta-analyses. Four studies restricted eligibility to overweight and/or obese children; 7 included all children regardless of body weight. Random effects meta-analytic models represent data from 6050 (body mass index [BMI]), 5863 (BMIz), and 416 (BMI percentile) children, respectively. Pooled analyses demonstrated statistically significant decreases in BMI (6 studies: −0.48 [95% CI −0.84, −0.12]; I2=91.2%, Q=68.1), BMIz (5 studies: −0.10 [95% CI: −0.15, −0.05]; I2=0, Q=2.3), and BMI percentile (3 studies: −0.41 [95% CI: −0.60, −0.21]; I2=0, Q=2.0). CONCLUSIONS These findings are similar to those of other meta-analyses of school-based interventions and suggest that school nurses can play a key role in implementing sustainable, effective school-based obesity interventions. [ABSTRACT FROM AUTHOR]

ABSTRACT BACKGROUND The aim of this study was to assess the beliefs and attitudes of preservice health and physical education ( HPE) specialist and nonspecialist schoolteachers toward obese children. METHODS A total of 177 nonspecialist and 62 HPE specialist trainee teachers completed a series of pen-and-paper validated measures of attitudes and beliefs toward obese children. RESULTS Both groups of preservice teachers reported strong implicit and moderate explicit anti-fat bias. Enrollment in the HPE specialist degree was found to be a significant predictor of both implicit bad/good anti-fat bias (β = 3.97, p = .002) and implicit bias on the stupid/smart scale (β = 2.983, p = .016) of the IAT. Beliefs that obese children were less healthy, more self-conscious, and less satisfied with themselves were strongly endorsed by the majority of participants. HPE specialists were found to have significantly lower expectations for obese children in regard to 'reasoning' (mean difference = 0.21, p = .0107) and 'cooperation' skills (mean difference = 0.25, p = .0354) compared to nonspecialist trainees. CONCLUSIONS This study is the first to document the strong anti-fat bias of both preservice nonspecialist and HPE specialist teachers. It is also the first to find that preservice HPE specialist teachers have stronger anti-fat biases and differential expectations regarding particular abilities of obese children, compared to nonspecialists. [ABSTRACT FROM AUTHOR]

BACKGROUND: Knowledge of first aid (FA), which constitutes lifesaving treatments for injuries or illnesses, is important for every individual. In this study, we have set up a group-randomized controlled trial to assess the effectiveness of a board game for learning FA. METHODS: Four class groups (120 students) were randomly assigned to 2 conditions, a board game or a traditional lecture method (control condition). The effect of the learning environment on students' achievement was examined through a paper-and-pencil test of FA knowledge. Two months after the intervention, the participants took a retention test and completed a questionnaire assessing enjoyment, interest, and motivation. RESULTS: An analysis of pre- and post-test knowledge scores showed that both conditions produced significant increases in knowledge. The lecture was significantly more effective in increasing knowledge, as compared to the board game. Participants indicated that they liked the game condition more than their fellow participants in the traditional lecture condition. CONCLUSION: These results suggest that traditional lectures are more effective in increasing student knowledge, whereas educational games are more effective for student enjoyment. From this case study we recommend alteration or a combination of these teaching methods to make learning both effective and enjoyable. [ABSTRACT FROM AUTHOR]

BACKGROUND: Mississippi (MS) Delta adults and youth report obesity rates far exceeding those of the state and nation. State law requires in-school physical activity and nutrition practices to address childhood obesity but does not require evaluation of outcomes, specifically the impact on weight-related outcomes. This paper offers 3 things: (1) describes the weight status of elementary school-age children in the MS Delta; (2) explains the importance of including waist-to-height ratio (WHtR) values when reporting body mass index (BMI); and (3) provides impetus for policy that requires weight-related health risk, as measured by WHtR, to be assessed regularly as a means to evaluate school health policy. METHODS: We took anthropometric measures in a cross-sectional investigation of 1136 children from 11 public elementary schools in the MS Delta. Measures included BMI, waist circumference (WC) and WHtR. RESULTS: The prevalence of overweight and obesity (BMI ≥85th percentile) was 47.1% (18.3% overweight and 28.8% obese). In this sample, 59.9% and 42.0% were 'at risk' for weight-related chronic disease based on WC (≥75th percentile) and WHtR (>0.5), respectively. The differences in these proportions were statistically significant. The predominantly black districts reported higher on all of the weight-related measures. CONCLUSIONS: Investigators recommend the assessment of health policy include measures of health risk in addition to BMI, namely WHtR as it accounts for growth in both WC and height over age. Furthermore, WHtR is a more accurate indicator of fat distribution and health risk than WC alone. [ABSTRACT FROM AUTHOR]

BACKGROUND: In 2020, schools shifted to remote learning in response to mitigating COVID‐19. Since then, students have fluctuated between in‐person and remote learning environments. Changes to instructional models raise questions about the impact on health. METHODS: This study leveraged a statewide surveillance system (Healthy Kids Colorado Survey) to examine the relationship between learning environment and adolescent health. The survey was administered in Fall 2020 to 26 high schools, resulting in 4564 respondents. RESULTS: Overall, results suggested positive and negative associations between the 3 learning environments. Notably, as compared to in‐person students, hybrid and remote students reported more stress (OR = 1.82, p <.001; OR = 1.41, p =.001), less school connectedness (OR = 0.71 and 0.61, p <.001); remote students reported more parental abuse (OR = 1.33, p =.010) and less alcohol consumption (OR = 0.61, p <.001). CONCLUSION: This study may be used to better understand risk and protective factors experienced by youth at school and home with the goal of improving prevention strategies. [ABSTRACT FROM AUTHOR]

BACKGROUND: School principals usually have to sacrifice health and family obligations to obtain sufficient work time. This study investigates school principals' somatic and psychological discomfort related to their time allocation to diverse work contexts and life domains, so as to test the optimal allocation of time to each context and domain. METHODS: This study is based on survey data of 347 school principals, from the preexisting 2021 Survey of School Teachers' Living Conditions in Shanghai. Generalized linear regression modeling was adopted to analyze the data according to the research purpose. RESULTS: This study finds that school principals' daily time spent on work at home, sleep, breakfast, exercise, and family obligations significantly predict their somatic or psychological discomfort. However, their time spent on work at school, daytime napping, lunch, and dinner are not of significance. CONCLUSIONS: This study reveals several unhealthy ways of working and lifestyle habits among school principals from a perspective of time allocation, such as extended periods working at home, sleep deficits, hurried breakfast, lack exercise, and failure to meet familial obligations. [ABSTRACT FROM AUTHOR]

BACKGROUND: Schools have become a primary access point for mental health services to cover the gap between need and service utilization that has long existed, particularly among vulnerable populations. This study aims to identify the profiles of comprehensive school mental and behavioral health system (CSMBHS) needs and examine related characteristics. METHODS: We used the 2019 National Survey of Drug Use and Health (NSDUH) collected from a nationally representative sample in the United States. The sample included 6th through 12th‐grade adolescents who had received CSMBHS services in the last 12 months (N = 1346). The study conducted latent class analysis and multinomial logistic regression using Vermunt's 3‐step approach. RESULTS: The analysis identified 3 profiles of student CSMBHS service need: depression needs (42%), multiple endorsements in most needs (depressed, friend, and school problems; 6.5%), and low endorsement (51.4%). Findings suggest that the profiles differed by age, a lifetime major depressive episode, family income, and use of other mental health services. IMPLICATIONS FOR SCHOOL HEALTH, POLICY, PRACTICE, AND EQUITY: Emphasis should be placed on proactively identifying student needs and advocating for appropriate interventions based on student needs. CONCLUSIONS: The study reveals important information regarding how schools best support students in need and in seeking services. [ABSTRACT FROM AUTHOR]

BACKGROUND: Associations between school participation in an academic medical center‐supported school‐based wellness initiative and programmatic components implemented with change in average student body mass index (BMI) over time were examined. METHODS: This was an observational study of 103 K‐12 South Carolina schools over school years 2014‐2018, classified as participating (n = 87 schools, 27,855 students) or non‐participating (n = 16 schools; 3608 students). Associations between students' BMI z‐score (BMIz) and school participation were evaluated by linear multilevel mixed‐effects modeling using data from FitnessGram and the School Wellness Checklist© (SWC), respectively. RESULTS: One‐third of the students had a BMI percentile ≥85. Average student BMIz decreased in participating schools (p =.026) and increased in non‐participating schools (p =.004) over time. For schools that participated two or more years, there was an inverse relationship between SWC score and student BMIz (p =.002) that did not differ by school type, rural/urban location, Title 1 status, or student sex. Physical activity and stress management interventions for students, as well as employee wellness and establishing a wellness committee at the school level were significantly associated with decreased average student BMIz (all p <.05). CONCLUSION: Implementation of similar comprehensive school‐based wellness programs focused on improving physical activity, stress management, and employee engagement may help prevent and reduce pediatric obesity in diverse communities. [ABSTRACT FROM AUTHOR]

BACKGROUND: Approximately 20% of US children are obese and these rates are expected to increase. The National School Lunch Program (NSLP) provides meals to millions of students and may influence their body mass index (BMI). This study aimed to investigate whether students who participate in the NSLP have a higher BMI when compared to those that do not. METHODS: Secondary data from the US Census Bureau were analyzed. Kruskal‐Wallis H tests were performed to find associations between NSLP participation and students' BMI. Race and economic stability were included as moderating variables. RESULTS: NSLP participation and respondents that identified as White/Caucasian, African American, and Native American were positively associated with BMI. Lower economic stability was also positively associated with BMI. CONCLUSION: Participation in the NSLP was significantly associated with participants' BMI, race, and economic stability. While a cause‐and‐effect relationship cannot be determined, these results are important given their potential influence on students' long‐term health. [ABSTRACT FROM AUTHOR]

ABSTRACT: BACKGROUND: Barriers to health care service utilization contribute to the spread of sexually transmitted infections (STIs) among teens. School‐based STI screening programs reach adolescents outside of the clinic‐based health care model and schools with school‐based health centers (SBHCs) may expedite treatment because of their proximity to the population. This study examined whether students who tested positive for STIs in a school‐based screening program had differing times to treatment based on treatment location. METHODS: All positive cases of chlamydia and gonorrhea from the 2012‐2013 school year in a Chicago Department of Public Health (CDPH) and Chicago Public Schools school‐based STI screening program were reviewed. Median time to treatment was compared for those treated at an SBHC versus those treated elsewhere (CDPH STI clinic, community health center, private physician). RESULTS: Overall, 540 students had positive results. The median age was 17 years, 427 had chlamydia (79.1%), 59 had gonorrhea (10.9%), and 54 had dual infections (10.0%); 144 were tested in a school with a SBHC on site (26.7%). Of the 483 students who received treatment (89.4%), those treated at a SBHC had a faster time to treatment compared to CDPH STI clinics (median 17 days versus 28 days, respectively, p < .001). CONCLUSIONS: For students testing positive in the Chicago school‐based STI program, time to treatment is accelerated in locations with SBHCs. [ABSTRACT FROM AUTHOR]

BACKGROUND: About 20‐30% of children worldwide report depressive symptoms. This study examined associations between children's depressive symptoms, life events, and family factors. METHODS: Nationally representative data (n = 95,725) were drawn from the 2017 School Health Promotion Study in Finland. The respondents were 4th and 5th grade pupils (aged 10‐12) in primary schools and their parents/guardians (n = 33,726). Data were analyzed for child‐parent dyads (n = 32,181). Associations were studied using cross tabulation and logistic regression models. RESULTS: Children's reports of poor self‐rated health, problems with family interactions, and the accumulation of life events were statistically significantly associated with depressive symptoms, also when controlling for sociodemographic factors. Financial situation and parent's depressed mood, both reported by parents, were associated with children's depressive symptoms when both were included in the regression model. However, this association disappeared when other predictors were added to the model. CONCLUSION: The results make apparent the complex associations between children's depressive symptoms and family factors. Further research is needed on the discrepancies between parent and child experiences. [ABSTRACT FROM AUTHOR]

BACKGROUND: Our objective is to describe violence‐related injuries to early adolescents that occurred at school, resulting in emergency department (ED) evaluation. METHODS: This retrospective cohort study at an urban academic pediatric ED in Baltimore, MD, identified patients 10‐15 years old who presented with an injury from intentional, interpersonal violence that occurred at school between January 2019‐December 2020. Descriptive statistics were used to summarize patient and event characteristics. RESULTS: Of 819 youth 10‐15 years of age evaluated for a violence‐related injury, school was the location in 115 cases (14.0%). All events occurred prior to the statewide stay at home order (March 30, 2020). School‐injured youth had a mean age of 12.7 ± 1.7 years and were predominantly male (64.3%). Of the 115 cases, 75 (65.2%) involved an altercation with a peer, 26 (22.6%) involved a teacher or school staff, 6 (5.2%) involved a family member, 1 (0.9%) involved police, 6 (5.2%) involved an unknown party, and 1 (0.9%) involved an unrelated but known adult. All injured youth were discharged from the ED. CONCLUSIONS: School‐based violence is a well‐recognized cause of traumatic injuries to adolescents and may involve peers, teachers, or school staff. [ABSTRACT FROM AUTHOR]

BACKGROUND: As COVID‐19 has let many students into remote learning environments and exacerbated inequality among marginalized individuals, there is a growing concern about Bias‐Based Bullying (BBB) in online spaces among school‐aged youths. Learning modality and perceived school fairness may affect youth's likelihood of reporting BBB. METHODS: Data were collected as part of "No Place For Hate" (NPFH) project, which was conducted by an equity office of a school district. A sample of middle and high school students (N = 1117) in the school district was used as an analytic sample. We conducted a series of independent samples t tests and calculated a hierarchical stepwise multivariate regression model to examine the proposition. RESULTS: Results demonstrated that students in fully remote modality reported slightly higher levels of witnessing BBB (t = 2.29, p <.05), lower perceived school fairness (t = −2.94, p <.01), and higher levels of likelihood of reporting BBB (t = 2.31, p <.05). Results of the regression model showed that perceived school fairness was positively associated with likelihood of reporting BBB, even when considering the influences of sociodemographic characteristics, learning modality, and experience of witnessing BBB. CONCLUSIONS: Findings of this study suggest that learning modality and perceived school fairness can meaningfully explain witnesses' likelihood of reporting BBB. Additional research should continue investigating how schools can encourage students to increase their likelihood of reporting and adopt the bystander response of reporting against BBB at school to ensure school health and safety. [ABSTRACT FROM AUTHOR]

Background: Cardiorespiratory fitness (CRF) plays a significant role in health and academic performance in youth. The purpose of this study was to examine the longitudinal relationship between CRF and academic performance from fifth to eighth grade among a large, diverse, and state‐wide cohort of students, and to determine the extent to which the relationship between change in CRF and academic performance is moderated by poverty status. Methods: CRF and academic performance data were obtained for a retrospective state‐wide cohort of 11,013 students with baseline (fifth grade, school year 2015‐2016) and follow‐up (eighth grade, school year 2018‐2019) data. Analysis of covariance was used to examine the association between changes in CRF over a 3‐year follow‐up period and eighth grade academic performance. Results: After adjusting for covariates, change in CRF and poverty status were positively and significantly associated with eighth grade academic performance. Poverty status did not significantly moderate the association between changes in CRF and academic performance. Conclusions: Schools should prioritize evidence‐based policies and programs that optimize students' access to high quantity and quality physical activity throughout the school day. Such efforts can improve and maintain student CRF and thus academic performance outcomes. [ABSTRACT FROM AUTHOR]

Background: Schools are essential public health partners for safeguarding students' health. Child Death Review (CDR) is one public health activity where collaboration with schools is integral for developing strategies to prevent child death but the degree of collaboration is unknown. This study assessed school participation in CDR and the prevalence of school problems in reviewed child death cases, comparing non‐suicide and suicide‐related deaths. Methods: Using the National Fatality Review‐Case Reporting System, we created a dataset of school‐aged children (5 to 20 years) whose death was reviewed from 2005 to 2017 and used frequencies, proportions, and chi‐squared statistics on selected measures. Results: Educational representatives infrequently participated in CDRs (24.9%). School records were rarely accessed for reviewed deaths (5.2%). Less than half (41.2%) of reviewed deaths had any school information and of these, 35.5% of children were indicated as having problems in school. Compared with non‐suicide deaths, a larger proportion of suicide deaths had school representatives attend CDRs (28.4% vs 24.1%, P <.0001), and access to educational records (4.2% vs 9.2%, P <.0001). Implications: Efforts are needed to address potential barriers to systems integration, including state policies and federal educational privacy laws. Conclusions: School participation in CDRs is lacking for both suicide and non‐suicide deaths. [ABSTRACT FROM AUTHOR]

BACKGROUND: Sexting is sending, receiving, or forwarding sexually explicit messages, images, or videos through electronic means. Research has examined sexting in high school and college students. This study seeks to add to the existing literature by exploring the nature of pressured or problematic sexting in middle school‐aged subjects. METHODS: We asked participants in public colleges in Massachusetts, Colorado, and Virginia, to recall their sexting‐related experiences in middle and high school. We utilized an online survey tool for data collection. We performed bivariate quantitative statistical analyses to examine attitudinal and behavioral differences, as well as motivations and consequences of adolescent sexting. RESULTS: The study revealed unique patterns of early‐onset sexting compared to sexting in later adolescence. Early‐onset adolescents typically start sexting before they become sexually active and are at a higher risk for poor outcomes associated with sexting, they are more likely to seek therapy. Early sexting is significantly more pressured than sexting in later adolescence. CONCLUSIONS: The study is an important contribution to the existing research on pressured sexting. Exploring pressured sexting at very early ages finds that early sexting activity is more likely pressured, creates more stress than later in life, and hence, it needs attention from school mental health professionals and education programs. The authors suggest that comprehensive sex education, including sexting should begin earlier than middle school to prevent risky online sexual behavior and provide for learning coping mechanisms for adolescents. [ABSTRACT FROM AUTHOR]

PURPOSE: Early in the COVID‐19 pandemic, there was a concern that cyberbullying incidents would increase as youth were spending more time online. Additionally, reports emerged that Asian American citizens were being disproportionately targeted due to the purported origination of the disease. The current study explores whether cyberbullying incidents increased among adolescents overall—and Asian American youth in particular—since the onset of the coronavirus. METHODS: Three unique national surveys of teens (aged 13–17, mean = 14.96) conducted in 2016 (N = 4742), 2019 (N = 4250), and 2021 (N = 2546) were analyzed to track experience over time with general cyberbullying, as well as cyberbullying based on race or color. Additionally, respondents were asked in 2021 whether they had been cyberbullied more or less since the start of the COVID‐19 pandemic. RESULTS: More youth have experienced cyberbullying since the beginning of the COVID‐19 pandemic, with Asian American youth most likely to report increased victimization during the pandemic. For example, in 2021, 23.2% of youth reported experiencing cyberbullying compared to 17.2% in 2019 and 16.7% in 2016. Among Asian American youth, 23.5% said they were cyberbullied because of their race in 2021, compared to 7.4% in 2019 and 13.9% in 2016. CONCLUSIONS: As more adolescents continue to spend more time online, cyberbullying victimization may increase across all racial groups. In the current politicized environment, Asian Americans may continue to be targeted because of their race. Schools and communities should augment existing implementations and pedagogy with more population‐specific approaches that are culturally relevant, culturally sustaining, and that reflect the unique lived experiences of Asian American youth. IMPLICATIONS AND CONTRIBUTION: The current study shows that more adolescents have experienced cyberbullying (both general and race‐based) since the start of the COVID‐19 pandemic. The increase in race‐based victimization was highest among Asian American youth. [ABSTRACT FROM AUTHOR]

Background: State‐level laws governing recess policies vary widely across the United States. We characterize the presence of such laws and assess their associations with child‐level outcomes. Methods: The presence of a state recess law was determined using the Classification of Laws Associated with School Students (CLASS) database. Parents of 6‐ to 11‐year‐old children reported physical activity, overall health, school absences, school‐related problems, and ability to make/keep friends as part of the National Survey of Children's Health (NSCH). Logistic regression was used to compare outcomes in states with and without recess laws cross‐sectionally in 2018 and between 2003 and 2011/2012 using a difference‐in‐differences analysis. Results: In 2018, 20 states had a law recommending or requiring recess. Cross‐sectionally, the odds of being physically active every day (odds ratio, 95% confidence interval: 2.8, 1.2‐6.5) and having no difficulty making or keeping friends (2.9, 1.2‐7.2) were significantly higher for children residing in states with versus without a recess law. There were no significant associations in the difference‐in‐differences model. Conclusions: Significant cross‐sectional associations in 2018 were not confirmed by a difference‐in‐differences analysis of two waves of the NSCH. Short follow‐up time and the apparent weakness of existing state laws warrant further assessment of state‐level recess law. [ABSTRACT FROM AUTHOR]

METHODS: Using the Theory of Planned Behavior (Ajzen 1991) as a theoretical framework, this study examined what administrators and teachers at a public elementary school located in a district in Northeast Georgia communicated as to their salient behavioral beliefs (attitude), normative beliefs (subjective norms), and control beliefs (perceived behavioral control) relative to the implementation of the district's written recess policy. RESULTS: The results of this study demonstrated that teachers new to the field and those certified in early childhood education were more supportive of implementing the practice. The results further demonstrated that more experienced teachers and those certified in elementary education were less supportive. IMPLICATIONS FOR SCHOOL HEALTH POLICY, PRACTICE, AND EQUITY: The findings in this study revealed that obtaining participant buy‐in was critical for the implementation and that targeted professional development would be a suitable vehicle for improving school health for students. CONCLUSIONS: The most cited reasons for support for the policy were an understanding that an unstructured break was beneficial for students and that participants considered it a non‐negotiable. The most cited reasons for a lack of support included more time needed for academics and a need for expanded behavioral consequences. [ABSTRACT FROM AUTHOR]

BACKGROUND: The Healthy Hunger‐Free Kids Act (HHFKA) of 2010 supported implementation of school gardens for promoting fruit and vegetable consumption. We examined school garden prevalence over time by school‐level factors during the period before and after the implementation of HHFKA. METHODS: Using data from the New Jersey Child Health Study, conducted in 4 low‐income New Jersey cities, prevalence of school gardens among K‐12 schools (n = 148) was assessed between school year 2010‐2011 and 2017‐2018. Multivariable analysis estimated changes in garden prevalence over time adjusting for school‐level factors. RESULTS: Overall, the sample included 97 elementary and 51 middle/high schools. Multivariable logistic regression showed that compared to 2010‐2011 (19%) a higher proportion of schools reported having a garden in 2013‐2014 (32%, p = 0.025). Over the entire study period, schools with majority Hispanic student enrollment had approximately half the odds of having a garden compared to schools with majority Black students (p = 0.036). CONCLUSION: School garden prevalence increased in the year immediately following the implementation of the HHFKA but this increase was not sustained over time. Future research should investigate the reasons for this decline and potential disparities by race/ethnicity. [ABSTRACT FROM AUTHOR]

BACKGROUND: Food insecurity (FI) rates in the United States are particularly high among households with children. This research set aims to analyze if high school students experiencing FI had higher risk for mental health and suicidal behaviors. METHODS: Using combined data from 11 states that conducted the 2017 Youth Risk Behavior Survey, a total of 26,962 and 24,051 high school students were used to estimate race/ethnicity and sex‐stratified prevalence ratios (PRs) from Poisson regression models. A single‐question was used to measure the exposure of FI and outcomes of mental health and suicidal behaviors. RESULTS: Overall, 10.8% of students reported FI. Students experiencing FI had increased risk for all mental health and suicide behavior outcomes, regardless of their race/ethnicity or sex. PRs ranged from 1.9 (95% confidence interval [CI]:1.8, 2.0) to 3.1 (CI: 2.7, 3.6). Among males, PRs for the association between FI and all outcomes were highest among non‐Hispanic black students (PRs ranged from 2.4 [CI: 1.7, 3.2] to 5.5 [CI: 2.3, 13.3]). Among females, PRs were highest among non‐Hispanic white students (PRs ranged from 1.9 [CI:1.7, 2.1] to 3.6 [CI:2.9, 4.5]). CONCLUSIONS: FI is consistently associated with mental health and suicidal behaviors among different subgroups of students. [ABSTRACT FROM AUTHOR]

Background: We evaluated the association between availability of specific physical activity (PA) spaces and PA practices among adolescents within Mexican high schools (HS). Methods: Data were collected through an online survey applied to principals or person in charge of 4023 Mexican HS during the 2015‐2016 school year. Adequate PA was defined as moderate to vigorous intensity PA for ≥60 minutes/day, ≥5 days/week, whereas PA‐specific spaces were considered those that were available and specifically designed/used for PA. HS demographic factors were explored as covariates. Associations were estimated using a logistic regression model. Results: From total participating HS, 83.10% had at least 1 PA‐specific space and 31.07% had adequate PA practices. A higher number of PA‐specific spaces was associated with greater adequate PA practices (33% to 61%). Possibilities for adequate PA increased when: physical education (PE) classes were led by a designated PE teacher (OR 2.39; 95%CI: 2.03‐2.83); the number of enrolled students was higher (OR 1.78; 95%CI, 1.43‐2.22 and OR 2.23; 95% CI, 1.71‐2.89, second and third tertile, respectively); HS financing sources were autonomous or private (OR 1.76; 95% CI, 1.19‐2.60); and HS were located in northern Mexico (OR 1.27; 95%CI, 1.02‐1.57). Conclusion: PA‐specific spaces, designated PE teachers, and financing sources are important factors in achieving adequate PA within Mexican high schools. [ABSTRACT FROM AUTHOR]

BACKGROUND: As a result of national lockdown due to the COVID‐19 outbreak, teachers were forced to suspend their classes and replace them with online teaching and home schooling. Additional stressors such as competing family responsibility have increased their worries and mental health problems. The aim of this study was to determine the impact of COVID‐19‐related worries on teachers' emotional symptoms, considering the mediating role of several protective factors. METHODS: A total of 614 Chilean teachers (94.60% women) participated in this study using a cross‐sectional design and incidental sampling method. Self‐report data was collected assessing emotional symptoms, COVID‐19‐related worries, life satisfaction, affect balance, and resilience. Descriptive analyses, Pearson's correlations, hierarchical regressions, and mediation models were conducted. RESULTS: The results indicated that emotional symptoms were associated with prepandemic physical and mental health problems, higher levels of worries and negative affect, as well as lower levels of life satisfaction and resilience. Results from the mediation models showed that the negative impact of COVID‐19‐related worries on emotional symptoms was alleviated by affect balance and resilience. CONCLUSIONS: These findings highlight the importance of addressing the risk and protective factors for teachers' mental health during exceptional situations such as the ongoing pandemic. [ABSTRACT FROM AUTHOR]

BACKGROUND: The closure of schools in response to COVID‐19 compromised access to essential meals for many students. The Emergency Meals‐to‐You program, a public/private partnership, was set up to address this challenge. More than 38.7 million meals were delivered between April and August 2020. This study explores lessons learned and identifies strategies for strengthening food access and security at schools and beyond. METHODS: Qualitative research methods were used. This included interviews and focus groups with participants involved in setting up and delivering the Emergency Meals‐to‐You program. Data were thematically analyzed using key phrases, ideas, and concepts, and interpreted. RESULTS: The program leveraged a multisectoral approach. Components relied on each other and included: schools, public/private partnership, eligibility, relationships, experience, centralized communication, food quality and branding, logistics, and transport. Strategies identified to strengthen food access focused on integration with emergency management structures, understanding food needs at the school level, building a fully procurable menu, and allowing distribution to be rapidly scaled. CONCLUSIONS: The lessons identified and strategies recommended provide a framework for working across the emergency management spectrum (school to national level) to strengthen food access and availability for students and their families affected by a pandemic, disaster, or crisis situation. [ABSTRACT FROM AUTHOR]

BACKGROUND: In Spring 2020, Georgia public schools implemented remote learning to manage the spread of COVID‐19. This study explores the effects of remote schooling on the learning of young children in Georgia during the early COVID‐19 pandemic from the perspectives of school administrators and essential working parents. METHODS: A qualitative exploratory study was conducted with eight school administrators and 26 essential working parents of children in kindergarten through third grades of two rural and two urban schools in Georgia. Data collection included online surveys, virtual interviews and focus groups. Descriptive analyses of the demographics provided context to emerging themes from qualitative data. RESULTS: Most school administrators and parents reported declines in student learning and academic behavior related to remote learning. Lack of Wi‐Fi, technology, and digital literacy were often cited as barriers to learning. Challenges with remote learning were amplified for students and parents of vulnerable groups. CONCLUSIONS: The findings of this study illustrate the need to institute policies, procedures, and supports to maximize schools' ability to safely offer in‐person learning during the COVID‐19 pandemic. Considerations should be made of the needs of essential working parents, vulnerable populations, and the digital divide. [ABSTRACT FROM AUTHOR]

BACKGROUND: School‐based health centers (SBHCs) provide health care to vulnerable youth. The purpose of the study was to identify characteristics of youth who use SBHCs with the highest frequency to understand their health needs and receipt of health services. METHODS: This study examined cross‐sectional survey data from adolescents in 3 urban school districts (n = 2641) to identify the characteristics of youth who use SBHCs with high frequency (10+ visits). Analyses included calculations of simple frequencies and percentages, chi‐square tests of significance and multivariate regression. RESULTS: High‐frequency SBHC users were more likely to have seriously considered attempting suicide (adjusted odds ratio [AOR]: 3.2), be sexually active (AOR: 6.8), and have been victimized at school (AOR: 2.2) compared to their peers who did not use the SBHC. High‐frequency SBHC users were also significantly more likely than their peers to report "always" getting mental health (AOR: 7.0) and sexual health (AOR: 6.6) care when needed, and having talked with a health care provider about their moods/feelings (AOR: 3.1) and how school is going (AOR: 3.2) in the past year. CONCLUSIONS: These findings hold important relevance to demonstrating the value of SBHCs in increasing vulnerable youth's access to health care, particularly in urban settings. [ABSTRACT FROM AUTHOR]

BACKGROUND: Tobacco use is known to worsen asthma management. No studies have investigated how trends in youth tobacco use and related harm perceptions vary by asthma status and sex. This study examined these trends among Florida high school students during 2012‐2018. METHODS: Data from the 2012, 2014, 2016, and 2018 Florida Youth Tobacco Survey were analyzed. Public high school students (grades 9‐12) with known asthma status were included along with their current tobacco product use, tobacco product harm perceptions, and demographics. Weighted multivariable logistic regression was used to assess trends in tobacco product use and harm perceptions and test differences by asthma status and sex. RESULTS: From 2012 to 2018, high school students with asthma had the slowest decline in cigarette and cigar use prevalence (asthma status‐time interaction p =.01) compared to those with no asthma. Cigarette and cigar smoking were perceived as less harmful over time, except among females with asthma who smoked cigarettes (p <.05). CONCLUSIONS: Those with asthma showed a slower decline and were more likely to smoke cigarettes. Results indicate that further public health efforts are needed to address tobacco use among high school students with asthma. [ABSTRACT FROM AUTHOR]

Background: There is a gap in the literature regarding data on sexting among youth under the age of 16 whereas the problems related to this practice could affect them more because of their ongoing development. This study aims to determine the prevalence rate and characteristics of sending one's own sexually related image among middle‐school teens. Methods: Data were obtained from a web‐based in‐school survey conducted between October 2019 and February 2020. The sample comprised 3006 (mean age 13.7; 50.2% males) 10th‐grade pupils in the canton of Vaud (Switzerland). Participants were asked "Have you ever sent a sexually related/sexy image of yourself?". Analysis of variance/chi‐square tests and multinomial regression analyses were used to compare the groups. Results: Overall, 93.0% reported never, 3.7% once and 3.3% several times. No gender differences were found. Sending was associated with older age, low academic performance, cyberbullying victimization and reception of unsolicited sexually related images. Conclusions: Education and health professionals should be aware that it is necessary to discuss the theme, perhaps with a more global approach including pressure, consent, exchange of nonsexual images, and so on from an early age. The context and reasons for sending remain to be explored, particularly to determine if the pressure is greater at this age. [ABSTRACT FROM AUTHOR]

BACKGROUND: To inform prevention strategies, this study provides incidence, factors, and actions taken when a suspected concussion occurred in K‐12 schools in Utah. METHODS: Data were collected using Utah's Student Injury Reporting System (SIRS) from the academic years 2011‐2012 to 2018‐2019. SIRS is a unique online system that tracks injuries that occur in the school setting among K‐12 students in Utah. Descriptive statistics were computed to characterize students with a suspected concussion. Chi‐square (χ2) analysis looking at characteristics by school level was also conducted. RESULTS: Over 63,000 K‐12 students in Utah sustained an injury at school during the study period. Suspected concussions comprised 10% of all injuries. The prevalence of concussions was highest among males (60.6%) and elementary school students (42.6%) and most often occurred outdoors (57.6%) or on a playground/playfield (33.9%), and in sports‐ and recreation‐related activities (75.1%) (specifically contact sports, 24.0%). Most students with a suspected concussion were absent 1 day or less from school (71.4%) but about 68% were seen by a medical professional. Further, there were differences by school level. Females and students playing contact sports had a higher percentage of suspected concussions as school level increased, whereas males and concussions sustained during school hours had a lower percentage of suspected concussions as school level increased. CONCLUSIONS: SIRS enables schools in Utah to identify groups at risk for concussion, as well as activities most commonly associated with these injuries, within the school environment. Using this information, schools may implement targeted prevention strategies to protect students. [ABSTRACT FROM AUTHOR]

ABSTRACT BACKGROUND As members of interdisciplinary teams, school nurses provide behavioral health services. Studies indicate that school nurses may lack sufficient continuing education in adolescent behavioral health and in the management of behavioral health emergencies, specifically. We conducted this study to describe the adolescent behavioral health emergencies managed by school nurses. METHODS We used data from a New Mexico public school nurse workforce survey to describe the involvement of school nurses in managing adolescent behavioral health emergencies. We included all respondents who self-identified as working in a secondary school (N = 186). We conducted descriptive analyses. RESULTS Two thirds of survey respondents had provided emergency management in the prior school year for child abuse or neglect, depression, and violence at school. Over 40% had provided emergency management for a suicidal student in the prior school year. Although almost 80% of respondents identified 'violence at school' as a very important continuing education topic, 40% reported having received continuing education on this topic in the prior 5 years. CONCLUSIONS In New Mexico, public school nurses provide substantial amounts of emergency management for adolescent behavioral health problems. Continuing education received by school nurses on behavioral health emergencies may not be commensurate with their clinical responsibilities. [ABSTRACT FROM AUTHOR]

BACKGROUND: Menstrual hygiene management is an important public health issue for adolescents. The objective of this study was to explore teacher perceptions and experiences addressing adolescent menstruation experiences at school and examine their perception of the impact of menstruation on student learning. METHODS: Teachers in a Midwest school district participated in an online survey about their perceptions of adolescent school‐based menstruation experiences, including: experience and comfort‐level with providing menstruation assistance, presence of menstrual products in classroom/office for students, perceptions about adolescent school‐based menstruation experiences, and perceptions on the impact of menstruation on student learning. RESULTS: Two hundred and nine teachers participated in this study. Teachers perceived students' school‐based menstruation experiences to be mostly negative, stressful, embarrassing, and focused on concealment. Teachers described school‐based menstruation events as a distraction to learning and responded by offering emotional support and menstrual products, typically purchased by teachers. CONCLUSION: Teachers' negative perception of about menstruation and distractions in the classroom are amplified by social norms associated with overall menstruation‐related stigma. Findings emphasize the importance of educating teachers on how to more positively address student menstruation experiences to foster a more supportive environment conducive to learning for these students. [ABSTRACT FROM AUTHOR]

BACKGROUND: Little is known about the effectiveness of school district concussion policies on reducing the concussion prevalence among students. METHODS: Data from the 2016 School Health Policies and Practices Study and 2017 Youth Risk Behavior Survey for 10 school districts were linked. The outcome variable was having a sports‐ or physical activity‐related concussion during the 12 months before of the survey. Exposure variables were 2 district policies, including district‐funded professional development and prioritizing return to the classroom before returning to athletics. Logistic regression models estimated the odds of a concussion among students in districts with one, both, or neither policy (referent). RESULTS: In districts with district‐funded professional development, the odds of students self‐reporting ≥2 sports‐ or physical activity‐related concussions were 1.4 times higher than in districts with neither policy. In districts with a policy prioritizing a return to the classroom before returning to athletics, the odds of students self‐reporting ≥2 concussions were significantly lower (OR = 0.6) than in districts with neither policy. CONCLUSION: School district concussion policies may have positive effects by identifying and reducing multiple concussions among students. [ABSTRACT FROM AUTHOR]

BACKGROUND: We present results of the development and feasibility testing of CATCH Healthy Smiles, a school‐based oral health program, among children in grades K‐2 in Houston, Texas. METHODS: Study design was cross‐sectional (N = 2 schools; N = 125 parent‐child dyads; 31 kindergarteners, 42 first graders, and 52 second graders). CATCH Healthy Smiles program was implemented by trained school teachers in the 2016‐2017 school year. Trained dentists conducted dental assessments to measure dental caries increment score (d3mfs). Parent‐reported 24‐hour dietary recalls and surveys assessed child and parent behavioral, environmental, and psychosocial factors. Logistic regression analysis assessed factors associated with caries experience adjusting for covariates. RESULTS: Of the 113 children with complete dental assessments, 54% children in grade K, 62% in first grade, and 73% in second grade had caries experience. Children with caries experience had a higher body weight (AdjOR = 1.13, 95% confidence interval [CI]: 1.02‐1.29), were less likely to be girls (AdjOR = 0.22, 95% CI: 0.05‐0.82), had greater odds of difficulty drinking hot or cold beverages because of dental problems (AdjOR = 13.13, 95% CI: 1.09‐275.14), greater frequency of consuming sugar‐sweetened beverages (AdjOR = 11.53, 95% CI: 2.10‐87.19), greater odds of receiving government assistance (AdjOR = 14.62, 95% CI: 2.74‐119.81), and lower odds of seeing a dental provider (AdjOR = 0.11, 95% CI: 0.02‐0.45). Process evaluation showed that 100% of the CATCH Healthy Smiles lessons and activities were taught in the two schools with a high degree of program fidelity and acceptability across the schools, children, and parents. CONCLUSIONS: These data will be used to conduct a subsequent fully powered cluster randomized controlled trial. [ABSTRACT FROM AUTHOR]

BACKGROUND Low‐income and racial/ethnic minority students often face distinct challenges in attending school eading to lower academic performance, low graduation rates, and overall, an indicator of diminished long‐term social and financial stability. Chronic absenteeism is a national problem and to address this, a better understanding of risks and points of intervention for the students most at risk is needed. This cross‐sectional study sought to assess risks and protective factors associated with chronic absenteeism in a predominantly low‐income minority school district in Southern. METHODS: Conducted in southern California, students (N = 24,439) ages 9 to 21 years were recruited. A logistic regression was used to assess the role poor physical and mental health, safety, bullying, and family risk factors attributed to chronic absenteeism. RESULTS: Results revealed that asthma (odds ratio [OR] = 1.35, p <.001), being overweight/obese (OR = 1.38, p <.01), presence of family risk factors (OR = 1.49, p <.001), bullying (OR = 0.84, p <.05) and perceptions of safety at school (OR = 1.24, p <.05) increased the odds of chronic absenteeism, while protective factors such as support (OR = 1.30, p <.001), increased sleep (OR = 0.96, p <.001) and positive growth mindset (OR = 0.96, p <.001), mitigated it. CONCLUSION: This study not only identifies risk but protective factors worth adhering to, to promote school attendance. Future research should further examine the role of mental health in chronic absenteeism. [ABSTRACT FROM AUTHOR]

BACKGROUND Child well‐being, which includes physical, mental, and social health, has a critical effect on academic performance. Schools face many challenges in meeting needs for child well‐being. Schools in low‐resource areas, including the Mississippi Delta, face greater challenges when meeting student needs. METHODS: Eleven focus groups with middle school students and 12 interviews with teachers, staff, and administration in one Mississippi Delta middle school were completed in 2019. The Social Ecological Model and Theory of Organizational Readiness for Change were used as a framework for the study. RESULTS: Focus group data with middle school students and interviews with teachers, staff, and administrators show that academic stressors play a major role in student well‐being; yet, teachers, staff, and administrators face immense pressure to achieve high test scores. However, students seem to be encouraged by a positive school environment, which could help minimize some stressors. CONCLUSIONS: It seems that small improvements to the school environment could have a significant effect on student well‐being, especially when school infrastructure and limited resources do not support comprehensive changes. [ABSTRACT FROM AUTHOR]

BACKGROUND: Transgender youth report high rates of negative experiences in schools. Using a lens of minority stress, this study sought to examine in‐school experiences of transgender youth to understand youth coping and to identify key opportunities for improving school environments for transgender youth. METHODS: Participants included 41 youth across 33 in‐depth interviews (Mage = 21.7) and two focus groups (N = 8; Mage = 17.3). Thematic analysis was used to analyze data. Themes related to stress, coping, and facilitators/barriers to stress/coping were derived and coded. RESULTS: Distal stressors, such as structural discrimination and prejudice events, were found to contribute to the exclusion of transgender youth from school life, while proximal stressors, such as concealment and expectations of rejection, reinforced transgender youth's feelings of personal isolation. Participants expressed coping with both challenges by advocating for inclusion through direct action with teachers and administrators and seeking/finding connection with trusted staff and peers. CONCLUSIONS: Findings suggest that creating safe and supportive environments at school for transgender youth is an attainable goal, as all identified barriers to inclusivity and connection were modifiable. By considering the needs of transgender youth in policies and programming, schools may improve climate for and wellbeing of transgender students. [ABSTRACT FROM AUTHOR]