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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]

BACKGROUND: This paper presents the process taken by a nonprofit educational organization to create authentic evaluation tools for Food Education in K‐12 schools. Development was a collaborative effort between organization staff and teachers during an Evaluation Summit. The program background, development of the Summit, and plans for post‐Summit work continuation are described. The Summit included 14 teacher participants (3‐4 per grade band in preK‐1, 2‐5, 6‐8, 9‐12). METHODS: The process of tool development was captured via direct observations and analysis of artifacts (eg, participants' brainstorming chart paper, online development documents) to identify themes in successful approaches and challenges. Additional post‐Summit activities were also captured via surveys and artifacts. Outcomes of this work are outlined, including the challenges in carrying out the creation of authentic assessments that accurately reflect the classroom teaching experience, and the value of in‐person community building in the Food Education space. RESULTS: Key findings relate to the importance of in‐person collaboration amongst teachers, centering students in evaluation, and equity and accessibility in tool development. CONCLUSIONS: Although outlining challenges and outcomes was not an a priori goal of this work, it provides important information for others working in the education nonprofit space—especially as it pertains to new approaches to classroom evaluation. [ABSTRACT FROM AUTHOR]

BACKGROUND: Sexual education programs in the United States are rooted in inequitable structures and are often inadequate at educating marginalized student groups such as students of color, Lesbian, Gay, Bisexual, Transgender, Queer (LGBTQ+), women, and disabled students. CONTRIBUTIONS TO THEORY: Current sexual education is irregularly implemented and often excludes or misrepresents the experiences of students with marginalized identities. This theoretical paper specifically discusses ways that sexual education has been harmful or exclusionary for marginalized student groups and how a shift toward making sexual education inclusive and equitable will improve outcomes for students of all identities. IMPLICATIONS FOR SCHOOL HEALTH POLICY, PRACTICE, AND EQUITY: This paper discusses several recommendations on improving access to equitable sexual health education for all students including reviewing and improving sexual education curriculum and delivery, as well as the need for additional research focused on this topic. CONCLUSIONS: This article provides an overview on the current sexual education system, its inadequacies, and how comprehensive sexuality education programs can be leveraged as a tool for equity for students of all backgrounds, but particularly those who are underrepresented in sexual education curricula. [ABSTRACT FROM AUTHOR]

BACKGROUND: Youth violence, victimization, and bullying are pervasive in schools across the United States and are detrimental for learning and healthy development. K‐12 school safety is an increasingly urgent issue to research and understand from multiple perspectives. Physical and psychological safety in school is linked to better student and school outcomes and is fundamental to fostering well‐being and prosocial behavior. METHODS: Despite research demonstrating positive outcomes associated with school safety, there is no comprehensive conceptual model in the literature that considers precursors, strategies, mechanisms, and outcomes of school safety together. The current paper presents an equity‐centered comprehensive model of school safety, which is intended as a holistic representation of the multiple factors and pathways that contribute to school safety and positive youth development. RESULTS: This model can guide research and practice through an equity‐centered and comprehensive approach. This model can enable practitioners, researchers, and policymakers to make informed decisions and reach consensus regarding planning and decisions related to reducing violence and establishing supportive school environments. CONCLUSION: Our model suggests that a comprehensive approach can ensure the safety and well‐being of students and staff. By thinking ecologically, schools, communities, and stakeholders can ensure that all aspects of the school context are included in school safety. [ABSTRACT FROM AUTHOR]

Background: More than 20 million children in the United States lack access to primary health care. Practice Learning: Research shows that students with regular access to physical and mental health services have fewer absences, are more social, less likely to participate in risky behaviors, have improved focus and higher test scores. Implication For School Health Policy, Practice, And Equity: School‐based health centers (SBHCs) can be an important, valuable and viable health care delivery option to meet the full‐range of primary health care needs of students where they spend the majority of their wake hours, ie, in school. Children in rural and other underserved communities, as well as those underinsured, non‐insured, economically challenged, underserved, and the most vulnerable among us are especially at risk. Conclusions: This paper discusses the history, value, and importance of SBHCs from myriad perspectives, including physical and emotional wellbeing, academic and social success, and the promotion of a positive transition to adulthood. In addition, the authors' experiences that resulted in building the first SBHC in the Mid‐Hudson Valley Region of New York State are shared. These experiences form the foundation for creating an important roadmap for individuals and school leaders that are interested in bringing a SBHC to their school and district. [ABSTRACT FROM AUTHOR]

Background: Anaphylaxis is a life‐threatening allergic reaction with significant risk for children with allergies. Access to potentially life‐saving medication is critical for these children. This review aims to describe state laws and policies guiding stock epinephrine in schools for allergic or anaphylactic events and detail recommendations for best practices. Methods: This paper is a comprehensive review of the 50 states and the District of Columbia's (DC) laws and policies for stock epinephrine at schools for children in pre‐kindergarten through 12th grade. Results: All 50 states and DC allow undesignated epinephrine in schools to use for allergic or anaphylactic reactions. A key difference arises in whether states allow (N = 37) or mandate (N = 14) that schools stock epinephrine. States exhibit differences in the body responsible for developing stock epinephrine policy (N = 48), along with stakeholders responsible for developing procedures (N = 30) and implementing them (N = 19). Differences also exist in state epinephrine procurement, administration, training, and liability. Conclusions: This review of stock epinephrine laws and policies highlights the significant variation in state legislation despite widespread adoption. Only one‐quarter of states mandate that schools have stock epinephrine available for emergency use, underscoring need for a more unified approach with consistent guidelines, comprehensive training, and possible funding for implementation. [ABSTRACT FROM AUTHOR]

BACKGROUND Mental health services in the United States public schools are an important component of the academic success of a student. Not all schools, however, have the necessary personnel and funding to offer such services. METHODS: In this paper, we provide an analysis of data collected from schools in 3 geographic locations. Comparisons were made of the availability of personnel to assess and treat mental health disorders in students enrolled in city, urban, and suburban schools, with over 10,000 schools represented. The data were part of the 2015 to 2016 School Survey on Crime and Safety. RESULTS: Accessibility of mental health practitioners and reasons that limited efforts of a school to provide the services were assessed. Statistically significant differences were identified by school location, demonstrating that those in rural communities were most challenged providing diagnostic assessment and treatment for students by school mental health professionals, for several reasons. CONCLUSIONS: Increased state and county funding to support mental health practitioners in public high schools is one suggestion to address mental health disorders in students. Other strategies are offered for timely and appropriate diagnoses and treatment for mental health disorders that may impact the quality of life of a student for a lifetime. [ABSTRACT FROM AUTHOR]

ABSTRACT: BACKGROUND: Asthma has no known cure, and though manageable, it disrupts the everyday lives of over 6 million US children. Because children spend more than half of their waking hours in school, students must be able to carry and administer their inhaler at school to manage their asthma. METHODS: This policy paper is a comprehensive review of all 50 states and the District of Columbia's laws and policies for the self‐carry and administration of quick‐relief asthma inhalers among children in prekindergarten through 12th grade. RESULTS: All states permit students to carry and administer their inhalers at school, although each state differs in their development and implementation of policies for asthma self‐management at school. This review examines how states regulate self‐carry policies by looking at policy development, regulated school systems, relevant stakeholders, required medical records, and school liability. CONCLUSIONS: Each state's laws have nuances that create gray areas, increasing the potential of misinterpreted or incorrectly implemented policies for asthma self‐management at school. As a result, children may not have immediate access to their inhaler for symptom management or in an emergency. State policymakers should reform current laws to remove barriers for students to carry and use inhalers at school. [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]

Background: The school environment, consisting of the physical environment and social‐emotional climate (SEC), plays a crucial role in both student and employee health; however, there is a lack of recent literature synthesizing school environment interventions in K‐12 settings. We describe updated evidence about school environment interventions to support K‐12 student and employee health in the United States. Methods: A 2‐phase search included a review of reviews (2010‐2018), followed by a search for individual articles (2010‐2020) that targeted school physical environment and/or SEC to address physical activity (PA) and/or nutrition. We also investigated how nutrition and PA interventions with an SEC component improves social‐emotional and/or mental health outcomes. Because research on dietary and PA behaviors for school employees is limited; we included studies on other worksites (eg, hospitals and offices) to provide insight for school employees. Findings: We identified 40 articles describing 40 unique studies and 45 interventions and grouped them by intervention type. Physical environment interventions demonstrated significant and positive nutrition and PA behavioral outcomes for students; outcomes among employees were mixed. Interventions with SEC components reported improvements in some mental health outcomes. Implications: The school environment can affect dietary and PA behaviors as well as mental health for students and employees. Conclusions: Establishing healthy school environments can support student and employee PA, dietary behaviors, and mental health. [ABSTRACT FROM AUTHOR]

Background: Schools play a vital role in student health, and a collaborative approach may affect health factors such as physical activity (PA) and nutrition. There is a lack of recent literature synthesizing collaborative approaches in K‐12 settings. We present updated evidence about interventions that used a coordinated school health approach to support K‐12 student PA and nutrition in the United States. Methods: A 2‐phase literature review search included a search of systematic reviews for individual qualifying studies (2010‐2018), followed by a search for individual articles (2010‐2020) that evaluated a coordinated approach or use of school wellness councils, committees, or teams to address PA and/or nutrition. Results: We identified 35 articles describing 30 studies and grouped them by intervention type. Interventions demonstrated promising findings for environmental changes and student dietary and PA behaviors. Implications: Coordinated and multicomponent interventions demonstrated significant improvements or null results, indicating that implementation of programs and/or policies to promote healthier eating and PA practices may support and do not appear to hinder environmental or behavioral outcomes. Conclusions: Schools can use a coordinated approach to implement opportunities for PA and nutrition; this may influence students' PA and dietary behaviors. [ABSTRACT FROM AUTHOR]

BACKGROUND: School efforts to promote health among students are more successful when families and community members are involved. METHODS: We conducted a scoping review to summarize and categorize family and community engagement strategies used in US school and out‐of‐school time (OST) interventions to address physical activity (PA) and nutrition in kindergarten through 12th grade students. RESULTS: The National Network of Partnership Schools' Six Keys to Success framework was useful in organizing the types of family and community engagement strategies used in included interventions. Many interventions used multiple family and community engagement strategies, with the most common being communicating with families and community members; providing support or education to families; and collaborations among school/OST program and community to support students and their families. CONCLUSIONS: This review identified six common family and community engagement strategies used in school and OST interventions for PA and nutrition. Including family and community engagement strategies in school and OST interventions could play an important role in maximizing support, resources, and expertise to promote healthy behaviors among all students. [ABSTRACT FROM AUTHOR]

BACKGROUND: Changes to policies at the federal, state, and local levels over the last decade have influenced the school nutrition environment and services. METHODS: This systematic review includes an analysis of individual research articles and government reports published from 2010 to 2021 that examine interventions to improve the school nutrition environment and services and increase the availability, selection, and consumption of healthier foods and beverages in K‐12 schools in the United States. RESULTS: Nutrition standards for school meals and food outside of meals improved access to healthier options in school. Providing school nutrition professionals with professional development, improving the palatability of school meals, offering taste tests, pre‐slicing fruit, providing recess before lunch, offering incentives for trying healthier options, and providing access to drinking water resulted in increased selection and consumption of healthier items. There were inconclusive or mixed findings for some intervention strategies including adequate seat time for meals. CONCLUSIONS: Despite demonstrated improvements to school meal programs and competitive foods, more work is needed to change the selection and consumption of healthier options among K‐12 students. Schools can use multiple interventions to improve the school nutrition environment and services and help students adopt food and beverage choices that support health. [ABSTRACT FROM AUTHOR]

BACKGROUND: When children and youth feel connected to their school, family, and others in their community, they are less likely to engage in risky behaviors and experience negative health. Disruptions to school operations during the COVID‐19 pandemic have led many teachers and school administrators to prioritize finding ways to strengthen and re‐establish a sense of connectedness among students and between students and adults in school. METHODS: We conducted a systematic search of peer‐reviewed literature that reported on US‐based research and were published in English from January 2010 through December 2019 to identify classroom management approaches that have been empirically tied to school connectedness‐related outcomes in K‐12 school settings. FINDINGS: Six categories of classroom management approaches were associated with improved school connectedness among students: (1) teacher caring and support, (2) peer connection and support, (3) student autonomy and empowerment, (4) management of classroom social dynamics, (5) teacher expectations, and (6) behavior management. IMPLICATIONS FOR SCHOOL HEALTH POLICY, PRACTICE, AND EQUITY: Prioritizing classroom management approaches that emphasize positive reinforcement of behavior, restorative discipline and communication, development of strong, trusting relationships, and explicitly emphasize fairness has potential to promote equitable disciplinary practices in schools. CONCLUSIONS: Classroom management approaches most linked to school connectedness are those that foster student autonomy and empowerment, mitigate social hierarchies and power differentials among students, prioritize positive reinforcement of behavior and restorative disciplinary practices, and emphasize equity and fairness. [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]

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 recess laws are recommended to encourage adequate and equitable access to recess and its benefits, but the downstream effects of state recess laws are unknown. We examined the association of state recess laws with district‐level policy and school recess provision. METHODS: This is cross‐sectional analysis of the School Health Policies and Practices Survey, a US nationally representative sample of school districts (2016) and schools (2014). State‐level recess laws were coded as none, recommend, or require recess. Logistic and linear regression were used to examine the association between state law with district policies and school recess provision, respectively. Data from 2000 are presented to highlight changes in recess policy and provision over time. RESULTS: The odds of a district policy requiring recess were 2.22 and 2.34 times greater when state recess law recommended or required recess, respectively, compared to states with no recess policy. There were no significant differences in school‐level recess provision by state recess law but point estimates from 2000 indicated states without a law had the largest declines in recess provision over time. CONCLUSIONS: State recess laws are positively associated with district‐level policy. Effects at the school level are unclear and continued surveillance is needed. [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]

BACKGROUND: Play is essential for child growth and development, and may have academic and social‐emotional implications. To understand the relationship between in‐school play opportunities and academic achievement (AA) and social‐emotional well‐being among elementary school students, a systematic review of the current in‐school play literature was conducted. METHODS: Keywords were input across 7 search engines. After screening, 20 peer‐reviewed publications related to play, AA, and social‐emotional well‐being met the inclusion criteria for this review. FINDINGS: Across the included publications, recess was the only in‐school play opportunity assessed. Overall, student behavior and social‐emotional outcomes benefited from more recess while mixed results were found between recess participation and academic outcomes. However, more recess was not detrimental to AA. CONCLUSION: The findings from this review support the need for recess as part of a whole child approach to education that may mitigate the negative outcomes of sitting through long periods of instruction. More research is needed on the AA and social‐emotional effects of other types of in‐school play opportunities (ie, centers, play stations, and other breaks). Findings from this review indicate that recess is a necessary part of the elementary school day. [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: Exposure to injury and violence early in life increases the risk of experiencing injury and violence later in life. In 2019, the top 3 leading causes of death among 15‐ to 18‐year‐olds in the United States were unintentional injury, suicide, and homicide. This study examines the extent to which schools promote injury and violence prevention. METHODS: This study examined injury‐ and violence‐related school policies and practices using nationally representative data from the 2014 School Health Policies and Practices Study. The social ecological model served as the theoretical framework to identify level of impact. RESULTS: For many injury‐related topics, more than 75% of schools nationwide had relevant policies and practices to address those topics. However, this study showed differences in schools' injury‐related policies and practices by urbanicity. CONCLUSIONS: Understanding and identifying gaps in school policies and practices is essential for reducing and preventing the injury and violence children experience. Collecting data on school policies and practices allows for better monitoring and evaluation to determine which are efficacious and aligned with the best available evidence. [ABSTRACT FROM AUTHOR]

BACKGROUND: Little is known about trends in implementing skills‐based instruction in US schools, specifically for sexual and reproductive health (SRH). We examined state‐level trends in the percentage of US secondary schools teaching SRH skills in a required course in grades 6 to 8 and 9 to 12. METHODS: Representative data from 35 states participating across 6 cycles of School Health Profiles (2008‐2018) was analyzed. The prevalence of teaching four SRH skills was assessed through lead health education teacher self‐administered questionnaires. Logistic regression models examined linear trends in the percentages of schools teaching SRH skills in grades 6 to 8 and 9 to 12. Trends were calculated for states with weighted data (response rates ≥70%) for at least 3 cycles, including 2018. RESULTS: During 2008 to 2018, the median percentage of schools addressing each SRH skill ranged from 63.5% to 69.7% (grades 6‐8) and 88.2% to 92.0% (grades 9‐12). Linear decreases in SRH skills instruction were more common for grades 6 to 8 than grades 9 to 12; linear increases were comparable for both groups. Most states demonstrated no change in the percentage of schools teaching SRH skills in grades 6 to 8 and 9 to 12. CONCLUSIONS: Limited changes and decreases in SRH skills instruction in US secondary schools suggest efforts to strengthen SRH education are needed. [ABSTRACT FROM AUTHOR]

BACKGROUND: Receiving treatment for behavioral health disorders remains problematic due to profound provider shortages. Telebehavioral health services are effective for providing quality care, but research literature on these services in schools is limited. METHODS: Data were collected during Fall 2019 and Spring 2020 semesters on all students receiving telebehavioral health services from 15 school‐based telehealth programs across the U.S. RESULTS: From Fall 2019 to Spring 2020, 62 schools providing services during both periods increased the number of students served from 396 to 745, increased the average number of encounters per student from 2.4 to 4.1, increased the percentage of encounters delivered by clinical social workers, mental health counselors, and clinical psychologists (all p <.001), and increased the use of individual counseling, family counseling, and group counseling (all p <.001). Schools that initiated the service in Spring 2020 (n = 25) averaged 6.5 encounters for the 301 students receiving services, delivered mostly by clinical social workers or professional counselors, using individual counseling. CONCLUSION: Overall, data indicate programs significantly increased both behavioral services provided to their ongoing schools and increased the number of schools served. Undoubtedly telebehavioral health care delivery provided a swift and necessary response to the challenges posed by the growing pandemic threat. [ABSTRACT FROM AUTHOR]

BACKGROUND Being bullied online is associated with being bullied in school. However, links between online bullying and violence‐related experiences are minimally understood. We evaluated potential disparities in these associations to illuminate opportunities to reduce school‐based violence. METHODS: We used five cohorts of Youth Risk Behavior Survey national cross‐sectional data (2011‐2019, Ntotal = 73 074). We used survey‐weighted logistic and multinomial models to examine links between online bullying and five school‐based violence‐related experiences: offline bullying, weapon carrying, avoiding school due to feeling unsafe, being threatened/injured with a weapon, and physical fighting. We examined interactions by sex, race/ethnicity, and sexual identity. RESULTS: Being bullied online was positively associated with all offline violence‐related behaviors. Groups with stronger associations between online bullying and physical fighting, including boys, adolescents whose sexual identity was gay/lesbian or unsure, and many adolescents of color (Black, Hispanic/Latino, and Asian/Pacific Islander adolescents), had stronger associations between online bullying and either weapon carrying or avoiding school. CONCLUSIONS: Online bullying is not an isolated harmful experience; many marginalized adolescents who experience online bullying are more likely to be targeted in school, feel unsafe, get in fights, and carry weapons. Reduction of online bullying should be prioritized as part of a comprehensive school‐based violence prevention strategy. [ABSTRACT FROM AUTHOR]

BACKGROUND: Parental Medicaid eligibility has been shown to be linked to positive academic and school outcomes for children. However, the impact of adult Medicaid expansion on children's school absenteeism is largely unexplored in the literature. The aim of this study was to examine whether Medicaid expansion for adults under the Affordable Care Act (ACA), affected school absenteeism of children. METHODS: This study used data from the National Survey of Children's Health 2016 to 2017 and the difference‐in‐differences method. RESULTS: The decrease in the predicted probability of missing 11 or more school days in Louisiana, after Medicaid expansion, among school‐going children from low‐income families, was greater by 18 percentage points (p =.007), as compared to the decrease in the predicted probability of missing 11 or more school days in the neighboring nonexpansion states of Texas and Mississippi. CONCLUSION: The positive impacts of Medicaid expansion are not limited to adults, but also extend to children's school absenteeism. [ABSTRACT FROM AUTHOR]

BACKGROUND The most recent Farm to School (FTS) Census reported that of the 42% of US schools that participate in FTS, 77% procure food locally. In 2019, Colorado joined many other states in passing legislation that provides per‐meal incentives for purchasing local foods. However, little is known about how these incentives impact procurement decisions of school Food Service Directors (FSDs), and purported benefits of FTS cannot accrue without additional local purchases by school FSDs. METHODS: We constructed a unique, primary dataset of fresh fruit and vegetable purchases from 18 months of school invoices in 3 Northern Colorado school districts and parameterized an optimization model that mimics FSD decisions. Subsequently, we simulated how procurement is impacted by local food reimbursements. RESULTS: Assuming 2017 and 2018 purchasing behavior, at $0.05 per meal reimbursement, FSDs would increase fresh fruit and vegetable purchasing by 11‐12% in August‐October, but by only 0‐1% in November‐December, likely due to seasonality constraints. CONCLUSIONS: While an increase in FTS procurement was expected, the magnitude of the potential increase when aligned with the Colorado growing season is notable. This work underscores that adequately funded reimbursement‐based FTS policies can increase FTS procurement without disrupting normal cost‐minimizing purchasing behavior. [ABSTRACT FROM AUTHOR]

BACKGROUND: Prevention of early age initiation of cannabis use is a national priority, highlighting the importance of identifying cannabis‐specific attitudes, norms, and perceived behavioral control in relation to initiation age. METHODS: Data were from the NEXT Generation Health Study, a national longitudinal sample of US adolescents followed from 10th grade (N = 1850). Cannabis‐specific attitudes, norms, and perceived behavioral control were assessed at 10th grade. Age of first use was reported retrospectively 2‐3 years after high‐school and participants were categorized as early initiators (<14 years; 3.8%), high‐school (HS) initiators (14‐18 years; 35.6%), post‐HS initiators (>18 years; 8.3%), or never users (52.3%). RESULTS: Relative to never users, early initiators were more likely to endorse pro‐use attitudes (AOR [adjusted odds ratio] = 2.39, 95% confidence interval [CI] = 1.27‐4.50), less disapproving parental attitudes toward use (AOR = 2.50, 95% CI = 1.45‐4.28), higher cannabis use among friends (AOR = 3.81, 95% CI = 2.21‐6.60), and higher ease of access (AOR = 2.10, 95% CI = 1.14‐3.87); HS initiators were similarly more likely to report less disapproving attitudes toward use (AOR = 1.55, 95% CI = 1.25‐1.91), higher cannabis use among friends (AOR = 2.81, 95% CI = 2.18‐3.65), and higher ease of access (AOR = 1.66, 95% CI = 1.21‐2.28). CONCLUSIONS: Earlier cannabis initiation was associated with more favorable cannabis attitudes, subjective norms, and perceived behavioral control, highlight these variables as potential intervention targets. [ABSTRACT FROM AUTHOR]

BACKGROUND: Frameworks such as the WSCC model provide evidence‐based guidance for addressing school health at the school, district, and regional level. However, frameworks do not implement themselves; they require the mobilization and collaboration of stakeholders within communities and an understanding of the unique resources and barriers within each context. Furthermore, addressing school health presents a complex systems problem. METHODS: Community‐based system dynamics (CBSD) is a participatory approach for engaging communities in understanding and changing complex systems. We used a descriptive multiple case study design to evaluate how and why CBSD was used as a tool for stakeholders to engage with the complexity of school health. RESULTS: We analyzed 3 cases to understand how these methods were used to enhance collaboration, analysis, and community action at multiple levels, including in 2 school districts, with a city‐wide stakeholder committee, and with a group of high school students. CONCLUSIONS: Community‐based system dynamics presents a promising approach for building shared language and ownership among stakeholders, tailoring to local community contexts, and mobilizing stakeholders for action based on new system insights. We close with a discussion of unique opportunities and challenges of expanding the use of CBSD in the field of school health. [ABSTRACT FROM AUTHOR]

BACKGROUND: Few studies examine why rural public schools have weaker policies and practices related to school nutrition environments compared to their urban counterparts. It is important to understand this disparity because federal school meal standards aim for children to access health‐promoting nutrition environments. In this study, we identify challenges and opportunities for the implementation of school meal standards in rural high schools. METHODS: We interviewed 38 rural school professionals from 22 high schools across 7 states. School professionals included food service directors, principals, school nurses, and teachers. Team coding in Atlas.ti Qualitative Data Analysis software v8 and principles of comparative analysis were employed to generate themes related to challenges and opportunities. RESULTS: Overall, school professionals described improvements with implementation experiences and student acceptance over time. Key challenges included the negative influences of home and community food environments and limited staff size and capacity. Key opportunities involved joining co‐ops to enhance purchasing power, leveraging state technical assistance, and forming external partnerships. CONCLUSIONS: This study offers insights from a broad range of rural school professionals' implementation experiences. The findings can inform governments and technical assistance agencies working with rural schools and school districts to facilitate implementation and sustainability of initiatives. [ABSTRACT FROM AUTHOR]

BACKGROUND: Whether parental permission of alcohol and other drug use in a home environment is protective against substance‐related negative outcomes remains controversial. We investigated substance use at home, with or without parental knowledge, and its association with substance‐related consequences. METHODS: The sample consisted of 21,207 U.S. students in the 6th to 12th grades surveyed between 2009 and 2017. Substance use patterns and rates of negative outcomes were analyzed by comparing groups of participants who had not used at home, or had used at home with and/or without parental knowledge. RESULTS: Adolescents who used substances at home without parental knowledge used alcohol and substances in greater amounts, and tended to have more negative outcomes than those who did not. Students who had not used at home or had used only with parental knowledge tended to have lower levels of use and negative outcomes. CONCLUSIONS: Using at home without parental knowledge was a consistent risk factor for substance‐related negative outcomes. These results highlight the importance of screening adolescents for the use of alcohol or drugs in the home without parental knowledge, as well as attempting to prevent substance use in the household. [ABSTRACT FROM AUTHOR]

BACKGROUND: Given the amount of time children and adolescents spend in school, these locations may be ideal for simultaneously supporting young people's health and academic achievement. School‐based health centers (SBHCs) not only bring care to students in accessible and familiar locations, these centers also provide guidance for young people during a life stage when they are establishing lifelong health behavior habits. METHODS: This article examines the literature exploring the impact of SBHCs from the perspective of multiple stakeholder groups including students, guardians, school personnel, community members, providers, hospital administrators, public health officials, and insurers. RESULTS: Studies describe the positive effects of SBHCs on students' health and educational outcomes. SBHCs are generally associated with decreased health care disparities among students, accelerated treatment, and increased school attendance. CONCLUSIONS: Additional research exploring strategies for optimizing SBHC's economic efficiency and tailoring SBHC services to meet the needs of vulnerable patient populations is essential. Investigation into the impacts of SBHCs on community stakeholders outside of the student population is also vital. [ABSTRACT FROM AUTHOR]

BACKGROUND: Limited research has addressed the effects of health literacy interventions in elementary schools. However, school‐aged children's health literacy is critical because children make decisions about their health every day. The purpose of the pilot project was to explore the feasibility of integrated health literacy lesson plans for second graders. METHODS: A pretest‐posttest evaluation was conducted with second grade students following implementation of health literacy lessons that were integrated into core curriculum (language arts, science, and social studies). RESULTS: Health educators, a hospital/health care system, and a school district developed a partnership. A research team of teachers, administrators, health literacy experts and health care organizations designed and implemented health literacy lesson plans. A developmentally appropriate measure of health literacy was adapted from the Newest Vital Sign. Data showed that students' health literacy scores significantly increased after implementation of 4 lesson plans. CONCLUSIONS: This was an exploratory, pilot project that provided a useful starting point for discussing how to integrate health literacy into elementary school curriculum. An interdisciplinary team developed integrated health literacy materials that acknowledged the needs of teachers, the resources available, and the developmental stages of children. This intervention serves as a model for future health literacy initiatives in schools. [ABSTRACT FROM AUTHOR]

BACKGROUND: In this study, we determined the prevalence of and factors associated with parent unawareness of youth tobacco use. METHODS: We used data from waves 1, 2, and 3 (2013‐2016) of the Population Assessment of Tobacco and Health study, a nationally representative study of 13,650 US youth ages 12 to 17 and their parents. We conducted weighted multivariate analyses comparing parent unawareness of youth‐reported ever use and associations between parents' unawareness of youth use and covariates. RESULTS: Youth ever tobacco use ranged from 21.8% in 2013‐2014, to 24.1% in 2014‐2015, to 23.4% in 2015‐2016. Parent unawareness ranged from 57.6% in 2013‐2014, to 61.9% in 2014‐2015, and 64.5% in 2015‐2016. Factors associated with higher parent unawareness of youth tobacco use in 2015‐2016 were youth being female, black, or Hispanic (adjusted odds ratio [AOR] = 1.24‐2.61; all ps <.05). Youth with lower academic performance, relatives who used tobacco, tobacco available in the home, or past 30‐day use, were less likely to have parents unaware of their use (AORs 0.33‐0.56; all ps <.05). CONCLUSIONS: Among youth who reported ever using tobacco, most had parents who were unaware of their use. School‐based efforts targeting specific sociodemographic factors could increase parent awareness of youth tobacco use. [ABSTRACT FROM AUTHOR]

BACKGROUND: Asthma can interfere with school attendance and engagement. School health programs are central to asthma management. Case identification is limited by reliance on parent‐completed forms, which are often missing. This project tested a low‐burden screening algorithm to stratify students based on priority for nurse outreach at 2 large, urban schools with high asthma prevalence. METHODS: Students in grades 1‐8 completed a 4‐item asthma screener. Two‐stage stratification incorporated screener responses, school nurse records, and absenteeism. Students were assigned low, medium, or high priority for follow up. Asthma prevalence in the high priority group was calculated for substantiated asthma. Whether stratification was more likely than chance to identify new cases of asthma in the high‐priority group was evaluated using chi‐square tests. RESULTS: Of 1397 students, 69.7% were screened. Secondary stratification decreased the number of students in the high and medium priority groups. New asthma cases were identified in 46.4% of high‐priority families reached for follow up. High‐priority students were more likely to be identified as having asthma than chance alone (p <.001). CONCLUSIONS: A low‐burden screening algorithm appropriately placed students with asthma in the high priority group. This approach may allow efficient, targeted follow up of the highest need students in high prevalence populations. [ABSTRACT FROM AUTHOR]

BACKGROUND: Although less than 2% of all homicides among young people are school‐associated, since 1970 1373 K‐12 school gun violence incidents have injured 1403 people and killed another 728. These incidents have changed the education landscape. Informed stakeholders must work together to prevent school gun violence. METHODS: We reviewed the nature of school gun violence in the United States and efforts to prevent it. RESULTS: We briefly outline a public health approach to prevent school gun violence, major actions the nation has taken, current school gun violence surveillance systems, the effects of school gun violence nationwide, the extent to which our schools are implementing various interventions to prevent it, and a national strategy to move forward. CONCLUSIONS: Our young people and our schools deserve a more organized national effort. [ABSTRACT FROM AUTHOR]

BACKGROUND: Despite the extensive research on rates of teen dating violence and abuse and its' consequences, less is known about help‐seeking behaviors among victims. The goals of this study were to document patterns of help‐seeking behaviors among teen victims of dating violence and abuse and examine sex differences related to such patterns. METHODS: The study involved cross‐sectional surveys of 3745 dating youth from 10 middle and high schools in the northeastern United States, 59% of whom reported some kind of dating abuse victimization. We examined the characteristics of youth who reported any type of dating abuse victimization comparing youth who reported seeking help to youth who did not report seeking help following their victimization. RESULTS: Only 9% of victims reported seeking help after their victimization experience. Help‐seeking differed significantly by sex; female victims were more likely to seek help than male victims, and the types of dating abuse that help‐seekers experienced also varied by sex. Overall, 17% of youth sought help from school counselors and 13% sought help from teachers. CONCLUSIONS: Results suggest that help‐seeking behavior is very uncommon among victim populations, particularly if they are not part of specific dating violence prevention programs. In addition, we found female victims were nearly 2 times more likely to seek help than male victims. Given that few youth seek help on their own, schools might create more formalized reporting mechanisms to ensure such violence is addressed effectively and efficiently, and create peer and parental support networks to build awareness and create comfort for victims. [ABSTRACT FROM AUTHOR]

BACKGROUND: Workplace safety and health is a major public health concern, but largely absent from the school health curriculum. Little is known about teachers' perceptions of teaching workplace safety and health topics. METHODS: We administered a 41‐item questionnaire reflecting the theory of planned behavior, modified to measure knowledge, to 242 middle and high school teachers in career and technical education and academic subjects. We conducted confirmatory factor analysis to assess the measures' psychometric properties and factorial ANOVAs to compare differences among participants' knowledge, attitude toward, self‐efficacy, and intention (to teach) workplace safety and health by sex, prior work injury, and main subject taught. RESULTS: Confirmatory factor analyses indicated the measures reflected the theory. Factorial ANOVAs suggested female teachers had statistically significantly lower mean self‐efficacy scores than did male teachers to teach workplace safety and health. Male occupational career and technical education teachers demonstrated higher mean knowledge scores than male teachers in other subjects. Participants not injured at work had higher knowledge scores than those who had been injured. CONCLUSION: Self‐efficacy (influenced by sex) and knowledge (influenced by subject taught and previous workplace injury) revealed factors that may affect teachers' provision of workplace safety and health education, a critical yet overlooked component of school health. [ABSTRACT FROM AUTHOR]

BACKGROUND: Poor mental health outcomes persist among adolescent youth. Secondary schools play a critical role in fostering positive mental health by implementing policies and practices grounded in evidence. The factors associated with implementation, however, are unclear. This study examines which school‐ and state‐level factors are associated with improved implementation of mental health policies and practices at secondary schools across the United States. METHODS: US Centers for Disease Control and Prevention data stemming from 3 datasets (School Health Policies and Practices, School Health Profiles, and Youth Risk Behavior Surveillance System) surveys were integrated and analyzed. RESULTS: Health educator certification, school use of data during school improvement planning, presence of a health/safety coordinator, presence of a health council and state‐provided health educator professional development in mental health and suicide prevention were each significantly positively associated with schools' implementation of mental health policies and practices. CONCLUSIONS: To promote improved implementation of mental health policies and practices in schools and provide better support for youth mental health outcomes, the use of certified health educators and health‐related supports should be considered. State health and education agencies should undertake evaluations of its mental health practices to ensure the assistance they offer to schools is evidence based. [ABSTRACT FROM AUTHOR]

BACKGROUND: Emergent evidence suggests a positive school climate may be a promising population‐level intervention to promote academic achievement and student well‐being. However, researchers have called for expanding the school climate evidence‐base to better describe how the construct is associated with student outcomes. The purpose of this study was to determine the associations between 10 school climate domains and academic achievement among middle and high school students. METHODS: ANOVAs were used to analyze survey data from 6–12 grade students in a Mid‐Atlantic US state (n = 2405, response rate: middle school = 82.4%, 50.5% female; high school = 62.5%, 56.1% female). RESULTS: Significant main effects were found for all school climate domains and varied between middle and high school students apart from academic support. Effect sizes ranged from small to medium, with academic support demonstrating the strongest effects among both middle and high school students. CONCLUSIONS: Findings suggest school climate is associated with academic achievement for both middle and high school students. Correctly identifying the role of key aspects of school climate by grade‐level may provide improved and developmentally appropriate recommendations for the delivery of instruction and school‐based interventions that promote positive school well‐being and student performance. [ABSTRACT FROM AUTHOR]

ABSTRACT: BACKGROUND: School lunches must meet National School Lunch Program (NSLP) requirements to receive reimbursement. In this study, we sought to determine whether there are significant differences in nutrient content and nutritional quality between 2 menus meeting NSLP requirements. METHODS: A cross‐sectional content analysis compared 6 weeks of a typical school lunch menu (TM) from an actual school district to a best practice school lunch menu (BPM) created by a registered dietitian based on Child and Adult Care Food Program (CACFP) best practices and Dietary Guidelines for Americans (DGA) healthy meal pattern recommendations. Daily nutrient content was determined using nutrient analysis software. Nutritional quality was computed using Healthy Eating Index (HEI) 2010. RESULTS: For nutrients required for analysis, the BPM was lower in calories, saturated fat, and sodium and higher in protein, carbohydrate, and fiber (ps < .01). For other nutrients of concern, the BPM was higher in vitamin A, vitamin D, phosphorus, and magnesium (ps < .01). The BPM had higher HEI scores for nutritional quality (p < .001). CONCLUSIONS: Results indicate the possibility for significant variation in nutritional quality of NSLP‐qualifying lunches. Using CACFP best practices and DGA recommendations may significantly impact school lunch dietary quality. [ABSTRACT FROM AUTHOR]

ABSTRACT: BACKGROUND: This study investigates the extent to which friendship network, family relations, and school context are related to adolescent cigarette smoking. Friendship network is measured in terms of delinquent peers; family relations in terms of parental supervision; and school environment in terms of objective (eg, antismoking policy) and subjective (eg, school attachment) characteristics. METHODS: Findings are based on the secondary analysis of the health behavior in school‐aged children, 2009–2010. Two‐level hierarchical generalized linear models are estimated using hierarchical linear modeling 7. RESULTS: At the student level, ties to delinquent friends is significantly related to higher odds of smoking, while greater parental supervision is associated with lower odds. At the school level, antismoking policy and curriculum independently lower smoking behavior. Better within‐class peer relations, greater school attachment, and higher academic performance are also negatively related to smoking. Last, the positive association between delinquent friends and smoking is weaker in schools with a formally enacted antismoking policy. However, this association is stronger in schools with better peer relations. CONCLUSIONS: Adolescent smoking behavior is embedded in a broader ecological setting. This research reveals that a proper understanding of it requires comprehensive analysis that incorporates factors measured at individual (student) and contextual (school) levels. [ABSTRACT FROM AUTHOR]

ABSTRACT BACKGROUND Health impact assessment (HIA) provides a structured process for examining the potential health impacts of proposed policies, plans, programs, and projects. This study systematically reviewed HIAs conducted in the United States on prekindergarten, primary, and secondary education-focused decisions. METHODS Relevant HIA reports were identified from web sources in late 2015. Key data elements were abstracted from each report. Four case studies were selected to highlight diversity of topics, methods, and impacts of the assessment process. RESULTS Twenty HIAs completed in 2003-2015 from 8 states on issues related to prekindergarten through secondary education were identified. The types of decisions examined included school structure and funding, transportation to and from school, physical modifications to school facilities, in-school physical activity and nutrition, and school discipline and climate. Assessments employed a range of methods to characterize the nature, magnitude, and severity of potential health impacts. Assessments fostered stakeholder engagement and provided health-promoting recommendations, some of which were subsequently incorporated into school policies. CONCLUSIONS Health impact assessment is a promising tool that education, health, and other stakeholders can use to maximize the health and well-being of students, families, and communities. [ABSTRACT FROM AUTHOR]

ABSTRACT BACKGROUND We examined the impact of the Fuel Up to Play 60 ( FUTP60) program on children's body mass index ( BMI) and aerobic capacity ( AC). METHODS Participation in the FUTP60 and both BMI and AC profiles were collected through the NFL PLAY 60 FitnessGram Partnership Project involving over 100 schools from 22 US states. We specifically examined the distributions of BMI and AC among participating versus nonparticipating schools in the 2012-2013 school year. Hierarchical linear models tested the impact of participation and availability of additional funding for program implementation on the proportions of youth meeting FitnessGram health-related fitness standards (ie, Needs Improvement-Health Risk [ NIHR] and Healthy Fitness Zone [ HFZ] categories). RESULTS After 1 year implementing the program, participating schools had lower proportions of boys (−4.1 ± 2.0%, p = .04) and girls (−4.5 ± 2.0%, p = .03) in the NIHR for BMI, and lower proportion of girls (−9.7 ± 4.0%, p = .02) in the NIHR for AC. There were no differences in the distributions for the HFZ and the availability of additional funding did not alter the relationships (p > .05). CONCLUSIONS This study provides preliminary evidence that participation in the FUTP60 is associated with improved profiles of health-related fitness. [ABSTRACT FROM AUTHOR]

ABSTRACT BACKGROUND Children and adolescents exposed to chronic trauma have a greater risk for mental health disorders and school failure. Children and adolescents of minority racial/ethnic groups and those living in poverty are at greater risk of exposure to trauma and less likely to have access to mental health services. School-based health centers (SBHCs) may be one strategy to decrease health disparities. METHODS Empirical studies between 2003 and 2013 of US pediatric populations and of US SBHCs were included if research was related to childhood trauma's effects, mental health care disparities, SBHC mental health services, or SBHC impact on academic achievement. RESULTS Eight studies show a significant risk of mental health disorders and poor academic achievement when exposed to childhood trauma. Seven studies found significant disparities in pediatric mental health care in the US. Nine studies reviewed SBHC mental health service access, utilization, quality, funding, and impact on school achievement. CONCLUSION Exposure to chronic childhood trauma negatively impacts school achievement when mediated by mental health disorders. Disparities are common in pediatric mental health care in the United States. SBHC mental health services have some showed evidence of their ability to reduce, though not eradicate, mental health care disparities. [ABSTRACT FROM AUTHOR]

ABSTRACT BACKGROUND The Healthy, Hunger-Free Kids Act of 2010 ( HHFKA) directed the US Department of Agriculture ( USDA) to revise school meal standards to increase healthy food offerings. A critical stakeholder in the implementation of standards is Food Service Directors ( FSDs). We sought to examine FSDs' perspectives on revised school meal standards to gain insight into successful implementation strategies. METHODS Semistructured interviews were conducted with FSDs (N = 9) from high schools that had achieved HealthierUS Schools Challenge: Smarter Lunchrooms ( HUSSC: SL) status. Qualitative interview data were team coded in Atlas.ti v7 and analyzed with principles of constant comparative analysis. RESULTS FSDs reported overall positive perceptions of the revised school meal standards and its potential impacts, as well as improved fruit and vegetable consumption, despite initial challenges with plate waste, procurement of whole grain-rich products, and fast paced sodium targets. Implementation was described as complex, ongoing processes; with time and in-service trainings, student acceptance to these changes improved. CONCLUSIONS These findings are directly relevant to future reauthorization of the Child Nutrition Act and to revisions to the implementation time line for the federal school meal standards related to sodium, whole grains, and flavored milk. Insights into FSDs' strategies suggest that more time and targeted technical assistance at federal, state, and local levels is warranted. [ABSTRACT FROM AUTHOR]

ABSTRACT BACKGROUND Mental health conditions among youth are a major concern. Schools can play an important role in supporting students affected by these conditions. This study examined district-level school health policies related to mental health and social services to determine if they varied by district demographic characteristics. METHODS The School Health Policies and Practices Study (SHPPS) 2012 collected cross-sectional data on school health policies and practices from a nationally representative sample of public school districts (N = 684). We used logistic regression to examine the association between district-level demographic characteristics and school mental health policies. RESULTS Southern and low-affluence districts had higher odds of requiring schools to have a specified counselor-to-student ratio as compared with Northeastern and average affluence districts, respectively. Northeastern and urban districts had higher odds of requiring educational and credentialing requirements for school mental health or social services staff, compared to other regions and rural districts, respectively. CONCLUSIONS Results describe the extent to which school mental health and social services programs in the United States are meeting various guidelines. More work is necessary to ensure that all schools have the resources needed to support their students' mental health and meet national guidelines, especially in districts with certain characteristics. [ABSTRACT FROM AUTHOR]

ABSTRACT BACKGROUND We examined the relationship between exposure to electronic bullying and absenteeism as a result of being afraid. METHODS This multivariate, multinomial regression analysis of the 2013 Youth Risk Behavior Survey data assessed the association between experiencing electronic bullying in the past year and how often students were absent in the last month due to feeling unsafe at/in transit to school. The model controlled for other predictors of school absence including demographics, physical/behavioral health, and risk factors. Missing data were multiply imputed. RESULTS Electronic bullying was significantly associated with absences. Controlling for model covariates, the relative risk of missing 1 day of school was 1.77 times higher, the relative risk of missing 2 to 3 days of school per month increased by a factor of 2.08, and the relative risk of missing 4 or more days of school per month increased by a factor of 1.77 for those who experienced electronic bullying in the past year compared with those who were not electronically bullied. CONCLUSIONS Electronic bullying's association with absenteeism places it among already recognized negative influences such as depression and binge drinking, necessitating schools to implement policies to mediate the resulting harmful effects. [ABSTRACT FROM AUTHOR]

ABSTRACT BACKGROUND Childhood obesity is a major public health concern. Children with disabilities have a higher prevalence of obesity. OBJECTIVE We examined factors associated with obesity within a cross-sectional study of US adolescents with and without disabilities. METHODS Data were obtained from the 2011 Youth Risk Behavior Survey. Logistic regression models were fitted to assess effects of dietary habits, physical activity, and unhealthy weight control behaviors on obesity. Effect modification by disability status was examined. RESULTS Twenty percent (1986 of 9775 participants) reported a disability. Adolescents with disabilities were more likely to be obese (odds ratio [ OR] = 1.7; 95% confidence interval [ CI]: 1.3-2.1) and have at least 1 unhealthy weight control behavior ( OR = 2.0; 95% CI: 1.6-2.5), and were less likely to be physically active ( OR = 0.5; 95% CI: 0.4-0.6). Lack of physical activity, increased television watching/video game playing, and unhealthy weight loss behaviors were significantly associated with obesity regardless of disability status (p-for-interaction >.05). CONCLUSIONS Successful obesity interventions should target diet, physical activity, and weight control among adolescents with disabilities. Understanding barriers to healthier diet and physical activity for this population is critical to developing effective obesity prevention programs and reducing the prevalence of unhealthy weight control behaviors. [ABSTRACT FROM AUTHOR]

ABSTRACT BACKGROUND A 2011 nationwide school pandemic preparedness study found schools to be deficient. We examined the impact of a school nurse educational intervention aimed at improving K-12 school biological event preparedness. METHODS Missouri Association of School Nurses ( MASN) members were e-mailed a survey link in fall 2013 (ie, preintervention), links to online education modules (ie, intervention) in late fall, and a postintervention survey link in spring, 2014. School biological event readiness was measured using 35 indicators, for a possible score range of 0-35. A paired t-test compared pre- to postintervention preparedness scores. RESULTS A total of 133 school nurses (33.6% response rate) completed a survey; 35.3% of those (N = 47) completed both pre- and postintervention survey that could be matched. Pre- and postintervention preparedness scores ranged from 5 to 28.5 ( [ABSTRACT FROM AUTHOR]

BACKGROUND: Approximately 15% of children in the United States 6-19 years of age have hearing loss. Even mild, unilateral hearing loss may adversely affect educational success. In 2014, the Pennsylvania Department of Health (PA DOH) began updating the 2001 regulations on state-mandated school hearing screens. To inform the updates, a needs assessment was conducted with PA-certified school nurses (CSNs) regarding current screening practice and potential barriers to making changes. METHODS: A 42-item electronic survey of CSNs developed with pediatricians, audiologists, nurses, and the PA DOH was administered in October 2014. RESULTS: There were 536 completed surveys. Most CSNs (50.8%) screened 251-500 students annually. Only 35.8% strictly followed PA DOH protocol, while 51.6% followed protocol and added nonguideline frequencies. Over half of screens (60.2%) were conducted in places where other people were present. Most CSNs (82.5%) reported annual audiometer calibration, but 92.4% were unsure whether the calibration was exhaustive or limited. Reported barriers to change included time, cost, and staffing. CONCLUSIONS: As most CSNs added frequencies to the PA DOH hearing screen, an update with added frequencies should be well accepted. Clarification regarding test environment and exhaustive audiometer calibration is needed. Adherence to best practice may be optimized by addressing CSN reported barriers to change. [ABSTRACT FROM AUTHOR]