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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: Concerns have been raised over teachers' mental health literacy in low‐income countries and lower‐ and middle‐income countries wherein pediatric mental health resources are limited. This study aims to investigate adolescent depression literacy among teachers in Eswatini and to explore the role of urbanicity. METHODS: We conducted a cross‐sectional survey in 59 public high schools in Eswatini in 2019‐2020. Data were collected by a paper‐and‐pencil questionnaire; depression literacy was assessed by the 17‐item Adolescent Depression Knowledge Questionnaire. RESULTS: Teachers' adolescent depression literacy item‐level correct rates fell between 27 and 80%. Although the multivariate response models indicated that teaching in urban areas was slightly associated with having higher depression literacy in general (adjusted odds ratio [aOR] = 1.46; 95% confidence interval = 1.00‐2.12), such urban‐rural differences did not manifest homogeneously across all items: urban teaching was significantly linked with reduced correct responses toward certain items concerning depression etiology and treatment, including "depression runs in some families," "major stress as a necessary cause," and "a curable illness" (aOR = 0.57 ∼ 0.68). CONCLUSION: Urban‐rural differences in teachers' depression literacy were manifested at both scale‐ and item‐levels. A critical need exists for urban/rural areas‐tailored intervention on teachers' literacy toward mental disorders in the resource‐limited regions to better improve health and developmental outcomes of students. [ABSTRACT FROM AUTHOR]

BACKGROUND: Through the Texas Childhood Obesity Research Demonstration study, we implemented and evaluated a system‐oriented model of primary and secondary prevention approaches to mitigate obesity among low‐income Texas children aged 2 to 12 years. Primary prevention included implementing the Coordinated Approach To Child Health Early Childhood (CATCH EC) program in Head Start preschools. In this paper, we describe the methods and results of CATCH EC program process evaluation over 2 years of implementation. METHODS: We used a quasi‐experimental design with serial cross‐sectional data collected from Head Start centers across intervention and comparison catchment areas in Houston and Austin, Texas (intervention: N = 12 centers in 2012‐2013 [Year 1], N = 12 in 2013‐2014 [Year 2]; comparison: N = 13 centers in Year 1, N = 12 in Year 2). Process evaluation included center director and teacher surveys conducted in both years of implementation. We developed indices for implementation of CATCH EC and non‐CATCH health events at the centers. RESULTS: Implementation scores were higher among intervention centers as compared to comparison centers across both years of implementation, and these differences were statistically significant (p < .01). There was also high variability in program implementation in intervention centers across both years ranging from 55% to 95%. CONCLUSION: These implementation index strategies may inform future evaluation of preschool‐based obesity prevention program implementation. [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 Health literacy is crucial to develop health-related knowledge, adopt healthy lifestyles, and benefit from health care services. However, research on the association between health literacy and adolescent health outcomes, particularly on their prospective associations, is rare. We assessed health literacy using 3 validated measures, and examined cross-sectional and prospective associations between health literacy and adolescent health behaviors and outcomes. METHODS We conducted a short-term prospective study of 250 adolescents (mean age = 14 years; 57% female; 48% African American) who were entering or in the ninth grade in an urban school district. Health literacy was assessed by individual interviews at baseline, and health-related behaviors and outcomes were assessed by a paper-and-pencil survey at baseline and at a 6-month follow-up. RESULTS Nearly half of the sample was reading at least 2 grades below expected levels. Lower baseline health literacy was associated with a lower self-rating of general health, unhealthier diet, heavier weight, and greater engagement in problem behaviors and sexual behaviors at baseline. Lower baseline health literacy also was associated with a greater increase in substance use over time. CONCLUSIONS Results point to the pressing need to improve health literacy in urban high school students. [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]

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]

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: Education about healthy and respectful relationships (HRR) is a key component of comprehensive sexual health curricula and is supposed to be universally provided in Oregon. This study: (1) assesses the extent to which high school students with disabilities received HRR education, and (2) examines associations between HRR education and experiences of sexual abuse. METHODS: Using data from the 2019 Oregon Healthy Teens survey, we conducted multivariable Poisson regression to compare 11th grade students with and without disabilities on self‐reported receipt of school based HRR instruction (N = 10,992), and to measure associations between HRR education and sexual abuse experiences among teens with (N = 3736) and without (N = 7256) disabilities. RESULTS: Students with disabilities were 41% more likely than students without disabilities to say they had never been taught in school about HRR (adjusted prevalence ratio 1.41, 95% confidence interval: 1.25‐156). Experiences of sexual abuse victimization were more common for all students who did not receive HRR education (34.1% vs 21.6% among students with disabilities; 16.2% vs 7.5% among students without disabilities). CONCLUSIONS: Students with disabilities are less likely to have received school‐based HRR education than their peers without disabilities. Providing inclusive HRR education may help reduce risk of sexual abuse and is essential for addressing health disparities affecting youth with disabilities. [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: We examined fidelity and feasibility of implementation of COVID‐19 preventive measures in schools, and explored associations between adherence to these measures and staff well‐being, to inform policy on sustainable implementation and staff wellbeing. METHODS: Surveys were conducted across 128 schools in England with 107 headteachers and 2698 staff‐members with reference to autumn term 2020, examining school‐level implementation of preventive measures, adherence, and teacher burnout (response rates for headteacher and staff surveys were 84% and 59%, respectively). RESULTS: The median number of measures implemented in primary and secondary schools was 33 (range 23‐41), and 32 (range 22‐40), respectively; most measures presented challenges. No differences were found regarding number of measures implemented by school‐level socio‐economic disadvantage. High adherence was reported for staff wearing face‐coverings, staff regularly washing their hands, (secondary only) desks facing forwards, and (primary only) increased cleaning of surfaces and student hand‐washing. Adherence to most measures was reported as higher in primary than secondary schools. Over half of school leaders and 42% (517/1234) of other teaching staff suffered from high emotional exhaustion. Higher teacher‐reported school‐wide adherence with measures was consistently associated with lower burnout for leaders and other teaching staff. CONCLUSIONS: Findings indicate a tremendous effort in implementing preventive measures and an urgent need to support investments in improving teacher wellbeing. [ABSTRACT FROM AUTHOR]

Background: Concussion public policies have been developed to address the burden of concussions. The aim of the present study was to examine implementation compliance, barriers, and facilitators of Canada's first concussion public policy, Ontario's Policy/Program Memorandum 158: School Board Policies on Concussion (PPM158). Methods: An electronic survey was sent to 515 randomly selected elementary and high school principals across specific geographic, language, and publicly funded school types in Ontario. Data were analyzed using both qualitative and quantitative methods. Results: One hundred and thirty‐five principals responded to the survey (26%). Concussion education was provided to teachers in 81% of schools, to students in 83%, and coaches in 79%. Additionally, 89% reported having a return‐to‐learn protocol in place and 90% reported having a return‐to‐play protocol. Implementation barriers included difficulties in providing concussion education to parents (42%), obtaining notes from physicians, and maintaining the volume of documentation. Eighty‐seven percent of respondents believed that PPM158 improves student well‐being. Conclusions: Identified implementation barriers and facilitators can inform concussion policy practices to improve student well‐being. We recommend: (1) an appointed concussion policy lead at each school, (2) electronic documentation, (3) determining the optimal education format to improve parent/guardian education, (4) fostering relationships between schools and health care professionals, and (5) student concussion education in every grade in Ontario schools. [ABSTRACT FROM AUTHOR]

BACKGROUND: The school presents an ideal environment to positively impact the long‐term health and nutrition outcomes of early adolescents, who are at risk of obesity and anemia. METHODS: In this cross‐sectional survey, we described differences in weight and anemia by sociodemographic, diet and physical activity indicators among 1059 students aged 11 to 15 years from 22 junior secondary schools in Ouagadougou, Burkina Faso. Weight was based on body mass index (BMI) z‐scores according to the WHO reference and anemia status was defined by standardized hemoglobin (Hb) measure cut‐offs. We calculated dietary diversity scores (DDS) from a 24‐hour dietary recall and a global diet quality score (GDQS) from a 7‐day dietary recall. RESULTS: The prevalence of obesity (5%) and anemia (50%) was relatively high among the students, which differed significantly between gender, household wealth and school grade, but not age groups. Eighteen percent of the female adolescents were overweight or obese and 22% were moderately anemic compared to 13% and 16% of the male adolescents. Dietary diversity was significantly different between weight categories, but not anemia status. For physical activity, those taking transportation to school were significantly more likely to be overweight or obese. In adjusted multivariable Poisson regression analyses, only the DDS was significantly associated with thinness and both thinness and anemia, while taking transportation to school was significantly associated with overweight among adolescents. CONCLUSION: We encourage the promotion of school‐based interventions and provision of a curriculum on health and healthy eating in order to reduce obesity, anemia, and its comorbidities. [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: 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: 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: 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: 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 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: 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]

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: 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: Many schools transitioned online to reduce viral spread and promote social distancing amid the COVID‐19 pandemic. Remote learning may impact health behaviors and coping strategies among adolescents, including reduced physical activity and increased screen time. Social media and peers provide information about the pandemic to adolescents and may influence prevention behaviors. This study aims to assess adolescent knowledge and information about COVID‐19, determine students' behavior change, and identify sources students turn to for information on the pandemic. METHODS: Students from 2 high schools in semi‐rural Georgia participated in a cross‐sectional online survey in March 2020 (N = 761). RESULTS: Common sources for COVID‐19 news were peers (80%) and social media (58%). Few adolescents (3%) indicated that teenagers were at higher risk of severe illness due to COVID‐19. Responses reveal adolescents understand social distancing and many are participating in prevention behaviors, including handwashing (87%) and staying at home as much as possible (87%). Most respondents reported increases in screen time outside of class (82%). CONCLUSIONS: Findings suggest adolescents are obtaining COVID‐19 knowledge from various sources, including social media, with varying degrees of implementation of prevention practices. Increases in screen time and reduced physical activity may impact long‐term health among adolescents. [ABSTRACT FROM AUTHOR]

BACKGROUND Most adolescents in the United States do not obtain sufficient sleep. Early school start times play a significant role in adolescent sleep deprivation. Most primary and secondary schools begin classes earlier than the 8:30 am. Perceived barriers to implementing a delayed school start time have been suggested in the literature but have not been quantified. This study explored perceived barriers and facilitating factors for implementing delayed high‐school start times. METHODS: A cross‐sectional study. School administrators who had delayed their school start times were invited to complete an online questionnaire ranking the perceived barriers and facilitating factors for implementing the delayed start times. RESULTS: Most commonly cited perceived barriers were lack of a tiered bus system, school athletes missing more afternoon classes, and less time after school for athletics. Most commonly cited facilitating factors were school‐administrator involvement in the decision‐making process and sleep education for family members and school administrators. CONCLUSIONS: Participants found that providing sleep education to fellow administrators, teachers, school staff members, families, and students and including them in the decision‐making process positively facilitated the implementation of delayed school start times. Perceived barriers to implementation may be overcome with support from stakeholders and planning committees. [ABSTRACT FROM AUTHOR]

BACKGROUND For youth between the ages of 10 and 24, suicide is the third leading cause of death, and results in approximately 4600 lives lost each year. Body weight status and bullying is associated with increase mental health disorders. METHODS: We analyzed data from the 2015 Youth Risk Behavior Survey, consisting of 15,506 students in grades 9‐12. Logistic regression analysis was performed using STATA13 to estimate the independent association of perceived weight status and bullying experienced at school and electronically to suicidal behaviors measured as—considered suicide, made a suicide plan, attempted suicide, and injurious suicide attempt, after controlling for socio‐demographics. RESULTS: Considered suicide and attempted suicide were significantly associated with very overweight, slightly overweight, very underweight, and slightly underweight weight perceptions. Made suicide plan was significantly associated with slightly and very overweight perceptions. Injurious suicide attempt was significantly associated with very underweight or very overweight perceptions. Bullying, at school and electronically was significantly associated with all suicidal behaviors. CONCLUSIONS: Examination of not just body weight status but body weight perceptions held by adolescent students, and the experience of not just in‐person bullying but also electronic bullying on youth suicidal behaviors is crucial. [ABSTRACT FROM AUTHOR]

BACKGROUND: The National School Lunch and Breakfast Programs help to reduce food insecurity and improve nutrition. The Community Eligibility Provision (CEP) enables high‐poverty schools to offer breakfast and lunch at no cost to all students. This study examines associations between CEP and participation among students eligible for free or reduced‐price meals ("FRPM"), possibly eligible ("near‐cutoff"), or ineligible ("full‐price"). METHODS: Using data from the 2013‐2015 Healthy Communities Study, we compared school breakfast and lunch participation between 842 students in K‐8 at 80 CEP schools and 1463 students at 118 schools without CEP. Cross‐sectional difference‐in‐difference (DID) models compared meal participation among near‐cutoff and full‐price groups to that in the FRPM group. RESULTS: Overall, FRPM students had high participation in school lunch and breakfast at both types of schools. In adjusted DID models, lunch participation among near‐cutoff students was 12 points higher in CEP versus comparison schools (p <.05). Among full‐price students, breakfast participation was 20 points higher and lunch participation 19 points higher in CEP than comparison schools (p <.001). CONCLUSIONS: Community Eligibility Provision improves access to school breakfast and lunch in high‐poverty schools, particularly for students who are near or above the cutoff for FRPM eligibility. [ABSTRACT FROM AUTHOR]

BACKGROUND: New Jersey (NJ) Safe Schools Program, primarily funded by the NJ Department of Education, has aims concerning safety and health including helping to alleviate harassment, intimidation, and bullying (HIB) in secondary school because HIB can affect learning. We evaluated officially reported adolescent HIB total incidents and estimated rates in NJ public city and county school districts for the 2011‐2016 school years. METHODS: A cross‐sectional observational study using population‐based state‐reported public data. We calculated point prevalence and incidence rates for K‐12 students in 22 public city school districts, students in 21 career‐technical‐vocational education (CTE) school districts, and 8 special services school districts during 2011‐2016. RESULTS: HIB is prevalent in NJ school classrooms. HIB comprised ≥75% of total officially reported in‐school violence‐related incidents in a given school year. Rates per 100 enrollees of total officially reported incidents for the 5‐year period of 2011‐2016 was highest in special services school districts (5.00; 95% confidence interval [CI]: 4.67, 5.34) followed by CTE districts (1.94; 95% CI: 1.86, 2.01), and lowest in city districts (1.46; 95% CI: 1.44, 1.48). The special services school district also had the highest rates per year and the 5‐year period. CONCLUSIONS: Data analyses suggested ideas for further research and improvements for school HIB incident reports. Policies and programs could remedy issues observed in state secondary school classrooms. Best practices within districts and schools can help protect students from HIB and promote safety, health, learning, and maturation. [ABSTRACT FROM AUTHOR]

BACKGROUND: Bullying has been associated with several adverse health outcomes, including substance use. However, little is known about the association between bullying and e‐cigarette use. This study examined the association between bully victimization and the frequency of e‐cigarette use. METHODS: Data from the 2016‐2017 Canadian Student Tobacco, Alcohol and Drugs Survey were used (N = 49,543). The target population consists of Canadian students enrolled in grades 7‐12. Multivariable logistic regression models were used to examine the association between bullying victimization status and e‐cigarette use. RESULTS: Among the students included in the study, 14.1% were bullied less than once a week. Bullying victimization was statistically significantly associated with higher odds of any e‐cigarette use in the last 30 days. Likewise, those bullied daily or almost daily were more likely to use e‐cigarettes more frequently compared to students not bullied. We found a statistically significant difference in analysis stratified by sex, with female bullying victims having higher odds of all measures of e‐cigarette use. CONCLUSIONS: Bullying victims were significantly more likely to use an e‐cigarette, and findings appeared to vary by sex. Female bullying victims had a higher likelihood of e‐cigarette use. [ABSTRACT FROM AUTHOR]

BACKGROUND: School policies and practices designed to educate athletes, parents, and coaches about youth sports concussions may be a way to reduce concussion risk and improve both the recognition and management of concussions. METHODS: Nationally representative data from the 2014 School Health Policies and Practices Study (SHPPS) were used to assess associations between school demographic characteristics (eg, school level, metropolitan status, and school type) and school policies and practices addressing youth sports concussion‐related education for athletes, parents, and coaches. RESULTS: Overall, many schools had policies and practices that addressed youth sports concussion‐related education for athletes, parents, and coaches. There was significant variability in the adoption of policies and practices by some school demographic characteristics. Middle schools, private schools, and urban schools were less likely to adopt many of the policies and practices than high schools, public schools, and rural schools, respectively. For other school characteristics, no consistent patterns of associations emerged. CONCLUSIONS: These findings suggest that middle, private, and urban schools, in particular, are more likely to lack youth sports concussion‐related educational policies and practices and may need information or resources about the importance of education related to preventing, recognizing, and responding to concussions. [ABSTRACT FROM AUTHOR]

BACKGROUND: For pandemic preparedness, researchers used online systematic searches to track unplanned school closures (USCs). We determine if Twitter provides complementary data. METHODS: Twitter handles of Michigan public schools and school districts were identified. All tweets associated with these handles were downloaded. USC‐related tweets were identified using 5 keywords. Descriptive statistics and multivariable logistic regression were performed in R. RESULTS: Among 3469 Michigan public schools, 2003 maintained their own active Twitter accounts or belonged to school districts with active Twitter accounts. Of these 2003 schools, in 2015‐2016 school year, at least 1 USC announcement was identified for 349 schools via the current method only, 678 schools via Twitter only, and 562 schools via both methods. No USC announcements were identified for 414 schools. Rural schools were less likely than city schools to have active Twitter coverage (adjusted relative risk [adjRR] = 0.3956, 95% confidence interval [CI] 0.3312‐0.4671), and to announce USCs on Twitter (adjRR = 0.5692, 95% CI 0.4645‐0.6823), but more likely to have USCs identified by the current method (adjRR = 1.4545, 95% CI 1.3545‐1.5490). CONCLUSIONS: Each method identified USCs that were missed by the other. Our results suggested that identifying USCs on Twitter is complementary to the current method. [ABSTRACT FROM AUTHOR]

BACKGROUND: The purpose of this study was to estimate the prevalence, identify risk factors, and assess the impact of nonphysical workplace violence (WPV) events among education workers (teachers, professionals, and support personnel). METHODS: A cross‐sectional survey was mailed to a random sample of 6450 education workers, stratified by sex, occupation, and school location in Pennsylvania. Multivariable logistic regression was performed to assess risk factors. RESULTS: Of the 2514 participants, 859 (34%) reported experiencing at least one nonphysical WPV event during the 2009‐2010 school year. Coworkers were the most common source of bullying. Most education workers responded that they did not receive an adequate response from their administration after reporting a nonphysical WPV event. Risks of nonphysical assaults increased for education workers who were female, those working in an urban school, and those in their first 3 years of working in their current school. Those assaulted were significantly likely to have low job satisfaction, find work more stressful, and have poor mental health compared to those were not assaulted. CONCLUSIONS: Administration support for specific prevention efforts and post‐event responses that address the risk factors for nonphysical WPV are essential for creating a positive, safe work environment in schools. [ABSTRACT FROM AUTHOR]

BACKGROUND: Screening, Brief Intervention and Referral to Treatment (SBIRT) is a clinical guideline that can help delay, prevent or reduce substance use behaviors in youth. We aimed to describe the experiences of middle and high school (MS and HS) students attending a school with an SBIRT program. METHODS: This was a survey study conducted in 2 school districts that implemented SBIRT programs prior to statewide roll‐out of mandatory school SBIRT in Massachusetts, in which students were asked about past‐year substance use and then received brief counseling by a school professional. Students in grades that received SBIRT were subsequently invited to complete an electronic questionnaire about their SBIRT experience. RESULTS: A total of 890 students were included in the study (63.7% MS, 36.3% HS). Experiences of school SBIRT were predominantly positive: 74.0% of participants reported that the information received was useful. Students who reported having used substances were less likely to agree that "schools should screen for substance use" than students who did not report substance use (AOR: 0.39, 95%CI: 0.29‐0.53). CONCLUSIONS: Most respondents found SBIRT of value, though students with past‐year substance use were less positive about the experience. More research is needed to optimize SBIRT delivery in schools. [ABSTRACT FROM AUTHOR]

BACKGROUND: High school students have few physical education (PE) and health requirements for graduation. Twenty‐first century students have choices to take their PE and health courses in the traditional face‐to‐face (F2F) setting or online through accredited virtual schools. The purpose of this inquiry was to examine differences in high school students' perceptions and experiences in traditional versus online PE and health‐related courses. METHODS: This cross‐sectional study utilized mixed methods through survey distribution. Participants included 506 students from traditional F2F high school health and PE classes and 355 students finishing an online course from an accredited online academy. RESULTS: The online education setting was found to be statistically significantly more favorable for students in terms of the feedback and responsiveness of the teacher, understanding and interest of the content and perceived positive health changes during the course. However, the qualitative findings on student perceptions were relatively consistent between both the online and F2F classes. CONCLUSIONS: The results indicate that students' positive perceptions in an online high school class may equal or surpass those in a traditional F2F format. Increasingly, youth are exhibiting enhanced capacity for online‐based coursework. Physical education classes have traditionally been F2F, but warrant further consideration as an online platform. [ABSTRACT FROM AUTHOR]

BACKGROUND: District wellness policies provide an avenue to advance the Whole School, Whole Community, Whole Child (WSCC) model. The extent to which wellness policies currently align with WSCC is unclear; to‐date, tools have been unavailable to examine this issue. METHODS: We reviewed written health‐focused policies among 37 school districts in Los Angeles County in 2017 utilizing a 54‐item tool designed to examine the quality of policies in the 10 WSCC domains. Descriptive analyses explored overall and domain‐specific comprehensiveness and strength; simple negative binomial regression models examined differences in the policy quality and structure by legislated status. RESULTS: Approximately half of expected policies were present in wellness policies (mean comprehensiveness score = 52.65, ±18.09), < 20% were strong (mean strength score = 16.97, ±8.05). Content in WSCC domains addressed by legislative mandates was significantly more comprehensive and stronger, and more frequently located within the wellness policies, relative to content in non‐legislated domains. CONCLUSIONS: Opportunities exist for better alignment of wellness policies with WSCC. Education and health practitioners can utilize the tool developed for this study to identify priority areas where policy support is needed in their jurisdictions. Additional efforts are needed to help schools facilitate and document practice gains around WSCC‐aligned policies. [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: This study examined the combined influence of gender variables (specifically gender stereotypes, sexism, and genderism/transphobia) as well as racism/xenophobia and attitudes toward bullying roles on gender‐bashing. METHODS: A trans‐cultural sample of 2410 Spanish and Portuguese students participated in the study (mean age = 15.13). Structural equation modeling and multiple group analyses were used to examine the relationships among variables. RESULTS: The model revealed a good fit with the data for the whole sample. Results showed that instrumentality, hostile sexism, genderism/transphobia, racism/xenophobia, and positive attitudes toward the bully were positively correlated with gender‐bashing. An inverse pattern was also observed: expressiveness, benevolent sexism, and positive attitudes toward the defender were negatively correlated with gender‐bashing. Overall, the eight variables explained 48% of the variance of gender‐bashing. Structural relationships among the assessed constructs were equivalent for girls and boys, and for Spain and Portugal. CONCLUSIONS: These results reveal the need to implement inclusive educational policies to improve school health, which promote expressiveness, egalitarian attitudes, and sexual and cultural diversity. [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]

BACKGROUND: Bullying has been associated with many mental health problems. The effect of bullying has been found to be affected by the way students are involved in bullying. The purpose of the study was to explore the association between mental well‐being, hopelessness, and being involved in bullying (as a bully, victim, or bully‐victim), and to detect more harmful bullying types to students' mental well‐being. METHODS: The study was conducted among Estonian students from grades 5 to 9 (N = 2048). The survey was nationwide, cross‐sectional, anonymous, and web‐based by nature. Mental well‐being was assessed by using WHO‐5 well‐being index and hopelessness by 1‐item Beck Hopelessness Scale. RESULTS: The odds for being severely distressed (ie, students expressing both poor mental well‐being and hopelessness) were greater for both sexes bullying others and being victims of bullying. For bully‐victims the odds were greater for girls only. The victims of extensive cyber bullying expressed the lowest level of mental well‐being for both sexes. CONCLUSIONS: Boys might be the most vulnerable if being pure victims, while girls if being bully‐victims. More attention should be paid to cyber bullying, as victims of extensive cyber bullying had the lowest level of mental well‐being. [ABSTRACT FROM AUTHOR]

BACKGROUND Improvements in health behaviors and academic outcomes have been associated with school‐based health centers (SBHCs). However, underlying mechanisms for these associations have been largely unexamined, particularly among lower‐income youth. The current study examines the relationship between SBHCs and school connectedness and whether this relationship differs by youths' socioeconomic status (SES). METHODS: Student‐level cross‐sectional data from 503 traditional high schools in California were analyzed using multilevel regression models. California Healthy Kids Survey 2013‐2014 data included information on 3 dimensions of school connectedness and demographic characteristics including SES as measured by parental education. School‐level demographic data was gathered from publicly available sources. RESULTS: Although no significant relationship between SBHCs and any of the school connectedness dimensions emerged, there were significant cross‐level interactions between SBHCs and parent education. SBHCs were more positively associated with school connectedness (adult caring, adult expectations, and meaningful participation) among lower SES students compared to students with higher SES. CONCLUSIONS: SBHCs may be particularly effective in affecting school connectedness among lower income youth populations. This has wide ranging implications with regards to planning (eg, careful selection of where SBHCs can be most effective), and future research (eg, examining the effectiveness of specific SBHC strategies that support connectedness). [ABSTRACT FROM AUTHOR]

BACKGROUND Limited evidence exists on effects of school‐based nutrition policies. This study explored the influence of mandatory versus voluntary provincial school nutrition policies on student eating behaviors. METHODS: A cross‐sectional, school‐based survey assessed student eating behaviors using self‐report survey measures in a representative sample of Canadian high school students from 7 provinces (N = 12,110). Provincial school nutrition policies were characterized as mandatory or voluntary. Healthful and nonhealthful eating behaviors were analyzed across sociodemographic characteristics. Regression models were used to assess the association between policy type and eating behaviors, and to explore potential moderating variables. RESULTS: Healthful and nonhealthful eating behaviors differed significantly across several sociodemographic characteristics. Overall, neither healthful nor nonhealthful eating behaviors differed significantly between schools with voluntary and mandatory nutrition policies (odds ratio [OR] = 0.83, 95% confidence interval [CI] 0.64‐1.08; OR = 1.16, 95% CI 0.83‐1.64). Frequency of buying lunch at school and buying lunch out moderated the association between policy enforcement level and healthful eating behaviors (p =.0472, p =.0119). Frequency of buying lunch out moderated the association between policy enforcement levels and nonhealthful eating behaviors (p =.0009). CONCLUSIONS: This study documents nonhealthful components of Canadian adolescents' diets, and the results highlight important areas for future research in assessing the effectiveness of school nutrition policies. [ABSTRACT FROM AUTHOR]

ABSTRACT: BACKGROUND: Weight discrimination has been associated with poor academic performance and decreased school attendance. Little is known about weight discrimination and students' feelings of belonging to their school. This study examined the association between weight discrimination and school connectedness among adolescents. Teacher support was examined as a protective factor. METHODS: Middle school students (N = 639; 57% white; Mean age = 12.16 years) completed a health behaviors survey. Weight discrimination from peers and/or good friends was dichotomized into never versus experienced weight discrimination. The mean of 5 school connectedness items assessed level of school connectedness. Teacher support was measured by taking the mean of 4 teacher support items. Hierarchical linear regression was used to examine the association between weight discrimination and school connectedness. Teacher support was tested as a moderator. RESULTS: Weight discrimination was associated with lower levels of school connectedness (p < .05). Teacher support was associated with higher levels of school connectedness (p < .001) but did not moderate the association between weight discrimination and school connectedness. CONCLUSION: The association between weight discrimination and low levels of school connectedness is important as students spend most of their time at school and should benefit from the positive effects of feeling connected to school. [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: Our objective was to examine the association between school wellness committees and implementation of nutrition wellness policies and children's weight status and obesity‐related dietary outcomes. METHODS: A cross‐sectional study was conducted of 4790 children aged 4‐15 years recruited from 130 communities in the Healthy Communities Study. Multilevel statistical models assessed associations between school wellness policies and anthropometric (body mass index z‐score [BMIz]) and nutrition measures, adjusting for child and community‐level covariates. RESULTS: Children had lower BMI z‐scores (−0.11, 95% confidence interval [CI]: −0.19, −0.03) and ate breakfast more frequently (0.14 days/week, 95% CI: 0.02‐0.25) if attending a school with a wellness committee that met once or more in the past year compared to attending a school with a wellness committee that did not meet/did not exist. Children had lower added sugar (p < .0001), lower energy‐dense foods (p = .0004), lower sugar intake from sugar‐sweetened beverages (p = .0002), and lower dairy consumption (p = .001) if attending a school with similar or stronger implementation of the nutrition components of the school wellness policies compared to other schools in the district. CONCLUSIONS: A more active wellness committee was associated with lower BMI z‐scores in US schoolchildren. Active school engagement in wellness policy implementation appears to play a positive role in efforts to reduce childhood obesity. [ABSTRACT FROM AUTHOR]

ABSTRACT: BACKGROUND: Existing literature indicates a relationship between stress and emotional eating in adults, yet limited research has examined the impact of school‐related stress on emotional eating in adolescents. This study investigated the influence of academic factors on emotional eating among minority adolescents. METHODS: A survey was implemented among a sample of minority adolescents (N = 666) to investigate the relationship between emotional eating and 3 academic factors: academic self‐esteem, grade point average (GPA), and academic worries. Forced‐entry multiple linear regressions were used to test for relationships. RESULTS: Findings indicate that GPA, academic self‐esteem, and academic worries were related to emotional eating scores in adolescents. There were no significant differences in academic factors between emotional eaters and nonemotional eaters. CONCLUSIONS: Additional research is needed to further elucidate the complex interaction between emotional eating behavior and academics. [ABSTRACT FROM AUTHOR]

ABSTRACT: BACKGROUND: The purpose of this study was to determine whether there was an association between dietary patterns and children's academic performance. METHODS: This cross‐sectional study involved 315 children aged 9‐11 years from 26 schools in Australia. Academic performance was measured in 4 domains (reading, writing, numeracy, and language—subdomains: spelling, grammarm and punctuation) using the National Assessment Program in Literacy and Numeracy (NAPLAN). A self‐reported child questionnaire collected dietary intake data. “Core” (healthy) and “noncore” (unhealthy) dietary patterns were derived using principal components analysis. RESULTS: The noncore pattern was associated with lower NAPLAN scores across all academic domains (mean: −12.6, 95% CI: −18.7 to −6.4, r2 = .073, p < .001) except writing, while the core foods pattern was not associated with NAPLAN scores across all domains. When the noncore model was adjusted for sociodemographic covariates (child body mass index, ethnicity, sex, parental education, household income, marital status, mother's employment hours, and number of siblings), the association was attenuated but remained statistically significant (NAPLAN summary score: −8.5, 95% CI −15.0 to −1.9, r2 = .123, p = .011). CONCLUSIONS: Academic performance was deleteriously associated with a nutrient‐poor, energy‐dense diet, yet not associated with a nutritious diet. [ABSTRACT FROM AUTHOR]

ABSTRACT: BACKGROUND: Risks associated with teen sexting draw increasing concern from teachers and communities as developments in communication software and devices make sharing private content faster and simpler each year. We examined rates, recipients, and predictors of teen sexting to better plan education and preventative policies and strategies. A comprehensive literature review was conducted to determine the most likely predictors of teen sexting using prior survey studies and theoretical conceptions. METHODS: We surveyed 314 high school students in an urban area of a large Midwestern city. RESULTS: Males were found to more frequently report sexting. Impulsivity, frequency of electronic communication, peer pressure, peer sexting, and social learning significantly predicted sexting beyond age, race, and sex. Self‐esteem did not moderate the effect of peer pressure to sext. Structural predictive models attained good fit to the data, and neither were moderated by sex. CONCLUSIONS: Sexting was highly associated with reported peer pressure, perceived norms, and impulsive decision making. Adolescents in relationships may be at particular risk of sexting. These findings will help parents, teens, and educators take appropriate measures to inform about and encourage the safe use of technology. [ABSTRACT FROM AUTHOR]

ABSTRACT: BACKGROUND: Health education (HE) courses in schools are vital paths for improving teenagers' health literacy. HE and physical education (PE) teachers lead HE courses, and their teaching intentions and competency influence the effectiveness of the courses and the ability to promote students' health literacy. This study attempted to understand HE and PE teachers' health literacy teaching intentions and professional competency and to investigate their relationships. METHODS: This study adopted a cross‐sectional design. A questionnaire survey was administered to 906 middle school HE and PE teachers in Taiwan by mail, and 545 provided valid data with consent. RESULTS: Participants had a favorable health literacy (47.78/50), positive health literacy teaching beliefs and attitudes, and acceptable efficacy. They intended to implement health literacy instruction within the subsequent year. Teaching beliefs, attitudes, and efficacy were all positively correlated with intentions (all p < .001). Demographic variables, health literacy, and teaching beliefs, attitudes, and efficacy explained 33.5% of the variance of teaching intentions. CONCLUSION: Teaching beliefs, attitudes, and efficacy were crucial predictors of health literacy teaching intentions. To improve students' health literacy, educational authorities and schools should pay attention to HE and PE teachers' intentions and vital factors, thereby enhancing teachers' willingness to perform health literacy instruction. [ABSTRACT FROM AUTHOR]