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

As obesity and physical inactivity rates continue to rise in the United States, Kentucky ranks third in childhood obesity rates (10-17 year olds) and 50th in physical inactivity. The public school environment is a logical place to examine practices and closely discern how time is spent. Federal legislation over the past 50 years has largely dictated the emphasis and priority of our public education system and how schools are funded and assessed. Recently, new federal legislation, the Every Student Succeeds Act (ESSA) of 2015, moved more power, flexibility, and accountability to the states allowing for additional funding opportunities surrounding not just reading and mathematics standardized test scores. Kentucky made promising steps toward including a well-rounded education in their accountability plan, however; ultimately removed those measures in their revised submission to the US Education Department. We must reexamine our current priorities and policies based on evidence-based best practices regarding health, physical activity, and academic achievement. This report outlines history, issues, and policy solutions which will move Kentucky's youth toward better opportunities for quality physical activity in our public schools within our current resources.

Type 2 diabetes is increasing among youth, with minority youth at highest risk. This preliminary study tested the feasibility of a school-based program to prevent type 2 diabetes in youth at risk. Forty-one participants (age 12.6 [+ or -] 1.1 years; 63% female, 51% African American, 44% Hispanic, and 5% Caucasian) were randomly assigned to one of two groups. Both the experimental and control groups received nutrition education and exercise training. The experimental group also received coping skills training. Data collected included body mass index (BMI), insulin resistance, dietary intake (24-Hour Food Recall), self-efficacy (Health Behavior Questionnaire), activity (Revised Godin-Shepard Activity Survey), and parents' health promoting behaviors (Health Promoting Lifestyle Profile III). At baseline BMI ranged from 27 to 53 (M=36.2 [+ or -] 6.0), and 95% (n = 39) demonstrated insulin resistance or pre-diabetes on an oral glucose tolerance test. After 12 months, the experimental group showed trends in improved usual food choices (p = .1) and increased dietary knowledge (p = .3). They also demonstrated lower glucose (p = .07) and insulin levels (p = .2). Experimental group parents demonstrated improved health responsibility (p = .03), healthier nutrition choices (p = .05), improved stress management skills (p = .05), increased activity (p = .2), and increased spirituality (p = .2). Data suggest a school-based program tailored to multiethnic youth may prove successful in helping these youth increase activity, improve nutrition status, and stabilize glucose and insulin metabolism, and also may be effective in changing parent health behavior.

This study examined ethnic differences in substance use and sexual behavior and whether drinking and drug use constitute risk factors for unsafe sexual practices among Native Hawaiian (NH), Caucasian, and Asian/Pacific Islander (API) high school students in Hawaii. A secondary data analysis of the Youth Risk Behavior Survey (1997 and 1999) using a representative sample of 2,657 students in 9-12 grades was performed. Chi-square tests for bivariate associations and multivariate regression analyses were conducted to identify predictors. NHs were more sexually active, initiated sex earlier, and tended to have multiple partners. Alcohol lifetime use was higher in NH, Caucasians, and males. NHs were more likely to initiate drinking by age 12 and engage more in episodic drinking. Non-episodic or episodic drinkers and students who use drugs were at risk to engage in sexual activity, have multiple partners, and use alcohol/drugs during sex. Risk was two times higher for substance use during sex if drinking was initiated at age 10 or younger compared to 15 years or older. Compared to abstainers, the risk doubled for lifetime multiple partners if drinking was initiated at ages 13-14. Overall, females were more sexually active. Because drinking was associated with sexual initiation and risky behavior, adverse effects of alcohol must be addressed in programs targeting underage drinking, thus helping youth delay of minimize sexual activity and prevent other associated problems. Intervention efforts should enhance life skills that endorse abstinence from alcohol and drug use.

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.

Background: Since the inception of the Youth Risk Behavior Surveillance System in 1991, all surveys have been conducted in schools, using paper and pencil instruments (PAPI). For the 2019 YRBSS, sites were offered the opportunity to conduct their surveys using electronic data collection. This study aimed to determine whether differences in select metrics existed between students who completed the survey electronically versus using PAPI., Methods: Thirty risk behaviors were examined in this study. Data completeness, response rates and bivariate comparisons of risk behavior prevalence between administration modes were examined., Results: Twenty-nine of 30 questions examined had more complete responses among students using electronic surveys. Small differences were found for student and school response rates between modes. Twenty-five of 30 adolescent risk behaviors showed no mode effect., Conclusions: Seven of 44 states and DC participated electronically. Because survey data were more complete; school and student response rates were consistent; and minor differences existed in risk behaviors between modes, the acceptability of collecting data electronically was demonstrated., (© 2022, American School Health Association. This article has been contributed to by U.S. Government employees and their work is in the public domain in the USA.)

As obesity and physical inactivity rates continue to rise in the United States, Kentucky ranks third in childhood obesity rates (10-17 year olds) and 50th in physical inactivity. The public school environment is a logical place to examine practices and closely discern how time is spent. Federal legislation over the past 50 years has largely dictated the emphasis and priority of our public education system and how schools are funded and assessed. Recently, new federal legislation, the Every Student Succeeds Act (ESSA) of 2015, moved more power, flexibility, and accountability to the states allowing for additional funding opportunities surrounding not just reading and mathematics standardized test scores. Kentucky made promising steps toward including a well-rounded education in their accountability plan, however; ultimately removed those measures in their revised submission to the US Education Department. We must reexamine our current priorities and policies based on evidence-based best practices regarding health, physical activity, and academic achievement. This report outlines history, issues, and policy solutions which will move Kentucky's youth toward better opportunities for quality physical activity in our public schools within our current resources., (© 2021 American School Health Association.)

As obesity and physical inactivity rates continue to rise in the United States, Kentucky ranks third in childhood obesity rates (10‐17 year olds) and 50th in physical inactivity. The public school environment is a logical place to examine practices and closely discern how time is spent. Federal legislation over the past 50 years has largely dictated the emphasis and priority of our public education system and how schools are funded and assessed. Recently, new federal legislation, the Every Student Succeeds Act (ESSA) of 2015, moved more power, flexibility, and accountability to the states allowing for additional funding opportunities surrounding not just reading and mathematics standardized test scores. Kentucky made promising steps toward including a well‐rounded education in their accountability plan, however; ultimately removed those measures in their revised submission to the US Education Department. We must reexamine our current priorities and policies based on evidence‐based best practices regarding health, physical activity, and academic achievement. This report outlines history, issues, and policy solutions which will move Kentucky's youth toward better opportunities for quality physical activity in our public schools within our current resources. [ABSTRACT FROM AUTHOR]

The Internet has become an inevitable tool for collecting health and health behavior questionnaires. This study compared the feasibility, presence of score differences, and subjective evaluations by chiMren between Internet and identical paper (asthma/ fruit) questionnaires in elementary schools. A randomized crossover design was applied, with children starting with one administration mode before completing (5 minutes later) the other mode. Ten Dutch elementary schools with 270 school children (fifth grade, 10-12 years) were approached to participate. Response was 92%. The Internet mode had significantly less missing/nonunique answers than the paper mode (p < .01). The completion times did not differ significantly between the Internet and the paper mode. Except for perceived self-efficacy to eat sufficient fruit (p < .05), no differences in the asthma and fruit scores were found when comparing between the 2 modes. All variables showed strong intraclass correlation coefficients (166 [great than or equal to] 0.64) between modes. Most items had good to very good agreement (kappa 0.61-0.95). The percentages for global and exact agreement ranged per item from 61.3 to 100. Most children preferred the Internet mode on 'general preference' and 'ease of use' aspects but rated no preference on 'understandability.' The majority rated the evaluation aspects of the Internet mode positively. Thus, Internet administration of a health and health behavior questionnaire is feasible at elementary schools, gives comparable responses, and is well accepted and preferred by children compared to the paper version. Therefore, it is recommended to use Internet as a tool in health and health behavior research among children. (J Sch Health. 2006;76(2):80-86), Health and health behavior questionnaires of youngsters enable the creation of community and school health profiles on which recommendations for interventions can be made. Such questionnaires may also provide a [...]

Despite widespread recognition of schools' role in the healthy development of youth, surprisingly little research has examined the relationships between schools' overall functioning and the health-related behavior of students. School functioning could become an important predictor of students' health-related behavior and may be amenable to intervention. This paper describes the development and testing of the School Functioning Index (SFI) as a first step in investigating this question. The index was developed for use with middle schools and conceived as a predictor of students' violent behavior, with the potential for extending research applications to additional health and social behaviors. Using social cognitive theory, social ecological theory, and social disorganization theory as guides, three domains were identified to operationalize school functioning and identify candidate SFI items: 1) resources available to the school and students; 2) stability of the school population; and 3) the schools' performance as a socializing agent for students. Data for candidate SFI items were collected from public archives and directly from 16 middle schools participating in a school-based dietary intervention study. Data collection from schools, particularly concerning student aggressive behavior and disciplinary actions, presented challenges. The final SFI comprised nine items and demonstrated good internal consistency and variability. The SFI was modestly correlated in expected directions with violence and other health behaviors. This work supports the feasibility of combining multiple school-level indicators to create a measure of overall school functioning. Further investigation of validity and more acceptable data collection methods are warranted. (J Sch Health. 2003;73(6):232-238), Despite widespread recognition of schools' role in the healthy development of youth, surprisingly little research has examined the relationships between schools' overall functioning and the health-related behavior of students. Schools [...]

The US Department of Education's Principles of Effectiveness require recipients of Safe and Drug-Free Schools and Community Act funds to: a) base drug and violence prevention programs on needs assessment data, b) develop measurable program goals and objectives, c) implement programs with research evidence of effectiveness, and d) periodically evaluate programs relative to their goals and objectives. This paper reports the extent of awareness of the Principles of Effectiveness and plans for their implementation among public school districts and schools in the United States in the year following their announcement. Results showed a greater percentage of public school districts than individual schools knew about the principles and planned for implementation, but baseline levels of awareness for both districts and schools were relatively low. Schools were more likely to know about the principles when their associated school district also knew. Results suggest a need for greater communication about the principles to school districts, and in turn, a need for greater communication between district and school-level substance use prevention staff., On July 1, 1998, the US Department of Education promulgated the Principles of Effectiveness and made compliance with the principles prerequisite for public schools to continue receiving funds through the [...]

Increasing physical activity among youth represents a national health goal, and using volunteer activity providers at schools offers one possible solution. This paper describes results from a program to recruit volunteer physical activity providers in middle schools. Twenty-one volunteers provided 850 physical activity hours at seven schools, including 575 activity sessions and 7,186 student contacts. Volunteers who received incentives offered more minutes of activity, conducted more activity sessions, reached a greater number of students, and logged more student-minutes of physical activity than those who received none. Male volunteers provided more activity minutes than female volunteers, but females were marginally more successful in engaging female students. Results can help guide schools to more effectively increase student physical activity throughout the school day., Young people are not meeting the physical activity levels recommended for health, (1-3) thereby increasing associated risks such as obesity. (4,5) Physical activity levels decline during adolescence (6) with more [...]

This study examined relationships between age of smoking and drinking initiation, and subsequent patterns of smoking and drinking among Japanese high school students. Self-administered anonymous questionnaires were conducted using a sample of 1,466 students in grades 10 through 12 at seven public senior high schools in urban areas of Okinawa, Japan. After controlling for demographic variables, students who began smoking at age 12 or younger were more likely to become heavy smokers and heavy drinkers than those who began smoking at ages 15 or older. Age of smoking initiation was not related to risks for current smoking and current drinking. Students who started drinking at age 12 or younger, and at 13 or 14 years, were significantly associated with current smoking, current drinking, heavy smoking, and heavy drinking, compared to students who began drinking at ages 15 or older. Early onset smoking and drinking represent significant predictors for subsequent use of cigarettes and alcohol. These findings suggest that smoking and drinking prevention programs should begin during elementary school. (J Sch Health. 2003;73(6):226-231), Cigarettes and alcohol are the substances most commonly used by Japanese adolescents, though minors are prohibited by law from smoking and drinking. In nationwide surveys of Japanese adolescents, the percentage [...]

School-based health centers (SBHCs) are increasingly charged with providing primary care services including asthma care. This study assessed SBHC provider adherence to the National Heart, Lung, and Blood Institute (NHLBI) asthma care guidelines and the association among provider adherence, patient characteristics, and asthma outcomes. A cross-sectional study design was used to assess SBHC chart data from 415 children with asthma attending four inner-city elementary schools (K-5) in the Bronx, NY. Asthma symptoms, peak flow use, follow-up visits, and referrals to asthma specialists were documented in the charts of 60%, 51%, 22%, and 3% of subjects, respectively. Thirty-three percent of charts had SBHC clinician-documented severity classifications, of which 70% had appropriate medications prescribed. Asthma education and an asthma plan were documented in 18% and 10% of charts, respectively. Environmental triggers and tobacco exposures were documented in 71% and 49% of charts, respectively. Older children (> 8 years) were more likely to have documentation of peak flow use for asthma management, asthma education, follow-up visits, and written asthma plans, whereas younger children (< 8 years) were more likely to miss more days of school (all p < .05). Overall, provider adherence to NHLBI guidelines was inadequate, with adherence somewhat better for older children., Asthma, the most common chronic illness affecting children, is associated with more than 570,000 emergency department visits and 3 million office visits annually for young children. (1,2) Asthma is the [...]

Of 490 middle and high school students attending alternative schools who participated in this study, 18.2% of females and 6.7% of males reported a past unwanted sexual experience. Relative to nonabused subjects, female and male adolescents who reported a forced sexual experience were more likely to exhibit externalizing problems such as sexual risk behaviors and internalizing problems such as depression and suicidal thoughts in the past two weeks. Females with a history of a coercive sexual experience also had increased odds of drug and alcohol use, and violence-related behaviors. The magnitude of these associations ranged from a twofold increase to a tenfold increase. Controlling for ethnicity, family income, and family support had less impact on the strength of associations between a forced sexual experience and sexual risk behaviors for females than for males. A forced sexual experience remained significantly associated with depression for females and suicidal thoughts for males. Alcohol use in the past 30 days was the only substance use-related problem that remained significant for females. Violence-related behaviors did not remain significant in the presence of control variables for females. Interventions focusing on adolescents with a history of a coercive sexual experience in general, and in alternative schools in particular, are suggested by these results. More research focusing on the differential impact of a coercive sexual experience on males and females is crucial., An estimated 7% to 53% of American women, and 3% to 37% of American men, have been victims of a coercive sexual experience during childhood or adolescence. (1) Estimates of [...]

Little is known about risk and protective factors associated with sexual experience among alternative school students that might prove useful in targeting and guiding early interventions to prevent onset of sexual risk behavior. Researchers analyzed data from the national Alternative High School Youth Risk Behavior Survey. Principal components analysis identified six risk and protective factors: weapon carrying; tobacco use; cocaine, inhalant, and needle use; alcohol and marijuana use; participation in sports; and fighting. Composite variables with significant bivariate relationships to sexual experience, as well as demographic variables, were entered into a logistic regression analysis to determine independent effects of these correlates on students' sexual experience (N = 6,037). Nearly 90% of students reported having sexual intercourse. In multivariate analyses, significant demographic correlates of sexual experience included female gender (58% more likely than males to report ever having sex), African American race (2.83 times more likely than non-Hispanic Whites), and age (28% more likely with each advancing year). Attending school in a rural or suburban region corresponded to a 31% decrease and 46% decrease, respectively, in the odds of ever having sex. Weapon carrying, and cocaine, inhalant, and needle use, were associated with a 35% and 46% increase, respectively, in the odds of ever having sex. Students reporting they had ever used alcohol or marijuana, and those reporting recent fighting behavior, were 2.7 and 1.6 times more likely, respectively, to report sexual experience. Most alternative school students have had sexual intercourse, with those students engaging in substance use, weapon carrying, and fighting behaviors being at greater risk for sexual experience. Prevention programs for high-risk youth attending alternative high schools need to consider how to promote continued abstinence among the small but important minority of alternative school students not yet sexually experienced., Sexual risk behavior declined for adolescents the past decade, but some groups of adolescents remain vulnerable to sexual risk and other health-risk behaviors. (1) One group of potentially vulnerable adolescents [...]

This report provides information about drug testing by American secondary schools, based on results from national surveys. The study provides descriptive information on drug-testing practices by schools from 1998 to 2001, and examines the association between drug testing by schools and reported drug use by students. School-level data on drug testing were obtained through the Youth, Education, and Society study, and student-level survey data were obtained from the same schools participating in the Monitoring the Future study. A relatively small percentage of schools (about 18%) reported testing students for drug use, with more high schools than middle schools reporting drug testing. Drug testing was not associated with students' reported illicit drug use, or with rate of use among experienced marijuana users. Drug testing of athletes was not associated with illicit drug use among male high school athletes. Policy implications are discussed. (J Sch Health. 2003;73(4):159-164), In the 'war on drugs,' schools employed a variety of mechanisms for enforcing zero-tolerance policies, including drug testing, metal detectors, closed circuit cameras, and sniff dogs. These policies and procedures [...]

Students who violate school smoking policies present a difficult health and disciplinary issue for school officials, Professionals know little about the characteristics of students who smoke at school. In a prospective study of 679 students in two cities in central Massachusetts, researchers examined how nicotine dependence contributes to the problem of smoking at school. After three years of follow up, smoking at school was reported by 10.3% of students. Among subjects who admitted to smoking at school, 63% reported that symptoms of nicotine dependence preceded their smoking at school. After adjusting for other variables, student smokers with symptoms of nicotine dependence were nine times more likely to report smoking in school (OR 9.1, 95% CI 2.9 - 28.5) than were student smokers without symptoms. Smoking at school was more common among daily smokers and those who paid for their own cigarettes. Age, gender, race, and parental smoking status were not significantly associated with students' reports of smoking at school. These data suggest nicotine dependence as an important contributor to the problem of smoking at school, but not the only reason why students violate school smoking policies. Disciplinary action against students caught violating school smoking policies should be supplemented with an offer of treatment for nicotine dependence. (J Sch Health. 2003;73(4): 154-158), With 31% of high school seniors reporting tobacco use within the previous 30 days, adolescent smoking represents a serious problem. (1) Since four of five persons who use tobacco begin [...]

To understand the relationship between demographic characteristics of schools and school health policies and programs, this study analyzed data from the School Health Policies and Programs Study (SHPPS) 2000. SHPPS 2000 provides nationally representative data on eight components of school health. Data were collected from school faculty and staff using onsite, computer-assisted personal interviews, then linked with extant data on school characteristics. Results from a series of regression analyses indicated that the presence of most policies and programs examined differed according to school type (public, private, or Catholic), urbanicity, school enrollment size, per-pupil expenditure, percentage of White students and, among high schools, percentage of college-bound students. No one type of school, however, was more likely than another type to have all key aspects of a school health program in place. Regardless of school characteristics, all schools are capable of implementing quality school health programs. (J Sch Health. 2003;73(4):143-149), School health programs can play a critical role in reducing health-risk behavior and promoting healthy behavior among young people. Allensworth and Kolbe described eight components of a comprehensive school health [...]

To determine the feasibility and value of spirometry in school-based asthma screening, spirometry testing was coupled with parent questionnaires in a school-based asthma screening project. Children in grades five to eight of the Catholic school system in Rochester, Minn., performed spirometry with coaching and data acquisition by nurses trained for this activity. Most students completed three tests. For each student, the best test was selected for interpretation. Tests were considered technically unacceptable for screening purposes if the FEV1 was less than 85% and the curve showed evidence of cough, delayed start, poor initial effort, incomplete effort, or non-reproducibility. Students with acceptable tests and FEV1, Asthma, the most common chronic disease of childhood, frequently goes unrecognized. (1,2) To address the problem, numerous school-based asthma screening programs were developed to identify children with undiagnosed asthma, with [...]

To identify factors associated with school adjustment and engagement, 1,267 sixth graders in four middle schools in one US school district were surveyed at the beginning (Time 1) of the school year, 1,081 (85.3%) of whom were surveyed again at the end (Time 2). School adjustment was higher for girls than boys at both Time 1 and Time 2 and the decline was less for girls than boys and Whites than Blacks. School engagement also declined significantly from Time 1 to Time 2, but no differences existed among subgroups. In multiple linear regression analyses, female gender, school engagement, social competence, parental involvement, and depressive symptoms (negative association) assessed at Time 1 were associated with school adjustment assessed cross-sectionally at Time 1 and prospectively at Time 2. Social competence and parental involvement assessed at Time 1 were associated with school engagement assessed at Time 1 and Time 2. Findings confirm the decline in school adjustment and engagement during middle school and provide evidence that parental involvement and social competence may be protective against declines in these variables., Declines in achievement motivation and performance during early adolescence (1,2) and acting out behaviors at school (3) are notable concerns of parents, teachers, and policy makers. Research has emphasized the [...]

This study examined whether participation in school team sports, exclusively or in combination with other extracurricular activities, is associated with higher levels of psychosocial functioning and healthy behavior than participation in other extracurricular activities alone or nonparticipation. The study sample includes 50,168 ninth grade public school students who completed an anonymous, voluntary statewide survey in 2001. Students were classified into four groups based on their participation in sports and other activities (such as clubs, volunteer work, band, choir, or music lessons): neither, both, other activities only, and sports only. Odds ratios for the group involved in both types of activities were significantly higher than those for all the other groups for all healthy behaviors and measures of connectedness, and significantly lower for all but one of the unhealthy behaviors. Students involved in sports, alone or in combination with other activities, had significantly higher odds than the other two groups for exercise, milk consumption, and healthy self-image, and significantly lower odds for emotional distress, suicidal behavior, family substance abuse, and physical and sexual abuse victimization. Students involved in other activities, alone or in combination with sports, had significantly higher odds than the other two groups for doing homework and significantly lower odds for alcohol consumption, marijuana use, and vandalism. The finding that abuse victims appeared to avoid sports but not other group activities raises concern and merits further research. Considering the potential benefits of participation in sports and other activities, more research is needed to identify and overcome barriers or deterrents, particularly for youth from low-income families., An extensive theoretical and research literature documents that a sense of belonging to the family and to the school community is critically important for healthy adolescent development. Such bonding serves [...]

This study assessed whether sexual norms and attitudes expressed during early adolescence by minority youth from economically disadvantaged urban areas produce a sustained influence on the timing of sexual initiation. African American and Latino youth attending three middle schools were enrolled in the Reach for Health study in seventh grade and followed from an average age of 12.2 to 16.1 years. Some 849 respondents answered the question, 'Have you ever had sexual intercourse' at four time points: fall seventh, spring seventh, spring eighth, and spring 10th grade. Culturally tailored scales assessed sex norms and outcome expectancies, sexual responsibility, and refusal attitudes at fall seventh grade. Influence of these norms and attitudes in early adolescence on timing of first reported sexual intercourse was examined using ANOVA controlling for gender. At fall seventh grade, 30.7% of boys and 7.7% of girls reported sexual intercourse; by spring 10th grade, the figures were 74.8% and 56.4%, respectively. Those reporting greater peer involvement in sex and more positive sex outcome expectancies were more likely to have initiated sex by fall seventh grade. Through 10th grade, the higher the scores on peer norms (f = 41.08, p, Early initiation of sexual activity has been linked with increased risk for negative health outcomes including HIV, other sexually transmitted diseases, and unintended pregnancy. (1-4) This link may exist because [...]

To help assess the quality of the questionnaires developed for the School Health Policies and Programs Study (SHPPS) 2000, the Centers for Disease Control and Prevention (CDC) conducted a data quality substudy in conjunction with SHPPS 2000. The substudy assessed validity of the state- and district-level questionnaires through telephone interviews with a subsample of the original state- and district-level respondents, and the test-retest reliability of the school- and classroom-level questionnaires through computer-assisted repeat interviews with a subsample of the school- and classroom-level respondents. Results indicated that although a few threats to the validity of responses to the state- and district-level questionnaires were identified, the questionnaires generally produced valid data. Among the school- and classroom-level questionnaires, some questions demonstrated poor reliability, but most exhibited moderate or substantial reliability, and some exhibited almost perfect reliability. CDC will use these results to revise the SHPPS 2000 questionnaires and will consider alternative methods of data collection to improve the quality of data collected in future versions of SHPPS. (J Sch Health. 2003;73(1):29-37), Between January and July 2000, the Centers for Disease Control and Prevention (CDC) conducted the School Health Policies and Programs Study (SHPPS) 2000, the most comprehensive assessment of school health [...]

This study examined whether receiving preservice instruction in health education methods affects the health instruction provided by elementary classroom teachers. Using a researcher-constructed self-report questionnaire, 800 third-, fourth-, and fifth-grade teachers in Indiana were randomly selected to complete the questionnaire. Returns included 366 usable responses from an effective sample of 772, for an overall response rate of 48.06%. Analysis of variance indicated a statistically significant difference among respondents in the mean number of 10 health content areas taught, the depth of coverage of all content areas except Community and Environmental Health, the mean number of health lessons taught per week, and the minutes spent teaching health per week. Pairwise comparisons indicated respondents who completed both a health education methods course and a physical education methods course taught a greater number of health content areas, and taught more topics in eight of the 10 health content areas, than did respondents who did not complete preservice instruction in health education methods., While elementary children may not suffer the immediate effects of lifestyle choices on their health, they already are at risk. Research indicates that once health behaviors are established during childhood, [...]

Television (TV) viewing has been associated with overweight, decreased physical activity, and unhealthy dietary behavior among children and adolescents, and may represent a modifiable cause of childhood obesity. This study examined race, ethnic, and gender-specific differences in these associations among high school students in the United States. The study analyzed data from the 1999 national Youth Risk Behavior Survey, a representative sample (N = 15,349) of US high school students. Logistic regression tested for significant associations. TV viewing on an average school day exceeded 2 hours/day among 43% of students; it was greater among Black (74%) and Hispanic (52%) than White (34%) students. Overall, 11% of students were overweight, 31% of students were sedentary (ie, did not participate in moderate or vigorous physical activity at recommended levels), and 76% ate less than five servings/day of fruits and vegetables. Watching TV more than 2 hours/day was associated with being overweight, being sedentary, and eating insufficient fruits and vegetables among White females, and with being overweight among Hispanic females. No significant associations were found among Black females. TV viewing was associated with being overweight and eating insufficient fruits and vegetables among White males. No significant associations were found among Hispanic males. Among Black males, TV viewing was associated with greater participation in physical activity. These findings suggest the presence of cultural factors to consider when developing interventions to promote physical activity, healthy eating, and healthy weight through reduced TV viewing among adolescents., Childhood obesity has more than doubled over the past 20 years, and it represents the most prevalent nutritional disease among youth in the United States. (1,2) Among children and adolescents, [...]

This study examined the relationship between academic and behavioral difficulties at school, and tobacco use in students. Participants included 1,219 students in fourth to seventh grade at the time of enrollment. Interviews were repeated eight months later with 85% of baseline participants. Telephone interviews assessed use of cigarettes, cigars, and chewing tobacco; students also were asked if they liked school, how often they got in trouble at school, and how well they were doing in school. At baseline, students reporting school difficulties were 1.4 - 5.6 times more likely to report a lifetime history of cigarette, cigar, and chewing tobacco use relative to students who did not report these difficulties. Average to below-average academic performance at baseline was predictive of new cigarette use at the eight-month follow-up (Relative Risk = 3.35; 95% Confidence Interval = [1.36, 8.22]). Self-reported school difficulties are associated with lifetime use of all major forms of tobacco and are predictive of future cigarette use in fourth- to seventh-grade students. (J Sch Health. 2002;72(9):368-373), Numerous studies indicate that sociodemographic and behavioral indices can help identify children and adolescents at high risk for tobacco use. (1-5) For example, adolescents with low levels of academic achievement [...]

This study examined classroom food practices and eating behavior of middle school teachers from 16 schools in a metropolitan area, located in the upper Midwest. In winter 1999-2000, teachers in sixth, seventh, and eighth grade were surveyed (response rate = 70%; n = 490/701). Questions addressed teachers' classroom food practices, eating behavior while at school, personal health, and attitudes about the school food environment. Use of food as an incentive/reward for students was a common classroom practice in middle schools, and most foods did not support development of healthy eating patterns by young adolescents. Candy was the most frequently used food item, reported by 73% of teachers, followed by cookies/doughnuts (37%), sweetened drinks (35%), and pizza (28%). Many middle school teachers did not role model healthy eating behavior at school. Prevalent use of vending was a particular concern, with beverage and snack vending use reported by 62% and 35% of teachers, respectively. Most vending items purchased were sweetened drinks (57%) and high-fat or high-sugar snacks (85%). Low perceived personal health, high-fat scores, and low support for the school food environment were some of the significant correlates of teachers' eating behavior. School and health professionals should continue to advocate for schoolwide policies and programs that support students and teachers if the goal of an integrated healthy school food environment is to be realized., The 1996 Centers for Disease Control and Prevention's Guidelines for School Health Programs to Promote Lifelong Healthy Eating focused attention on the critical role of schools in promoting and supporting [...]

This study assessed the effectiveness of a model for diffusing the Life Skills Training (LST) Program into middle schools, examined implementation fidelity, and explored factors associated with involvement in training and program implementation. A convenience sample of master trainers (n = 44) and teachers (n = 45)from 16 Kentucky counties participated. Teachers were observed for content and process fidelity, and trainers and teachers completed questionnaires to assess factors related to training and program implementation. More than one-fourth (27%) of master trainers conducted training sessions, and 60% of teachers taught the curriculum. While implementation fidelity was relatively high, teachers were less likely to use the more innovative elements of the program. Trainers and teachers who conducted training and/or taught the LST Program were more enthusiastic toward the program than those who did nothing beyond being trained. (J Sch Health. 2002;72(7):282-287), The Life Skills Training (LST) Program is a substance abuse prevention curriculum based on a multifactorial causal model of youth alcohol, tobacco, and other drug use and on Social Learning [...]

This study set three objectives: 1) to examine the perceived influence of health concerns, labeling and nutrition information, taste, cost, availability, and peers on adolescents' food choices, particularly in the school cafeteria; 2) to determine whether these factors vary by gender, grade level, or adolescents' health and weight concerns; and 3) to provide recommendations regarding promotion of low-fat foods in the school cafeteria based on factors associated with food choices. Data were collected from a school survey that assessed key influences on adolescents' food choices, including low-fat foods. Some 289 students in grades 10-12 from a senior high school in a metropolitan area served as subjects. Descriptive statistics, chi-square, and general linear models were used for analysis. Results indicated that, when choosing foods from the school cafeteria, taste and getting a lot for their money were important to most students (93.7% and 71.7%, respectively). Females, and students who thought about their health and weight more frequently when deciding what to eat, were more likely to report greater interest in labeling and nutrition information and availability of low-fat foods in the school cafeteria. Findings suggest that efforts to promote low-fat foods to adolescents need to address the taste of low-fat foods, availability of low-fat options, and point-of-purchase labeling of low-fat foods. Focusing on the value and cost of low-fat foods may offer a key strategy for promoting low-fat foods to males., Healthy eating during adolescence helps youth to achieve full growth potential, to promote health and well-being, and to reduce the risk of chronic diseases in adulthood. (1) Total nutrient needs [...]

ABSTRACT: The North Carolina 'Baby Think It Over' (BTIO) evaluation was conducted during spring semester 2000. Data were collected from participating teachers, students, and parents. Twenty-five teachers were selected randomly [...]

This study, a secondary analysis of the National Longitudinal Study of Adolescent Health, used a representative sample of 7th- through 12th-grade students enrolled in US public schools between April and December 1995. Data were collected in respondents' homes using trained interviewers. A subset of 4,485 adolescents aged 12-17 were surveyed with regard to alcohol-use practices and related health-risk behavior, interpersonal problems, and demographic characteristics. Results showed adolescent males as significantly more likely to drink at high risk than adolescent females. Among those who drank one or more times in the past year, older adolescents were significantly more likely to report high-risk drinking than younger adolescents. Significantly more high-risk adolescents reported having a hangover, vomiting, regretting a behavior, having trouble with parents, regretting a sexual activity, having dating problems, fighting, having trouble with friends, and experiencing school trouble than did low-risk adolescents. These findings underscore the long-range significance of a coordinated school health program; in particular, school health services, school health instruction, and school health environment. Implications for school-based and community-based prevention and intervention programs are presented., The use, misuse, and abuse of alcohol among adolescents has been characterized as America's No. 1 public health problem. (1) More than two decades of nationwide research involving adolescents (2) [...]

Increasing evidence shows that when adolescents feel cared for by people at their school and feel like a part of their school, they are less likely to use substances, engage in violence, or initiate sexual activity at an early age. However, specific strategies to increase students' connectedness to school have not been studied. This study examined the association between school connectedness and the school environment to identify ways to increase students' connectedness to school. Data from the in-school and school administrator surveys of the National Longitudinal Study of Adolescent Health (75,515 students in 127 schools) and hierarchical linear models were used to estimate the association between school characteristics and the average level of school connectedness in each school. Positive classroom management climates, participation in extracurricular activities, tolerant disciplinary policies, and small school size were associated positively with higher school connectedness., When adolescents feel cared for by people at their school and feel like a part of their school, they are less likely to use substances, engage in violence, or initiate [...]

This study examined relationships among perceived stress, self-esteem, acculturation, and gender with the coping response of 472 Mexican American adolescents aged 14 to 16 years. Subjects were drawn from a predominantly Mexican American population located in the Lower Rio Grande Valley region of Texas. Data were collected through a self-report instrument consisting of perceived stress, acculturative status, self-esteem, and coping strategy scales. Subjects reported relatively high perceived stress levels, low acculturation, and moderate self-esteem scores with no significant gender differences. Analysis revealed self-esteem as most predictive of a more effective overall coping response. Results suggest Mexican American adolescents possessing high self-esteem are less likely to encounter damage to their sense of self when confronted with stressors, thus allowing for productive coping., Compelling evidence suggests adolescents' unhealthy adaptation to stress contributes to a number of emotional and behavioral problems. Adolescents' inability to cope with life stressors has been associated with diminished academic [...]

CATCH provides multiethnic cohort data from third to eighth grades from four US geographic regions. This study examined smoking behaviors and predictors from fifth and eighth grades by ethnicity, gender, and geographic location through self-report data obtained from the cohort (N = 3,654). Overall, eighth grade prevalence for ever smoked was about 44%, 30-day prevalence was about 20%, 7-day prevalence 13.3%, and daily prevalence 7.4%. Prevalence was similar for Caucasians (21.5%) and Latinos (21.6%) and lowest for African Americans (13.1%). The 30-day prevalence for smokeless tobacco was higher for boys than for girls (9.8% vs 5.1%). Tobacco use by parents, siblings, and friends, and easy accessibility in the home in fifth grade, were significant predictors for smoking in eighth grade. Results did not differ by race, gender, or geographic location. The strongest correlate of smoking in eighth grade was having a best friend who smoked. Intention not to smoke in fifth grade predicted nonsmoking in eighth grade. Predictor strength across ethnic groups in different geographic regions was impressive. The social environment of young people continues to be an important instigator of smoking onset. The connection between intention and behavior over time suggests students' intentions not to smoke reflect decision-making at an early age. (J Sch Health. 2002;72(2):58-64), Tobacco use constitutes the most lethal modifiable behavior persistent in the United States today, and it represents a significant factor in developing heart disease and specific cancers. (1) Tobacco-related illnesses [...]

The Social Ecology Model of Adolescent Interpersonal Violence Prevention (SEMAIVP) was used to examine adolescent beliefs and behaviors about interpersonal violence. Cross-sectional data were collected from middle school students using the Youth Conflict Mediation Survey. Regression models were developed for the total sample, by gender and by race. Factors explaining 48% of the variance in violence avoidance responses include more frequent positive recognition for violence avoidance, possessing a higher sense of nonviolence self-efficacy, and more frequent involvement in violence engagement behaviors. Factors explaining 53% of the variance in violence engagement responses include more exposure to neighborhood fighting, fewer prosocial anger control beliefs, fewer prosocial anger control strategies, more skill development opportunities, and more frequent involvement in violence avoidance behaviors. Findings suggest that prevention approaches need to use a comprehensive social ecology approach that includes intrapersonal, personal, school, and neighborhood environmental components and that provides recognition to adolescents for using violence avoidance skills. (J Sch Health. 2002;72(2):65-70), Few empirically tested theoretical models of adolescent violence prevention exist to guide development of effective prevention programs. Without simple yet comprehensive models, professionals find it difficult to develop effective prevention [...]

This study determined if differences existed between four race/gender groups in regard to attempted suicide among a randomly selected, cross-sectional population of 4,565 public high school students in South Carolina. A modified Youth Risk Behavior Survey was designed to gather information on quality of life, life satisfaction, and six risk-behavior categories. Data first were analyzed using logistic regression analysis and subsequently analyzed using path analysis. Results suggest several independent variables (feelings of intimidation, alcohol and cocaine use, self-perceptions of mental health, self-perceptions of body weight, dieting practices, bulimic episodes, and physical and sexual abuse) were associated significantly (p < .01) with adolescent attempted suicide either directly or indirectly through mediating variables. Significant associations among risk behaviors, mediating variables, and self-reported attempted suicide varied across the four race/gender groups, indicating a need to further study differences noticed in each race/gender scheme. (J Sch Health. 2002;72(2):71-77), Suicide currently ranks as the second-leading cause of death for youth aged 15 to 19 years. (1) The suicide rate for this group has increased more than 300% since 1950 [...]

As part of the Partners in School Asthma Management Program, environmental data were collected from 385 rooms in 60 elementary schools in southeast Texas, using an Environmental Observation Checklist and a Q-TRAK Indoor Air Quality Monitor. Dust samples for allergen analysis were collected from floors, carpets, and area rugs in 80 classrooms in a subset of 20 schools. C[O.sub.2] levels > 1,000 ppm were found in 86% of rooms; 69% had indoor humidity above recommended levels. Der p I dust mite allergen levels >2,000 ng/g were present in 20% of rooms, but only 2.5% of rooms had Der f I mite allergen levels exceeding recommended tolerances. Detectable levels of cockroach allergen (Bla g H) were found in all schools (median 5.5 ng/g), with 10% of rooms over the recommended threshold. Almost two-thirds of classrooms had mold spore counts > 10,000 col/g (median, 14,400 col/g; range, 2,000 - 52,000 col/g)., Indoor allergens such as cat and rodent dander, cockroach, dust mites, and fungi/mold have all been implicated in exacerbating asthma symptoms among sensitized individuals. Exposure to dust mites also may [...]

This study examined the influence of demographic characteristics and selected family factors on consumption of a healthy breakfast and lunch and consumption of fruits and vegetables among adolescents. A cross-sectional survey was completed by a representative sample (n=3,155) of students from all high schools in a suburban county near Atlanta, Georgia. Students consuming healthy breakfasts, healthy lunches, and more fruits and vegetables were more likely to be White or Asian (lunch/fruits and vegetables only), better able to communicate with parents or guardians on serious issues, closely monitored by their parents, living with one or both parents, spending less time at home without adults, perceiving themselves at about the right weight or underweight (lunch/breakfast only), male (lunch/breakfast only), and in 9th or 10th grade (breakfast only). These results suggest family factors should be considered in the development and implementation of nutrition interventions. (J Sch Health. 2001;71(10):483-488), Researchers agree that a relationship exists between diet and chronic disease, but converting the research into changes in dietary behavior poses a challenge. (1, 2) Americans typically consume meals primarily [...]

The family milieu provides a potential context for integrating smoking cessation and prevention activities to complement school-based efforts. In this study, surveys were mailed to caregivers of elementary school children to assess demographics, smoking characteristics and attitudes, and receptivity to and preferred format for health promotion programs. Fifty-three percent (n=276) of 501 caregivers responded. Among smokers, most did not want their children to smoke, and they wanted to quit themselves; 91% considered it important to involve their children in their smoking cessation attempts; and 70% expressed willingness to participate in health promotion for the entire family. Written materials either mailed home or brought home from school were the preferred program formats. These findings suggest the feasibility of a program in which adults and children work together at home on smoking cessation and prevention activities that might increase the effectiveness of school-based smoking prevention messages. (J Sch Health. 2001;71 (10):489-494), Tobacco use, primarily cigarette smoking, represents the leading cause of premature death and disability in the United States, accounting for 400,000 deaths, some 5 million years of potential life lost, [...]

This study examined primary grade teachers' knowledge of head lice, perceived self-efficacy in dealing with head lice, and preferred resources of additional information on head lice. Survey data from a three-wave mailing (M=292; 60%) found that teachers needed more knowledge regarding head lice and were significantly more knowledgeable as teaching experience increased. A plurality (46%) had high efficacy expectations scores regarding their ability to control the spread of head lice. Most (71%) primary teachers reported they received most of their head lice information from school nurses. Most (63%) said they would like more information on how to prevent head lice infestation, and they wanted the information in the form of videotapes (68%) and brochures (51%). Only 23% provided yearly instruction regarding head lice. (J Sch Health. 2001;71(9):448-452), Management of head lice has stumped parents, health professionals, and teachers for years. Infestation of head lice can affect the child and the family financially, educationally, and psychologically. Education, recognition, [...]

Background: Computerized surveys present many advantages over paper surveys. However, school-based adolescent research questionnaires still mainly rely on paper-and-pencil surveys as access to computers in schools is often not practical. Tablet-assisted self-interviews (TASI) present a possible solution, but their use is largely untested. This paper presents a method for and our experiences with implementing a TASI in a school setting., Methods: A TASI was administered to 3907 middle and high school students from 79 schools. The survey assessed use of tobacco products and exposure to tobacco marketing. To assess in-depth tobacco use behaviors, the TASI employed extensive skip patterns to reduce the number of not-applicable questions that nontobacco users received. Pictures were added to help respondents identify the tobacco products they were being queried about., Results: Students were receptive to the tablets and required no instructions in their use. None were lost, stolen, or broken. Item nonresponse, unanswered questions, was a pre-administration concern; however, 92% of participants answered 96% or more of the questions., Conclusions: This method was feasible and successful among a diverse population of students and schools. It generated a unique dataset of in-depth tobacco use behaviors that would not have been possible through a paper-and-pencil survey., (© 2017, American School Health Association.)