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ABSTRACT BACKGROUND Approximately 9% of school-aged children in the United States have asthma. Since 1997, the Asthma Action Plan ( AAP) has been recommended as an asthma self-management tool for individuals with asthma. In the school setting, the use of the AAP has been primarily dependent on communication between the family and the school through a paper process. METHODS To address the limited availability of AAPs, the Southeast Minnesota Beacon Project developed and implemented a secure portal designed for the electronic exchange of the AAP between providers and schools. This project was designed to assess school nurses' responses to the portal and the perceived value of AAPs, efficiency, self-efficacy, and project impact. RESULTS School nurses perceive that the AAP enables more efficient management of the care of students with asthma and increases school nurse self-efficacy in regard to asthma management. Overall, school nurses felt the AAP portal was useful and they reported satisfaction with its function as a school health office resource. CONCLUSION Electronic sharing of the AAP has the potential to increase efficiency and enhance effective communication among health care providers, families, and schools. [ABSTRACT FROM AUTHOR]

Weight perception has been studied with a limited focus on 'feeling overweight.' This study, using a more inclusive definition of overestimation and underestimation, examines adolescents' weight perception focusing on how accurate it is in relation to body mass index (BMI)-based weight status and how it varies across socio-demographic factors. Data are from the 2007 Minnesota Student Survey, a paper-and-pencil survey completed in the classroom by students in public schools. The final analyses were based on the data from 87,418 high school students who were asked about their height and weight. Weight perception and the BMI-based weight status (based on self-reported weight and height) were strongly and positively correlated, but substantial discordance was observed with more than a quarter of the students (27.6%) having discordant weight perception. Males, minorities, and those from low-income households were more likely than their respective counterparts to have a discordant weight perception. Overall, underestimation was more prevalent than overestimation. Girls were more likely to overestimate, while boys were more likely to underestimate. Black and Hispanic females and those from low-income households were more likely to underestimate than overestimate their weight, while Asian/Pacific Islander males were more likely to overestimate than underestimate. If underestimation is more prevalent among Black or Hispanic females and those from low-income households, the already higher prevalence of obesity among these groups is unlikely to decrease. Overestimation, on the other hand, can be a risk factor for unhealthy weight-control behaviors. Monitoring adolescents' perceived weight in addition to their BMI is critical to understanding the challenge we face with childhood obesity. [ABSTRACT FROM AUTHOR]

BACKGROUND There is limited evidence addressing the impact of adverse childhood experiences (ACEs) on adolescent sexual risk behaviors and pregnancy. In this study, we examined whether individual and cumulative ACEs increased the risk of unhealthy sexual behaviors and adolescent pregnancy. To inform intervention efforts, potential mediating mechanisms focusing on youth developmental assets were examined to explain the association. METHODS: Analyses included 88,815 (9th and 11th grade) students who completed the Minnesota Student Survey in the spring of 2016. RESULTS: Adolescents who reported each category of ACEs were more likely to initiate sex, have multiple sex partners, engage in unprotected sex, and be involved in pregnancy. Different youth assets, included self‐regulation skills, connectedness to school, not skipping school, and academic performance, were associated with lower likelihood of sexual initiation and sexual risk‐taking. They served as important mediators to reduce, though not completely diminish, the adverse effects of ACEs on sexual initiation and adolescent pregnancy. CONCLUSIONS: The results suggest that the relationship between ACEs and adolescent sexual risk behaviors and pregnancy is strong and graded. Effective school initiatives and intervention efforts should encourage the development of self‐regulation and connectedness to school among teens who had been exposed to ACEs. [ABSTRACT FROM AUTHOR]

BACKGROUND: Adolescents frequently miss breakfast which may impact cognitive, academic, and health outcomes. This analysis describes the effect of a trial to assess school level changes to increase breakfast consumption on grade point average (GPA). METHODS: Sixteen rural Minnesota high schools were randomized to a policy and environmental change intervention or delayed intervention (control) group. Baseline screening identified, randomly selected and enrolled 9th and 10th grade students who eat breakfast ≤3 times per school week for assessment. Mean unweighted GPA was provided by 13 schools for 636 students. Student‐level and administrative data were used for sociodemographic and free or reduced‐price meals (FRPM). Linear mixed models and latent class analysis (LCA) were used to assess change in GPA. RESULTS: Students were 54% female, 76% white, and 34% received FRPM. Unweighted cumulative GPA mean = 2.82 (0.78) at baseline. There was no significant intervention effect on GPA postintervention or 1‐year follow‐up. LCA revealed two classes: "higher" (N = 495) and "lower" (N = 141) resource. There was an intervention effect among low‐resource students from baseline to 1‐year post only among the control condition (delayed intervention). CONCLUSIONS: In combination with the full study results, increasing breakfast consumption may have an impact particularly for low resource students. [ABSTRACT FROM AUTHOR]

BACKGROUND: School breakfast is an important nutritional component of a student's day. Many schools operate a school breakfast program, but high schools have low rates of participation. This study aimed to investigate the economic impact on school food service, of expanding the school breakfast program to increase participation in high schools. METHODS: Ten rural high schools participated in the economic analysis of expanding their school breakfast program. Schools provided data on costs of daily operation and start‐up costs. Analyses calculated the daily breakeven point, revenue, cost, and days needed to recoup costs. RESULTS: Schools sold enough breakfast meals to break even on daily costs of operating an expanded program. Schools saw daily profits ranging from $196–$432 and recouped costs associated with expanding the breakfast program within 15–46 days. CONCLUSIONS: Expanding the school breakfast program can be economical for schools, while increasing student exposure to the health and academic benefits of school breakfast. [ABSTRACT FROM AUTHOR]

ABSTRACT BACKGROUND The purpose is to determine if altering school breakfast policies and the school breakfast environment will positively impact adolescent beliefs of the barriers and benefits of eating breakfast. METHODS There were 904 adolescents from 16 rural high schools, Minnesota, in the BreakFAST Study who reported eating breakfast fewer than 4 times per week at baseline. Schools were randomized to intervention (N = 8 schools) or delayed intervention (N = 8) condition. The intervention lasted 1 school year. Students completed an online survey of beliefs of barriers and benefits to eating breakfast at baseline and follow-up. Summative scales were created. Bivariate and multivariate linear regression, accounting for clustering by school, was performed using SAS. Sex interaction was tested. Models tested the effect of the intervention on change in summative scales from baseline to follow -up. RESULTS Participants were 54% female, 69.1% white, 36.6% eligible for free or reduced-price meals (FRM) and 13.1% of families received public assistance. The change in reported barriers was significantly different in intervention versus control schools (Net difference = 1.0, p = .03). There was no intervention effect of perceived benefits. CONCLUSIONS A school-based policy and environmental change intervention can successfully reduce perceived barriers to eating school breakfast. [ABSTRACT FROM AUTHOR]

ABSTRACT BACKGROUND Parental incarceration impacts millions of children in the United States and has important consequences for youths' adjustment and school-based outcomes. METHODS Using data from a survey of youth behavior in one large Midwestern state, we examined the effect of both present and past parental incarceration on school-based outcomes, across 3 school settings (public schools, alternative learning centers, and juvenile correctional facilities). RESULTS Parental incarceration was significantly associated with students' poor school-based outcomes; however, these effects varied markedly by school setting. Among youth in public schools, parental incarceration was consistently associated with poor school outcomes. There were mixed effects among youth in alternative learning centers and no significant effects among youth in juvenile correctional facilities. CONCLUSIONS The study adds to a body of literature demonstrating the negative effects of parental incarceration on youth's school-based outcomes for youth in public schools; however, findings were mixed for youth in alternative learning centers and juvenile correctional facilities. Implications for future research and school practitioners are discussed. [ABSTRACT FROM AUTHOR]

ABSTRACT BACKGROUND Hennepin County partnered with schools to implement lunchroom strategies to encourage fruit and vegetable consumption. An in-depth evaluation measured changes in consumption following implementation of encouragement strategies including slicing apples and attractive labels. METHODS A pre-post prospective evaluation measured changes in average fruit and vegetable consumption at 2 elementary schools. The plate waste method was used to weigh individual waste. To measure consumption, 373 students were matched pre/post. Additional measures included change in fruit and vegetable selection, change in whole servings consumed and apple consumption. RESULTS Average fruit consumption increased by 3.0 g (p = .09), average vegetable consumption increased by 1.1 g (p = .27), neither significantly. The number of students selecting fruit significantly increased (p = .02), while the number taking vegetables increased, but not significantly (p = .28). The number of students consuming an entire serving of fruit (p = .15) or vegetables (p = .45) both increased but not significantly. Apple consumption more than doubled at one school. CONCLUSIONS Implementing lunchroom changes can increase the number of students selecting fruit, and changes including slicing can increase consumption of apples. Additional strategies are needed to increase vegetable selection and fruit and vegetable consumption. [ABSTRACT FROM AUTHOR]

ABSTRACT BACKGROUND We sought to determine if perceived barriers, benefits, and modifiable behaviors support or interfere with breakfast consumption in a racially and economically diverse rural high school population. METHODS The participants were 832 Minnesota adolescents from 16 rural high schools. We used baseline data from a group randomized trial aimed at increasing school breakfast participation through policy and environmental-level school changes. Students completed an online survey asking about demographics, breakfast eating behaviors, and the barriers and benefits of eating as it relates to school performance. Bivariate and multivariate logistic regression, accounting for clustering by school, was performed using SAS. Each scale was modeled independently. RESULTS Participants were 9th and 10th grade students, 36% free/reduced-price lunch ( FRL), 30% non-White, and 55% female. Breakfast skippers compared to nonbreakfast skippers reported fewer school related benefits and beliefs and more barriers to eating breakfast (p < .01). Adjusted models revealed students reported more positive beliefs ( OR = 0.78, 95% CI = 0.73-0.83), more benefits ( OR = 0.95, 95% CI = 0.93-0.97) and fewer barriers ( OR = 0.85, 95% CI = 0.82-0.87) and were less likely to skip breakfast. CONCLUSIONS Future intervention research should focus on alleviating barriers and enhancing education around the school related benefits of eating breakfast. [ABSTRACT FROM AUTHOR]

ABSTRACT BACKGROUND This study explores ways southeast Minnesota schools currently address asthma problems, identifies areas for improvement, and assesses the potential value of asthma action plans (AAPs) in schools. METHODS Focus groups were used to query stakeholder groups on asthma care in schools. Groups were held separately for elementary school personnel, parents of elementary school children with asthma, and health professionals (N = 103). Transcripts were analyzed by hand and by using NVivo 9 software. RESULTS Overall 103 stakeholders participated in focus groups. Major themes were (1) Communication; no uniform way of exchanging information between schools and health professionals. (2) Asthma Control Continuum; students require individualized instructions and information related to their asthma care. (3) Policy/Protocol; school staff roles and rules vary and are unclear. (4) Self-Reliance; older children self-manage their asthma and are unknown until they need emergent support. Solution recommended included AAPs used systematically with a method to communicate back from schools to physicians and parents. CONCLUSIONS The AAP may solve several of the school's concerns regarding their ability to provide asthma support in school. However, the AAP must reach the school, and that is currently not happening. In addition, schools would like tools and systems to assess asthma control and share information back with parents and physicians. [ABSTRACT FROM AUTHOR]

The Healthy Learners Asthma Initiative (HLAI) involved collaboration between Minneapolis Public Schools (MPS), local health care providers/payors, parents, and other partners. The intervention included development of enhanced asthma care in school health offices and clinic performance improvement projects to foster adoption of National Institutes of Health asthma guidelines. Goals were to improve asthma management among school children and reduce asthma-related school absences, hospitalizations, and emergency department visits. The effectiveness evaluation utilized a randomized community trial design with 16 elementary and middle schools matched and randomly assigned to either an intervention or a control group. Outcomes investigated were (a) school health office impacts and (b) school attendance. Data sources included school health office records, district attendance, enrollment, and demographics files. Following implementation of the HLAI, asthma visits to health offices were significantly lower in intervention schools compared to control schools (91 vs 121 visits per 100 students with asthma per month), and intervention schools had greater availability of medication and asthma action plans and more peakflow measurements, asthma education, and parent communication. Clinics initiated significantly more asthma action plans and sent them to MPS. Attendance differences between groups were limited to students who received asthma care through the school health office. Monitoring of asthma management activities provided through school health offices from 2002 to 2005 indicates sustained implementation of enhanced asthma care in schools and increased asthma communication between school, parents, and health care providers. (J Sch Health. 2006;76(6):276-282) [ABSTRACT FROM AUTHOR]

Evaluates the screening program for asthma implemented in inner-city elementary schools in Minneapolis, Minnesota. Standards for screening; Questionnaire requirements; Implications of screening tests on the prevention of childhood asthma incidence.