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BackgroundAlthough it has been recommended that schools be the hub of efforts to improve child nutrition, research describing school nutrition environments in US public schools and their associations with child health is limited.ObjectiveThis study aimed to evaluate the applicability of factor analysis methods to characterize school nutrition environments by identifying underlying factors, or dimensions, in the observed data and to examine the relation between school nutrition environment dimensions and child anthropometric and dietary outcomes.MethodsThis study examined a cross-sectional sample of 4635 US children aged 4-15 y from 386 US elementary and middle schools from the Healthy Communities Study (2013-2015). Data collected from schools were used to create 34 variables that assessed the school nutrition environment. To identify dimensions of school nutrition environments, exploratory factor analysis was conducted with orthogonal rotation, and factor scores were derived using methods to account for sporadic missing data. Mixed-effects regression models adjusted for child- and community-level variables and clustered by community and school examined the associations of school nutrition environment dimensions with child anthropometric and dietary outcomes.ResultsSix dimensions of school nutrition environments were derived: nutrition education, food options, wellness policies, dining environment, unhealthy food restriction, and nutrition programs. The unhealthy food restriction dimension was negatively associated with added sugar intake (β = -1.13, P

Background Many adolescents experience mental health problems which may have serious consequences for short- and long-term health and wellbeing. This study investigates socioeconomic inequality in emotional symptoms, self-efficacy and social competence. Further, whether self-efficacy and social competence reduce socioeconomic inequalities in emotional symptoms. Methods Data stem from the cross-sectional Danish Health Behaviour in School-aged Children Methodology Development Survey 2012. Data were collected among all schoolchildren in grades 5–9 (11–15-year-olds) in 23 public schools in two municipalities. Participation rate was 76.8% (n = 3969). Analyses of the associations between daily emotional symptoms, occupational social class, self-efficacy and social competence were performed through logistic regression analyses using SAS version 9.3. Multilevel logistic regression analyses were used to study effect modification. Results Schoolchildren from lower socioeconomic positions have higher odds for daily emotional symptoms and lower levels of high self-efficacy and high social competence compared to schoolchildren from higher socioeconomic positions. High self-efficacy and high social competence buffer the association between socioeconomic position and emotional symptoms, i.e. they seem to protect children and adolescents from lower socioeconomic strata against the higher risk of daily emotional symptoms. Conclusions High self-efficacy and high social competence buffer the negative effects of low socioeconomic status on emotional symptoms among schoolchildren. Self-efficacy and social competence can be promoted e.g. through school-based initiatives and may be an effective way to improve mental health and reduce socioeconomic inequality in emotional symptoms among children and adolescents. [ABSTRACT FROM AUTHOR]

Introduction: Youth with autism spectrum disorder (ASD) face high rates of unemployment, with unique challenges for military-dependent and -connected youth with ASD. This paper reports preliminary findings from Year One of a randomized waitlist controlled trial investigating the efficacy of the Project SEARCH + ASD Supports (PS + ASD) intervention model for military-dependent and -connected youth with ASD.Methods: Treatment group participants (n = 6) participated in internships at a military installation in the southeastern United States; waitlist group participants (n = 8) received special education transition services at their local high schools. Employment outcome data were collected at 12 months for both groups.Results: Fourteen unique internship experiences were developed across seven business partner organizations on the military installation during Year One. Five of six PS + ASD treatment group participants obtained competitive integrated employment for an overall employment rate of 83.3%. Four of the positions were federal jobs. None of the waitlist group participants obtained competitive integrated employment during the same period.Conclusions: Initial results are promising and suggest that the PS + ASD model may help to meet the transition needs of military-dependent and -connected youth with ASD and the employment needs of local military communities. [ABSTRACT FROM AUTHOR]

Background The concept of health literac y (HL) may help us to better understand the mechanisms leading to health disparities, and to focus on the factors that can be influenced. However, not much is yet known about how HL is related to health disparities, or whether the association exists among adolescents. The aim of the study was to examine the associations between structural stratifiers, HL and health indicators among adolescents. Methods The nationally representative Finnish Health Behaviour in School-aged Children survey data (n =3833) were collected from 13- and 15-year-old pupils in the spring of 2014. Pearson correlation coefficients were calculated, and separate path models were estimated for the perceived health and health behaviour measures. Results HL was found to be an independent factor explaining disparities in health. Higher HL was related to positive health outcomes. HL also acted as a mediator between health behaviours and structural stratifiers, except for gender. School achievement and educational aspirations were among the factors explaining the HL level, which in turn, explained the health indicators. Conclusion The concept of HL is of use in understanding health disparities. In particular, HL provides a mechanism via which school achievement and educational plans affect health outcomes. Low HL places adolescents who have poor school achievement and who do not intend to continue on an academic path in an unequal position with respect to their health. [ABSTRACT FROM AUTHOR]

Background Organized group activities (e.g. sports or arts clubs) have long been noted as important developmental settings for youth, yet previous studies on the relationships between participation and mental health outcomes have focused on short-term effects among school-aged adolescents. The subsequent period of life, emerging adulthood, has been largely overlooked despite being another important life stage where individuals face new existential challenges and may benefit from group activity participation. The potential for macroeconomic conditions to modify these relationships has also not been considered. Methods Participants (n = 1654) comprise two cohorts, born in either 1965 (n = 968) or 1973 (n = 686), from the same middle-sized industrial town in Northern Sweden. Both cohorts completed detailed questionnaires at age 21 (macroeconomic boom for Cohort 65, recession for Cohort 73) and approximately 20 years follow-up (age 43 for Cohort 65, age 39 for Cohort 73). General linear models were used to assess concurrent and prospective associations between regular group activity participation and depressive symptoms, as well as the potential interaction with boom/recession. Results After controlling for sociodemographic factors, regular group activity participation at age 21 was associated with lower depressive symptoms, both concurrently and at follow-up. Those exposed to recession at age 21 reported higher depressive symptoms at the time but there was no interaction between cohort (boom/recession) and group activity participation. Conclusions Regular group activity participation during emerging adulthood is associated with lower depressive symptoms uniformly in times of boom and recession. Beneficial effects of such participation may contribute to better mental health over 20 years. [ABSTRACT FROM AUTHOR]

Background Health literacy (HL) is an important determinant of health and health behaviours, and there is a need to monitor HL levels among all population groups. It is therefore essential to develop instruments to assess HL during childhood and adolescence. The aim of this study was to examine the cross-national measurement invariance of the instrument Health Literacy for School-aged Children (HLSAC) in four European countries. Methods The data were collected via standardized self-administered anonymous questionnaires within classrooms in Finland, Poland, Slovakia, and Belgium. There were in total 1468 respondents (aged 13, N = 690; aged 15, N = 778). The HLSAC instrument was used to measure the subjective HL of adolescents in each country. A multigroup confirmatory factor analysis was applied to test measurement invariance. Results Configural and metric invariance was established, but scalar invariance did not hold. However, the instrument exhibited high internal consistency (α = 0.85) and showed adequate fit with the data. Moreover, the partial invariance allowed comparison of mean values across the countries in question. There were significant mean value differences between countries and age-groups. Conclusions HL mean values (as assessed via the HLSAC instrument) can be compared across countries. The instrument has utility for large-scale international HL studies on adolescents. [ABSTRACT FROM AUTHOR]

Background Measles is an infectious disease providing lifelong immunity. Epidemics periodically occur among unvaccinated orthodox Protestants in the Netherlands. During the 2013/2014 epidemic, 17% of the reported patients was over 14 years old. Apparently, they did not catch measles during the previous 1999/2000 epidemic and remained susceptible. We wanted to identify risk factors for this so-called persisting measles susceptibility, and thus risk factors for acquiring measles at older age with increased risk of complications. Methods A case-control study was performed among unvaccinated orthodox Protestants born between 1988 and 1998; cases had measles in 2013/2014, controls during or before 1999/2000. Associations between demographic, geographical and religion-related determinants and persisting measles susceptibility were determined using univariate and multivariable logistic regression. Analyses were stratified in two age-groups: infants/toddlers and primary school-aged children during the 1999/2000 measles epidemic. Results In total, 204 cases and 563 controls were included. Risk factors for persisting measles susceptibility for infants/toddlers in 1999/2000 were belonging to a moderately conservative church, absence of older siblings and residency outside low vaccination coverage (LVC)-municipalities. Risk factors for primary school-aged children were residency outside LVC-municipalities and attendance of non-orthodox Protestant primary school. Conclusion Unvaccinated orthodox Protestant adolescents and adults who resided outside the LVC-municipalities, did not attend an orthodox Protestant primary school, had no older siblings and belonged to a moderately conservative church were at risk for persisting measles susceptibility and, thus, for acquiring measles at older age with increased risk of complications. For this subgroup of orthodox Protestants targeted information on vaccination is recommended. [ABSTRACT FROM AUTHOR]

Background In spite of many positive trends that have emerged in the health of young people, adolescents from more affluent groups continue to experience more favourable health outcomes. There are no groups that are more vulnerable than those who report very poor (‘bottom-end’) indicators of health behaviour. The present study investigated the role of socio-economic factors as potential determinants of bottom-end health behaviours pertaining to physical activity and diet. Methods Our analysis incorporated health data for some 700 000 15-year-old adolescents in 34 countries. The data source was four cycles of the Health Behaviour in School-aged Children (HBSC) study (2001/2002, 2005/2006, 2009/2010 and 2013/2014). As per UNICEF precedents, adolescents whose health behaviour scores were below the mean of the lower half of the distribution fell into the ‘bottom-end’ on this indicator. Results Adolescents from less affluent families were much more likely to report being in the bottom-end of the distribution of these health indicators. Large, persistent and widespread socio-economic gradients existed for physical activity and healthy eating, while the findings were mixed for unhealthy eating. Such socio-economic inequalities were largely stable or widened for physical activity and healthy eating, while inequalities in unhealthy eating narrowed. Conclusion Although it is important to continue monitoring average levels of adolescent health, national and international policies need to pay attention to the concentration of poor health outcomes among adolescents from less affluent families and to redress social inequalities in adolescent health behaviour. [ABSTRACT FROM AUTHOR]

The aim was to examine trends in social inequality in poor self-rated health (SRH) among adolescents in Denmark 1991–2014. The analysis included 18 996 11–15-year-old school children from the cross-sectional Health Behaviour in School-aged Children studies in 1991, 2002, 2006, 2010 and 2014. Across the five surveys, the prevalence of poor SRH was 14.2%, remaining almost unchanged from 1991 to 2014. The proportion with poor SRH was 12.2% in high, 14.3% in middle and 17.6% in low occupational social class. This social inequality in poor SRH was persistent during the entire study period, both in terms of absolute and relative social inequality. [ABSTRACT FROM AUTHOR]

Background Developmentally-appropriate disclosure of human immunodeficiency virus (HIV) status to children living with HIV (CLWH) is essential to achieve optimal health outcomes, but stigma and fear result in delaying disclosure into adolescence. The American Academy of Pediatrics recommends disclosure of HIV status to school-age children. The objective of this quality improvement (QI) project was to increase the proportion of CLWH > 10 years of age who are disclosed about their HIV status from 57% to 80% by 18 months. Methods The Institute for Healthcare Improvement's Model for Improvement was utilized for this QI project. This model accelerates quality improvement by implementing Plan-Do-Study-Act (PDSA) cycles to determine whether changes lead to improvement. The target population included CLWH followed at an urban pediatric HIV clinic. The primary outcome measure was the proportion of children > 10 years of age who are disclosed about their HIV status. PDSA cycles included monthly clinic check-ins to discuss new disclosures, quarterly team meetings to discuss implementation of new changes to improve disclosure and modifying a note template to prompt providers to document disclosure status and plan for undisclosed patients. Our process measure was the proportion of undisclosed children who have a documented disclosure status/plan. Annotated run charts were used to track the data. Results Prior to our first PDSA cycle, 57% of CLWH > 10 years of age were disclosed to about their HIV status, and none of the undisclosed children had a disclosure status/plan documented in their medical record. The proportion of CLWH disclosed to about their HIV status increased to 66% since meeting with the team regularly to discuss disclosure status (figure). Four months after introduction of the modified note template, the proportion of CLWH with documentation of their disclosure status and plan increased to 54%. Conclusion Team awareness of the importance of disclosure and a modified clinic note template were associated with increases in the proportion of CLWH with age-appropriate HIV disclosure and documentation of disclosure status. Future interventions will include adapting methods of step-wise disclosure which have been proven effective in other settings. Disclosures All authors: No reported disclosures. [ABSTRACT FROM AUTHOR]