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Objective: To investigate two risky behaviours (i.e. binge drinking and drinking and driving) and their individual- and college-level correlates among South Korean international college students in the USA Design: Cross-sectional online survey (student response rate = 41.6%). Setting: South Korean college students (N = 1201) were recruited from 52 different four-year universities in the USA in 2009. Method: Self-reported binge drinking, drinking and driving, smoking, study-related stress, life dissatisfaction, region lived in, and type of university attended, were assessed using already-validated instruments. Results: A total of 92% of the sample reported at least one occasion of binge drinking in the previous 30 days. Among those who had driven a motor vehicle in the previous 30 days (n = 950; 79% of the overall sample), 67% had engaged in drinking and driving. Students' binge drinking was positively associated with current cigarette use and higher levels of life dissatisfaction at college and study-related stress. Students' drinking and driving was also positively associated with higher levels of life dissatisfaction at college and studyrelated stress. These relationships were stronger among students attending private institutions than among those attending public institutions. While both college-level correlates (university region and university type) were significantly associated with drinking and driving, none of the college-level correlates were significant in the binge drinking models. Conclusion: A very high proportion of South Korean international students attending colleges in the USA appear to engage in binge drinking and drinking and driving. Development of intervention programmes designed specifically for them is necessary. [ABSTRACT FROM AUTHOR]

Objectives: In fall 2004, the authors used a survey to assess the knowledge, attitudes, motivations, and behaviors of college students relative to oral cancer prevention to inform development of targeted prevention programming. Participants: A convenience sample of 1,003 undergraduate students at one public university in Indiana participated. Methods: Discriminant function analysis was employed to analyze participants' motivations; perceived risks; individuals who influence participants' alcohol, tobacco, and marijuana use; and factors that facilitate and discourage use. The study sample was divided into users and nonusers to differentiate between groups and predictor (discriminating) variables. Multiple regression analysis was used to determine the extent to which participants' knowledge, attitudes, peer perceptions, sex, age, and ethnicity contributed to participants' combined alcohol, tobacco, and marijuana use behaviors. Results: With 2 exceptions, discriminant function analysis (p < .01) correctly categorized user status (ie, nonusers vs combined users of alcohol and cigarettes; nonusers vs combined users of alcohol, cigarettes, and marijuana) by the predictor variables. Multiple regression analysis to determine whether independent variables predicted combined drug use generated significant (p < .01) results across all combined use behaviors. Conclusions: Multiple oral cancer prevention program options along with additional formative research efforts were suggested by study results. [ABSTRACT FROM AUTHOR]

Research has shown significant declines in gateway drug use among participants in a school/community substance abuse prevention intervention in a midwestern, suburban school district (Lohrmann, Alter, Greene, & Younoszai, 2005). Though still at or below national levels, student marijuana use was not impacted as positively. The current study investigated the possibility that efforts to prevent alcohol use resulted in an unintentional substitution effect thereby increasing marijuana use. Factors including perceived access to alcohol and marijuana, along with perceived harm associated with alcohol and marijuana use, were examined to determine their role in marijuana use. Findings revealed a relationship between perceived access to and perceptions of harm associated with marijuana and its use that depended on the level of perceived access to and harm associated with alcohol. [ABSTRACT FROM AUTHOR]

This study examined long-term effects of a school/family/community substance abuse prevention partnership intervention lead by a Midwestern school district. Previous findings suggested that the program contributed to decreased tobacco and marijuana, but not alcohol, use prior to and after implementation between 1987 and 1991. The current study examined 8th-12th grade student drug use prevalence data from 1991 and 2003 to determine whether previous program effects were sustained. With one exception, reported lifetime and monthly cigarette use decreased below 1991 levels for all grades. Lifetime and monthly alcohol use decreased below 1991 levels for most grades, a result not previously detected. While still below national rates, reported lifetime use of marijuana increased for all grades over time. The intervention was effective in reducing cigarette and alcohol use over time and in suppressing marijuana use levels below national rates; however, these gains tended to erode in later high school grades. [ABSTRACT FROM AUTHOR]

This study involved a school-based prevention program initiated to reduce alcohol, tobacco, and other drug (ATOD) use among adolescents in the Troy School District in the Detroit area. One purpose was to describe the current ATOD situation by investigating changes in reported ATOD use from 1987 to 1991. Another purpose was to explore and identify the most salient risk and protective factors present. In 1987, 1,490 students (comprising grades 8 and 11) and in 1991, 3,171 students (comprising grades 8 to 12) completed questionnaires. Significant decreases were found for use of most drugs with the exception of alcohol. Involvement in problem behaviors was identified as the most salient risk factor, while having a member of a non-using peer group was the most salient protective factor. Implications for the design of subsequent intervention programs are discussed. [ABSTRACT FROM AUTHOR]

Factors associated with occupational exposure and universal precautions (UP) compliance were assessed among employees in one urban school district. Half of the employees surveyed reported responding to bleeding injuries and cleaning blood or other body fluids (e.g., vomit, urine) during the previous school year. Also, 1 in 4 custodians and 1 in 10 teachers/teacher's aides had direct contact with blood or body fluids without protection. In multivariate logistic regression analyses, direct contact was most likely among secondary school employees in unpredictable situations who did not have protective equipment or comply with UP. UP compliance was greater among those who had protective equipment available and felt self-confident. Self-confidence was associated with having received training or protective equipment. Routine communications between administrators and employees, staff training, provision of protective equipment, and exposure incident monitoring are essential to effective implementation of UP policies in schools and work settings where occupational exposure could occur. [ABSTRACT FROM AUTHOR]

Guided by the reasoned action approach, this study examined select individual, information, and social factors that influence intention toward pursuing a career in geriatrics among 314 clinical medical and nursing students in Ghana. A Poisson regression showed attitude toward older persons was a significant influencing factor of intention to choose a career in geriatrics for medical students (B = 0.015, SE = 0.0048, p = 0.002) but not nursing students (B = 0.009, SE = 0.0145, p = 0.512). Personal interest was, however, a significant influencing factor for both medical and nursing students (B = 0.462, SE = 0.0592, p = 0.000) and (B = 0.015, SE = 0.0048, p = 0.002), respectively. Nursing students with moderate to strong interest were 1.6 times more likely to express an intention to specialize in geriatrics, and medical students were 1.5 times more likely to express an intention to specialize in geriatrics. The results show that the most important factor influencing geriatric career intention is students' personal interest in the field. Evidence-based interventions such as early educational and practice exposure to the field and interactions with older adults are recommended., (© 2024 John Wiley & Sons Australia, Ltd.)

Further study is needed regarding the intersection of community violence exposure, coping strategies, and health behaviors among young adult African American men and Hispanic/Latino men. This study did so in Lake County, Indiana, which contains multiple areas with disproportionate prevalence of violence relative to population size. Approximately 22 miles from Chicago, Lake County includes noteworthy mid-sized cities such as Gary, Hammond, and East Chicago. This study explored the perceptions of African American men and Hispanic/Latino men ages 18 to 25 regarding coping strategies and both healthy and health risk behaviors after directly witnessing or indirectly experiencing a violent act or event. We used aspects of social cognitive theory to design this community-based participatory research study. Thirteen males who self-identified as African American, Hispanic/Latino, or both, completed 34- to 80-minute, audio-recorded phone interviews. Audio recordings were transcribed, and NVivo 12 Windows was used by the research team (primary researchers and two coders) to complete transcript analysis. Findings from this study provided insight around African American men and Hispanic/Latino men regarding (a) witnessing violence directly or indirectly experiencing violence; (b) changes in everyday life experiences; (c) coping strategies that involved socio-emotional health, spiritual health, social health, and risky health behaviors; (d) rationales for not asking for help; (e) observations of significant others' coping; (f) what to do differently in the future; (g) beliefs about mentors; and (h) beliefs about mental health providers. Delving into participants' experiences revealed that African American men and Hispanic/Latino men in Lake County, Indiana chose to adopt a range of health risk and health positive strategies after directly witnessing or indirectly experiencing violence. Becoming knowledgeable about African American men's and Hispanic/Latino men's diverse coping strategies and health behaviors may help inform the community about how best to cocreate spaces that aim to alleviate the traumatic experience of having directly or indirectly experienced community violence., Competing Interests: Declaration of Conflicting InterestsThe author(s) declared no potential conflicts of interests with respect to the authorship and/or publication of this article.

Air pollution is considered a risk factor for several diseases, particularly respiratory and cardiovascular diseases. However, the effects of air pollution on neurobehavioral disorders have not been confirmed as of yet. Thus, the aim of this study was to determine whether there was an association between seven air pollutants and ADHD medication administration (ADHD-MA) in Pennsylvania-located elementary schools over a 3-year period. An ecological study design involving records of 168,825 children from elementary schools in 49 Pennsylvania counties was used. The number of children with ADHD-MA was extracted from an online software specifically designed for allowing nurses to record health conditions in schools. Daily measurements of air pollutants were obtained from the U.S Environmental Protection Agency. The differences in the number of ADHD-MA among the four seasons, for all years, were statistically significant (P<0.001). Three air pollutants (SO 2 , CO, and PM2.5) were significantly associated with ADHD-MA; no interactions among air pollutants were significant. Air pollution was thus likely associated with ADHD-MA. Prospective epidemiological and biomedical studies should next examine the molecular relationship between air pollution and ADHD symptoms., Competing Interests: The authors declare that they have no competing interests., (Copyright © 2020, Spandidos Publications.)

This cross-sectional, secondary data analysis examines the association between cigarette smoking and self-reported health-related quality of life (HRQoL) in adult survivors of Adolescent and Young Adult Cancer. Pooled data for survivors of Adolescent and Young Adult Cancer (N = 1495) were drawn from the 2016 and 2017 Behavioral Risk Factor Surveillance Survey. Binary logistic regression models were utilized to examine independent associations between each of the four HRQoL domains (i.e., self-related general health, activity limitation days, poor physical, and mental health days) and cigarette smoking. Of the 1495 Adolescent and Young Adult Onset Cancer Survivors (AYAO-CS) in this study, approximately 30% reported currently smoking cigarettes. Relative to never smokers, the odds of reporting fair/poor general health were significantly higher for current and former smokers: (OR = 3.95, 95% CI: 2.08-7.50) and (OR = 2.51, 95% CI: 1.46-4.32), respectively. Likewise, current smokers were significantly more likely to report frequent days of poor physical health (OR = 2.79, 95% CI: 1.38-5.65). The study findings suggest a significant cross-sectional association between cigarette smoking and poor health-related quality of life in adult survivors of adolescent and young adult cancer. These findings, although cross-sectional, underscore the need for prospective studies to examine the longitudinal association between HRQoL and cigarette smoking among cancer survivors. Findings also help establish both the need for smoking cessation programs and the importance of effective strategies for addressing HRQoL issues among cancer survivors., (© 2020. American Association for Cancer Education.)

Purpose: This study examined the relationship between frequent social media use and subsequent mental health in a representative sample of US adolescents. Also investigated were sex differences in multiyear growth trajectories of mental health problem internalization relative to social media use., Methods: Four waves (2013-2018) of nationally representative, longitudinal Population Assessment of Tobacco and Health data were analyzed. A total of 5,114 US adolescents aged 12-14 years at baseline had repeated data across all waves. Statistical analysis involved testing a series of sequential-weighted single-group and multi-group latent growth curve models using R version 3.6.2., Results: Of the 5,114 respondents, 2,491 were girls (48.7%). The percentage of frequent social media use was 26.4% at Wave 1 and 69.1% at Wave 4 for boys compared to 38.3% and 80.6% for girls (p < .001). Boys showed an improving (-0.218, p = .005) but girls showed a deteriorating linear trend (0.229, p = .028) for mental health at the full multigroup latent growth curve model. Social media use accounted for mental health conditions across Waves 1-3 for boys (ps<.01) but only at Wave 1 for girls (p = .035). With the addition of the social media use variable alone, model fit dramatically improved, and residual variances in growth patterns (i.e., random effect) became nonsignificant for boys. Substantial sex differences existed in baseline status, directionality, and shape of mental health growth trajectories as well as interplay of social media use with other factors., Discussion: Findings of the study suggest that frequent social media use is associated with poorer subsequent mental health for adolescents., (Copyright © 2021 Society for Adolescent Health and Medicine. Published by Elsevier Inc. All rights reserved.)

Background: Despite proven health and learning benefits, health education implementation in elementary schools is not optimal. This study investigated learning environment, leadership, and training factors that may influence elementary-level health education implementation in the current standardized testing-saturated environment., Methods: Survey data were collected from principals of 8 Michigan elementary schools and, via focus groups, 30 teachers in their schools. Teacher groups were separated into 2 categories based on principals' understanding of state health education policies. Grounded theory analysis was used., Results: Despite all 30 teachers' positive attitudes toward health education, numerous consistent implementation barriers were identified; competition for instructional time with tested subjects was most critical. Teachers with principals who indicated a greater understanding of state policies reported more: consistent instruction; availability of resources, and encouragement to teach select topics, especially mental health., Conclusion: That these findings were produced in a state with strong CSHE polices, proven curricula, and expansive support systems are disheartening and accentuate the profound impact of standardized testing on elementary-level health education implementation. More promising, principals' understanding of applicable state-level policies appeared to generate stronger health education implementation. Future research should focus on the possible impact of time devoted to health instruction on standardized test scores., (© 2021 American School Health Association.)

Ghana has one of the fastest growing aging populations in sub-Sahara Africa, but little is known about the geriatric workforce. A sample of 12 medical students in one Ghanaian public university participated in an exploratory qualitative study to share their perspectives on specialty choices in Ghana, interest in working with older patients, and their consideration of geriatrics for future practice. The findings revealed limited knowledge of geriatrics as well as low interest in its selection as a specialty for future practice. These were attributable to multi-faceted factors, including the lack of both exposure to geriatric medicine and geriatrics-focused training for students in this institution. It is critical that geriatric education be prioritized and incorporated in medical schools to nurture students' interest and future consideration of the specialty. This will help bolster the number of geriatric-oriented physicians and secure specialized care for the aging population.

Objectives: Preadolescence substance exposure, which increases the risk of regular substance use, has been a public health concern. Although studies found that impulsivity is a predisposing factor of early substance exposure, the pathways through which impulsivity is associated with early substance exposure remain unclear. This study examined how family conflict mediates this association among U.S. preteens as family environment plays an essential role in pre-adolescent development., Methods: Respondents (N = 11,800, 9-10 years old) from the Adolescent Brain Cognitive Development (ABCD) Study Release 2.01 (July 2019) were included in this study. Generalized structural equation modeling was performed to investigate the mediation effects of family conflict on the associations between childhood impulsivity and early exposure to alcohol and tobacco use, controlling for covariates based on the Problem Behavior Theory., Results: Pre-adolescents with high impulsivity levels (≥90 th percentile) were more likely to report early alcohol and tobacco exposure (total effect: ORs = 1.49 and 1.70, respectively), where 4.13% and 12.41% of the associations, respectively, were meditated by family conflict (indirect effect: ORs = 1.02 and 1.07; Sobel test ps = 0.022 and 0.005, respectively)., Conclusions: Family conflict mediates the associations between childhood impulsivity and early substance exposure among preteens, with higher impulsivity leading to more severe family conflicts that are, in turn, associated with a higher likelihood of early substance exposure. To prevent preteens with high impulsivity level from early use of substances, interventions may focus on reducing family conflicts such as parenting counseling that guides parents to strengthen conflict-resolution skills and create a stable home environment for preteens., (Copyright © 2020 Elsevier Ltd. All rights reserved.)

Background:: Studies have shown some linkage between adverse childhood experiences (ACEs) and prescription opioid misuse. While preventable, once an individual is exposed to ACEs, they can have irreparable health impacts. Resilience could have protective effects on preventing those with ACEs from adulthood health-risk behaviors. Objectives : To examine how resilience mediates the association between ACEs and adulthood prescription opioid misuse among U.S. adults. Methods : Adult respondents ( n  = 33,613) from the National Epidemiologic Survey on Alcohol and Related Conditions-III (2012-2013) were included. A count of ten types of ACEs constituted the ACE score (range: 0-10). A latent variable was created to measure resilience based on the Connor-Davidson Resilience Scale. Generalized structural equation modeling (GSEM) was utilized to conduct the mediation analysis. The Problem Behavior Theory was used to guide covariate selection. Results : The GSEM measurement model estimated the latent variable resilience and determined that tolerance of negative effects, self-control, acceptance of change, and spiritual influence were all associated with resilience, holding personal competence constrained for estimation purposes. Respondents with a higher ACE score were more likely to misuse prescription opioids in the past year (OR = 1.08; p  < 0.01), where 40.8% of the association was mediated by resilience (indirect effect OR = 1.06). Conclusion : Reducing prescription opioid misuse is an essential step in alleviating the current opioid epidemic. Findings suggested that resilience mediated the relationship between ACEs and adulthood prescription opioid misuse. To prevent adults with ACEs from misusing prescription opioids, interventions designed to address ACEs' impact should include behavioral and educational components for enhancing the priority dimensions of resilience.

Objectives: This study is a systematic review on stimulators of interest in pursuing a geriatric career among medical students in different countries. The review also assessed whether there were differences or similarities based on geographic regions or income categorisations., Methods: A 20-year (1998-2018) review of quality primary research articles was conducted (n = 10). For analysis, studies were categorised into low- and middle-income countries (LMICs), and high-income countries, based on World Health Organization and World Bank's income grouping for the 2019 fiscal year., Results: The frequently mentioned stimulators of interest in geriatrics were as follows: cultivating positive attitudes towards older people, participation in geriatric-related interventions and positive experiences during a geriatric training. Lack of published peer-reviewed articles from the LMICs limited the researchers' ability to compare the two income groups., Conclusion: Suggestions to improve future systematic reviews that consider global factors, global participation or any aspect of global inclusion are discussed., (© 2020 AJA Inc.)

The purpose of this study was to identify adolescents' consequence, referent, and circumstance beliefs about trying to meditate at least twice in the next week in order to inform subsequent meditation intervention design. A survey based on reasoned action approach (RAA) constructs was developed and pilot-tested. Thereafter, adolescents ( N = 129), recruited from a northeastern U.S. high school, responded to open-ended survey questions eliciting beliefs underlying intention to try meditating. Thematic analysis was executed to examine beliefs and frequencies of beliefs. Five types of salient meditation beliefs were identified: advantages (e.g., reduces stress, increases relaxation, improves focus), disadvantages (e.g., slows everything down), supporters and disapprovers (e.g., family and friends), and facilitating circumstances (e.g., more time, fewer distractions). Adolescents recognize meditation as having health benefits but as also taking time. They further viewed meditation as socially acceptable but need sufficient time and a conducive environment to try it. To be effective, interventions designed to promote adolescents' self-regulation through meditation should address identified salient beliefs.

Background: Concerns have been raised regarding e-cigarette use as a potential stepping-stone to marijuana use. Based on Kandel's gateway hypothesis, this study investigated if e-cigarette use could lead to marijuana use by testing two hypotheses with a longitudinal national U.S. adult sample, including (1) primary hypothesis: e-cigarette use is a gateway to marijuana use; and (2) falsification hypothesis: marijuana use is not a gateway to e-cigarette use., Methods: Adults were extracted from the Population Assessment of Tobacco and Health Study Waves 1-3 (2013-2016). For primary hypotheses, based on baseline e-cigarette use statuses, three study groups were defined, and three logistic regressions were conducted to examine associations between baseline e-cigarette use and follow-up marijuana use initiation, reinitiation, and persistence, respectively. Similarly, for falsification hypotheses, three additional study groups were defined, and three logistic regressions were conducted to examine associations between baseline marijuana use and follow-up e-cigarette use behaviors., Results: Baseline e-cigarette use was associated with marijuana use initiation and reinitiation (ORs = 2.08, 1.37, respectively, both ps < .05) but not persistence at follow-up. Additionally, baseline marijuana use was associated with only e-cigarette use initiation (OR = 2.23, p < .01) but not reinitiation or persistence at follow-up., Conclusions: Findings partially support the gateway hypothesis that e-cigarette use could be a steppingstone to marijuana use reinitiation among the U.S. adults. The mechanisms and behavioral characteristics, such as etiological and psychosocial factors, that may pertain to the progression from e-cigarette use to reinitiation of other substance use should be further investigated to inform effective behavioral, educational, and policy interventions., (Copyright © 2020 Elsevier B.V. All rights reserved.)

Background: Consistent with the Whole School, Whole Community, Whole Child Approach, food education encompasses nutritional status, culture, community, environment, and society. Unifying standards are needed to support food education integration in K-12 curricula. Pilot Light, a Chicago-based nonprofit, sought to generate such standards. This study reports a formative evaluation research process that led to the development of Food Education Standards (FES)., Methods: Nine FES were drafted within the context of the National Health Education Standards. The 2-day Pilot Light Food Education Summit convened 26 experts and community members to review draft FES. A facilitated, consensus-building process generated refined FES and K-12 competencies. Drawing on Summit outcomes and expert feedback, a team of teachers subsequently drafted final FES. Summit participants completed pre- and post-Summit surveys to assess changes in food education priorities., Results: The initial 9 FES were refined to 7. Comparison data indicated shifts in endorsed priorities for food education, moving from prioritizing specific knowledge, such as "categorizing food into food groups," toward "students having a conscious decision-making process around food.", Conclusions: Developed with input from experts across multidisciplinary fields, the evidence-based Pilot Light FES can be feasibly implemented in multiple subjects across all school types and community socio-demographic levels., (© 2019, American School Health Association.)

To be effective, school health instruction should be taught by health educators who have graduated from accredited health education teacher education programs and are certified in health education. Unfortunately, the nation has failed to ensure that all those who teach health in schools are well prepared. States vary in the required coursework for health teachers in terms of initial licensure and continuing education for licensure renewal; most elementary teachers are not required to receive preparation in health education; health education and physical education are often viewed as synonymous disciplines; support for in-service education of health teachers is often lacking; and more research is needed in professional preparation and development of school health educators. This article provides a call to action in five areas to strengthen both the professional preparation and professional development of school health educators. Given that education is a social determinant of health, public health educators must become stronger allies in supporting school health to promote health equity. Public health practitioners can advocate to state and community school decision makers for comprehensive school health education taught by teachers with appropriate professional preparation and certification in health education. Public health faculty can educate their students about the Whole School, Whole Community, Whole Child framework and effective strategies for its implementation, and seek rigorous professional preparation and certification and accreditation standards for their school teacher preparation programs. National health and education organizations can call for new leadership and investments in health education teacher preparation and development for a brighter future.

The long-held priority of teaching young people the knowledge and skills needed for healthy living has recently been diminished in many preK-12 schools. Driven by federal and state priorities, laws, and policies associated with high-stakes testing, instruction in untested subjects has been reduced or eliminated in most schools in order to devote more attention to tested subjects, like reading, math, writing, and science. This article proposes a pathway to ensure that all children are able to learn what society knows about health. To that end, four challenges to the reliable, large-scale implementation of effective school health education are identified: (1) establishing school health education as an undeniable social and cultural priority through improved advocacy; (2) strengthening educational institutions' capacities to reliably deliver large-scale, high-quality, school-based health education; (3) collaboratively coordinating efforts of health-promoting governmental and nongovernmental organizations that generate thought leadership for school health education; and (4) creating multidisciplinary research capacities for solving problems associated with the implementation of reliable, large-scale, effective school health education. By implementing specific strategies associated with each challenge, health educators can promote the social and system-level conditions required to support, elevate, and ensure delivery of effective health education to every student in every school every year.

Purpose: The number of pediatric cancer survivors has increased dramatically over recent decades. Prior studies involving pediatric cancer survivors have reported reduced physical activity and fitness levels. Thus, the aim of this meta-analysis was to synthesize previous findings on physical activity and fitness levels of pediatric cancer survivors, who had completed cancer treatment and are in complete remission compared with age-matched, non-athletic healthy controls with no history of cancer diagnosis., Methods: Three electronic databases (PubMed, Web of Science, and EBSCO) were searched using a combination of 24 terms. Observational studies examining the post-treatment physical activity and/or fitness levels of pediatric cancer survivors compared with that of non-cancer controls and published in peer-reviewed, English-language journals before August 22, 2018 were eligible. Random-effect models were used in Comprehensive Meta-Analysis software for effect-size estimations of eight studies for physical activity and eight for fitness., Results: The studies included a total sample of 2628; 1413 pediatric cancer survivors and 1215 non-cancer controls. Both physical activity and fitness were significantly lower in childhood cancer survivors than in non-cancer controls (g = - 0.889; 95% confidence interval [CI] = - 1.648 - 0.130; p = 0.022) and (g = - 1.435; 95% CI = - 2.615 - 0.225; p = 0.017), respectively, with high heterogeneity., Conclusions: Pediatric cancer sequelae and its treatment may limit participation in physical activity and fitness activities by survivors of pediatric cancer. Accentuating the need to incorporate physical activity and fitness into treatment protocols and post-treatment recommendations may improve pediatric cancer survivors' health and well-being.

Purpose: Prior studies established significant associations between e-cigarette use and combustible cigarette smoking in the general population; however, little is known about such associations among cancer survivors. Thus, the current study examined possible associations between e-cigarette use and combustible cigarette smoking among U.S. cancer survivors., Methods: Cross-sectional data were drawn from the 2016 Behavioral Risk Factor Surveillance System Survey. Binary logistic regression was used to analyze the associations between e-cigarette user status and combustible cigarette-smoking status in a sample of 4680 cancer survivors, controlling for alcohol use and sociodemographic factors. Analyses were weighted for unequal probability of sample selection to reflect national cancer survivor population estimates., Results: Prevalence for current e-cigarette use and combustible cigarette smoking for cancer survivors was 2.57% and 16.16%, respectively. In the adjusted analyses, cancer survivors who reported current e-cigarette use, compared to never-users, had greater odds of being current combustible cigarette smokers (odds ratio [OR] = 11.81, 95% confidence interval [CI] = 5.38-25.93). Likewise, former e-cigarette users, compared to never-users, had greater odds of being current combustible cigarette smokers (OR = 15.90, 95% CI = 10.68-23.36)., Conclusion: Among cancer survivors in the USA, e-cigarette use had a positive and highly significant association with combustible cigarette smoking., Implications for Cancer Survivors: In order to prevent multiple and substitute use of nicotine-delivery products, prevention interventions and cessation programs designed for cancer survivors should specifically target both current combustible cigarette smokers and non-smokers who report former and current e-cigarette use.

Introduction: This study examined the associations of BMI-based and perceived body weight status with electronic vapor product use, cigarette smoking, and dual use among U.S. adolescents., Methods: A cross-sectional analysis was conducted in 2017 on data from 15,129 adolescents in the National Youth Risk Behavior Survey, 2015. Multiple logistic regression analyses were used to examine the associations of BMI-based and perceived weight status with electronic vapor product use, cigarette smoking, and dual use, after adjusting for all other covariates. The regression models were stratified by gender., Results: Overall, 25.5% of males used electronic vapor products, 11.6% smoked cigarettes, and 8.1% used both; percentages among females were 22.6%, 9.8%, and 6.8%, respectively. Females who perceived themselves as overweight were more likely than those who perceived themselves as normal weight to be current electronic vapor product users (AOR=1.09, 95% CI=1.01, 1.19) and dual users (AOR=1.23, 95% CI=1.01, 1.49). When compared with normal BMI-based category, males with obese BMI status were more likely to be current cigarette smokers (AOR=1.61, 95% CI=1.06, 2.44), however, only females with overweight BMI status were more likely to be current smokers (AOR=1.89, 95% CI=1.25, 2.86)., Conclusions: Findings suggest that the influence of adolescents' body weight perceptions and BMI-based status should be accounted for when developing nicotine-containing product use prevention programs for adolescents. Specific strategies for influencing female adolescents who perceive themselves as overweight should be included to prevent emerging electronic vapor product and dual use., (Copyright © 2018 American Journal of Preventive Medicine. Published by Elsevier Inc. All rights reserved.)

Introduction: This study examined the associations of BMI category and central obesity status, with falls among community-dwelling older adults in the U.S., Methods: Data were drawn from the 2012 and 2014 U.S. Health and Retirement Study, a nationally representative longitudinal panel study funded by the National Institute of Aging. The study participants were U.S. community-dwelling older adults aged ≥65 years (N=3,383). Multiple logistic regression and Poisson regression analyses examined the associations of BMI category and central obesity (waist circumference >102 cm in men and >88 cm in women) with experiencing a fall and fall injury, after adjusting for all other covariates. A prospective analysis was conducted in which independent variables from 2012 were examined in relation to dependent variables measured in the same participants in 2014., Results: Overall, 35.2% of older adults experienced at least one fall in the past 2 years. Compared with those who were not, centrally obese older adults were more likely to experience a fall (AOR=1.37, 95% CI=1.01, 1.85) and fall more frequently (incidence rate ratio=1.15, 95% CI=1.03, 1.29). Fallers in the obese BMI category were less likely than normal-weight fallers to experience a fall injury (AOR=0.56, 95% CI=0.35, 0.91)., Conclusions: These findings suggest that (1) central obesity be measured when assessing older adults' fall risk and (2) specific community prevention strategies for centrally obese older adults be developed to better prevent falls and fall-related injuries., (Copyright © 2018 American Journal of Preventive Medicine. Published by Elsevier Inc. All rights reserved.)

Purpose: To estimate school-level obesity burden, as reflected in prevalence of obesity, based on the characteristics of students' socioeconomic and geographic environments., Design: Secondary analysis of cross-sectional data., Setting: Public schools (N = 504) from 43 of 67 counties in Pennsylvania., Participants: Kindergarten through grade 12 students (N = 255 949)., Measures: School-level obesity prevalence for the year 2014 was calculated from state-mandated student body mass index (BMI) measurements. Eighteen aggregate variables, characterizing schools and counties, were retrieved from federal data sources., Analysis: Three classification variables-excess weight (BMI ≥ 85th percentile), obesity (BMI ≥ 95th percentile), and severe obesity (BMI > 35% or 120% of 95th percentile)-each with 3 groups of schools (low-, average-, and high-prevalence) were created for discriminant function analysis, based on state mean and standard deviation of school distribution. Analysis tested each classification model to reveal school- and county-level dimensions on which school groups differed from each other., Results: Discriminant functions for obesity, which contained school enrollment, percentage of students receiving free/reduced-price lunch, percentage of black/Hispanic students, school location (suburban/other), percentage of county adults with postsecondary education, and percentage of county adults with obesity, yielded 67.86% correct classification (highest accuracy), compared to 34.23% schools classified by chance alone., Conclusion: In the absence of mandated student BMI screenings, the model developed in this study can be used to identify schools most likely to have high obesity burden and, thereafter, determine dissemination of enhanced resources for the implementation of proven prevention policies and programs.

Primary care clinics provide an array of diagnostic and clinical services that assist patients in preventing the onset or managing acute and chronic conditions. Some chronic conditions such as high blood pressure, high cholesterol, and type 2 diabetes require primary care professionals to seek additional medical intervention from registered dieticians. This study explored beliefs, attitudes, and practices of medical and administrative professionals in primary care clinics encountering patients who are potential candidates for ongoing nutrition education or counselling. Five focus groups with primary care providers and clinical staff (n = 24) were conducted to identify perceived intra-organisational factors influencing initiation of community health medical nutrition therapy (MNT) referrals. Lack of clarity regarding community health dieticians' role in chronic disease management was the primary finding for the absence of MNT referrals. Insurance-imposed constraints, perceived patient readiness to change, and service inaccessibility were revealed as barriers that influence referrals to both community health and specialty care dieticians. This study underscores the importance of identifying organisational and interpersonal barriers that influence the initiation of community health MNT referrals. Understanding these barriers can create stronger interprofessional collaboration between primary care providers and community health dieticians.

Background: We examined the longitudinal trajectory of substance use (binge drinking, marijuana use, and cocaine use) in relation to self-esteem from adolescence to young adulthood., Methods: Generalized estimating equation models were fit using SAS to investigate changes in the relation between self-esteem and each substance use (binge drinking, marijuana use, and cocaine use) from adolescence to young adulthood. Data were drawn from the 3 waves of the National Longitudinal Study of Adolescent Health, a nationally representative sample of middle and high school students in the United States (N = 6504)., Results: Self-esteem was a significant predictor for the use of all 3 substances at 15 years of age (ps < .001). However, at age 21, self-esteem no longer predicted binge drinking and marijuana use in the controlled model., Conclusions: It appears that self-esteem loses its protective role against substance use except cocaine use as adolescents transition to young adulthood., (© 2018, American School Health Association.)

Objective: This study examined the effect of two e-cigarette warning labels on college students' perceived advantages and risks of e-cigarette use, as well as students' intentions to use e-cigarettes. The company-produced e-cigarette warning label carries abundant information with small font size while the governmental warning label has only two sentences presented in large font size. The effect of both labels have not yet been examined and verified., Methods: Data were collected in October 2015 from college students at a Midwestern university. A pretest-posttest design was employed with 338 students exposed to the warning label proposed by the FDA and 328 students exposed to the label created by e-cigarette companies. Structural equation modeling analysis was implemented to examine the effect of warning labels with the analytical model grounded in the Theory of Planned Behavior., Results: Findings showed that college students' perceived advantages of e-cigarette use were positively related to their intentions to use e-cigarettes, while perceived risks were negatively associated with their intentions. When comparing two labels, the governmental label was found to reduce college students' intentions to use e-cigarettes via increasing perceived risks of e-cigarette use (β=0.10, p<0.05), however, not via decreasing perceived advantages of e-cigarette use. The warning label currently used by e-cigarette companies showed no influence on beliefs about or intentions to use e-cigarettes., Conclusions: The warning label proposed by the FDA is more effective than that created by e-cigarette companies, however, has room for improvement to make a greater impact on e-cigarette use intention., (Copyright © 2017 Elsevier Ltd. All rights reserved.)

Objective: This study investigated characteristics of potential and current e-cigarette users based on four different levels of use acceptability along with the determinants that promote e-cigarette use acceptability among college students., Methods: College students (N=1198) aged 18-25years at a Midwestern university were surveyed in September-October 2015. Participants were categorized into four groups based on e-cigarette use acceptability adapted from the Diffusion of Innovation Theory (i.e., laggards, late majority, early majority, and adopters). Multinomial logistic regressions and Heckman two-step selection procedures were performed to examine the determinants that promote e-cigarette use acceptability., Results: Approximately 40% of the participants reported ever using e-cigarettes. E-cigarette adopters agreed that e-cigarettes are more socially acceptable than traditional tobacco cigarettes (relative risk ratio [RRR]=1.43, p<0.01). Unique features such as flavor appeared to encourage college students' experimentation with e-cigarettes (ps<0.05). Participants mentioned positive sensory experiences as a reason for e-cigarette use (ps<0.01) and reported caring about their appearance more than their health (ps<0.05) when asked about possible outcomes of e-cigarette use., Conclusions: Study findings indicate a possible explosive increase in e-cigarette experimentation or use among college students. Unique features of e-cigarettes such as flavor and USB rechargeability appear to be strong factors making e-cigarettes more acceptable and appealing to young adults regardless of their smoking status. Concerted efforts should be initiated to effectively counter or eliminate attractive features that lure young adults to experiment with e-cigarettes., (Copyright © 2016 Elsevier Ltd. All rights reserved.)

Middle-aged women are at a higher risk of being obese. We examined the trajectory of post-surgical % total weight loss (%TWL) among middle-aged female bariatric patients. We fitted sequential generalized estimating equations models to analyze a sample of women who received bariatric surgery in 1995-2012, aged 40-65 years at the time of surgery (N = 158,292) whose pre-operative body mass index (BMI) was ≥ 30 kg/m 2 in the Bariatric Outcomes Longitudinal Database. The %TWL computed by 100% × (pre-surgery BMI - post-surgery BMI) / pre-surgery BMI showed different trajectories depending on type of surgery. For gastric banding, %TWL increased rapidly right after bariatric surgery and started to decrease around 1 year after surgery. For Roux-en-Y gastric bypass (RYGB) and sleeve gastrectomy, %TWL overall did not show remarkable changes from around 1 year after surgery. The highest increase in %TWL was observed in patients whose pre-operative BMI was 40 or higher and those who had undergone RYGB ( p s < 0.001). Whereas the trajectories of %TWL among patients with sleeve gastrectomy and gastric banding did not differ much between different pre-operative BMI groups, the trajectories for RYGB were notably different between different pre-operative BMI groups ( p s < 0.001). Middle-aged female bariatric patients are likely to achieve the highest %TWL if they receive RYGB and if their pre-operative BMI is 40 or higher. Further research is warranted to corroborate the present study's finding on the long-term effect of different types of bariatric surgery on %TWL among middle-aged women.

Empirical evidence suggested that mind-body interventions can be effectively delivered online. This study aimed to examine whether preventive online mindfulness interventions (POMI) for non-clinical populations improve short- and long-term outcomes for perceived-stress (primary) and mindfulness (secondary). Systematic search of four electronic databases, manuscript reference lists, and journal content lists was conducted in 2016, using 21 search-terms. Eight randomized controlled trials (RCTs) evaluating effects of POMI in non-clinical populations with adequately reported perceived-stress and mindfulness measures pre- and post-intervention were included. Random-effects models utilized for all effect-size estimations with meta-regression performed for mean age and %females. Participants were volunteers (adults; predominantly female) from academic, workplace, or community settings. Most interventions utilized simplified Mindfulness-Based Stress Reduction protocols over 2-12 week periods. Post-intervention, significant medium effect found for perceived-stress (g = 0.432), with moderate heterogeneity and significant, but small, effect size for mindfulness (g = 0.275) with low heterogeneity; highest effects were for middle-aged individuals. At follow-up, significant large effect found for perceived-stress (g = 0.699) with low heterogeneity and significant medium effect (g = 0.466) for mindfulness with high heterogeneity. No publication bias was found for perceived-stress; publication bias found for mindfulness outcomes led to underestimation of effects, not overestimation. Number of eligible RCTs was low with inadequate data reporting in some studies. POMI had substantial stress reduction effects and some mindfulness improvement effects. POMI can be a more convenient and cost-effective strategy, compared to traditional face-to-face interventions, especially in the context of busy, hard-to-reach, but digitally-accessible populations.

Objectives: Regarding weight management, changes in exercise behavior can also influence nutrition behavior by application of self-regulatory psychological resources across behaviors (transfer effect). This study aimed to determine: (1) if changes in exercise frequency in young adulthood predict simultaneous changes in fruit/vegetable intake (transfer as co-occurrence); and (2) if exercise frequency affects future fruit/vegetable intake (transfer as carry-over)., Methods: 6244 respondents of the National Longitudinal Survey of Youth 1997 were followed at ages 18-22 (Time-1), 23-27 (Time-2), and 27-31 (Time-3). Repeated measures analysis of variance and hierarchical multiple regression determined if the change in exercise frequency between Time-1 and Time-2 was associated with simultaneous and sequential changes in fruit/vegetable intake frequency, controlling for sex, race/ethnicity, education, income, body mass index, and baseline fruit/vegetable intake., Results: Only 9% continued exercising for 30 minutes more than 5 days/week, while 15% transitioned to adequate exercise and another 15% transitioned to inadequate exercise; for both fruits and vegetables, intake of once per day or more increased with age. Males were more likely to exercise adequately and females to consume fruits/vegetables adequately. Exercise frequency transition was linearly associated with concurrent fruit/vegetable intake during Time-1 and Time-2. The highest increase in mean fruit/vegetable intake occurred for participants who transitioned from inadequate to adequate exercise. A significant Time-2 exercise frequency effect on Time-3 fruit/vegetable intake emerged, after accounting for baseline intake. Increase in Time-2 exercise by one day/week resulted in increased Time-3 fruit and vegetable intakes by 0.17 and 0.13 times/week, respectively., Conclusion: Transfer effects, although usually discussed in interventions, may also be applicable to voluntary behavior change processes. Newly engaging in and continuing exercise behavior over time may establish exercise habits that facilitate improved fruit/vegetable consumption. Interventions that facilitate transferring resources across behaviors likely will enhance this effect.

Background: The new Whole School, Whole Community, Whole Child (WSCC) model, designed to depict links between health and learning, is founded on concepts of coordinated school health (CSH) and a whole child approach to education., Methods: The existing literature, including scientific articles and key publications from national agencies and organizations, was reviewed and synthesized to describe (1) the historical context for CSH and a whole child approach, and (2) lessons learned from the implementation and evaluation of these approaches., Results: The literature revealed that interventions conducted in the context of CSH can improve health-related and academic outcomes, as well as policies, programs, or partnerships. Several structural elements and processes have proved useful for implementing CSH and a whole child approach in schools, including use of school health coordinators, school-level and district-level councils or teams; systematic assessment and planning; strong leadership and administrative support, particularly from school principals; integration of health-related goals into school improvement plans; and strong community collaborations., Conclusions: Lessons learned from years of experience with CSH and the whole child approaches have applicability for developing a better understanding of the WSCC model as well as maximizing and documenting its potential for impacting both health and education outcomes., (© 2015 The Authors. Journal of School Health published by Wiley Periodicals, Inc. on behalf of American School Health Association.)

Background: Little is known on the extent of weight misperception and its relation with dietary intake among Chinese youth., Purpose: The study aimed to investigate extent and correlates of weight misperception and its relation with dietary intake among Chinese youth., Method: Data pertaining to Chinese youth, 6-17 years of age, from the 2004-2009 China Health and Nutrition Survey (N = 3,923) were analyzed using STATA version 12.1. The heights and weights of the participants were measured by well-trained health workers at the participants' homes or a local clinic following the reference protocol recommended by the World Health Organization. The dietary intake data of the participants were collected on three consecutive days at both the household and individual levels., Results: Of the children 6-11 years of age, 18.9% were underweight and 15.3% were overweight. Among the children 12-17 years of age, 18.3% were underweight and 8.1% were overweight. Less than 60 % of Chinese youth accurately estimated their weight status. Nutrition knowledge was positively related to a perception of being overweight (adjusted odds ratio [AOR] = 1.98, p = .007) among children 12-17 years of age. A perception of being overweight was positively associated with fat and protein intake among children 6-11 years of age (p < .05)., Conclusions: A discrepancy exists between the actual and perceived weight status of Chinese youth. Efforts are needed in China to promote accurate weight perception, healthy weight, and eating behaviors.

Background: The rate of childhood obesity has more than tripled during the past 30 years. Research shows that prevention at an early age is more effective than treatment later in life. Energize is a multicomponent intervention incorporated into the school day that combines nutrition education and physical activity aimed at maintaining healthy weight among elementary school youth. This study evaluated the effectiveness of the Energize program for changing dietary and physical activity habits compared to a control group of children not participating in the program., Methods: A total of 104, 3rd and 4th graders in 3 southern Indiana elementary schools took part in the study. A quasi-experimental design was used to assess dietary and exercise habits of students in Energize and control groups through 12-week diet/activity logs and post-test questionnaires after controlling for the pre-test results., Results: Energize reduced consumption of French fries and potato chips, but did not increase physical activity., Conclusions: This study provides future researchers with a foundation for preparing longer studies of Energize or to compare multiple years of a standardized Energize curriculum., (© 2013, American School Health Association.)

Adults with intellectual disabilities (ID) have low levels of physical activity and higher than average rates of related chronic health conditions. Understanding correlates of their physical activity participation may improve health promoting interventions. Forty-two adults with ID participated in a physical activity study. Physical activity knowledge and skills, awareness of recommendations and demographic characteristics were analyzed for their association with moderate-to-vigorous physical activity (MVPA) participation measured by accelerometers. Five variables were significantly correlated with MVPA. Body mass index was inversely correlated with MVPA, and gender, job location, job tasks, and place of residence were all significantly associated with MVPA. Understanding correlates of physical activity in this population will help inform disability service and health promotion professionals in future research and health intervention design.

Background: Health eTools for Schools was developed to assist school nurses with routine entries, including height and weight, on student health records, thus providing a readily accessible data base. Data-mining techniques were applied to this database to determine if clinically significant results could be generated., Methods: Body mass index (BMI) data collected and entered in eTools by school nurses from 657,068 students attending 1156 schools in 49 of 67 Pennsylvania counties during 2005-2009 were analyzed. Students in each BMI category were sorted; regression was used to model mean and percentage trends. A chi-square test of individually matched BMI percentages was computed and migration across normal, overweight, and obese states determined., Results: The highest percentage of obese students occured in middle school. The mean trends for obesity and overweight had increasing slopes of 0.189 and 0.227, respectively; with regression slope for overweight >59%. Within groups, substantial percentages of individually matched BMIs changed significantly (p < .0001) over 2 years, migrating between normal weight, overweight, and obese. A comparison of 2009 measured BMI for grades 9-12 from eTools with 2009 Pennsylvania Youth Risk Behavior Survey self-reported BMI yielded substantial diferences., Conclusion: A pattern of increasing BMI for elementary students with a corresponding decrease among middle and high school students emerged. The means trends for both overweight and obesity were greater in 2009 than in 2005, increasing steadily to 2008 and slightly declining to 2009. The dominant overall pattern flows from overweight to obese. If continued unabated, percentage of students who are obese will dominate over time., (© 2013, American School Health Association.)

Objective and Participants: This study explored (1) the prevalence of cigarette smoking among South Korean international college students in the United States, (2) differences in smoking between on- and off-campus living arrangements, and (3) predictors of an increase in smoking over time in the United States, Methods: An online survey was completed by 1,201 students at 52 4-year US universities (34% response rate)., Results: The overall smoking prevalence was 43.5%. The smoking rate (29.0%) of female students was higher than that (4%) of female college students in South Korea. Sex, living place, living situation, length of stay as a student in the United States, home smoking rules, campus-wide tobacco-free policies, and levels of acculturative stress, anxiety, and depression were significantly associated with an increase in smoking (p < .05)., Conclusions: Given the high smoking prevalence among the South Korean students on US college campuses, targeted prevention efforts for these students may be warranted.

Climatic factors and air pollution are important in predicting asthma exacerbations among children. This study was designed to determine if a relationship exists between asthma exacerbations among elementary school children and the combined effect of daily upper atmosphere observations (temperature, relative humidity, dew point, and mixing ratio) and daily air pollution (particulate matter, sulfur dioxide, nitrogen dioxide, carbon monoxide, and ozone) and, if so, to predict asthma exacerbations among children using a mathematical model. Using an ecological study design, school health records of 168,825 students in elementary schools enrolled in "Health eTools for Schools" within 49 Pennsylvania counties were analyzed. Data representing asthma exacerbations were originally recorded by school nurses as the type of treatment given to a student during a clinic visit on a particular day. Daily upper atmosphere measurements from ground level to the 850-mb pressure level and air pollution measurements were obtained. A generalized estimating equation model was used to predict the occurrence of >48 asthma exacerbations, the daily mean for 2008-2010. The greatest occurrence of asthma among school children was in the fall, followed by summer, spring, and winter. Upper atmosphere temperature, dew point, mixing ratio, and six air pollutants as well as their interactions predicted the probability of asthma exacerbations occurring among children. Monitoring of upper atmosphere observation data and air pollutants over time can be a reliable means for predicting increases of asthma exacerbations among elementary school children. Such predictions could help parents and school officials implement effective precautionary measures.

Objectives of this study are to determine if a relationship exists between asthma exacerbations among elementary school children in industrialized countries (with climatic seasons) and exposure to daily air pollution with particulate matter, sulfur dioxide, nitrogen dioxide, nitrogen oxides, carbon monoxide, and ozone, when controlled for potential confounders; and, if so, to derive a statistical model that predicts variation of asthma exacerbations among elementary school children. Using an ecological study design, health records of 168,25 students from elementary schools in 49 Pennsylvania counties employing "Health eTools for Schools" were analyzed. Asthma exacerbations were recorded by nurses as treatment given during clinic visits each day. Daily air pollution measurements were obtained from the EPA's air quality monitoring sites. The distribution of asthmatic grouping for pollen and calendar seasons was developed. A Poisson regression model was used to predict the number of asthma exacerbations. The greatest occurrence of asthma exacerbations was in autumn, followed by summer, spring and winter. If the number of asthma exacerbations on a day is N and the daily mean of asthma exacerbations for the three-year period is 48, the probabilities of N > 48 in tree pollen and grass pollen seasons were 56.5% and 40.8%, respectively (p < 0.001). According to the Poisson regression, the week number and prior day CO, SO₂, NO₂, NOx, PM₂.₅, and O₃ had significant effects on asthma exacerbations among students. Monitoring of air pollutants over time could be a reliable new means for predicting asthma exacerbations among elementary school children. Such predictions could help parents and school nurses implement effective precautionary measures.

Objective: To determine whether a relationship exists between asthma exacerbations among elementary school children and daily upper-air observations (temperature, relative humidity, dew point, and mixing ratio) and, if so, to derive a mathematical model that predicts asthma exacerbations among children., Methods: Using an ecological study design, school health records of 168,825 elementary school students enrolled in the Health eTools for Schools program within 49 Pennsylvania counties were analyzed. Data representing asthma exacerbations were originally recorded by school nurses as the type of treatment given to a student during a clinic visit on a particular day. Daily upper-air measurements from ground level to the 850 mb pressure level, covering a radius of 800 km around Pittsburgh, PA, were obtained. The Wilcoxon two-sample test was used to identify associations. A generalized estimating equation model was used to predict the occurrence of more than 48 asthma exacerbations, the daily mean for 2008-2010., Results: Surveillance of asthma among school children in Pennsylvania increased over 3 years. The greatest occurrence was in the fall, followed by summer, spring, and winter. Annual averages of upper-air observations were significantly different between seasons (p < .02). Upper-air temperature, dew point, and mixing ratio above their 3-year mean values and upper-air relative humidity ≥ 50% were significantly associated with occurrence of asthma exacerbations (p < .011)., Conclusions: Monitoring of upper-air observation data over time can be a reliable means for predicting increases of asthma exacerbations among elementary school children. Such predictions could help parents and school nurses implement effective precautionary measures.

Purpose: The purpose of this study was to assess novel methods of health education and promotion to increase physical activity among adults with intellectual disabilities., Design: A pre-post delayed treatment design was employed to assess the effect of the intervention., Setting: The intervention was administered at two agencies that serve adults with intellectual disabilities., Subjects: Forty-two adults ranging in age from 19 to 62 with mild to moderate intellectual disability participated in the study. Participants were equally divided by gender., Intervention: An eight-session intervention employed a combination of video instruction, pictorial memory tools, and interactive class activities as educational methods., Measures: Physical activity knowledge was evaluated using Illingworth, Moore, and McGillivray's Nutrition Activity Knowledge Scale (NAKS) and the Physical Activity Recommendations Assessment (PARA). Average daily minutes of physical activity were measured using dual-axis accelerometers., Analysis: Paired and independent samples t-tests were used to assess the knowledge scales. Wilcoxon signed-rank tests and Mann-Whitney U-tests were used to assess physical activity participation., Results: Overall, there were mean improvements in scores for both the NAKS (p < .05) and the PARA (p < .001) following the intervention. Physical activity also improved, but not significantly., Conclusion: The education and training methods used in this curriculum are promising for future health education programs in this population. Additional interventions may be necessary to improve physical activity participation.

Adults with intellectual disabilities have high rates of physical inactivity and related chronic diseases. Researchers have called for an increase in the development and evaluation of health education programs adapted to the unique needs of this population. Formative and process evaluation strategies were applied to develop a physical activity education program. The first phase of formative evaluation included a comprehensive literature review to select educational strategies and curriculum content. The theory of planned behavior was selected as a guiding framework, and meetings with stakeholders were held to assess feasibility. The second phase of formative evaluation included an assessment of materials by an expert panel and the priority population, and pilot testing. Next, field testing was implemented, followed by process evaluation and an assessment of implementation fidelity. The final curriculum was developed as a result of the completion of the aforementioned steps and led to a successful physical activity intervention.

Background: The purpose of this study was to detect and document common themes among success stories, along with challenges, as related by participants in the Michiana Coordinated School Health Leadership Institute. Four-member teams from 18 Michigan and Indiana school districts participated in semiannual Institute workshops over a 3-year period and were tasked with implementing Coordinated School Health Programs (CSHPs)., Methods: Qualitative methods were used to generate themes from interviews. Data were gathered through a combined survey/interview process related to programmatic successes, evidence of success, and implementation challenges. One participant from 11 of 18 participating school districts completed the survey/interview., Results: Each participant reported at least 1 success that had a positive effect on students and/or staff, many of which were related to the federally mandated wellness policy. With some notable exceptions, success was based on subjective judgments rather than systematically collected data. Unanimous expression of time constraints and being overworked in their current positions constituted major challenges., Conclusions: Although the Institute required only process evaluation, some participants collected outcome data, a task that is important in validating the benefits of CSHPs. Most districts were not able to hire the recommended coordinator to ensure implementation of health program planning initially developed during the institute. Encouragingly, at the time of data collection many teams were still acting to ensure health programming remained a priority. Nevertheless, without the network of social support provided by the Institute, some respondents struggled to maintain momentum., (© 2011, American School Health Association.)

Background: Dengue fever and dengue hemorrhagic fever (DF/DHF) are epidemic and endemic in tropical and subtropical countries including Sri Lanka. Numerous structural and community interventions have been shown to be effective in interrupting the life cycle of mosquitoes that transmit DF/DHF; however, these interventions are not always implemented intensely and/or consistently enough to control the mosquito populations and suppress the disease. Following a planned and systematic training and mobilizing program, in conjunction with a public information campaign, seventh-, eighth-, and ninth-grade students in 2 schools performed multiple mosquito control and education interventions in their communities once a week for 8 weeks., Methods: Five actions identified in previous literature and executed by students were tracked and secondary entomology data were obtained from public health surveillance systems. The Z-test for determining differences between proportions was utilized to determine significant changes between pre- and post-entomological survey findings in 2 intervention areas, 1 rural and 1 urban. Pre- and post-incidence rates from the intervention areas and comparable control areas were compared., Results: In intervention areas, all proportions of larval indexes were found to be significantly lower following the intervention. Surveillance data showed a 73% reduction in case load for the urban area and a 61% reduction in the rural area during the year following intervention., Conclusion: If properly involved and guided, school children can be an asset to mosquito-borne disease control; the education sector could be an important partner in DF/DHF control., (© 2011, American School Health Association.)

Background: This study explores the relationship between instructional strategies and effective health education curricula., Methods: A content analysis of 10 health education curricula was conducted to determine if they include common instructional strategies for actively engaging students in acquisition of health skills. To be included, the curricula had to (1) be research-based and proven via empirical testing to positively influence the health behaviors and (2) address 1 of Centers for Disease Control and Prevention's 6 priority health risk behaviors., Results: Content analysis revealed 5 active learning strategies incorporated to involve students in acquiring health skills. Role play, group cooperation, and small group discussion were found in all 10 curricula. To a lesser extent, interactive technology and team games were also included., Conclusion: When combined with previous research regarding the characteristics of effective teachers, it becomes clear that effective health education is delivered by teachers who employ a wide repertoire of active learning strategies while devoting substantial instructional time to those specific strategies that involve students in skills practice., (© 2011, American School Health Association.)

Background: A complementary ecological model of the coordinated school health program (CSHP) reflecting 20 years of evolved changes is proposed. Ecology refers to the complex interrelationship between intrapersonal factors, interpersonal processes and primary groups, institutional factors, community factors, and public policy., Methods: Public health and child development theories that incorporate the influence of personal and social environments on health behavior, along with models that incorporate the influence of ecology, were consulted., Results: Concepts from several models were combined with the 8 components of CSHP to formulate an ecological model involving 6 program and services components in an inner circle surrounded by 4 concentric rings representing the healthy school environment, essential structures of CSHP, local school district governance, and family and community involvement., Conclusion: This complementary ecological model is intended to serve as an additional conceptual approach to CSHP practice, evaluation, and research, and should prove especially useful to practitioners and researchers who already have a fundamental understanding of CSHP.