Search

BACKGROUND In addition to sociodemographic and COVID-19- related factors, the needs of school support, including material, psychological and information support, have seldom been discussed as factors influencing anxiety and depression among college students during the COVID-19 pandemic. MATERIAL AND METHODS In this cross-sectional study, 3351 college students from China were surveyed through questionnaires about their sociodemographic and COVID-19 characteristics, the needs of school support, and their experiences with anxiety and depression. RESULTS Anxiety and depression were reported by 6.88% and 10.50% of students, respectively. Married, higher education, non-medical, and urban students had significantly higher risks of anxiety or depression. Additionally, symptoms such as cough and fever, especially when following a possible contact with suspected individuals, quarantine history of a personal contact, going out 1-3 times a week, not wearing a mask, and spending 2-3 hours browsing COVID-19-related information were significantly associated with the occurrence of anxiety or depression. Those who used methods to regulate their emotional state, used a psychological hotline, and who had visited a psychiatrist showed higher anxiety or depression. Those who used online curricula and books, used preventive methods for COVID-19, and who had real-time information about the epidemic situation of the school showed lower anxiety and depression. CONCLUSIONS In addition to sociodemographic and COVID-19-related aspects, students' needs for psychological assistance and information from schools were also associated with anxiety and depression among college students.

Educational indicators are metrics that assist in assessing the quality of the educational system. They are often associated with economic and social factors suggested to contribute to good school performance, however there is no consensus on the impact of these factors. The main objective of this work was to evaluate the factors related to school performance. Using a data set composed by Brazilian schools' performance (IDEB), socioeconomic and school structure variables, we generated different models. The non-linear model predicted the best performance, measured by the error and determination coefficient metrics. The heterogeneity of the importance of the variable between school cycles and regions of the country was detected, this effect may contribute to the development of public educational policies., Competing Interests: The authors have declared that no competing interests exist.

Background: There are concerns that school track recommendations that are mostly based on teachers' judgements of students' performance ('judgement-based recommendations') are more biased by students' SES than school track recommendations that are mostly based on standardized test results ('test-based recommendations'). A recent policy reform of the Dutch educational system has provided us the unique opportunity to compare the effects of students' SES on these two types of track recommendations., Aims: The aim of this study was to examine the differences between test-based and judgement-based recommendations regarding the direct and indirect effect of students' SES at student level and school level., Sample: The sample consisted of 8,639 grade 6 students from 105 Dutch primary schools., Methods: Data were analysed using two-level multilevel mediation models., Results: Track recommendations were higher for high-SES students. This was mostly due to differences in students' prior performance. SES also had a small, direct effect on judgement-based, but not on test-based recommendations. The effects were partly situated at school level., Conclusion: Overall, the results indicated that teachers based their track recommendations mostly on students' prior performance without being biased by students' SES., (© 2020 The Authors. British Journal of Educational Psychology published by John Wiley & Sons Ltd on behalf of British Psychological Society.)

Objective: To study school lifestyle interventions for elementary school children (The Healthy Primary School of the Future)., Research Question: What are the effects of the introduction of increased physical activity with or without healthy nutrition on health behaviour and BMI of young children and what are the costs of this program?, Design: Prospective controlled non-randomized study with nearly 1700 children in Parkstad (South-East Netherlands)., Results: Preliminary results after two years show that the combination of increased physical activity and healthy nutrition result in a decreased BMIz-score (-0.036), increased physical activity alone in hardly any change (-0.10) while in the control group the BMIz-score increased (0.052). The net societal costs of the combination of physical activity and health nutrition costs were 1 euro per child per day., Conclusion: The study contributes to the increasing amount of evidence proving that lifestyle interventions are effective in reducing the obesity epidemic. Future studies will show whether a weight reduction in children will result in the prevention of chronic disease later on in life and what the cost reduction related to this result will be.

We examined special education classifications among students aged 3-21 in North Carolina public schools, highlighting autism spectrum disorder (ASD) and intellectual disability (ID). Results revealed variability by county in ASD and ID prevalence, and in county-level ratios of ID vs. ASD classifications. Sociodemographic characteristics predicted proportion of ASD or ID within a county; correlations showed an association between race and ID, but not ASD. County's median household income predicted proportion of students classified as ASD and ID (opposite directions), controlling for number of students and gender. Variability was unlikely related to biological incidence, and more likely related to district/school practices, or differences in resources. Disparities warrant further examination to ensure that North Carolina's youth with disabilities access necessary, appropriate resources.

Childhood obesity remains a pressing public health concern. Children consume a substantial amount of their caloric intake while in school, making the passage of the Healthy Hunger-Free Kids Act (HHFKA) in 2010 and the subsequent improvements to the school meal standards a key policy change. Using data from the School Nutrition and Meal Cost Study, this paper seeks to re-examine the association between students' ( N = 1963) weight status and participation in the National School Lunch Program (NSLP) and School Breakfast Program (SBP) since the implementation of these policy changes to determine whether, and how, this relationship has changed. After controlling for a wide array of student characteristics and school-level fixed effects, findings from the multivariate regression analyses indicate that usual participation in the school meal programs has no clear association with students' weight status, which contradicts findings from earlier studies conducted prior to the passage of the HHFKA. These findings are discussed in relation to changes in the demographic composition of usual NSLP participants over time.

As school districts across the United States consider how to safely operate during the 2020-21 academic year, CDC recommends mitigation strategies that schools can adopt to reduce the risk for transmission of SARS-CoV-2, the virus that causes coronavirus disease 2019 (COVID-19) (1). To identify the resources and costs needed to implement school-based mitigation strategies and provide schools and jurisdictions with information to aid resource allocation, a microcosting methodology was employed to estimate costs in three categories: materials and consumables, additional custodial staff members, and potential additional transportation. National average estimates, using the national pre-kindergarten through grade 12 (preK-12) public enrollment of 50,685,567 students, range between a mean of $55 (materials and consumables only) to $442 (all three categories) per student. State-by-state estimates of additional funds needed as a percentage of fiscal year 2018 student expenditures (2) range from an additional 0.3% (materials and consumables only) to 7.1% (all three categories); however, only seven states had a maximum estimate above 4.2%. These estimates, although not exhaustive, highlight the level of resources needed to ensure that schools reopen and remain open in the safest possible manner and offer administrators at schools and school districts and other decision-makers the cost information necessary to budget and prioritize school resources during the COVID-19 pandemic., Competing Interests: All authors have completed and submitted the International Committee of Medical Journal Editors form for disclosure of potential conflicts of interest. No potential conflicts of interest were disclosed.

This study examined longitudinal relations between emotion knowledge (EK) in pre-kindergarten (pre-K; M age  = 4.8 years) and math and reading achievement 1 and 3 years later in a sample of 1,050 primarily Black children (over half from immigrant families) living in historically disinvested neighborhoods. Participants were part of a follow-up study of a cluster randomized controlled trial. Controlling for pre-academic skills, other social-emotional skills, sociodemographic characteristics, and school intervention status, higher EK at the end of pre-K predicted higher math and reading achievement test scores in kindergarten and second grade. Moderation analyses suggest that relations were attenuated among children from immigrant families. Findings suggest the importance of enriching pre-K programs for children of color with EK-promotive interventions and strategies., (© 2020 Society for Research in Child Development.)

Background: China is the largest producer and consumer of tobacco products worldwide. While direct marketing and advertisement of tobacco products is restricted, indirect marketing still exists under the guise of sponsorship and corporate social responsibility (CSR). This case study is focused on tobacco industry-sponsored elementary schools in Chinese rural areas., Methods: Field visits were conducted in Yunnan province to interview students, teachers, school principals and parents to understand their perceptions of the tobacco industry and its sponsorship of schools. Interviews with tobacco control activists were conducted in Beijing to discuss national tobacco control efforts targeting tobacco industry sponsorship. Interview data were transcribed and coded, with key themes developed using thematic analysis., Results: While health consequences of smoking are generally known, attitudes towards the tobacco industry and its CSR activities remain positive among the general public. Educators and parents do not perceive any impacts on schoolchildren from exposure to 'pro-tobacco propaganda' created by the industry's CSR activities. Attitudes among tobacco control activists were drastically different, with consensus that CSR activities constitute indirect marketing attempts that should be banned., Conclusion: National tobacco control legislation banning all forms of indirect marketing including CSR is needed in order to protect the health of future generations., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2020. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Background: School-based injuries represent a sizeable portion of child injuries. This study investigated the rates of school-based injuries in Lebanon, examining injury mechanisms, outcomes and associated risk factors., Methods: Data were prospectively collected by intern school nurses at 11 private schools for the 2018-2019 academic year. Descriptive and inferential analyses were performed. Chi-square comparisons were conducted to determine the significance of any differences in injury rates between boys and girls for each category of school., Results: 4,619 injury cases were collected. The yearly rate for school injuries was 419.1 per 1,000 children for the year 2018-2019. Boys demonstrated a significantly higher injury rate for all mechanisms of injuries, with the exception of being injured while walking, injured in the gym/sports areas, and other areas outside the playground and classroom. Elementary school children had the highest rate of injuries, nearly 2.4 times higher than kindergarten, 2.8 times higher than middle school, and 14.5 times higher than high school. Injuries to the face, upper extremities, and lower extremities were nearly 3 times more common than injuries to other areas of the body. Bumps/hits and bruises were most common-almost 3 times more likely than all other injury types. Injuries were mainly minor or moderate in severity-severe injuries were about 10 times less likely. Most injuries were unintentional, with rates nearly 5 times higher than those with unclear intent and 12 times higher than intentional injuries., Conclusions: School injuries represent a relatively common problem. Compliance with playground safety standards coupled with the implementation of injury prevention strategies and active supervision at schools can curtail child injuries and ensure a safe and injury-free school environment., Competing Interests: The authors have declared that no competing interests exist.

Given limited resources, schools are encouraged to consider not only what works, but also at what cost. Cost-effectiveness analysis offers a formal methodology to conceptualize and calculate the ratio of the costs to implement an intervention to its effects (i.e., incremental cost-effectiveness ratios). This study used the ingredients method to analyze secondary data from a randomized controlled trial (N = 537 fourth- and fifth-grade students) to calculate the cost-effectiveness of a classwide math intervention, and provides an overview of cost-effectiveness analysis for readers unfamiliar with the formal methodology. For fourth-graders, the incremental cost-effectiveness ratio was $169.07, indicating it cost $169.07 per student for a 1 standard deviation increase in scaled scores on the state assessment. For fifth-graders, there was no statistically significant effect on the state assessment, but there were improvements in curriculum-based measurement (CBM) scores with incremental cost-effectiveness ratios ranging from $65.08 to $469.12, depending on the type of CBM probe and implementation context. Additionally, using number-needed-to-treat (i.e., the number of participants who must be provided with the intervention to prevent one failure on the state assessment), the cost was $126.90 to prevent failure on the state assessment for one fourth-grade student receiving special education services or for one student who scored below the 25th percentile on the prior year's state assessment. Implications and directions for future research are discussed., (Copyright © 2020 Society for the Study of School Psychology. Published by Elsevier Ltd. All rights reserved.)

No studies have documented the prevalence of the food industry's funding of academic programs, which is problematic because such funding can create conflicts of interest in research and clinical practice. We aimed to quantify the publicly available information on the food industry's donations to academic programs by documenting the amount of donations given over time, categorizing the types of academic programs that receive food industry donations, cataloguing the source of the donation information, and identifying any stated reasons for donations. Researchers cataloged online data from publicly available sources (e.g., official press releases, news articles, tax documents) on the food industry's donations to academic programs from 2000 to 2016. Companies included 26 food and beverage corporations from the 2016 Fortune 500 list in the United States. Researchers recorded the: (1) monetary value of the donations; (2) years the donations were distributed; (3) the name and type of recipient; (4) source of donation information; and (5) reasons for donations. Adjusting for inflation, we identified $366 million in food industry donations (N = 3274) to academic programs. Universities received 45.2% ( n = 1480) of donations but accounted for 67.9% of total dollars given in the sample. Community colleges, schools (i.e., preschool, elementary, middle, and high schools), and academic nonprofits, institutes, foundations, and research hospitals collectively received 54.8% of the donations, but made up less than one-third of the monetary value of donations. Half of the donations (49.0%) did not include a stated reason for the donation. In our sample, donations grew from $3 million in 2000 to $24 million in 2016. Food companies in our sample donated millions of dollars to universities and other academic programs but disclosed little information on the purpose of the donations. Achieving transparency in donation practices may only be possible if federal policies begin to require disclosures or if companies voluntarily disclose information.

Background: Asthma is epidemic in many locations in the United States. Asthma exacerbations pose serious health and education risks for students through school absences, school dropout, and introduction to the juvenile justice system. Accurate school district-level asthma data, currently in short supply, would enable early interventions that focus on specific geographic areas and racial and ethnic subgroups that have higher asthma prevalence., Methods: To support the development of better local level data systems, we used two California student databases, as well as state education and financial databases, to develop two models to estimate school absences and to extrapolate their economic impact in lost school revenue., Results: Analysis demonstrated subpopulations that are appropriate for early intervention: African American elementary school boys have 9.4 average absences per year, higher than other primary racial and ethnic groups. Students who miss ≥3 school days due to asthma account for $26 million of lost revenue., Conclusions: Accurate local level asthma data can identify subpopulations of students for whom environmental and treatment programs can be employed to reduce asthma absences and other related outcomes, and to reduce currently lost school revenues. Such programs also may diminish other asthma-related school inequities., (© 2020, American School Health Association.)

Background: Schools are commonly asked to take on roles that support the emotional well-being of students. These practices are in line with humanistic education theory and can be difficult to fulfil by schools. Broader ecological pressures, such as periods of austerity, are likely to add to the difficulty in meeting students' needs., Aims: To explore whether professionals in schools believe that their work supporting pupils' emotional well-being has changed as a consequence of the current period of austerity., Sample: This project reports the views of staff from three secondary schools in the North West of England. A purposive sample of 29 individuals, including members of the senior leadership team and newly qualified teachers, were involved., Methods: All participants were interviewed about their perceptions of the impact of a sustained period of austerity upon their work. The transcripts of these interviews were analysed using thematic analysis., Findings: Educational professionals associated wider socio-political factors with a perceived increase in the need for emotional support of pupils. They reported taking on new roles and responsibilities to accommodate this and noted they are doing so with fewer resources and limited governmental support., Conclusions: This paper concludes that considering humanistic education theory alongside ecological theory helps to conceptualize how socio-political factors can impact upon the emotional well-being in schools. An ecologically informed humanistic framework is depicted based upon the findings of this project as a means of understanding how these two theories complement one another and interact., (© 2019 The Authors. British Journal of Educational Psychology published by John Wiley & Sons Ltd on behalf of British Psychological Society.)

Introduction: The decision-making process for malaria control and elimination strategies has become more challenging. Interventions need to be targeted at council level to allow for changing malaria epidemiology and an increase in the number of possible interventions. Models of malaria dynamics can support this process by simulating potential impacts of multiple interventions in different settings and determining appropriate packages of interventions for meeting specific expected targets., Methods: The OpenMalaria model of malaria dynamics was calibrated for all 184 councils in mainland Tanzania using data from malaria indicator surveys, school parasitaemia surveys, entomological surveillance, and vector control deployment data. The simulations were run for different transmission intensities per region and five interventions, currently or potentially included in the National Malaria Strategic Plan, individually and in combination. The simulated prevalences were fitted to council specific prevalences derived from geostatistical models to obtain council specific predictions of the prevalence and number of cases between 2017 and 2020. The predictions were used to evaluate in silico the feasibility of the national target of reaching a prevalence of below 1% by 2020, and to suggest alternative intervention stratifications for the country., Results: The historical prevalence trend was fitted for each council with an agreement of 87% in 2016 (95%CI: 0.84-0.90) and an agreement of 90% for the historical trend (2003-2016) (95%CI: 0.87-0.93) The current national malaria strategy was expected to reduce the malaria prevalence between 2016 and 2020 on average by 23.8% (95% CI: 19.7%-27.9%) if current case management levels were maintained, and by 52.1% (95% CI: 48.8%-55.3%) if the case management were improved. Insecticide treated nets and case management were the most cost-effective interventions, expected to reduce the prevalence by 25.0% (95% CI: 19.7%-30.2) and to avert 37 million cases between 2017 and 2020. Mass drug administration was included in most councils in the stratification selected for meeting the national target at minimal costs, expected to reduce the prevalence by 77.5% (95%CI: 70.5%-84.5%) and to avert 102 million cases, with almost twice higher costs than those of the current national strategy. In summary, the model suggested that current interventions are not sufficient to reach the national aim of a prevalence of less than 1% by 2020 and a revised strategic plan needs to consider additional, more effective interventions, especially in high transmission areas and that the targets need to be revisited., Conclusion: The methodology reported here is based on intensive interactions with the NMCP and provides a helpful tool for assessing the feasibility of country specific targets and for determining which intervention stratifications at sub-national level will have most impact. This country-led application could support strategic planning of malaria control in many other malaria endemic countries., Competing Interests: The authors have declared that no competing interests exist.

The study aimed to verify the adequacy of funds for food purchases from family farming in the scope of the National School Food Program (PNAE) in Brazil's state capitals and the Federal District. This was a descriptive study based on secondary data obtained from the webpage of the National Fund for the Development of Education (FNDE) in the link dedicated to information on family farming. We analyzed the amounts transferred to the FNDE and the percentage used in purchasing foods from family farmers for school meals in the state capitals and Federal District from 2011 to 2017. Data were collected in May 2019. One-third of the 27 cities (33.3%) reported purchases above the minimum recommended level (30%). The North of Brazil complied with the recommended level (39.4%), while the Southeast reported the lowest level (6.4%). There was an increase from 2011 to 2017 in the total amounts invested and in the number of cities that purchased foods from family farming. Boa Vista (Roraima) was the capital that spent the largest share of its school meal funds on foods produced by family farmers (56.6%). In 2017, the local governments in Boa Vista and Aracaju (Sergipe) offered matching funds for the funds transferred from the FNDE for these food purchases. In conclusion, from 2011 to 2017, only one-third of the capital cities adequately used the percentage of funds for purchasing foods from family farming, although there was a gradual increase in the purchase of these foods, especially in the state capitals from North and Northeast Brazil.

Economic inequality and ensuing economic stratification in educational and community contexts are growing in the United States. Given these patterns, it is essential to understand the implications of economic stratification in early education settings. This paper delineates repercussions of the concentration of poor children in preschool programs using lagged structural equation models estimated in two longitudinal studies following 3396 4-year-old children in 486 primarily publicly-funded preschool classrooms through kindergarten entrance. Concentrated poverty in preschool classrooms was associated with lower language and reading skills in kindergarten in part through children's exposure to less cognitively-skilled peers, with teacher instructional quality not serving as a reliable mediator. These associations did not emerge in relation to children's math skills. Results expand conceptual models of peer effects and inform preschool policies which seek to increase quality and equity and enhance children's learning., (Copyright © 2019 Society for the Study of School Psychology. Published by Elsevier Ltd. All rights reserved.)

Background: Bystander cardiopulmonary resuscitation (CPR) initiated before medical help arrives saves lives. Hands-Only CPR keeps the blood flowing to the brain and other organs, increasing a person's chance of survival., Methods: A literature review identified Hands-Only CPR as the preferred method of CPR performed in the community setting. Many states have passed legislation making CPR education a high school graduation requirement., Results: School nurses can play a pivotal role as school districts address these new CPR requirements. The school nurse involvement in these newly mandated CPR training requirements can support student success and improve the health of communities., Conclusions: School nurses need to use these newly mandated CPR training requirements as an opportunity to showcase the profession of nursing to ensure the school nurse remains present in our schools., (© 2019, American School Health Association.)

Multiple substances (alcohol, tobacco, cannabis and other illicit drugs (OID)) have been frequently used in early adolescents maybe due to school, violence and mental-health difficulties. We investigated the associations between substance-use patterns and related difficulties among 1559 middle-school adolescents from north-eastern France (mean age 13.5 ± 1.3). They completed a questionnaire including socioeconomic features, school, violence and mental-health difficulties (school grade repetition, sustained physical/verbal violence, sexual abuse, perpetrated violence, poor social support, depressive symptoms and suicide attempt; cumulated number noted SVMD score ) and the time of their first occurrence during the life course. Data were analyzed using logistic and negative binomial regression models. Alcohol, tobacco, cannabis and OID use affected 35.2, 11.2, 5.6 and 2.8% of the subjects respectively. The risk of using tobacco only, alcohol and tobacco, alcohol plus tobacco and cannabis, or all alcohol, tobacco, cannabis and OID strongly increased with the SVMD score (socioeconomic features-adjusted odds ratio reaching 85). The risk began in early years in middle schools and then steadily increased, more markedly for elevated SVMD score . Exposure to several SVMDs may be a transmission vector towards the substance use, starting mostly with alcohol/tobacco, and then shifting to cannabis/OID. These findings help to understand substance-use risk patterns and identify at-risk adolescents., (Copyright © 2019 Elsevier B.V. All rights reserved.)

This article provides a rich longitudinal portrait of the financial and social resources available in the school districts of high- and low-income students in the United States from 1990 to 2014. Combining multiple publicly available data sources for most school districts in the United States, we document levels and gaps in school district financial resources-total per-pupil expenditures-and social resources-local rates of adult educational attainment, family structure, and adult unemployment-available to the average public school student at a variety of income levels over time. In addition to using eligibility for the National School Lunch Program as a blunt measure of student income, we estimate resource inequalities between income deciles to analyze resource gaps between affluent and poor children. We then examine the relationship between income segregation and resource gaps between the school districts of high- and low-income children. In previous work, the social context of schooling has been a theoretical but unmeasured mechanism through which income segregation may operate to create unequal opportunities for children. Our results show large and, in some cases, growing social resource gaps in the districts of high- and low-income students nationally and provide evidence that these gaps are exacerbated by income segregation. Conversely, per-pupil funding became more compensatory between high- and low-income students' school districts over this period, especially in highly segregated states. However, there are early signs of reversal in this trend. The results provide evidence that school finance reforms have been somewhat effective in reducing the consequences of income segregation on funding inequities, while inequalities in the social context of schooling continue to grow.

There is great potential for reducing greenhouse gas emissions (GHGE) from public-sector meals. This paper aimed to develop a strategy for reducing GHGE in the Swedish school food supply while ensuring nutritional adequacy, affordability, and cultural acceptability. Amounts, prices and GHGE-values for all foods and drinks supplied to three schools over one year were gathered. The amounts were optimized by linear programming. Four nutritionally adequate models were developed: Model 1 minimized GHGE while constraining the relative deviation (RD) from the observed food supply, Model 2 minimized total RD while imposing stepwise GHGE reductions, Model 3 additionally constrained RD for individual foods to an upper and lower limit, and Model 4 further controlled how pair-wise ratios of 15 food groups could deviate. Models 1 and 2 reduced GHGE by up to 95% but omitted entire food categories or increased the supply of some individual foods by more than 800% and were deemed unfeasible. Model 3 reduced GHGE by up to 60%, excluded no foods, avoided high RDs of individual foods, but resulted in large changes in food-group ratios. Model 4 limited the changes in food-group ratios but resulted in a higher number of foods deviating from the observed supply and limited the potential of reducing GHGE in one school to 20%. Cost was reduced in almost all solutions. An omnivorous, nutritionally adequate, and affordable school food supply with considerably lower GHGE is achievable with moderate changes to the observed food supply; i.e., with Models 3 and 4. Trade-offs will always have to be made between achieving GHGE reductions and preserving similarity to the current supply.

Physical inactivity has been identified as a leading risk factor for premature mortality globally, and adolescents, in particular, have low physical activity levels. Schools have been identified as a setting to tackle physical inactivity. Economic evidence of school-based physical activity programmes is limited, and the costs of these programmes are not always collected in full. This paper describes a micro-costing and cost-consequence analysis of the 'Girls Active' secondary school-based programme as part of a cluster randomised controlled trial (RCT). Micro-costing and cost-consequence analyses were conducted using bespoke cost diaries and questionnaires to collect programme delivery information. Outcomes for the cost-consequence analysis included health-related quality of life measured by the Child Health Utility-9D (CHU-9D), primary care General Practitioner (GP) and school-based (school nurse and school counsellor) service use as part of a cluster RCT of the 'Girls Active' programme. Overall, 1,752 secondary pupils were recruited and a complete case sample of 997 participants (Intervention n = 570, Control n = 427) was used for the cost-consequence analysis. The micro-costing analysis demonstrated that, depending upon how the programme was delivered, 'Girls Active' costs ranged from £1,054 (£2 per pupil, per school year) to £3,489 (£7 per pupil, per school year). The least costly option was to absorb 'Girls Active' strictly within curriculum hours. The analysis demonstrated no effect for the programme for the three main outcomes of interest (health-related quality of life, physical activity and service use).Micro-costing analyses demonstrated the costs of delivering the 'Girls Active' programme, addressing a gap in the United Kingdom (UK) literature regarding economic evidence from school-based physical activity programmes. This paper provides recommendations for those gathering cost and service use data in school settings to supplement validated and objective measures, furthering economic research in this field. Trial registration: -ISRCTN, ISRCTN10688342., Competing Interests: MJD has acted as consultant, advisory board member and speaker for Novo Nordisk, Sanofi-Aventis, Lilly, Merck Sharp & Dohme, Boehringer Ingelheim, AstraZeneca and Janssen, an advisory board member for Servier and as a speaker for Mitsubishi Tanabe Pharma Corporation and Takeda Pharmaceuticals International Inc. MJD has received grants in support of investigator and investigator initiated trials from Novo Nordisk, Sanofi-Aventis, Lilly, Boehringer Ingelheim and Janssen. This does not alter our adherence to PLOS ONE policies on sharing data and materials. KK has served as a speaker/consultant for Amgen, AstraZeneca, Bayer, NAPP, Lilly, Merck Sharp & Dohme, Novartis, Novo Nordisk, Roche, Berlin-Chemie AG / Menarini Group, Sanofi-Aventis and Servier. KK has received grants in support of investigator and investigator initiated trials from AstraZeneca, Novartis, Novo Nordisk, Sanofi-Aventis, Lilly, Pfizer, Boehringer Ingelheim and Merck Sharp & Dohme. KK has served on advisory boards for Amgen, AstraZeneca, Bayer, NAPP, Lilly, Merck Sharp & Dohme, Novartis, Novo Nordisk, Roche, Berlin-Chemie AG / Menarini Group, Sanofi-Aventis and Servier. This does not alter our adherence to PLOS ONE policies on sharing data and materials. Outside of the submitted work, JMC and RTE report funding from Public Health Wales during the conduct of the study. CE reports grants from National Institute for Health Research Public Health Research during the conduct of the study. DHB, TG, DMH, LS and TY all have nothing to declare.

Background: A healthy preK-12th-grade school environment is critical to student well-being and success. As role models, school employees play a significant part in creating a healthy environment. Research suggests that employee wellness programs (EWPs) may help school employees adopt healthier lifestyles and, therefore, be healthier, more productive, and serve as healthy role models for students. This article describes the process by which a school district in central Texas partnered with a local university to plan, develop, and implement an affordable EWP., Methods: A university-led leadership team sought input from employees, including administrators, and conducted a 4-week trial. These resulted in an EWP that provided health risk appraisals, fitness testing, group exercise classes, education seminars, online wellness resources, and blood draws/analysis., Results: During the first 4 years, membership ranged from 107 to 384 (10-37%), and the annual cost of the program ranged from $49 to $116 per participating employee., Conclusions: University-led EWP programs can support, at a low cost, the health of school employees. Despite low employee engagement, need was demonstrated and feedback was positive. Challenges identified include time demands and lack of principals' support. Future considerations include targeting principals, utilizing the Human Resources Office, and strategically building a culture of health., (© 2019, American School Health Association.)

Background/objective: Headache in pupils is underestimated and has a negative impact on learning and life. The aim of this study was to investigate headache prevalence and its collateral effects, in pupils of different ages and school types in a German city., Methods: Anonymized questionnaires were distributed to 5419 pupils attending primary and secondary schools. Demographics, headache frequency, analgesic use, school absence and, for secondary school children, data on lifestyle were collected., Results: The questionnaire was returned by 2706 children (49%), 1362 (50.3%) girls, 1344 (49.7%) boys. Of these, 36.6% indicated a frequency of 1, and 31.5% a frequency of ≥ 2 headache days per month within the last 3 months. Headache prevalence increased with school grade, age and secondary school type: 63.6%, 67.2% and 79.5% for primary school children, pupils attending 8-year and pupils attending 6-year secondary schools, respectively. With secondary school level I certificates, pupils are prepared for general professional training in 6 years. Secondary school level II results, after 8 years of training, in university entrance level II certificates, which are the precondition for university studies. Girls reported significantly more headache than boys (73% vs. 63.1%). A significant relationship has been observed between headache frequency and school absence and between headache intensity and headache frequency. Of pupils with headache at least twice a month, 48.1% reported analgesic intake. Ibuprofen (49.1%) and paracetamol (32.8%) were the most frequently used analgesics. Of those pupils with headache ≥ 2 days/month, 68.3% did not have a specific headache diagnosis. Concomitant diseases and regular drug intake, analgesic intake for another reason than headache, caffeine consumption and lack of participation in sports were positively correlated with headache., Conclusions: The majority of pupils suffer from headache at least once a month. Since frequent headache results in educational and social limitations, pupils at risk should be identified and referred to headache education programs. Efforts are needed to improve the management of juvenile headache patients.

We replicated the study by Tucker-Drob, Cheung, and Briley (2014), who found that the association between science interest and science knowledge depended on economic resources at the family, school, and national levels, using data from the 2006 Programme for International Student Assessment (PISA). In more economically prosperous families, schools, and nations, student interest was more strongly correlated with actual knowledge. Here, we investigated whether these results still held despite substantial changes to educational and economic systems over roughly a decade. Using similar data from PISA 2015 ( N = 537,170), we found largely consistent results. Students from more economically advantaged homes, schools, and nations exhibited a stronger link between interests and knowledge. However, these moderation effects were substantially reduced, and the main effect of science interest increased by nearly 25%, driven almost entirely by families of low socioeconomic status and nations with low gross domestic product. The interdependence of interests and resources is robust but perhaps weakening with educational progress.

This study provides a cost-benefit analysis of expanding access to universal preschool education, focusing on a Spanish reform that lowered the age of eligibility for publicly provided universal preschool from age 4 to age 3. Benefits in terms of child development and maternal employment are estimated using evidence on the causal effects of this reform. In the baseline estimation the benefit-cost ratio is over 4, indicating sizeable net societal benefits of the preschool investment. The results show that the child development effects are the major determinant of the cost-benefit ratio; the employment gains for parents appear to play a relatively minor role. Overall, the cost-benefit analysis provides support for investing in high-quality preschool education., (© 2017 The Authors. Child Development © 2017 Society for Research in Child Development, Inc.)

Introduction: Children exposed to secondhand smoke (SHS) are at increased risk of respiratory illnesses. We piloted a Smoke Free Intervention (SFI) and trial methods before investigating its effectiveness and cost-effectiveness in primary school children., Methods: In a pilot cluster randomized controlled trial in Bangladesh, primary schools were allocated to usual education (control) or SFI, using minimization. Year-5 children were recruited. Masking treatment allocation was not possible. Delivered by schoolteachers, SFI consisted of two 45-min and four 15-min educational sessions. Our primary outcome was SHS exposure at two months post randomization, verified by children's salivary cotinine. The trial is registered at ISRCTN.com; ISRCTN68690577., Results: Between April 1, 2015 and June 30, 2015, we recruited 12 schools. Of the 484 children present in Year-5, 481 consented. Six schools were allocated to both SFI (n = 245) and to usual education only (n = 236). Of them, 450 children (SFI = 229; control = 221) who had cotinine levels indicative of SHS exposure were followed-up. All schools were retained, 91% children (208/229) in SFI and 88% (194/221) in the control arm completed primary outcome assessment. Their mean cotinine at the cluster level was 0.53 ng/ml (SD 0.36) in SFI and 1.84 ng/ml (SD 1.49) in the control arm-a mean difference of -1.31 ng/ml (95% CI = -2.86 to 0.24)., Conclusion: It was feasible to recruit, randomize, and retain primary schools and children in our trial. Our study, though not powered to detect differences in mean cotinine between the two arms, provides estimates to inform the likely effect size for future trials., Implications: In countries with high smoking prevalence, children remain at risk of many conditions due to secondhand smoke exposure. There is little empirical evidence on the effectiveness and cost-effectiveness of interventions that can reduce their exposure to secondhand smoke at homes. CLASS II trial found that a school-based intervention (SFI) has the potential to reduce children's exposure to SHS-an approach that has been rarely used, but has considerable merit in school-based contexts. CLASS II trial provides key information to conduct a future definitive trial in this area of public health, which despite its importance has so far received little attention., (© The Author(s) 2018. Published by Oxford University Press on behalf of the Society for Research on Nicotine and Tobacco.)

Publicly funded center-based preschool programs were designed to enhance low-income children's early cognitive and social-emotional skills in preparation for kindergarten. In the U.S., the federal Head Start program and state-funded public school-based pre-kindergarten (pre-k) programs are the two primary center-based settings in which low-income children experience publicly funded preschool. Although evidence suggests that these programs generally promote cognitive and social-emotional skills for low-income children overall, whether the benefits of program participation vary for low-income children with difficult temperaments is unexplored. Difficult temperament status is a source of vulnerability that connotes increased risk for poor early school outcomes-risks that may be ameliorated by public preschool programs known to promote kindergarten readiness among other vulnerable populations. Using a nationally representative sample of low-income children ( N ≈ 3,000) drawn from the Early Childhood Longitudinal Study-Birth Cohort (ECLS-B), this study tests whether associations between public preschool participation and children's cognitive and social-emotional skills in kindergarten are moderated by difficult temperament status. We focus on Head Start and public school-based pre-k, comparing both with parental care and with each other. Results provide weak evidence that public preschool's benefits on children's cognitive and social-emotional skills in kindergarten are moderated by child temperament. School-based pre-k is significantly associated with better reading skills relative to parental care only for children with difficult temperaments. Additionally, for children with difficult temperaments, Head Start is significantly associated with better approaches to learning relative to parental care, and with reduced externalizing behavior problems relative to school-based pre-k. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Aim: The main aim of this study was to explore factors compromising early intervention (EI) service delivery to hearing impaired children in South Africa, as expressed by their caregivers., Methods: Within a qualitative survey design, a sample of 19 hearing impaired children's caregivers completed structured self-administered questionnaires on factors that they perceive compromise EI for their children. These caregivers included mothers, fathers, grandparents, and legal guardians or adoptive parents of children with hearing impairment. Descriptive analysis of the data was undertaken., Results: Findings indicated various factors compromising EI as reported by caregivers. These included limited availability of appropriate schools and health care facilities for their hearing impaired children; long distances between the few services that are available and the places of residence of the service users; significant costs linked to the services (such as medical expenses, boarding school facilities costs); limited skills and knowledge of professionals and teachers regarding hearing impairment; inconsistent and conflicting professional opinions about the child's diagnosis and treatment; as well as limited community awareness about hearing impairment along with services available for hearing impaired children., Conclusion: These findings have important clinical, training, policy, and advocacy implications within the South African context; if both access to and success within the EI services will be successful., (Copyright © 2018 Elsevier B.V. All rights reserved.)

Context: Hiring athletic trainers (ATs) in high schools may lower medical payments by third-party payers such as Medicaid or commercial insurers by reducing injury risks or may increase medical payments due to more referrals to other health care providers. To date, evidence is lacking on the actual financial effect of high school ATs based on an analysis of medical claims., Objective: To assess the overall cost-benefit of hiring ATs in Oregon high schools based on medical claims data across years., Design: Cost-benefit study., Setting: Oregon public high schools., Patients or Other Participants: Patients aged 14 to 18 years old., Main Outcome Measure(s): We analyzed the 2011-2014 limited dataset from the Oregon Health Authority's All Payer All Claims database. Paired t tests were used to compare claims payments at the zip code level between periods of having and not having ATs in Oregon high schools. We also used the percentage of AT effort to adjust for AT investment. The main outcome measure was the return on investment associated with hiring ATs in high schools., Results: The presence of ATs in Oregon high schools may have had different effects on medical payments for Medicaid and commercial insurance. With every dollar invested in hiring ATs in Oregon public high schools from 2011 to 2014, Medicaid payments increased by 24 cents per month at the zip code level, while commercial insurance payments decreased by 24 cents, although the changes were not statistically significant., Conclusions: Hiring ATs in an outreach model for high schools may not necessarily generate medical savings for Medicaid or commercial insurers. Further research is needed to determine if the lack of cost savings in our study was a factor of the employment model, resulted from increased health care utilization, or reflected the need for ATs to deliver more on-site AT services.

Context: Secondary schools have made significant progress in providing athletic trainer (AT) coverage to their student-athletes, but the levels of access at schools with ATs may vary widely. Socioeconomic disparities in medical coverage and access have been noted in other health care fields, but such disparities in the level of access to AT services have not been thoroughly examined., Objective: To determine if (1) access to AT services or (2) the level of access (AT hours per week and athletes per AT hour) differed based on the socioeconomic characteristics of secondary schools., Design: Cross-sectional study., Setting: Mailed and e-mailed surveys., Patients or Other Participants: High school athletic directors and ATs from 402 Wisconsin high schools., Main Outcome Measure(s): Respondents provided information as to whether their school used the services of an AT and the number of hours per week that their school had an AT on-site. The number of athletes per AT hour was calculated by dividing the total number of athletes at the school by the number of hours of AT coverage per week. The socioeconomic status of each school was determined using the percentage of students with free or reduced-cost lunch and the county median household income (MHI)., Results: Schools without an AT on-site were in lower MHI counties ( P < .001) and had more students eligible for a free or reduced-cost lunch ( P < .001). Lower levels of AT access (fewer hours of AT access per week and more athletes per AT hour) were observed at schools in the lowest third of the county MHI and with the highest third of students eligible for a free or reduced-cost lunch ( P < .001)., Conclusions: Socioeconomic disparities were present in access to AT services. New models are needed to focus on providing a high level of AT access for all student-athletes, regardless of socioeconomic status.

Background: The objective of this study was to determine if a school support intervention for adolescent orphans in Kenya had effects on mental health, a secondary outcome., Methods: In this paper, we analyzed data from a 4-year cluster-randomized trial of a school support intervention (school uniforms, school fees, and nurse visits) conducted with orphaned adolescents in Siaya County, western Kenya, who were about to transition to secondary school. 26 primary schools were randomized (1:1) to intervention (410 students) or control (425 students) arms. The study was longitudinal with annual repeated measures collected over 4 years from 2011 to 2014. We administered five items from the 20-item Center for Epidemiologic Studies Depression Scale Revised, a self-reported depression screening instrument., Results: The intervention prevented depression severity scores from increasing over time among adolescents recruited from intervention schools. There was no evidence of treatment heterogeneity by gender or baseline depression status. The intervention effect on depression was partially mediated by higher levels of continuous school enrollment among the intervention group, but this mediated effect was small., Conclusions: School support for orphans may help to buffer against the onset or worsening of depression symptoms over time, promoting resilience among an important at-risk population., (© 2018 Association for Child and Adolescent Mental Health.)

We present a non-parametric extension of the conditional logit model, using Gaussian process priors. The conditional logit model is used in quantitative social science for inferring interaction effects between personal features and choice characteristics from observations of individual multinomial decisions, such as where to live, which car to buy or which school to choose. The classic, parametric model presupposes a latent utility function that is a linear combination of choice characteristics and their interactions with personal features. This imposes strong and unrealistic constraints on the form of individuals' preferences. Extensions using non-linear basis functions derived from the original features can ameliorate this problem but at the cost of high model complexity and increased reliance on the user in model specification. In this paper we develop a non-parametric conditional logit model based on Gaussian process logit models. We demonstrate its application on housing choice data from over 50,000 moving households from the Stockholm area over a two year period to reveal complex homophilic patterns in income, ethnicity and parental status., Competing Interests: The authors have declared that no competing interests exist.

Objectives: To elucidate details about the barriers (time, funding, staffing, and space) to integrating and sustaining school gardens., Methods: A total of 99 school gardeners from 15 states participated in an online survey in June 2017. The 29-item survey contained qualitative and quantitative items that we analyzed using descriptive statistics and inductive content analysis., Results: In order of greatest to least barrier, gardeners ranked time, staff, funding, curriculum, and space. Time for classes to use the garden (66% of respondents) and time for staff training (62%) were the most frequently listed time-related challenges. Respondents also reported low engagement within the school community. An overall lack of funding was the most common funding-related barrier, and gardeners were unaware of how to obtain more funding., Conclusions: We identified 3 aspects of school gardens as opportunities to address time- and staff-related issues: strengthening of garden committees, professional development, and community outreach. Better channels are needed to disseminate funding opportunities within schools and to communicate with communities at large. Ultimately, doing so will strengthen existing school gardens as a vehicle to promote dietary, physical, and social health within communities.

Background: We seek to identify conditions under which a plan by the Toronto District School Board (TDSB) to equip high schools with naloxone kits would be cost-effective., Methods: We developed a decision-analytic model to evaluate the costs, benefits, and cost-effectiveness of a school-based naloxone program. We estimated model inputs from the medical literature and used Toronto-specific sources whenever available. We present our results varying both the expected total number of opioid overdoses per year across all 112 TDSB high schools and the effectiveness of a school-based naloxone program in reducing mortality., Results: A school naloxone program likely costs less than CAD$50,000 per quality-adjusted life-year gained if the overdose frequency is at least once each year and it reduces opioid poisoning mortality by at least 40% (from 10% to <6.0%) or if the overdose frequency is at least two per year and the program reduces mortality by at least 20% (from 10% to <8.0%). The results are sensitive to the intensity and cost of staff training, the lifetime costs and life-expectancy of overdose survivors, and the probability of an overdose being fatal in the absence of a school naloxone program., Conclusions: School naloxone programs are relatively inexpensive, but that does not ensure that they are a cost-effective use of resources. While potentially cost-effective, if the risk of an overdose in a Toronto high school is low, then other programs aimed at improving the health and wellbeing of students may be better use of limited resources., (Copyright © 2018 Elsevier B.V. All rights reserved.)

We present a rationale for, and results from, the pilot of a direct individual-to-institution remittance system in the context of school fee payment in rural Benin. Data confirm that school fees act as an impediment to educational attainment, and in very rural poor settings such as northern Benin, students often depend on extended family and kinship networks to pay fees. But existing remittance options are costly, in terms of fees, time, and risk. We pilot a new technology bundle in a single public high school in northeastern Benin, and evaluate its effectiveness. Here we describe the technical and institutional implementation of the project, as well as our findings from the first year of operation. We discuss takeaways and implications for scale-up., Competing Interests: The authors have declared that no competing interests exist.

Background: Globally, adolescent girls' physical activity (PA) levels are low. The 'Girls Active' secondary school-based programme, developed by the Youth Sport Trust, aims to increase PA in adolescent girls. This paper explores the effectiveness of the 'Girls Active' school-based PA programme., Methods: A random sample of girls aged 11-14 from 20 secondary schools (Midlands, UK) participated in a two-arm cluster randomised controlled trial. Ten schools received Girls Active and 10 continued with usual practice. Measurements were taken at baseline, seven- and 14-month follow-up., Primary Outcome: wrist-worn accelerometer measured moderate- to vigorous-intensity PA (MVPA)., Secondary Outcomes: overall PA, light PA, sedentary time, body composition, and psychosocial outcomes. Generalised estimating equations, adjusted for school cluster and potential confounders, were used and A priori subgroup analysis was undertaken. Micro-costing and cost-consequence analyses were conducted using bespoke collection methods on programme delivery information. Outcomes for the cost-consequence analysis were health related quality of life measured by the Child Health Utility-9D and service use., Results: Overall, 1752 pupils participated, 1211 (69.1%) provided valid 14-month accelerometer data. No difference in MVPA (mins/day; 95% confidence intervals) was found at 14 months (1.7; -0.8 to 4.3), there was at seven months (2.4; 0.1 to 4.7). Subgroup analyses showed significant intervention effects on 14-month in larger schools (3.9; 1.39 to 6.09) and in White Europeans (3.1; 0.60 to 6.02) and in early maturers (5.1; 1.69 to 8.48) at seven months. The control group did better in smaller schools at 14-months (-4.38; -7.34 to -1.41). Significant group differences were found in 14-month identified motivation (-0.09; -0.18 to -0.01) and at seven months in: overall PA (1.39 mg/day; 0.1 to 2.2), after-school sedentary time (-4.7; -8.9 to -0.6), whole day (5.7; 1.0 to 10.5) and school day (4.5; 0.25 to 8.75) light PA, self-esteem. Small, statistically significant, differences in some psychosocial variables favoured control schools. Micro-costing demonstrated that delivering the programme resulted in a range of time and financial costs at each school. Cost-consequence analysis demonstrated no effect of the programme for health related quality of life or service use., Conclusions: Compared with usual practice, 'Girls Active' did not affect 14-month MVPA., Trial Registration: ISRCTN10688342.

Background: School food environment policies may be a critical tool to promote healthy diets in children, yet their effectiveness remains unclear., Objective: To systematically review and quantify the impact of school food environment policies on dietary habits, adiposity, and metabolic risk in children., Methods: We systematically searched online databases for randomized or quasi-experimental interventions assessing effects of school food environment policies on children's dietary habits, adiposity, or metabolic risk factors. Data were extracted independently and in duplicate, and pooled using inverse-variance random-effects meta-analysis. Habitual (within+outside school) dietary intakes were the primary outcome. Heterogeneity was explored using meta-regression and subgroup analysis. Funnel plots, Begg's and Egger's test evaluated potential publication bias., Results: From 6,636 abstracts, 91 interventions (55 in US/Canada, 36 in Europe/New Zealand) were included, on direct provision of healthful foods/beverages (N = 39 studies), competitive food/beverage standards (N = 29), and school meal standards (N = 39) (some interventions assessed multiple policies). Direct provision policies, which largely targeted fruits and vegetables, increased consumption of fruits by 0.27 servings/d (n = 15 estimates (95%CI: 0.17, 0.36)) and combined fruits and vegetables by 0.28 servings/d (n = 16 (0.17, 0.40)); with a slight impact on vegetables (n = 11; 0.04 (0.01, 0.08)), and no effects on total calories (n = 6; -56 kcal/d (-174, 62)). In interventions targeting water, habitual intake was unchanged (n = 3; 0.33 glasses/d (-0.27, 0.93)). Competitive food/beverage standards reduced sugar-sweetened beverage intake by 0.18 servings/d (n = 3 (-0.31, -0.05)); and unhealthy snacks by 0.17 servings/d (n = 2 (-0.22, -0.13)), without effects on total calories (n = 5; -79 kcal/d (-179, 21)). School meal standards (mainly lunch) increased fruit intake (n = 2; 0.76 servings/d (0.37, 1.16)) and reduced total fat (-1.49%energy; n = 6 (-2.42, -0.57)), saturated fat (n = 4; -0.93%energy (-1.15, -0.70)) and sodium (n = 4; -170 mg/d (-242, -98)); but not total calories (n = 8; -38 kcal/d (-137, 62)). In 17 studies evaluating adiposity, significant decreases were generally not identified; few studies assessed metabolic factors (blood lipids/glucose/pressure), with mixed findings. Significant sources of heterogeneity or publication bias were not identified., Conclusions: Specific school food environment policies can improve targeted dietary behaviors; effects on adiposity and metabolic risk require further investigation. These findings inform ongoing policy discussions and debates on best practices to improve childhood dietary habits and health.

Let's Move! Active Schools (LMAS), now Active Schools, is a national initiative in the United States (US) that aims to engage schools to increase students' opportunities to be physically active. This evaluation describes changes in school-level practices related to physical education (PE) and physical activity (PA) among schools that received an LMAS-partner grant from ChildObesity180 or Fuel Up to Play 60 (FUTP60). ChildObesity180 and FUTP60 asked grantee schools to complete nine common questions, between October 2013 and August 2014, before and after receiving the grants to assess progress in implementing practices for PE and PA. "Yes" responses indicated presence of PE/PA-supportive practices. For schools with complete pre and post data (n=972), frequencies of "yes" responses were calculated for each practice at pre/post. Schools receiving a FUTP60 partner grant reported statistically significant improvements from pre to post across five practices for PE and PA, and ChildObesity180 grantees reported significant increases on all practices except daily recess, which was already in place at 95% of schools at pre-survey. Schools across both grant programs reported the largest increases for promoting PA via messaging, implementing classroom PA breaks, and providing PA before and after school. Schools in both programs reported smaller, but statistically significant, increases in requiring the recommended minutes of PE. This study illustrates the feasibility of offering small grants, at a national scale, for schools to make changes that support PA throughout the day. Results suggest that schools can shift PA policies and practices over the course of a school year., (Published by Elsevier Inc.)

Social, emotional, and behavioral skills are foundational to learning and long-term success. However, poverty and exposure to adverse childhood experiences reduce the chances of children entering kindergarten socially-behaviorally ready to learn. This study examined the unique impact of 5-year-old children (N = 11,412) entering kindergarten not socially-behaviorally ready on three costly school outcomes by fourth grade in Baltimore City Public Schools: being retained in grade, receiving services and supports through an IEP or 504 plan, and being suspended/expelled. Controlling for all other types of school readiness, students not identified as socially-behaviorally ready for kindergarten were more likely to experience all three school outcomes. Findings underscore the importance of early prevention and intervention strategies targeting parents and social-behavioral readiness skills during the first 5 years of life.

Purpose: Using a clustered randomized controlled trial design, we evaluated whether support to keep Kenyan orphaned adolescents in school reduces the risk of HIV infection., Methods: Participants included 835 orphaned boys and girls in grades 7 and 8 (mean age at the baseline = 15 years) in western Kenya. Primary schools (N = 26) were randomized to the study condition. Intervention participants received school uniforms, payment of tuition when they transitioned into high school, and nurse visits to monitor school absenteeism and provide assistance to stay in school. Annual surveys were conducted from 2011 through 2014, and HIV and herpes simplex virus 2 (HSV-2) biomarker data were collected at the baseline and the end line. Data were analyzed using survey logistic regression or generalized estimating equations controlling for age, gender, and socioeconomic status., Results: Intervention and control groups were equivalent at the baseline and did not differ on new HIV or HSV-2 incidence at the end line. The school support intervention increased school retention but had few HIV-related effects, except increased circumcision among male participants and reduced likelihood of transactional sex., Conclusions: Despite a strong study design, we found no relative reduction in HIV or HSV-2 infection after 3 years of intervention implementation. New incidence of HIV was lower than expected in this region among youth whose average age at end line was 18 years (range = 14-23). Although support for secondary school promises many benefits for vulnerable youth, our study adds to the growing body of research showing weak evidence for its effectiveness as an HIV prevention., (Copyright © 2017 The Society for Adolescent Health and Medicine. Published by Elsevier Inc. All rights reserved.)

Numerous studies have shown that later school start times (SST) are associated with positive student outcomes, including improvements in academic performance, mental and physical health, and public safety. While the benefits of later SST are very well documented in the literature, in practice there is opposition against delaying SST. A major argument against later SST is the claim that delaying SST will result in significant additional costs for schools due to changes in bussing strategies. However, to date, there has only been one published study that has quantified the potential economic benefits of later SST in relation to potential costs. The current study investigates the economic implications of later school start times by examining a policy experiment and its subsequent state-wide economic effects of a state-wide universal shift in school start times to 8.30AM. Using a novel macroeconomic modeling approach, the study estimates changes in the economic performance of 47 US states following a delayed school start time, which includes the benefits of higher academic performance of students and reduced car crash rates. The benefit-cost projections of this study suggest that delaying school start times is a cost-effective, population-level strategy, which could have a significant impact on public health and the US economy. From a policy perspective, these findings are crucial as they demonstrate that significant economic gains resulting from the delay in SST accrue over a relatively short period of time following the adoption of the policy shift., (Copyright © 2017 National Sleep Foundation. Published by Elsevier Inc. All rights reserved.)

Background: Offering free glasses can be important to increase children's wear. We sought to assess whether "Upgrade glasses" could avoid reduced glasses sales when offering free glasses to children in China., Methods: In this cluster-randomized, controlled trial, children with uncorrected visual acuity (VA)< = 6/12 in either eye correctable to >6/12 in both eyes at 138 randomly-selected primary schools in 9 counties in Guangdong and Yunnan provinces, China, were randomized by school to one of four groups: glasses prescription only (Control); Free Glasses; Free Glasses + offer of $15 Upgrade Glasses; Free Glasses + offer of $30 Upgrade Glasses. Spectacle purchase (main outcome) was assessed 6 months after randomization., Results: Among 10,234 children screened, 882 (8.62%, mean age 10.6 years, 45.5% boys) were eligible and randomized: 257 (29.1%) at 37 schools to Control; 253 (28.7%) at 32 schools to Free Glasses; 187 (21.2%) at 31 schools to Free Glasses + $15 Upgrade; and 185 (21.0%) at 27 schools to Free Glasses +$30 Upgrade. Baseline ownership among these children needing glasses was 11.8% (104/882), and 867 (98.3%) children completed follow-up. Glasses purchase was significantly less likely when free glasses were given: Control: 59/250 = 23.6%; Free glasses: 32/252 = 12.7%, P = 0.010. Offering Upgrade Glasses eliminated this difference: Free + $15 Upgrade: 39/183 = 21.3%, multiple regression relative risk (RR) 0.90 (0.56-1.43), P = 0.65; Free + $30 Upgrade: 38/182 = 20.9%, RR 0.91 (0.59, 1.42), P = 0.69., Conclusions: Upgrade glasses can prevent reductions in glasses purchase when free spectacles are provided, providing important program income., Trial Registration: ClinicalTrials.gov Identifier: NCT02231606. Registered on 31 August 2014.

Background: The aim of this mixed-methods, systematic literature review was to develop an understanding of the factors affecting the implementation of tobacco and substance use intervention programmes in the secondary school setting using NPT as an analytical framework., Methods: A search strategy was developed that combined implementation, school and intervention search terms. Literature searches were conducted in MEDLINE, Embase, PsycHINFO, Scopus, ERIC, CINAHL, Web of Science and the Cochrane Library. PROSPERO was also searched for similar systematic reviews and a grey literature search of policy documents and relevant material was also conducted. Papers were eligible for inclusion if they were based in a secondary school and focused on the implementation of a tobacco or substance use programme. Both quantitative and qualitative methodologies were considered for inclusion. Normalisation Process Theory (NPT) was used as a conceptual framework to identify facilitators and barriers of implementation and to structure the synthesis., Results: Inclusion criteria were met by 15 papers. The included papers were both quantitative and qualitative and focused on a range of tobacco and substance use interventions, delivered by differing providers. Key facilitating factors for implementation were positive organisational climate, adequate training and teacher's and pupil's motivation. Barriers to implementation included heavy workloads, budget cuts and lack of resources or support. Quality appraisal identified papers to be of moderate to weak quality, as papers generally lacked detail., Conclusion: NPT highlighted the need for studies to extend their focus to include reflexive monitoring around appraisal and the evaluation processes of implementing new tobacco or substance use programs. Future research should also focus on employing implementation theory as a tool to facilitate bridging the gap between school health research and practice.

Based on a review of literature published in refereed archival journals, ventilation rates in classrooms often fall far short of the minimum ventilation rates specified in standards. There is compelling evidence, from both cross-sectional and intervention studies, of an association of increased student performance with increased ventilation rates. There is evidence that reduced respiratory health effects and reduced student absence are associated with increased ventilation rates. Increasing ventilation rates in schools imposes energy costs and can increase heating, ventilating, and air-conditioning system capital costs. The net annual costs, ranging from a few dollars to about 10 dollars per person, are less than 0.1% of typical public spending on elementary and secondary education in the United States. Such expenditures seem like a small price to pay given the evidence of health and performance benefits., (© 2017 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)

Objective: To explore and compare the characteristics of Primary Education Centres (PEC) in Andalusia, the Canary Islands and the Principality of Asturias depending on whether or not they make local food purchases (LFP) for school meals and to explore the opinion of cafeteria managers about the benefits and challenges of this type of purchase., Method: Information on the characteristics of 186 PECs and opinions of cafeteria managers about the benefits/challenges of LFP was collected through an electronic questionnaire. Data were stratified according to how the products were purchased (LFP: yes/no), and the chi square test was applied., Results: 38.2% of the PECs studied make LFP. This is more frequent in rural areas (51.0 with self-managed cafeterias (80.0%), and their own kitchen (65.5%). These centres have less expensive menus than their peers (69.8%), participate more frequently in healthy eating programmes (81.5%) and purchase more organic food products (65.8%). According to the majority of the participants whose centres engage in LFP, the benefits include: supporting the local economy (97.2%), the offer of fresh foods (97.2%) and environmental sustainability (93.0%). The challenges include: productive capacity of the region (50.7%), the seasonal variation in food production (71.8%), and the lack of support (42.3%) and information from the government (46.5%)., Conclusion: The location of the centres, the management of the cafeteria and the availability of a kitchen on site can influence the development of LFP in schools. Government support could help to integrate LFP in schools, improving school meals at a lower economic and environmental cost., (Copyright © 2017 SESPAS. Publicado por Elsevier España, S.L.U. All rights reserved.)

Despite growing interest from government agencies, non-governmental organizations and school boards in restricting or regulating unhealthy food and beverage marketing to children, limited research has examined the emerging knowledge base regarding school-based food and beverage marketing in high-income countries. This review examined current approaches for measuring school food and beverage marketing practices, and evidence regarding the extent of exposure and hypothesized associations with children's diet-related outcomes. Five databases (MEDLINE, Web of Science, CINAHL, Embase, and PsycINFO) and six grey literature sources were searched for papers that explicitly examined school-based food and beverage marketing policies or practices. Twenty-seven papers, across four high-income countries including Canada ( n = 2), Ireland ( n = 1), Poland ( n = 1) and United States ( n = 23) were identified and reviewed. Results showed that three main methodological approaches have been used: direct observation, self-report surveys, and in-person/telephone interviews, but few studies reported on the validity or reliability of measures. Findings suggest that students in the U.S. are commonly exposed to a broad array of food and beverage marketing approaches including direct and indirect advertising, although the extent of exposure varies widely across studies. More pervasive marketing exposure was found among secondary or high schools compared with elementary/middle schools and among schools with lower compared with higher socio-economic status. Three of five studies examining diet-related outcomes found that exposure to school-based food and beverage marketing was associated with food purchasing or consumption, particularly for minimally nutritious items. There remains a need for a core set of standard and universal measures that are sufficiently rigorous and comprehensive to assess the totality of school food and beverage marketing practices that can be used to compare exposure between study contexts and over time. Future research should examine the validity of school food and beverage marketing assessments and the impacts of exposure (and emerging policies that reduce exposure) on children's purchasing and diet-related knowledge, attitudes and behaviors in school settings., Competing Interests: The authors declare no conflict of interest.

Because many school districts receive funding based on student attendance, absenteeism results in a high cost for the public education system. This study shows the direct links between bias-based bullying, school absenteeism because of feeling unsafe at school, and loss of funds for school districts in California. Data from the 2011-2013 California Healthy Kids Survey and the California Department of Education were utilized. Results indicate that annually, California school districts lose an estimated $276 million of unallocated funds because of student absences resulting from feeling unsafe at school. Experiences of bias-based bullying were significantly associated with student absenteeism, and the combination of these experiences resulted in a loss of funds to school districts. For example, the absence of students who experienced bullying based on their race or ethnicity resulted in a projected loss of $78 million in unallocated funds. These data indicate that in addition to fostering student safety and well-being, schools have the societal obligation and economic responsibility to prevent bias-based bullying and related absenteeism. (PsycINFO Database Record, ((c) 2017 APA, all rights reserved).)