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We examined associations between adolescent self-reported hunger, health risk behaviors, and adverse experiences during the 2018-2019 school year. Youth Risk Behavior Survey data were pooled from 10 states. Prevalence ratios were calculated, and we assessed effect measure modification by sex. The prevalence of self-reported hunger was 13%. Self-reported hunger was associated with a higher prevalence of every health risk behavior/adverse experience analyzed, even after adjusting for sex, grade, and race/ethnicity. Sex did not modify associations. Findings underscore needs for longitudinal research with more robust measures of adolescent food insecurity to clarify the temporality of relationships.

Background: This systematic review aims to identify out-of-school time (OST) interventions (eg, programming, policies) that increased opportunities for physical activity (PA) and healthy eating and/or improved youth PA and dietary behaviors. Methods: We searched for articles within systematic reviews that met our criteria (2010-2018) and for individual articles (2010-2020). Reviewer pairs screened articles, double-extracted data, assessed risk of bias (RoB), and achieved consensus. We included 71 articles (55 studies, 60 intervention arms). Results: Health (n = 3) and nutrition education (n = 7) interventions showed promising results, but most used weak designs and had high RoB. PA-focused interventions (n = 23) were largely consistent in improving fitness and moderate to vigorous PA during programming. Programmatic interventions that improved both PA and nutrition outcomes engaged family or community members (n = 4/13). Most organizational policy interventions improved the nutrition environment and student PA during OST. Conclusions: Organization-level policy and programmatic interventions can improve environmental supports and youth behaviors during OST programming, complementing school-day efforts to address student PA and dietary intake. To maximize their potential impact, OST programs need to be accessible to families. Administrators can consider actions to reduce participation barriers.

Background: We introduce the Whole School, Whole Community, Whole Child approach to supporting student and school staff physical activity and nutrition and describe the methods used to generate the evidence synthesized across the special issue articles. Methods: A 2-phase literature review search included a search of systematic reviews (2010-2018) for individual qualifying articles (Phase 1) and a search for individual articles on topics not addressed by a review (2010-2020) or that needed an update because they were in a review that was older (2010-2016) or showed insufficient evidence (Phase 2). Research librarians developed search strategies. In each phase, pairs of subject matter experts applied criteria to review abstracts and full-text articles and extracted data using standardized forms. We included 314 articles, describing 293 studies. Findings: Most of the included studies looked at elementary or secondary school level interventions; 51% were rated poor quality, and few took place in a rural setting. Implications for School Health Policy, Practice, and Equity: Most of the identified studies engaged majority minority or racially/ethnically diverse schools, suggesting that these interventions are feasible in a variety of settings. Conclusions: This collection of 10 articles identifies evidence-based interventions, gaps in research, and implications for health equity.

Background: Schools play a vital role in student health, and a collaborative approach may affect health factors such as physical activity (PA) and nutrition. There is a lack of recent literature synthesizing collaborative approaches in K-12 settings. We present updated evidence about interventions that used a coordinated school health approach to support K-12 student PA and nutrition in the United States. Methods: A 2-phase literature review search included a search of systematic reviews for individual qualifying studies (2010-2018), followed by a search for individual articles (2010-2020) that evaluated a coordinated approach or use of school wellness councils, committees, or teams to address PA and/or nutrition. Results: We identified 35 articles describing 30 studies and grouped them by intervention type. Interventions demonstrated promising findings for environmental changes and student dietary and PA behaviors. Implications: Coordinated and multicomponent interventions demonstrated significant improvements or null results, indicating that implementation of programs and/or policies to promote healthier eating and PA practices may support and do not appear to hinder environmental or behavioral outcomes. Conclusions: Schools can use a coordinated approach to implement opportunities for PA and nutrition; this may influence students' PA and dietary behaviors.

OBJECTIVES: To estimate whether school-based body mass index (BMI) reports impacted the accuracy of childrens self-reported weight category, for children overall and within subgroups. METHODS: We analyzed existing data from the Fit Study, a randomized controlled trial of a BMI screening and reporting intervention conducted in California from 2014 to 2017. The sample included 4690 children in 27 schools randomized to receive BMI reports and 4975 children in 27 controls schools that received BMI screening only. To estimate how BMI reporting affected accuracy, we fit multinomial logistic regression models to our data. We calculated average marginal effects, which capture the change in probability that children more accurately reported their weight category because of BMI reporting. RESULTS: We detected no impact of BMI reporting on childrens self-reported weight accuracy. Exploratory subgroup analyses show that for Black children, exposure to 1 round of BMI reporting was associated with a 10.0 percentage point increase in the probability of accurately reporting their weight category (95% confidence interval [CI]: 2.6 to 17.4). Two rounds of reporting were associated with an increase in the probability of accuracy for Asian children (6.6 percentage points; 95% CI: 0.4 to 12.8), 5th graders (11.1 percentage points; 95% CI: 1.6 to 20.5), and those with BMI

Background: COVID-19-disrupted schools, including shifts to virtual learning which may have impacted academic progress. This study assessed characteristics associated with changes in academic grades (before and during the pandemic) for different learning modalities for US students ages 13-19. Methods: Students (N = 2152) completed a web survey on school-related experiences during the 2020-2021 school year. County social vulnerability and SARS-CoV-2 transmission data were merged with survey data. Multivariable logistic regression analysis for grade change was conducted with student and school characteristics for each learning modality, controlling for community characteristics. Results: Greater proportions of remote/virtual (34.4%) and hybrid (30.1%) learning students reported grade decline compared to in-person students (19.9%). Among in-person students, odds of reporting same/improved grades were 65% lower among non-Hispanic black students and 66% lower among non-Hispanic students from other races, compared to non-Hispanic white students. Among hybrid students, odds of reporting same/improved grades for students reporting anxiety were 47% lower than students without anxiety, and odds of reporting same/improved grades among students reporting substance use were 40% lower than students not reporting substance use. Among remote/virtual students, odds of reporting same/improved grades among students with depression were 62% lower than odds of students not reporting depression symptoms. Remote/virtual students who received school-provided educational services also had 1.55 times the odds of reporting same/improved grades, compared to remote/virtual students not receiving these services. Conclusions: Academic grades were negatively impacted during COVID-19 and learning mode may have contributed. Understanding these impacts is critical to student health and academic achievement.

Background: Food insecurity (FI) rates in the United States are particularly high among households with children. This research set aims to analyze if high school students experiencing FI had higher risk for mental health and suicidal behaviors. Methods: Using combined data from 11 states that conducted the 2017 Youth Risk Behavior Survey, a total of 26,962 and 24,051 high school students were used to estimate race/ethnicity and sex-stratified prevalence ratios (PRs) from Poisson regression models. A single-question was used to measure the exposure of FI and outcomes of mental health and suicidal behaviors. Results: Overall, 10.8% of students reported FI. Students experiencing FI had increased risk for all mental health and suicide behavior outcomes, regardless of their race/ethnicity or sex. PRs ranged from 1.9 (95% confidence interval [CI]:1.8, 2.0) to 3.1 (CI: 2.7, 3.6). Among males, PRs for the association between FI and all outcomes were highest among non-Hispanic black students (PRs ranged from 2.4 [CI: 1.7, 3.2] to 5.5 [CI: 2.3, 13.3]). Among females, PRs were highest among non-Hispanic white students (PRs ranged from 1.9 [CI:1.7, 2.1] to 3.6 [CI:2.9, 4.5]). Conclusions: FI is consistently associated with mental health and suicidal behaviors among different subgroups of students.

Background: Studies show that food insecurity is associated with adverse health behaviors for children and adults. However, published data among adolescents are limited. The objective of this study was to examine the association between food insecurity and substance use behaviors among US high school students. Methods: Data from the 2017 Youth Risk Behavior Survey in 10 states were combined to examine the association between household food insecurity and adolescent use of alcohol, marijuana, prescription opioid misuse, and illicit drugs using logistic regression. Results: Among surveyed respondents, 12.3% of high school students reported experiencing food insecurity. In unadjusted analyses, the prevalence of substance use was higher among students with food insecurity compared to food secure students: current binge drinking (16.2% vs 11.5%), current marijuana use (24.0% vs 16.2%), lifetime prescription opioid misuse (21.3% vs 12.6%), and lifetime use of illicit drugs (12.3% vs 5.0%) (all p < 0.05). In adjusted models, food insecurity was associated with lifetime prescription opioid misuse and lifetime use of illicit drugs (aPR 1.38 and 1.70, respectively). Conclusion: Students with food insecurity are a potential group at a higher rise of substance misuse and may benefit from prevention programs designed to address their needs.

Breakfast consumption is positively associated with academic achievement and diet quality among students, whereas skipping breakfast has been linked with poor mental health. Data from CDC's 2023 nationally representative Youth Risk Behavior Survey were used to describe how often high school students ate breakfast in the past 7 days and the associations between skipping breakfast every day (ate breakfast on 0 of the past 7 days), experiencing persistent feelings of sadness or hopelessness, school connectedness, and self-reported grades. Prevalence estimates and corresponding 95% CIs were calculated, and t-tests were used to identify differences within demographic groups (e.g., sex, race and ethnicity, and sexual identity). Logistic regression analyses were conducted to calculate prevalence ratios describing breakfast skipping, adjusting for demographics, and stratified by sex and race and ethnicity. Most students missed breakfast ≥1 time in the past 7 days (72.6%), and 17.9% of students skipped breakfast every day, with differences by sex, sexual identity, and race and ethnicity. Overall, and among both males and females, students who experienced persistent feelings of sadness or hopelessness were more likely to skip breakfast every day. The association between feelings of sadness and hopelessness and skipping breakfast was generally consistent across racial and ethnic groups. In contrast, greater levels of school connectedness and earning mostly As or Bs were inversely associated with skipping breakfast. Students who had higher school connectedness were approximately 30% less likely to skip breakfast on all 7 days. Skipping breakfast and poor mental health co-occur among many adolescents and might impede students' readiness to learn. School efforts to make breakfast accessible and appealing to high school students might yield multiple benefits and help reinforce school administrators' efforts to recover student learning losses that occurred during the COVID-19 pandemic. Parents, school decision-makers, and organizations that partner with schools and families can use these findings to guide efforts to promote breakfast consumption. [ABSTRACT FROM AUTHOR]

Schools are in a unique position to offer opportunities for students to be physically active throughout the school day and promote health and well-being. However, experiences that threaten safety or perceptions of safety might affect students' physical activity behaviors. Using the 2023 national Youth Risk Behavior Survey, six physical activity behaviors and five negative safety and violence experiences were examined from a nationally representative sample of U.S. high school students. This report updates national estimates for physical activity behaviors overall and by sex, grade, race and ethnicity, and sexual identity. In addition, associations between negative experiences and physical activity behaviors were examined, stratified by sex, via unadjusted and adjusted prevalence ratios. Regardless of negative safety and violence experiences, male students had a higher prevalence of meeting aerobic, musclestrengthening, and both aerobic and muscle-strengthening physical activity guidelines compared with female students. In adjusted models among female students, a positive association was observed between being threatened or injured with a weapon at school and meeting the aerobic guideline, meeting the muscle-strengthening guideline, and playing on =1 sports team. Among male students, positive associations were observed between witnessing neighborhood violence and meeting the aerobic guideline and the muscle-strengthening guideline. A negative association was observed between attending physical education classes on all 5 days and witnessing neighborhood violence among female students and being bullied electronically among male students. Physical activity might serve as a mechanism that students employ to cope with negative safety and violence experiences. Understanding current physical activity behaviors among students with these negative experiences will be useful for school leaders, teachers, and public health practitioners who influence physical activity infrastructure and programming in schools and work to support safe, supportive, and inclusive school environments for student health. Although future research is needed to further explore these associations, physical activity continues to be an important behavior to prioritize for adolescent health in the school setting. [ABSTRACT FROM AUTHOR]

The Centers for Disease Control and Prevention recommends that schools adopt 10 safeguards before launching a body mass index (BMI) screening program; however, little is known about schools' safeguard adoption. Authors identified questions from the 2014 School Health Policies and Practices Study that aligned with 4 of the 10 safeguards to estimate safeguard prevalence among schools that screened students for BMI (40.7%, N = 223). Among these schools, 3.1% had all four safeguards and 56.5% had none or one. The most prevalent safeguard was having reliable and accurate equipment (54.1%, 95% confidence interval [CI] = [46.1, 62.1]). Providing staff with appropriate expertise and training was the least prevalent; respondents in 26.4% (95% CI [17.1, 35.6]) of schools received recent training on weight status assessment, weight management, and eating disorder identification. School-based BMI screening is common, but adopting multiple recommended safeguards is not. Absent these safeguards, BMI screening programs may fall short of intended outcomes and potentially incur unintended consequences.

Background: Out-of-school time (OST) programs are an important setting for supporting student health and academic achievement. This study describes the prevalence and characteristics of school-based OST programs, which can inform efforts to promote healthy behaviors in this setting. Methods: A nationally representative sample of public elementary schools (N = 640) completed surveys in 2013-2014. Administrators reported on OST programs and policies at their school. Multivariable logistic regression models estimated the prevalence of school-based OST programs, adjusting for school characteristics. Among schools with OST programs (N = 475), chi-square tests identified school characteristics associated with having an OST policy about physical activity or nutrition. Results: Three fourths of elementary schools (75.6%) had a full- or partial-year school-based OST program, with 30.8% having both. Full- and partial-year programs were significantly less prevalent in rural and township areas versus urban settings. Only 27.5% of schools with OST programs reported having physical activity and/or nutrition policies. Conclusions: Most US elementary schools have an on-site OST program, but disparities in access exist, and most lack policies or awareness of existing policies regarding physical activity and nutrition. To maximize OST programs' potential benefits, strategies are needed to increase access to programs and physical activity and/or nutrition policy adoption.

The disruption of school operations and routines caused by the COVID-19 pandemic affected students' physical and emotional well-being. Providing physical activity opportunities in schools can encourage students to positively engage with each other. Using a nationally representative sample of U.S. high school students from the Adolescent Behaviors and Experiences Survey (January to June 2021), we examined the association between physical activity behaviors and feeling close to people at school using sex-stratified and race/ethnicity-stratified multiple linear regressions models. Participating in team sports, being more physically active, and attending physical education (PE) during an average week were all associated with higher levels of feeling close to people at school, with variation by sex and race/ethnicity. These associations were also significant when the physical activity behavior variables were categorized to reflect national recommendations. Daily physical activity (i.e., ≥60 minutes all 7 days), daily PE (i.e., attended all 5 days), and the number of Comprehensive School Physical Activity Program (CSPAP) components implemented were associated with higher levels of feeling close to people at school. These findings suggest that opportunities for physical activity before, during, and after school are associated with increased levels of feeling close to people at school during crises like COVID-19. [ABSTRACT FROM AUTHOR]

In October 2009, "JOPERD" published a special issue about "Engaging Urban Youths in Physical Education and Physical Activity." Seven years later, many of the considerations mentioned remain relevant, such as large class sizes, limited access to equipment, and the lack of a dedicated gymnasium or outdoor space. These structural challenges matter. Some data suggest that larger class sizes and indoor lessons are associated with students spending significantly less time in moderate-to-vigorous physical activity and with teachers spending more time on classroom management. In addition, high rates of teacher turnover, difficulties communicating with English language learners, and low self-efficacy affect teachers' ability to engage students in physical education in urban settings. The purposes of this narrative review are to identify the attributes of urban settings that influence how physical education is taught, and to provide action-oriented strategies for addressing challenges and for making the most of available resources.

Objectives Depressive symptoms have been associated with obesity. Little is known about this relationship among immigrants. We examined relationships between depressive symptoms and weight status in immigrant women from three ethnic groups. Methods Participants were Brazilian, Haitian, and Latina women (n = 345) enrolled in Live Well, a community-based, randomized intervention designed to prevent weight gain in recent immigrants. Study data are from baseline when participants completed the Center for Epidemiological Studies Depression Scale (CES-D), Perceived Stress Scale, a physical activity questionnaire, and socio-demographic questions; BMI was calculated from measured height and weight. Results Forty-four percent of participants (36 % of Brazilians, 66 % of Haitians, 30 % of Latinas) had high depressive symptoms (CES-D [greater than or equal to] 16), and 38 % (26 % of Brazilians, 49 % of Haitians, 42 % of Latinas) were obese (BMI [greater than or equal to] 30.0). Those reporting more depressive symptoms were more likely to be obese (Wald Chi square = 4.82, p < .05). An interaction between depressive symptoms, ethnic group, and income was revealed (F(4,340) = 2.91, p < .05), such that higher depressive symptoms were associated with higher BMI among Brazilians earning [greater than or equal to]$30,000 per year and with lower BMI among Brazilians earning, Author(s): Stephanie Anzman-Frasca[sup.1] , Christina D. Economos[sup.2] , Alison Tovar[sup.3] , Rebecca Boulos[sup.4] , Sarah Sliwa[sup.5] , David M. Gute[sup.6] , Alex Pirie[sup.7] , Aviva Must[sup.8] Author Affiliations: (1) Department [...]

Abstract Background Research has shown that parental feeding styles may influence children’s food consumption, energy intake, and ultimately, weight status. We examine this relationship, among recent immigrants to the US. Given that immigrant parents and children are at greater risk for becoming overweight/obese with increased time in the US, identification of risk factors for weight gain is critical. Methods Baseline data was collected on 383 mother-child dyads enrolled in Live Well, a community-based, participatory, randomized controlled lifestyle intervention to prevent weight gain in recent immigrant mothers. Socio-demographic information together with heights and weights were collected for both mother and child. Acculturation, behavioral data, and responses to the Caregiver’s Feeding Styles Questionnaire (CFSQ) were also obtained from the mother. Results The children’s average age was 6.2 ± 2.7 years, 58% male. Mothers had been in the country for an average of 6.0 ± 3.3 years, and are Brazilian (36%), Haitian (34%) and Latino (30%). Seventy-two percent of the mothers were overweight/obese, while 43% of the children were overweight/obese. Fifteen percent of mothers reported their feeding style as being high demanding/high responsive; 32% as being high demanding/low responsive; 34% as being low demanding/high responsive and 18% as being low demanding/low responsive. In bivariate analyses, feeding styles significantly differed by child BMIz-score, ethnic group, and mother’s perceived stress. In multiple linear regression, a low demanding/high responsive feeding style was found to be positively associated (ß = 0.56) with a higher child weight as compared to high demanding/high responsive, controlling for known covariates (p = 0.01). Conclusions Most mothers report having a low demanding/high responsive feeding style, which is associated with higher child weight status in this diverse immigrant population. This finding adds to the growing literature that suggests this type of feeding style may be a risk factor for childhood obesity. Further research is needed to help understand the larger socio-cultural context and its influence on feeding dynamics among immigrant families and families of lower incomes. How parents establish a certain feeding style in their home country compared to when they move to the US “obesogenic” environment, should also be explored.