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BACKGROUND: Extant literature indicates students living with food allergies (FA) experience biopsychosocial challenges (eg, social isolation, anxiety). The purpose of this study was to explore the experiences of students living with FA during a usual weekday in a school setting. METHODS: Phenomenological study with purposive convenience sample from the US states of Florida and Colorado. Students aged 10-14 years who have been managing an IgE-mediated FA for more than 1 year within a school setting. Data collection was guided by a story path process with semi-structured interview, with Interpretive Phenomenological Analysis used to ascribe meaning to their experiences. RESULTS: Four themes: (1) Living with Restraints: A Way of Life; (2) Managing Exposure; (3) Experiencing Stigma; and (4) Experiencing Lack of Knowledge. CONCLUSION: Findings underscore unique biopsychosocial challenges faced by students living with FA, highlighting the need for comprehensive approaches beyond traditional biological management in developing strategies, policies, future research, and recommendations in school settings.

To investigate additive and interactive associations of food allergies with three glutathione S-transferase (GST) genes in relation to ASD and ASD severity in Jamaican children. Using data from 344 1:1 age- and sex-matched ASD cases and typically developing controls, we assessed additive and interactive associations of food allergies with polymorphisms in GST genes (GSTM1, GSTP1 and GSTT1) in relation to ASD by applying conditional logistic regression models, and in relation to ASD severity in ASD cases as measured by the Autism Diagnostic Observation Schedule-2nd Edition (ADOS-2) total and domains specific comparison scores (CSs) by fitting general linear models. Although food allergies and GST genes were not associated with ASD, ASD cases allergic to non-dairy food had higher mean ADOS-2 Restricted and Repetitive Behaviors (RRB) CS (8.8 vs. 8.0, P = 0.04). In addition, allergy to dairy was associated with higher mean RRB CS only among ASD cases with GSTT1 DD genotype (9.9 vs. 7.8, P < 0.01, interaction P = 0.01), and GSTP1 Val/Val genotype under a recessive genetic model (9.8 vs. 7.8, P = 0.02, interaction P = 0.06). Our findings are consistent with the role for GST genes in ASD and food allergies, though require replication in other populations.

The primary goal of this study was to examine young adults' perspectives about the effects of their food allergies (FAs) on their social lives from school-age to young adulthood. Young adults aged 18-21 (n = 10) at the University of South Carolina were interviewed. A qualitative descriptive method to find themes and commonalities from transcribed interviews was used for data analysis. Identified themes were (1) feeling different and being isolated, (2) strategies for managing feeling different and being isolated, (3) strategies for managing safety, and (4) acceptance of myself and by others. School-age children attributed the school lunch allergy table as contributing to social isolation. Additionally, participants described feeling different and concerns about safety. Strategies to mitigate those experiences were identified by participants. Implications for children with FAs, their parents, school nurses, and other education and health professionals who work with children are presented.

Background: This article introduces the concept, food allergy literacy (FAL), which encompasses the knowledge, behaviors, and skills needed to manage a food allergy and is thus critical to child safety. Yet, there is limited clarity on how to promote FAL in children. Methods: Twelve academic databases were systematically searched to identify publications on interventions to promote FAL in children. Five publications met the inclusion criteria, which involved children (3 to 12 years), their parents, or educators and tested the efficacy of an intervention. Findings: Four interventions were for parents and educators, while 1 intervention was for parents with their children. The interventions were educational and focused on promoting participant knowledge and skills of food allergy, and/or psychosocial in nature, promoting coping, confidence, and self-efficacy in managing children's allergies. All interventions were deemed effective. Only 1 study used a control group, and none assessed the long-term benefits of the interventions. Implications for School Policy, Practice, and Equity: The results can enable health service providers and educators to design evidence-based interventions to promote FAL. This might involve designing, implementing, and evaluating curricula and play-based activities, therein, that award greater attention to food allergy--its consequences, risks, skills to prevent risk, and managing food allergy in educational settings. Conclusions: There is limited evidence on child-focused interventions that promote FAL. There is, therefore, considerable opportunity to co-design and test interventions with children.

Food allergies affect approximately two children per average-sized classroom, and prevalence has increased in recent decades (Gupta et al., 2011; Pawankar et al., 2013). This increase has important implications for school psychologists and counselors because allergies can impact various psychosocial aspects of students' lives (Vale et al., 2015). Unfortunately, psychosocial considerations related to allergy management are often treated as peripheral in school food allergy policy development (Behrmann, 2010a). The purpose of the current review was to examine the availability of state-level guidelines and to evaluate available guidelines according to research supported practices for students including those impacting psychosocial facets of students' lives. Guideline documents identified varied in size and form and when available tended to provide limited coverage of social and emotional factors. Our review provides insight into scope of attention to psychosocial facets of well-being in state-level allergy policy guidelines and concludes with implications for practice across multiple tiers of support.

Biostatisticians apply statistical methods to solve problems in the biological sciences. Successful practioners of biostatistics have advanced technical knowledge, are skilled communicators, and can seamlesslessly integrate with interdisciplinary scientific teams. Despite the breadth of skills required for success in this field, most biostatistics education programs place heavier emphasis on development of technical skills than skills necessary for collaborative work, including critical thinking, writing, and public speaking. Our master's degree program in biostatistics aims for stronger integration of education in collaborative work alongside development of technical knowledge in biostatistics. Toward that end, we propose a model that provides students with a mental map for practicing biostatistics, and that can serve as a tool for faculty to create hands-on learning experiences for biostatistics students. The model helps students organize their knowledge of biostatistics, unifying the technical and collaborative aspects of the discipline in a single framework that can be applied across the broad array of activities that biostatisticians engage in. In this article we describe the model in detail and provide an initial assessment of whether the model might meet its intended purpose by applying the model to a common task for practicing biostatisticians and biostatistics students: describing the results of a medical research study.

Autism spectrum disorder (ASD) is an etiologically heterogeneous neurodevelopmental condition that eludes a single explanation or cure. Epidemiological studies reveal risk factors, relevant comorbidities, and behavioral correlates to reach a better understanding of ASD. To contribute such data from an understudied ASD population, this paper presents epidemiological data from a Turkish sample of individuals with ASD (n = 911, 748 boys (82.1%) and 163 girls (17.9%) between 1 and 18 years of age). Average age at diagnosis was 31.06 ± 11.88 months, and the male-to-female ratio was 4.6:1. Three in 4 individuals with ASD had obsessive behaviors, and 1 in 4 had allergic conditions, inappropriate sexual behaviors, self-harming behaviors, and harmful behaviors towards others. One in 3 received a dietary treatment for at least 3 months; almost half received vitamin supplements; the majority (70%) did not experience constipation; and 2 in 3 were picky eaters. This paper presents data on the age of diagnosis, gender ratios, accompanying behaviors, and dietary interventions in Turkish individuals with ASD, which are topics of current research interest about ASD. Such data from non-Western populations may supplement epidemiological knowledge gained from Western populations to help reach a more comprehensive understanding of this condition with many unknowns.

The purpose of this article is to describe a modeling sequence about the digestive system. "What happens in your body when you have lactose intolerance?" is the initial question that will guide the activities. Students will build a 3D plaster cast of the digestive system as part of a modeling cycle through which they are expected to evaluate and refine their models both individually and cooperatively. Today, about two-thirds of the population in the world are known to have lactose intolerance. Besides, lactose intolerance and allergy to cow's milk are usually mistaken by the public. For those reasons, the topic seems fundamental to be taught to children in the science class.

Allergic reactions to allergenic foods can pose a lethal threat to children with food allergies. Previous research has demonstrated the effectiveness of using behavioral skills training (BST) plus in situ training (IST) to teach safety responses to children. However, there has not been an evaluation of using BST to teach food safety to children with food allergies. Three elementary-school children of neurotypical development with food allergies participated. We evaluated the efficacy of BST with IST in teaching participants to identify and respond to allergenic foods by (a) asking to see the food packaging, (b) scanning the food label for the allergenic food, and (c) reporting the safety threat to an adult while not consuming the food. Trials without allergenic foods were also presented to ensure discriminated responding. All participants demonstrated the three correct safety responses after BST and responded differentially across allergenic and nonallergenic foods, with two participants requiring feedback (IST).

Purpose/Objective: This study aimed to evaluate the knowledge, attitudes, and beliefs of teachers regarding food allergies. This project highlighted the importance of training teachers and incorporating food allergy management and protocols to keep children with food allergies safe and in an inclusive environment at school. Methods: A cross-sectional online survey was sent to 77 elementary school principals from 20 school districts. The survey was distributed to K-4th grade teachers. The "Chicago Food Allergy Research Survey" was used to measure food allergy knowledge (n = 16) and food allergy attitudes and beliefs (n = 15). Demographic factors and general knowledge scores underwent a descriptive analysis using Excel. Based on the proportion of knowledge items that were correctly answered, knowledge scores were computed. Using SPSS version 27, frequencies were calculated for the variables relating to attitudes and beliefs. Results: A total of 42 teachers from 77 elementary school buildings, in 20 school districts participated in the study. For anonymity, the school district and building where the teacher works were not collected. Of the 42 teachers, 36% (n=15) reported having a food-allergic child in their class, and 24% (n=10) teachers reported having food allergy worksite training. Knowledge of treatment and use of healthcare ranked lowest in this study. Teachers tended to minimize the stigma and acceptability issues children encounter with food allergies with 7% (n=3) who believe children with food allergies are teased at school, 45% (n=19) believe children with food allergies are treated differently, and 71% (n=30) feel children should sit at a table specifically for children with food allergies. Applications To Child Nutrition Professionals: Teachers are one level in a school that can help manage food allergies. All school staff including recess monitors, substitute teachers, and food service need consistent, structured food allergy education and training to help lower the risk of severe allergic reactions and understand the stigma and quality of life issues food allergic children face. Federal, state, and local policy leaders must collaborate to require allergy training and management at all schools to make them safer and more inclusive learning environments for children with food allergies.

Over the past 2 decades, eosinophilic esophagitis (EoE) has become increasingly recognized as a common cause of gastrointestinal morbidity in children. A mainstay of treatment is food avoidance, which must be implemented in both the home and school settings for school-aged children. The aim of this study is to assess school nurses' familiarity with EoE with regard to food avoidance and treatment in the school setting. We conducted a 19-question online survey of 60 school nurses (elementary through high school) recruited from Dauphin, Lebanon, and Lancaster Counties in Pennsylvania. Results indicated that 62% of respondents were familiar with EoE. However, only 22% felt comfortable distinguishing between symptoms of EoE and food-dependent anaphylaxis. Almost all respondents (97%) were interested in learning more about EoE. We report significantly increased familiarity with food-dependent anaphylaxis in comparison with EoE among school nurses. There is an interest and need for increasing education on EoE.

Access to emergency medications is a growing concern, particularly regarding the availability, safety, and use of these medications in schools. The purpose of this article is to report results not previously published from a national survey, specifically regarding the emergency use of epinephrine, albuterol inhalers, and glucagon. A nonexperimental, cross-sectional design was utilized for this descriptive study. An online survey was distributed to school nurses in 2015, and data from 6,298 school nurse respondents are presented in the analysis. Findings related to stock and student-specific emergency medication use and storage, epinephrine usage data, and delegation of emergency medication administration to unlicensed assistive personnel are presented in this article. Further development of policies and procedures regarding emergency medication administration in schools is needed. School nurses are a valuable resource for obtaining knowledge in this area and keeping students safe at school.

Background: Researchers have found a relationship between having food allergies and anxiety in children. Anxiety may relate to others' lack of food allergy knowledge. This study investigated the relationship between having a food allergy and self-reported anxiety among children. Furthermore, knowledge of food allergies among children without food allergies and teachers was explored. Methods: Children with food allergies and their parents each completed a perceived food allergy severity questionnaire. Children without food allergies completed a food allergy knowledge measure. All children completed a self-reported anxiety measure. Teachers completed a questionnaire investigating knowledge, attitudes, and beliefs about food allergies. Correlational analyses and analyses of variance were conducted. Results: Overall anxiety was significantly higher in children with food allergies than in children without food allergies. When controlling for the effects of sex and age, children with food allergies had significantly higher social phobia and school phobia. Teachers correctly answered 69.7% of knowledge-based questions about food allergies; children without food allergies correctly answered 62.7%. Conclusions: Findings highlight the need for an integrated approach in which families, school personnel, psychologists and other mental health professionals, and medical professionals work together to increase awareness about the multifaceted needs of children with food allergies.

Background: Many schools implement well-intentioned food allergy policies; however, may not ease parents'/children's worry and concern. The purpose of this study was to (1) explore children's and parents' perceptions their school's food allergy policy and (2) compare these perceptions to the documented school policy. Methods: Children ages 8 to 18 with a food allergy and their parents (N = 18 pairs) across the US completed one-on-one semi-structured, audio-recorded phone interviews. School food allergy policies were collected from school websites. Content analysis was applied to the transcriptions by two investigators to identify themes among parents and children. Results: Parents and children described policies may impact the child's social and/or emotional well-being. Many opportunities for improvement were provided by parents and children. There is a wide variation in food allergy policies across the schools in this study, and overall, parents and children thought that policy enforcement needs to be improved. Conclusions: With so much variation in food allergy policies in schools coupled with inconsistent enforcement, parents and children may feel unsafe or unsupported by the school. Schools should adopt a team- or whole-school approach to develop and enforce policies that help protect children with food allergies.

Background: Anaphylaxis is a life-threatening allergic reaction with significant risk for children with allergies. Access to potentially life-saving medication is critical for these children. This review aims to describe state laws and policies guiding stock epinephrine in schools for allergic or anaphylactic events and detail recommendations for best practices. Methods: This paper is a comprehensive review of the 50 states and the District of Columbia's (DC) laws and policies for stock epinephrine at schools for children in pre-kindergarten through 12th grade. Results: All 50 states and DC allow undesignated epinephrine in schools to use for allergic or anaphylactic reactions. A key difference arises in whether states allow (N = 37) or mandate (N = 14) that schools stock epinephrine. States exhibit differences in the body responsible for developing stock epinephrine policy (N = 48), along with stakeholders responsible for developing procedures (N = 30) and implementing them (N = 19). Differences also exist in state epinephrine procurement, administration, training, and liability. Conclusions: This review of stock epinephrine laws and policies highlights the significant variation in state legislation despite widespread adoption. Only one-quarter of states mandate that schools have stock epinephrine available for emergency use, underscoring need for a more unified approach with consistent guidelines, comprehensive training, and possible funding for implementation.

Objective: To determine the prevalence of food allergy (FA) and intolerance and estimate associations with anxiety and depression in a diverse sample of young adults. Participants: Undergraduates at a major university (n = 1,574) enrolled in the Spit for Science cohort study. Methods: Participants completed self-report assessments of current FA and/or intolerance as well as anxiety and depressive symptoms using the Symptom Checklist-90. Results: The estimated prevalence of any current, physician-diagnosed FA was 7.6% (n = 119), while 14.6% (n = 227) reported at least one food intolerance. The most reported allergies were tree nut (3.1%) and peanut (2.6%). Any FA was associated with higher depressive symptom scores (ß: 0.78; 95% CI: 0.03-1.54). Any food intolerance was associated with higher depressive (ß: 1.26; 95% CI: 0.70-1.83) and anxiety (ß: 1.19; 95% CI: 0.71-1.67) symptom scores. Conclusion: Living with a FA and/or intolerance is associated with greater internalizing symptoms among a cohort of US college students. [The Spit for Science Working Group co-authored this article.]

Children in child welfare protective custody (e.g., foster care) are known to have increased health concerns compared to children not in protective custody. The poor health documented for children in protective custody persists well into adulthood; young adults who emancipate from protective custody report poorer health, lower quality of life, and increased health risk behaviors compared to young adults in the general population. This includes increased mental health concerns, substance use, sexually transmitted infections, unintended pregnancy, and HIV diagnosis. Identifying youth in protective custody with mental health concerns, chronic medical conditions, and increased health risk behaviors while they remain in custody would provide the opportunity to target prevention and intervention efforts to curtail poor health outcomes while youth are still connected to health and social services. This study leveraged linked electronic health records and child welfare administrative records for 351 youth ages 15 and older to identify young people in custody who were experiencing mental health conditions, chronic medical conditions, and health risk behaviors (e.g., substance use, sexual risk). Results indicate that 41.6% of youth have a mental health diagnosis, with depression and behavior disorders most common. Additionally, 41.3% of youth experience chronic medical conditions, primarily allergies, obesity, and vision and hearing concerns. Finally, 39.6% of youth use substances and 37.0% engage in risky sexual behaviors. Predictors of health risks were examined. Those findings indicate that women, those with longer lengths of stay and more times in custody, and those in independent living and conjugate care settings are at greatest risk for mental health conditions, chronic medical conditions, and health risk behaviors. Results suggest a need to ensure that youth remain connected to health and mental health safety nets, with particular attention needed for adolescents in care for longer and/or those placed in non-family style settings. Understanding who is at risk is critical for developing interventions and policies to target youth who are most vulnerable for increased health concerns that can be implemented while they are in custody and are available to receive services.

Background: Access to unassigned epinephrine is critical for schools to treat anaphylaxis. Low socioeconomic status is associated with decreased access to epinephrine in the school setting. In and around New Orleans, physicians partner with schools to assist with stocking unassigned epinephrine autoinjectors (EAIs). New Orleans' decentralized public charter school district makes widespread adoption challenging. Methods: Physicians partnered with New Orleans decentralized public charter schools, as well as neighboring centralized public school districts, to perform training on recognizing and treating anaphylaxis, assist with the adoption of school policy for stock epinephrine, and aid with obtaining stock EIAs free-of-cost through the EpiPen4Schools® program. We used publicly available school enrollment data and our own calendar records to calculate how many children we covered with stock epinephrine per hour of physician or administrator time. Results: For centralized school districts, we cover approximately 4000 children with stock epinephrine per hour of time. For the decentralized district of New Orleans, we estimate covering only 400 children with stock epinephrine per hour of time. Conclusion: Decentralized school districts reduce educational disparities, but require more time and energy to get EAIs in place than centralized school districts do.

This article sheds light on how chronic health conditions impact upon concepts of inclusion in children's early childhood education and care in England; it draws upon findings from a small-scale research project which highlights the need to consider health, in particular, the impact of chronic health conditions on early childhood education and care. The study was conducted in two stages: Stage 1 involved a postal questionnaire to 60 early childhood settings and Stage 2 included interviews with 6 practitioners in 4 settings, interviews with parents and observations of a child (called DJ) in his setting over the course of a year. The findings from this study indicate that in an attempt to be inclusive, practitioners may be unintentionally exclusive in their practice. The data suggest that this may be as a consequence of practitioners having different understandings and definitions of what is meant by the term inclusion, leading to confusion about the aims of inclusion. The findings indicate that there is a need to identify what effective pedagogy is for children with chronic health conditions, as well as a need to redefine inclusion in relation to their needs.

Background: Approximately 8% of schoolchildren in the United States experience potentially life-threatening food allergies. They must diligently avoid allergenic foods and have prompt access to epinephrine to treat anaphylaxis. These prevention strategies must be sustained without interruption, posing a range of challenges at school. Methods: We conducted semi-structured interviews with 178 participants about their experiences managing food allergies outside the home. Interviews were transcribed and analyzed using an iterative approach in NVivo 10. Results: Participants reported highly varied school experiences across the ecological model. They described the need to be proactive and self-sufficient to manage food allergies. Whereas food allergy-related social exclusion was common, participants also described positive peer interactions, including intensive peer engagement and support. They perceived that formal school policies were limited in scope and inconsistently implemented. Prevention-oriented policies were more common in lower grades than in higher grades. Conclusions: Poorly defined and implemented policies disrupted students' social and educational experiences at school, families' relationships with school staff, and, ultimately, the safety and wellbeing of students with allergies. Given the high prevalence of food allergies among children, these findings demonstrate the need for multiple layers of support to facilitate safe, socially inclusive food allergy management at schools.

This study surveyed 115 Australian parents' knowledge, views, and feelings of food allergy management and guidelines in primary schools. Although most parents were knowledgeable about food allergy management and related guidelines, half of them had limited understanding on how schools identify and respond to anaphylaxis, or teachers' recent training in anaphylaxis. Overall, parents' satisfaction surrounding the schools' food allergy management was mixed. Yet they highly appreciated the schools' efforts and practices in preventing the risks of food allergy, for example by identifying affected children and/or raising awareness about food allergies among the school community. Despite these efforts, parents were concerned about their child's overall safety at school, especially in playground and non-routine activities such as school camps and lapses in communication and implementation of state guidelines. To address these concerns, parents suggested many improvements in the schools' practices and guidelines, including proactive communication with parents on matters of food allergy. The implications of these findings for educators, along with recommendations for further research are presented.

This study examines the extent to which specific school accommodation policies relate to bullying victimization among children with food allergies using a labeling framework. Data were collected through a web-based survey of parents of children with food allergies from several online support groups (N = 622). Using logistic regression, results reveal that school the self-carry rescue medication and hand-washing food accommodation policies are related to increased odds of bullying victimization. Potential policy implications of these findings are discussed.

Objective: Food allergies are on the rise in the U.S. Factors associated with willingness and readiness to act in a food allergic emergency on a college campus are currently unknown. Participants: College students in one Catholic college enrolled during spring of 2017. Methods: A previously piloted survey was distributed by e-mail. Results: Four hundred seventy-four individuals responded. All readiness components correlated, and all willingness components correlated with each other. Age, having children, college major had statistically significant correlations with readiness and willingness to act. Readiness was highly predictive of willingness to act in an FAE. Thirty-five percent of variability in willingness to act was explained by age, being health professions students, desire to be trained, social desirability, and readiness. Students in nonhealth related majors expressed high willingness, but low readiness. Conclusion: A pool of willing, trained to act individuals should be considered on college campuses including availability of unassigned epinephrine auto-injector.

Children with food allergies report relatively high rates of bullying compared with the general population. Scholars have raised concerns that children with food allergies may be targeted for bullying because accommodation policies can isolate the child or generate stigma among peers. Yet, few have empirically examined the extent to which accommodation policies relate to bullying victimization or considered bullying beyond that which is committed by peers. This study examines if having a 504 plan and having more serious food allergy conditions are related to bullying victimization among children with food allergies by considering bullying committed by peers and school staff. Data were collected using a web-based survey of parents of children with food allergies (N = 613). Results show that having a 504 plan is related to increased odds that children with food allergies are bullied by both peers and school staff.

A respected principal finds himself caught in the middle of a complex legal conundrum when a student requests to bring a service animal to his public school where another student may be dangerously allergic to the animal. This case explores how accommodations per the Americans with Disabilities Act (ADA), Section 504 of the Rehabilitation Act of 1973, and the Individuals with Disabilities Education Improvement Act (IDEA) intersect in a public school setting where classroom space and personnel resources are limited. Educational leaders will be able to construct effective responses by understanding how the three laws apply to students with disabilities who request that their service animals accompany them to public school and when their requests may come into conflict with the needs of others.

Food allergy (FA) impacts 8% of U.S. children, thus it is critical to document allergic reactions to assist schools in managing FAs. We implemented and evaluated an online tool to assist school health personnel in tracking the characteristics of allergic reactions occurring at schools. The Online School Allergic Reaction Registry (OScARR) was modified from the Epinephrine Administration Form developed by the Massachusetts Department of Public Health, adapted for integration into existing school health records, and implemented in three Chicago schools during the 2016-2017 school year. All allergic reactions occurring at participating schools were recorded by school nurses. Twenty-five percent of the 20 allergic reactions reported were characterized as anaphylaxis by school nurses. School nurses reported that they would recommend OScARR for use in other schools. Detailed data obtained from three Chicago schools underscore the importance of proper documentation to improve the understanding of the causative allergen and location and management of allergic reactions in schools.

An association between allergic disease, depression and suicidality has been reported. Objective: To explore the relationships between suicidality and asthma, allergy, internet addiction, stress, sleep quality, pain/discomfort, and depression, among emerging adults. Participants: 929 college students completed an online survey between October 2015 and April 2017. Methods: A cross-sectional study using multivariate analysis techniques was implemented. Results: Using structural equation modeling, we found that allergies and stress were directly related to pain/discomfort; pain/discomfort was associated to poor sleep, depression, and suicidality. Sleep quality was also affected by stress; while sleep, stress, pain/discomfort, and internet addiction were directly related to depression (all p < 0.05). Ultimately, four factors impacted suicidality: stress, pain/discomfort, depression, and, indirectly, sleep quality (all p < 0.05). Although allergy had some effects, these did not reach statistical significance (p < 0.09). Conclusion: Findings suggest that allergy might impact suicidality indirectly through increased pain/discomfort, poor sleep, and depression.

Purpose: The USDA requires children with food allergies be offered modified menus with no additional meal reimbursement. Food allergies affect up to 8% of children in the U.S.; eight allergens account for over 90% of allergic reactions. This study assessed perceptions of child nutrition program menu planners in California, a state with a high and diverse population, of costs associated with allergy related meal accommodations. Methods: An online survey was sent to the population of menu planners for children with food allergies at all California public schools (N = 902). Results: Child nutrition program menu planners (n = 212) frequently identified two factors affecting cost of food in providing meals for children with food allergies: type of allergy and additional cost of special foods. Multiple factors were frequently identified as affecting labor costs including purchase of special foods, planning menus, training foodservice workers, communication with nutrition staff and others, separation of food production areas to avoid cross-contact, research of suitable food substitutions, and time for documentation on production records. Participants perceived accommodating children with wheat, soy, milk products, and multiple allergens cost more than providing non-modified meals. Ready availability and ease of sourcing substitute foods reduced perceptions of negative labor impacts on operations. Applications for Child Nutrition Professionals: Knowledge of the local frequency of accommodations for children with specific food allergies can be used to plan lower cost menus for the most frequently modified allergens. Short cycle menus could be prepared in advance for the most common allergens or allergen combinations in the district reducing the time spent and potentially reducing cost of labor for menu planning of modified meals. Further, information about types and frequency of allergen accommodations within the district can be useful when developing specifications for bid purchases of foods and inclusion of identified acceptable substitutes.

Over 50 million Americans have a food allergy to one or more foods (Berdanier, 2017). Approximately 1 in 25 school-aged children are diagnosed with food allergies (Sicherer, Mahr, & The Section on Allergy and Immunology, 2010), while 25% of children may not experience a reaction until later in life (Leo & Clark, 2017). A food sensitivity or intolerance, on the other hand, can be defined as any undesired reaction to a food or food group (Berdanier, 2017). As of now, research regarding school nutrition professionals' knowledge of food sensitivities, food intolerances, and food trends that may affect students' food preferences is not available. Yet, food trends show that some consumers are demanding specialized diets including milk/dairy alternatives, meat alternatives, as well as foods that align with Whole30, and low-FODMAP diets (Brissette, 2018). Because of this demand, there is a need for training school nutrition personnel about food sensitivities as well as new food trends, in addition to food allergy training.

Bullying needs to be understood and positioned as a form of child abuse -- peer abuse. For too many people, bullying is a benign term. This article will include information collected from a wide-range of researchers and discussions with over 50,000 students that I have facilitated during the past twenty years. The content will focus on new morbidities related to bullying such as depression and suicide, obesity, eating disorders, food allergies, juvenile diabetes, truancy, and substance and alcohol abuse. Making a cultural change in our society will require identified Change Agents, along with recommendations for collaboration, policies, projects and legislation.

Worldwide the prevalence of severe and life threatening allergies is rising. In 2007 35% of Victorian schools had students at-risk for anaphylaxis (Office of the Premier), and three children have allegedly died from anaphylaxis in Australian school and early childhood education settings during the last six years alone. Teaching personnel are increasingly responsible for the safety of severely allergic children, yet there is a dearth of research examining anaphylaxis management in Australian educational and child-care facilities. This study examines the teacher's role in anaphylaxis management through indepth interviews with 12 Victorian primary school teachers. The resulting data indicate that teachers' roles in anaphylaxis management were complex, multifaceted, and emotionally demanding. Stress and anxiety were strongly associated with the onus to prevent a reaction, and to provide medical care in the event of an emergency. Participants considered such responsibilities beyond the reasonable parameters of teacher duties yet an increasingly common expectation in a teaching climate characterised by work intensification. Stress and coping was impacted primarily by a number of local sociocultural factors such as the attitude of parents and colleagues. Factors identified in previous literature were also significant, namely, clear policy and procedures; and practical considerations such as teacher education and safety measures.

Despite the increasing attendance of children with food allergy in schools in Australia and globally, little is known about how affected families manage their children's transition to school. This paper discusses the experiences and support needs of ten mothers during their child's transition to school in Sydney, Australia, drawn from the thematic analysis of Photo Elicitation Interviews in homes. One of the significant findings of this study was that most mothers found their child's transition to school both emotionally and practically challenging, even though their children previously attended a long day care or preschool setting. While the school's pro-active transitional planning, procedures of food allergy management and psychological support provided to families facilitated a smooth start to school, a lack of these, together with poor or no communication and non-involvement of families in the management of children's food allergy hindered it. Correspondingly, mothers highlighted the need for schools to keep children's food allergy at the forefront of their transitional planning and support them holistically by pro-actively communicating, collaborating and involving families in the discussions about food allergy, empowering them with information on the school's policies and procedures, and acknowledging their concerns of safety. Mothers considered these things to be essential. Additionally, mothers provided advice to other parents on how to achieve a positive start to school. The implications of this study's findings for schools and families are discussed. Considering the small sample size and generalisability of the findings to other contexts and countries, further research is recommended both nationally and internationally.

Background: Anaphylaxis is a serious and growing concern in the school setting as the prevalence of food allergies and food-induced severe allergic reactions continues to increase. Methods: A cross-sectional, web-based survey was conducted regarding anaphylactic events that occurred during the 2014-2015 school year. Eligible schools were enrolled in the EPIPEN4SCHOOLS® program (Mylan Specialty L.P., Canonsburg, PA), which provides free epinephrine auto-injectors to qualifying US schools. Participating schools completed a 29-item survey on anaphylactic event occurrence and treatment, epinephrine stock, school policies regarding anaphylaxis, school staff training, and school nursing coverage. Results: Responses were provided by 12,275 schools. Epinephrine was administered on school property for 63.7% of reported anaphylactic events (1272/1998). In 38.5% (235/610) of events for which epinephrine was not used, antihistamines were cited as the reason. Only 59.4% of schools cited epinephrine as their standard first-line therapy for anaphylaxis. School nurses were most likely to be trained in anaphylaxis recognition and permitted to administer epinephrine; however, just 53.6% of schools had a full-time nurse on staff. Conclusions: Process-related barriers to the appropriate use of epinephrine go beyond access to medication. Widespread staff training and review of school policies are needed to ensure that anaphylaxis is appropriately managed in schools.

The purpose of this article is to describe changes in problematic eating symptoms across 6 months in children seen in an outpatient feeding clinic and explore child characteristics associated with symptom changes. Participants were 58 parents of children aged 6 months to 7 years of age who were seen in an outpatient feeding clinic. Parents completed an online survey at 3 time points: enrollment and 3 and 6 months later. The survey consisted of the Pediatric Eating Assessment Tool (PediEAT) and a set of questions assessing demographic information, child's medical and feeding history, medical diagnoses, gastrointestinal function, and medications. Linear mixed modeling was used to examine changes in PediEAT total and subscale scores over time and explore associated child characteristics. The PediEAT total score significantly decreased over time with the greatest change in the Physiologic Symptoms subscale. Several child characteristics were associated with more severe symptoms of problematic feeding: older child age, more symptoms of constipation, and diagnoses of speech-language delay, developmental delay, food allergy, and/or genetic disorder. Parent report of child symptoms of problematic eating decreased across 6 months. Associations with child characteristics highlight the complexity of pediatric eating problems and the need for more research on potential factors influencing symptoms of eating problems.

Purpose/Objectives: The purpose of this study was to collect current baseline data about food allergy management in school districts. The guiding objectives included determining the extent of food allergy accommodations and frequency of allergic reactions in schools, in addition to assessing management strategies implemented by school nutrition programs. Methods: The research design included an online questionnaire designed to address the research objectives. It was distributed to a randomized national sample of child nutrition program directors (n = 5,592). Results: Participants responded to pre-screening and various conditional branching questions. Usable survey responses totaled 480. Responses represented demographic and operational diversity. Nearly all reporting school districts provided meals to students with allergies to peanuts (97%) and milk (94%), followed closely by tree nuts (77%), wheat (77%), and eggs (71%). About 79% of the school districts reported maintaining appropriate documentation for students with food allergies, with school nurses (58%) primarily responsible for maintaining said documentation. Approximately 74% of the respondents indicated that their district had a plan for managing food allergies, and of those, most (74%) indicated their plans were about 76% complete. Applications To Child Nutrition Professionals: A school district's ability to provide allergen-free meals to children with food allergies requires attention and effective communication among many internal and external stakeholders. Food allergy management in schools is also uniquely multidisciplinary as it involves parents, school nutrition staff who prepare and serve food, school nurses who may be responsible when an allergic reaction occurs, teachers, and food manufacturers and suppliers. [This research was funded, in part, with federal funds from the U.S. Department of Agriculture through the Center for Food Safety in Child Nutrition Programs.]

Objective: This study examined barriers to engagement in self-management behaviors among food-allergic college students (1) within the frameworks of the health belief model (HBM) and common sense self-regulation model (CS-SRM) and (2) in the context of overall risky behaviors. Participants: Undergraduate college students who reported having a physician-diagnosed food allergy (N = 141). Research was conducted from February 2015 through May 2016. Methods: Participants were recruited from college campuses through email and social media. The frequency of adherence to self-management behaviors was measured along with HBM, CS-SRM, and risk-taking behaviors through a self-report survey. Results: Among all participants, HBM and CS-SRM constructs and Tobacco Use explained 30.6% of the variance in adherence. CS-SRM constructs and Tobacco Use explained 44.8% of the variance for participants with self-injectable epinephrine (SIE). Conclusions: Food-allergic college students demonstrate inconsistent adherence, and interventions designed to improve adherence should take both SIE prescription status and contextual factors into consideration.

The purpose of this study was to investigate the experiences of parents of pre-K to grade four children who had food allergies. Also examined were the management strategies put in place by the participants to assist the children deal with their unique situations. An in-depth interview was conducted with ten parents whose children had food allergies. Results of the interview indicate that the children's allergies were identified between ages six months and two years. Most of the parents reported that their children were aware of their problem(s). The most challenging issues for the parents were getting the specific food allergies diagnosed by professionals and staying alert all the time. Parents indicated that they were confident about their children's safety and well-being in school that had adopted a no-peanut policy. (Contains 1 table.)