Most recent papers:

• Impact of NFL PLAY 60 Programming on Elementary School Children's Body Mass Index and Aerobic Capacity: The NFL PLAY 60 FitnessGram Partnership Project.
  Pedro F. Saint‐Maurice, Yang Bai, Gregory J. Welk, Lorraine N. Bandelli, Kelly Allums‐Featherston, Norma Candelaria.
  Journal of School Health / The Journal of School Health. October 11, 2017
  BACKGROUND We examined the impact of the Fuel Up to Play 60 (FUTP60) program on children's body mass index (BMI) and aerobic capacity (AC). METHODS Participation in the FUTP60 and both BMI and AC profiles were collected through the NFL PLAY 60 FitnessGram Partnership Project involving over 100 schools from 22 US states. We specifically examined the distributions of BMI and AC among participating versus nonparticipating schools in the 2012‐2013 school year. Hierarchical linear models tested the impact of participation and availability of additional funding for program implementation on the proportions of youth meeting FitnessGram health‐related fitness standards (ie, Needs Improvement—Health Risk [NIHR] and Healthy Fitness Zone [HFZ] categories). RESULTS After 1 year implementing the program, participating schools had lower proportions of boys (−4.1 ± 2.0%, p = .04) and girls (−4.5 ± 2.0%, p = .03) in the NIHR for BMI, and lower proportion of girls (−9.7 ± 4.0%, p = .02) in the NIHR for AC. There were no differences in the distributions for the HFZ and the availability of additional funding did not alter the relationships (p > .05). CONCLUSIONS This study provides preliminary evidence that participation in the FUTP60 is associated with improved profiles of health‐related fitness.

  October 11, 2017   doi: 10.1111/josh.12561   open full text
• Association Between Experiencing Relational Bullying and Adolescent Health‐Related Quality of Life.
  Kayleigh L. Chester, Neil H. Spencer, Lisa Whiting, Fiona M. Brooks.
  Journal of School Health / The Journal of School Health. October 11, 2017
  BACKGROUND Bullying is a public health concern for the school‐aged population, however, the health outcomes associated with the subtype of relational bullying are less understood. The purpose of this study was to examine the association between relational bullying and health‐related quality of life (HRQL) among young people. METHODS This study utilized data from 5335 students aged 11‐15 years, collected as part of the 2014 Health Behavior in School‐aged Children (HBSC) study conducted in England. Data were collected through self‐completed surveys. Multilevel analysis modeled the relationship between relational bullying and HRQL. Demographic variables (sex, age, ethnicity, socioeconomic status) and other forms of bullying were controlled for. RESULTS Experiencing relational bullying had a significant negative association with HRQL whilst controlling for other forms of bullying. Weekly relational bullying resulted in an estimated 5.352 (95% confidence interval (CI), −4.178, −6.526) decrease in KIDSCREEN‐10 score compared with those not experiencing relational bullying. CONCLUSION Experiencing relational bullying is associated with poorer HRQL. The findings question the perception of relational bullying as being a predominantly female problem. Girls were more likely to report experiencing relational bullying, but the negative association with HRQL was equal for boys and girls.

  October 11, 2017   doi: 10.1111/josh.12558   open full text
• Effectiveness of a Brief Home Parenting Intervention for Reducing Early Sexual Risks Among Latino Adolescents: Salud y Éxito.
  Lydia O'Donnell, Shai Fuxman.
  Journal of School Health / The Journal of School Health. October 11, 2017
  BACKGROUND Teen pregnancy rates and related risks remain elevated among Latino teens. We tested the impact on youth sexual behaviors of a brief, culturally targeted, bilingual media intervention designed for parents of young adolescents. METHODS Salud y éxito (Health & Success) uses dramatic audio stories to model positive parenting practices. After completing classroom surveys, 27 urban schools in the Northeast and Southwest serving low‐income Latino communities were randomized so that all families of seventh grade students were sent either: (1) booklets on healthy eating and exercise; (2) Salud‐50, where families either received booklets or the intervention, or (3) Salud‐100, where all families received the intervention. Postintervention follow‐up surveys were conducted at 3‐ and 12‐months. Multilevel analyses tested intervention effects, controlling for sociodemographics. RESULTS Compared with controls, at 12‐months postintervention (8th grade spring), youth in Salud‐100 report lower sexual risks (touching, AOR 1.46, CI 1.19‐0.84, p < .001; lifetime sex (AOR 0.74, CI 0.61‐0.90, p < .01); and sex intentions (AOR 0.78, CI 0.63‐0.96, p < .05). Consistent with a dose‐response, Salud‐50 results are between those from Salud‐100 and control schools. CONCLUSIONS Salud y éxito is an effective parenting intervention that can augment school‐based health and sexuality education and help Latino parents support their children during early adolescence.

  October 11, 2017   doi: 10.1111/josh.12560   open full text
• School‐Based Health Centers and Adolescent Substance Use: Moderating Effects of Race/Ethnicity and Socioeconomic Status.
  Melina Bersamin, Mallie J. Paschall, Deborah A. Fisher.
  Journal of School Health / The Journal of School Health. October 11, 2017
  BACKGROUND School‐based health centers (SBHCs) have been associated with many positive health and academic outcomes. The current study extends previous research and examines possible differences in the association between SBHC exposure and adolescent alcohol, tobacco, and other drug use by race/ethnicity, sex, and socioeconomic status (SES). METHODS California Healthy Kids Survey data from 504 traditional high schools in California were linked with publicly available data on SBHCs and school demographics. Multilevel logistic regression analyses were conducted controlling for school and individual characteristics. RESULTS Significant interactions suggest that SBHC exposure was inversely associated with past 30‐day alcohol use, binge drinking, and cigarette and e‐cigarette use among African American youth and negatively associated with cigarette and marijuana use among Asian youth, relative to whites. There was also a significant interaction between SBHC exposure and parent education for past 30‐day alcohol use and binge drinking. No significant sex interactions were observed. CONCLUSIONS SBHC exposure appears to be inversely related to substance use among youth in some ethnic minority groups and youth of lower SES. This may have implications regarding SBHC placement and investment. Additional research is necessary to understand the mechanisms through which SBHCs may influence adolescent substance use and other health behaviors.

  October 11, 2017   doi: 10.1111/josh.12559   open full text
• High School Students' Recommendations to Improve School Food Environments: Insights From a Critical Stakeholder Group.
  Yuka Asada, Alejandro G. Hughes, Margaret Read, Marlene B. Schwartz, Jamie F. Chriqui.
  Journal of School Health / The Journal of School Health. October 11, 2017
  BACKGROUND The Healthy, Hunger‐Free Kids Act of 2010 (HHFKA) directed the US Department of Agriculture (USDA) to revise school meal standards. Students are most affected by efforts to improve the school food environment; yet, few studies directly include students. This study examined high school students' experiences of school meal reform to gain insight into implementation recommendations. METHODS We conducted 5 focus groups with high school students (N = 15) from high schools across 9 states. We also conducted follow‐up interviews to further explore personal experiences. Focus groups and interview transcripts were coded and organized in Atlas.ti v7 by analysts, following principles of constant comparative analysis. RESULTS Students reported overall positive perceptions of the revised school meal standards and supported continued efforts to improve the food environment. Recommendations to improve the food environment included engaging students, focusing on the quality and palatability of meal items, moving toward scratch‐cooking, and addressing cafeteria infrastructure. CONCLUSIONS Students' recommendations point to opportunities where school districts, as well as local, state, and federal organizations can work to improve the school food environment. Their insights are directly relevant to USDA's recently released Local School Wellness Policy final rule, of which school meal standards are one provision.

  October 11, 2017   doi: 10.1111/josh.12562   open full text
• Associations Between Peer Harassment and School Risk and Protection Profiles.
  Kari M. Gloppen, Amy L. Gower, Barbara J. McMorris, Marla E. Eisenberg.
  Journal of School Health / The Journal of School Health. October 11, 2017
  BACKGROUND Peer harassment can have serious implications for students' success and well‐being, and prevention programs need to consider the school context. This study aimed to: (1) identify groups of similar schools based on their risk and protective factors and demographic characteristics and (2) examine associations between school profiles and students' bullying involvement. METHODS Data came from 505 schools and 122,106 students who completed the 2013 Minnesota Student Survey. School‐level risk and protective factors and demographic characteristics were included in a latent profile analysis (LPA) to identify profiles of schools. Multilevel logistic regression was used to assess associations between school profiles and peer harassment. RESULTS Six qualitatively different school profiles were identified. Unadjusted models showed that schools with higher levels of risk had greater odds of peer harassment. However, after controlling for student‐level risk and protection, regardless of school‐level risk, students in metro‐area schools with a more diverse student body reported lower odds of bullying involvement. CONCLUSIONS These findings highlight the importance of the social environment into peer harassment. In addition to addressing student‐level risk and protection, larger community factors and norms also need to be taken into account for developing, selecting, and implementing the most effective approaches to bullying prevention.

  October 11, 2017   doi: 10.1111/josh.12557   open full text
• Mixed‐Methods Evaluation of a Healthy Exercise, Eating, and Lifestyle Program for Primary Schools.
  Thomas Cochrane, Rachel C. Davey.
  Journal of School Health / The Journal of School Health. October 11, 2017
  BACKGROUND Reversing decline in physical fitness and increase in excess body weight in school children are considered major public health challenges. We evaluated a proposed model to integrate a screening and healthy exercise, eating, and lifestyle program (HEELP) into primary schools in Canberra, Australia. Objectives were: (1) to establish body status and physical competencies of 5‐ to 10‐year‐old children; (2) to evaluate the service's impact on body status and physical fitness; and (3) to gauge parent/guardian and school perspectives on the service. METHODS A mixed‐methods approach was used over 4 school years, 2010‐2013. Primary evaluation used direct quantitative measurement. Confirmatory qualitative methods were implemented in the last 2 years. RESULTS The service was delivered on 71 occasions involving 25 schools; 7750 children were screened and 709 completed all aspects of the HEELP evaluation. Over 60% of children screened had 2 or more measures that would benefit from remedial intervention. CONCLUSIONS All body status and physical fitness measures showed small beneficial changes on a population basis immediately after the HEELP. Further benefit did not accrue at 6 months after the program. Semistructured interviews with schools and parent/guardian surveys confirmed some beneficial effects observed by direct quantitative measurement.

  October 11, 2017   doi: 10.1111/josh.12555   open full text
• A Mixed‐Methods Comparison of Classroom Context During Food, Health & Choices, a Childhood Obesity Prevention Intervention.
  Marissa Burgermaster, Jenna Koroly, Isobel Contento, Pamela Koch, Heewon L. Gray.
  Journal of School Health / The Journal of School Health. October 11, 2017
  BACKGROUND Schools are frequent settings for childhood obesity prevention; however, intervention results are mixed. Classroom context may hold important clues to improving these interventions. METHODS We used mixed methods to examine classroom context during a curriculum intervention taught by trained instructors in fifth grade classrooms. We identified classrooms with high and low buy‐in using cluster analysis and compared intervention delivery and reception, student energy balance‐related behavior, and student perceptions about supports and barriers to energy balance. RESULTS Delivery and reception did not differ between the groups. Between‐group differences in unhealthy behaviors were smaller at posttest, due to improvement in low buy‐in classes. Although student perceptions of supports and barriers to energy balance were similar across groups, students in high buy‐in classes indicated food preferences as a support while students in low buy‐in classes indicated food preferences as a barrier. Neighborhood environment emerged as a universal barrier. CONCLUSIONS Trained instructors may improve intervention delivery and reception regardless of classroom context. Social norms could explain high levels of unhealthy behavior in low buy‐in classes at baseline; improvement at posttest suggests that the curriculum may have motivated change. All children need more strategies and supportive policies to overcome a challenging food environment.

  October 11, 2017   doi: 10.1111/josh.12556   open full text
• A Scoping Review to Address the Culture of Concussion in Youth and High School Sports.
  Kelly Sarmiento, Zoe Donnell, Rosanne Hoffman.
  Journal of School Health / The Journal of School Health. September 05, 2017
  BACKGROUND In 2013, the National Academy of Sciences emphasized the need to develop, implement, and evaluate effective large‐scale educational strategies to improve the culture of concussion in youth and high school sports. In support of this recommendation, in this article we summarize research on factors that contribute to the culture of concussion. METHODS We conducted the literature search using 7 electronic databases. We used a scoping review method to identify studies that addressed knowledge, attitudes, behaviors, use of educational resources, and interventions related to concussion among young athletes, coaches, and parents. RESULTS Of the 33 articles identified, most focused on concussion education (N = 15), followed by knowledge (N = 13), behaviors (N = 13), and attitudes (N = 5). Three studies addressed multiple study populations. CONCLUSIONS The rapid spread of concussion education and awareness efforts has outpaced research on effective strategies to improve knowledge, attitudes, and behaviors that contribute to the culture of concussion. Further research is critical to inform the development and implementation of large‐scale educational efforts. This research should incorporate rigorous study designs; be inclusive of diverse ages, socioeconomic status, and racial/ethnic groups; and examine opportunities to improve behavioral outcomes around concussion prevention, reporting, and management.

  September 05, 2017   doi: 10.1111/josh.12552   open full text
• A School‐Based Dental Program Evaluation: Comparison to the Massachusetts Statewide Survey.
  Corinna S. Culler, Milton Kotelchuck, Eugene Declercq, Karen Kuhlthau, Kari Jones, Karen M. Yoder.
  Journal of School Health / The Journal of School Health. September 05, 2017
  BACKGROUND School‐based dental programs target high‐risk communities and reduce barriers to obtaining dental services by delivering care to students in their schools. We describe the evaluation of a school‐based dental program operating in Chelsea, a city north of Boston, with a low‐income and largely minority population, by comparing participants' oral health to a Massachusetts oral health assessment. METHODS Standardized dental screenings were conducted for students in kindergarten, third, and sixth grades. Outcomes were compared in bivariate analysis, stratified by grade and income levels. RESULTS A greater percentage of Chelsea students had untreated decay and severe treatment need than students statewide. Yet, fewer Chelsea third graders had severe treatment need, and more had dental sealants. There was no significant difference in the percentage of Chelsea students having severe treatment need or dental sealants by income level. CONCLUSIONS Students participating in our program do not have lower decay levels than students statewide. However, they do have lower levels of severe treatment need, likely due to treatment referrals. Our results confirm that school‐based prevention programs can lead to increased prevalence of dental sealants among high‐risk populations. Results provide support for the establishment of full‐service school‐based programs in similar communities.

  September 05, 2017   doi: 10.1111/josh.12553   open full text
• Types and Nature of Parental Support for Overweight Students to Cope With Weight‐Related Teasing.
  Qi Zhao, Weidong Li, Paul B. Rukavina.
  Journal of School Health / The Journal of School Health. September 05, 2017
  BACKGROUND Parental support can protect adolescents from various forms of bullying. There is a lack of in‐depth information about what social support parents provide to overweight adolescents when they are teased at school. In this study, we took an initial step to address this gap in the literature by describing the types and nature of support that parents provided to their overweight child when they were teased. METHODS A conversational style semistructured interview/prompts and probes were conducted with 28 volunteering parents. Inductive content analysis was used to analyze the data. Data trustworthiness was established through a variety of strategies. RESULTS Six themes emerged from the data: (1) having conversations, being encouraging, and “being supportive”; (2) using religion to teach self‐acceptance and comfort their child; (3) offering advice on how to cope with the teasing; (4) fostering their child's self‐esteem; (5) teaching reality and acceptance of criticism in early life; and (6) seeking support from other parents or professionals. CONCLUSIONS Parents offered multiple supports for their child when they were teased. This information can facilitate the development of effective family‐based interventions on coping with teasing among overweight students. Future research is also needed to examine the effectiveness of the recommended interventions.

  September 05, 2017   doi: 10.1111/josh.12551   open full text
• Relationship Between Adherence to Individual Goals Within the 5‐2‐1‐0 Guidelines for Obesity Prevention and Number of PACER Laps in Adolescents.
  Kibum Cho, Emily Jones, Christa Lilly, Sean Bulger, Luciana Braga, Eloise Elliott.
  Journal of School Health / The Journal of School Health. September 05, 2017
  BACKGROUND The purpose of this study was to evaluate the relationship between adolescents' adherence to the 5‐2‐1‐0 goals and the number of completed Progressive Cardiovascular Endurance Run (PACER) laps. METHODS Participants included 1792 students aged 10 to 16 years who were randomly selected across 9 data collection periods between 2012 and 2014. The Survey of Physical Activity and Nutrition was used to measure time spent in physical activity and sedentary behavior, and dietary intake and the dependent variable was the number of PACER laps achieved. The Kruskal‐Wallis test and pairwise post hoc comparisons were conducted. RESULTS Only 0.95% (N = 17) participants met all 4 goals outlined within the 5‐2‐1‐0 guidelines. Whereas 10.04% met 3 (N = 180), 41.63% met 2 (N = 746), 34.99% met 1 (N = 627), and 12.39% did not meet any goals (N = 222). Pairwise comparisons indicated there were significant differences: between groups not meeting any of the 5‐2‐1‐0 goals and other groups (meeting one goal [p = .000], 2 goals [p = .000], 3 goals [p = .000], and all 4 [p = .008]). CONCLUSIONS The positive relationship between PACER laps and adherence to the 5‐2‐1‐0 goals suggests targeted and sequential behavioral changes may have positive implications on adolescents' cardiovascular fitness and body mass index.

  September 05, 2017   doi: 10.1111/josh.12549   open full text
• Measuring the Implementation of a School Wellness Policy.
  Anastasia Snelling, Sarah Irvine Belson, Erin Watts, Elizabeth Malloy, Hugo Van Dyke, Stephanie George, Sandra Schlicker, Nancy Brenowitz Katz.
  Journal of School Health / The Journal of School Health. September 05, 2017
  BACKGROUND With the rise in childhood obesity, school policies related to nutrition and physical activity have been written and implemented. In this paper, we present a model to evaluate the degree to which state legislation for school health policies are implemented at the school level. METHODS Using Washington, DC's Healthy Schools Act (HSA) and a self‐report measure of the implementation of the HSA, we illustrate the process of developing a composite score that can be used to measure compliance with the provisions of the law. RESULTS We calculated elementary and middle school composite scores based on the provisions within the HSA. Schools have been successful in implementing nutrition provisions; however, more resources are needed for schools to achieve the minutes of health and physical education. We found statistically significant differences between public charter and traditional public schools on the implementation of the provisions of the HSA. CONCLUSIONS Understanding how schools are complying with school wellness policies is a next step to determining where additional resources or support are needed in order to support school‐wide adoption of healthy policies.

  September 05, 2017   doi: 10.1111/josh.12548   open full text
• Sydney Playground Project: A Cluster‐Randomized Trial to Increase Physical Activity, Play, and Social Skills.
  Anita Bundy, Lina Engelen, Shirley Wyver, Paul Tranter, Jo Ragen, Adrian Bauman, Louise Baur, Wendy Schiller, Judy M. Simpson, Anita N. Niehues, Gabrielle Perry, Glenda Jessup, Geraldine Naughton.
  Journal of School Health / The Journal of School Health. September 05, 2017
  BACKGROUND We assessed the effectiveness of a simple intervention for increasing children's physical activity, play, perceived competence/social acceptance, and social skills. METHODS A cluster‐randomized controlled trial was conducted, in which schools were the clusters. Twelve Sydney (Australia) primary schools were randomly allocated to intervention or control conditions, with 226 children (5‐7 years old) selected randomly to participate. Data were collected at baseline and after 13 weeks. The intervention consisted of introducing recycled materials without an obvious play purpose into school playgrounds and a risk‐reframing workshop for parents and teachers. RESULTS Children from the intervention schools increased physical activity and reduced sedentary time while control schools decreased physical activity and increased sedentary time. The intervention yielded increases in total accelerometer counts (β = 9350 counts, 95% CI 3490‐1522, p = .002), minutes of moderate/vigorous physical activity (MVPA) (β = 1.8 min, 95% CI 0.52‐3.12, p = .006), and reductions in sedentary time (β = −2.1 min, 95% CI −3.77‐(−0.51), p = .01). Although the changes in time spent in play and nonplay were not statistically different (p = .08) the effect size (d = .27) indicates clinical significance. CONCLUSIONS This intervention was effective for increasing MVPA during recess and demonstrated capacity to improve play opportunities in school playgrounds.

  September 05, 2017   doi: 10.1111/josh.12550   open full text
• Bullying and HIV Risk Among High School Teenagers: The Mediating Role of Teen Dating Violence.
  Moses Okumu, Cecilia Mengo, Bernadette Ombayo, Eusebius Small.
  Journal of School Health / The Journal of School Health. September 05, 2017
  BACKGROUND Teen dating violence (TDV), bullying, and HIV risk behaviors are public health concerns that impact adolescents in the United States. National estimates reveal high rates of these risk behaviors among high school students. Based on theoretical and empirical evidence, we hypothesized that experiencing teen dating violence (sexual and physical) would mediate the impact of bullying on HIV risk. METHODS Data were from the 2013 National Youth Behavior Risk Surveillance Survey (YRBSS) among students who answered questions on bullying, TDV, and HIV risk (N = 13,571). The YRBSS is conducted biennially among 9th‐ to 12th‐grade students nationally. We used multiple regression analysis and Hayes' SPSS process macro to examine the 2 study hypotheses. RESULTS Findings from bivariate analysis suggest an association between bullying and HIV risk. The study also found associations between physical, sexual teen dating violence and HIV risk. Results also indicate that both physical and sexual teen dating violence mediate the association between bullying and HIV risk. CONCLUSION Our findings suggest that multidimensional interventions should be developed to reduce the rate of teen dating violence and combat bullying as a preventative method for HIV risk among high school students.

  September 05, 2017   doi: 10.1111/josh.12547   open full text
• Achieving Consensus on Principles of Good Practice for School Health in Independent Schools: A Delphi Study.
  Miguel G. Marshall, John P. Allegrante.
  Journal of School Health / The Journal of School Health. September 05, 2017
  BACKGROUND Although the 8 components of the coordinated school health (CSH) framework have been implemented to various degrees in the nation's public schools, principles of good practice (PGPs) to guide health promotion efforts in independent schools do not exist. The purpose of this study was to generate PGPs and rate their feasibility of implementation. METHODS A modified Delphi process was used to generate PGPs for school health in independent schools and develop consensus regarding their feasibility of implementation. A working group of 6 independent school health professionals (ISHPs) was convened to propose draft PGPs based on the CSH framework. The proposed PGPs were then reviewed by a national and geographically diverse expert panel of 10 school health researchers and 23 ISHPs that completed 3 Delphi rounds to achieve consensus on the PGPs. Of 33 participants originally invited to participate, 27 completed the Delphi process. RESULTS A total of 27 panelists rated 67 PGPs, provided 399 comments, and achieved consensus using interquartile range on 56 (84%) of the proposed PGPs, 41 of which were rated feasible and 15 somewhat feasible. CONCLUSION This study has generated empirical support for the feasibility of PGPs for school health in independent schools.

  September 05, 2017   doi: 10.1111/josh.12545   open full text
• School Breakfast Program Participation and Rural Adolescents' Purchasing Behaviors in Food Stores and Restaurants.
  Caitlin Eicher Caspi, Qi Wang, Amy Shanafelt, Nicole Larson, Susan Wei, Mary O. Hearst, Marilyn S. Nanney.
  Journal of School Health / The Journal of School Health. September 05, 2017
  BACKGROUND Little is known about adolescents' food purchasing behaviors in rural areas. This study examined whether purchasing food at stores/restaurants around schools was related to adolescents' participation in school breakfast programs and overall diet in rural Minnesota. METHODS Breakfast‐skippers enrolled in a group‐randomized intervention in 2014 to 2015 (N = 404 from 8 schools) completed 24‐hour dietary recalls and pre/post surveys assessing food establishment purchase frequency. Healthy Eating Index Scores (HEI‐2010) were calculated for each student. Student‐level school breakfast participation (SBP) was obtained from school food service records. Mixed‐effects regression models estimated: (1) whether SBP was associated with store/restaurant use at baseline, (2) whether an increase in SBP was associated with a decrease in store/restaurant use, and (3) whether stores/restaurant use was associated with HEI‐2010 scores at baseline. RESULTS Students with increased SBP were more likely to decrease fast‐food restaurant purchases on the way home from school (OR 1.017, 95% CI 1.005, 1.029), but were less likely to decrease purchases at food stores for breakfast (OR 0.979, 95% CI 0.959, 0.999). Food establishment use was associated with lower HEI‐2010 dairy component scores (p = .017). CONCLUSIONS Increasing participation in school breakfast may result in modest changes in purchases at food establishments.

  September 05, 2017   doi: 10.1111/josh.12546   open full text
• The Body Mass Index of Adolescents Attending Seventh‐Day Adventist Schools in Australia: 2001‐2012.
  Bevan A. Craig, Darren P. Morton, Lillian M. Kent, Terry L. Butler, Paul M. Rankin, Kevin R. Price.
  Journal of School Health / The Journal of School Health. July 09, 2017
  BACKGROUND We examined the body mass index (BMI) of students attending Seventh‐day Adventist (Adventist) schools in Australia in 2001 and 2012. METHODS A total of 3069 students attending Adventist schools in Australia responded to a health and lifestyle survey in 2001 (N = 1335) and 2012 (N = 1734). The survey captured self‐reported height and weight, demographics (age, sex, year level, religion), and select health behaviors. RESULTS Compared with national norms, lower rates of overweight and obesity were observed in the study cohort, but higher rates of underweight. There was no change in the mean BMI of the students attending Adventist schools in Australia from 2001 to 2012. Regression analyses indicated that a lower BMI was associated with age, sex, more regularly eating breakfast, consuming less soft drink, and having a regular exercise program. The students reported a high consumption of fruits, vegetables, and whole grains compared with Australian national norms, and 29% claimed to be vegetarian. CONCLUSIONS Students attending Adventist schools appear to have a lower prevalence of overweight and obesity than the secular population, but a higher prevalence of underweight. The mechanisms through which Adventist schools may influence student's BMI warrants further investigation.

  July 09, 2017   doi: 10.1111/josh.12535   open full text
• Children With Type 1 Diabetes Mellitus: Self‐Management Experiences in School.
  Valéria de Cássia Sparapani, Raphael D.R. Liberatore, Elaine B.C. Damião, Isa R. de Oliveira Dantas, Rosangela A.A. de Camargo, Lucila C. Nascimento.
  Journal of School Health / The Journal of School Health. July 09, 2017
  BACKGROUND Children with type 1 diabetes mellitus (T1DM) need to perform self‐management activities at school and in other environments. Learning about their experiences at school is crucial to assist them in this challenging task. METHODS Qualitative interviews were conducted with children with T1DM, aged between 7 and 12. A scenario was created and puppets were used during the interviews to help the participating children to communicate about school, daily routines, and experiences in diabetes management. Data were collected over a period of 1 year and analyzed according to content analysis procedures. RESULTS Nineteen children, 13 boys and 6 girls, at the mean age of 9.8 ± 1.8 years and mean time since diagnosis of 3.3 years, participated in the study. Three themes were identified: lack of information on T1DM, diabetes self‐care at school, and support received by the children. CONCLUSIONS The study provides useful information to understand the children's experiences in managing the disease at school. The partnership between school staff, health teams, children with T1DM, and their families need to be enhanced to promote appropriate strategies that improve the management of diabetes in this setting.

  July 09, 2017   doi: 10.1111/josh.12529   open full text
• The Impact of Multiple Strategies to Encourage Fruit and Vegetable Consumption During School Lunch.
  Emily Thompson, David C. Johnson, Amy Leite‐Bennett, Yingmei Ding, Komal Mehrotra.
  Journal of School Health / The Journal of School Health. July 09, 2017
  BACKGROUND Hennepin County partnered with schools to implement lunchroom strategies to encourage fruit and vegetable consumption. An in‐depth evaluation measured changes in consumption following implementation of encouragement strategies including slicing apples and attractive labels. METHODS A pre‐post prospective evaluation measured changes in average fruit and vegetable consumption at 2 elementary schools. The plate waste method was used to weigh individual waste. To measure consumption, 373 students were matched pre/post. Additional measures included change in fruit and vegetable selection, change in whole servings consumed and apple consumption. RESULTS Average fruit consumption increased by 3.0 g (p = .09), average vegetable consumption increased by 1.1 g (p = .27), neither significantly. The number of students selecting fruit significantly increased (p = .02), while the number taking vegetables increased, but not significantly (p = .28). The number of students consuming an entire serving of fruit (p = .15) or vegetables (p = .45) both increased but not significantly. Apple consumption more than doubled at one school. CONCLUSIONS Implementing lunchroom changes can increase the number of students selecting fruit, and changes including slicing can increase consumption of apples. Additional strategies are needed to increase vegetable selection and fruit and vegetable consumption.

  July 09, 2017   doi: 10.1111/josh.12533   open full text
• Successes and Challenges in School Meal Reform: Qualitative Insights From Food Service Directors.
  Yuka Asada, Margaret Ziemann, Lara Zatz, Jamie Chriqui.
  Journal of School Health / The Journal of School Health. July 09, 2017
  BACKGROUND The Healthy, Hunger‐Free Kids Act of 2010 (HHFKA) directed the US Department of Agriculture (USDA) to revise school meal standards to increase healthy food offerings. A critical stakeholder in the implementation of standards is Food Service Directors (FSDs). We sought to examine FSDs' perspectives on revised school meal standards to gain insight into successful implementation strategies. METHODS Semistructured interviews were conducted with FSDs (N = 9) from high schools that had achieved HealthierUS Schools Challenge: Smarter Lunchrooms (HUSSC: SL) status. Qualitative interview data were team coded in Atlas.ti v7 and analyzed with principles of constant comparative analysis. RESULTS FSDs reported overall positive perceptions of the revised school meal standards and its potential impacts, as well as improved fruit and vegetable consumption, despite initial challenges with plate waste, procurement of whole grain‐rich products, and fast paced sodium targets. Implementation was described as complex, ongoing processes; with time and in‐service trainings, student acceptance to these changes improved. CONCLUSIONS These findings are directly relevant to future reauthorization of the Child Nutrition Act and to revisions to the implementation time line for the federal school meal standards related to sodium, whole grains, and flavored milk. Insights into FSDs' strategies suggest that more time and targeted technical assistance at federal, state, and local levels is warranted.

  July 09, 2017   doi: 10.1111/josh.12534   open full text
• Physical Education Increases Daily Moderate to Vigorous Physical Activity and Reduces Sedentary Time.
  Kerli Mooses, Maret Pihu, Eva‐Maria Riso, Aave Hannus, Priit Kaasik, Merike Kull.
  Journal of School Health / The Journal of School Health. July 09, 2017
  BACKGROUND Physical activity (PA) is important to mental and physical health. Physical education (PE) lessons have the potential to increase daily moderate to vigorous PA (MVPA) and reduce sedentary time (SED). We measured MVPA and SED in primary school PE, determined the contribution of PE to daily MVPA and SED, and compared PA on days with and without PE. METHODS PA was measured in 504 first (ages 7‐9) and second (ages 10‐12) school level children for 1 school week, with inclusion criteria of at least 10 hours of valid data. Linear mixed methods were used for data analysis. RESULTS In PE, students spent 28.6 ± 16.5% in MVPA and 29.3 ± 19.8% in SED. Each additional MVPA minute in PE was associated with 1.4 more daily MVPA minutes. On days with PE, students had 12.8 (95% CI 10.5; 15.0) minutes more MVPA and 9.7 (95% CI 16.3; 3.1) minutes less SED compared with days without PE. CONCLUSIONS Although MVPA in PE was relatively low and SED high, PE significantly increased daily MVPA and reduced SED, confirming the important role of PE in supporting the healthy development of children.

  July 09, 2017   doi: 10.1111/josh.12530   open full text
• Academic Performance in Primary School Children With Common Emotional and Behavioral Problems.
  Lisa K. Mundy, Louise Canterford, Dawn Tucker, Jordana Bayer, Helena Romaniuk, Susan Sawyer, Petra Lietz, Gerry Redmond, Jenny Proimos, Nicholas Allen, George Patton.
  Journal of School Health / The Journal of School Health. July 09, 2017
  BACKGROUND Many emotional and behavioral problems first emerge in primary school and are the forerunners of mental health problems occurring in adolescence. However, the extent that these problems may be associated with academic failure has been explored less. We aimed to quantify the association between emotional and behavioral problems with academic performance. METHODS A stratified random sample of 8‐ to 9‐year‐olds (N = 1239) were recruited from schools in Australia. Data linkage was performed with a national assessment of academic performance to assess reading and numeracy. Parent report assessed emotional and behavioral problems with students dichotomized into “borderline/abnormal” and “normal” categories. RESULTS One in 5 grade 3 students fell in the “borderline/abnormal” category. Boys with total difficulties (β = ‐47.8, 95% CI: ‐62.8 to ‐32.8), conduct problems, and peer problems scored lower on reading. Numeracy scores were lower in boys with total difficulties (β = ‐37.7, 95% CI: ‐53.9 to ‐21.5) and emotional symptoms. Children with hyperactivity/inattention scored lower in numeracy. Girls with peer problems scored lower in numeracy. CONCLUSIONS Boys with emotional and behavioral problems in mid‐primary school were 12 months behind their peers. Children with emotional and behavioral problems are at high risk for academic failure, and this risk is evident in mid‐primary school.

  July 09, 2017   doi: 10.1111/josh.12531   open full text
• Utilization of Mental Health Services in School‐Based Health Centers.
  Ranbir M. Bains, Regina Cusson, Jesse White‐Frese, Stephen Walsh.
  Journal of School Health / The Journal of School Health. July 09, 2017
  BACKGROUND We summarize utilization patterns for mental health services in school‐based health centers. METHODS Administrative data on school‐based health center visits in New Haven, Connecticut were examined for the 2007‐2009 school years. Relative frequencies of mental health visits by age were calculated as a percentage of all visits and were stratified by sex, ethnicity/race, and insurance status. RESULTS Mental health visits accounted for the highest proportion of visits (31.8%). The proportion of mental health visits was highest at 8 years (42.8%) and at 13 years (39.0%). The proportion of mental health visits among boys (38.4%) was higher than among girls (26.7%). Hispanic students had a lower proportion of mental health visits than black students (23.5% vs 35.8%) in all but 2 age groups. Students in the white/other ethnicity category had higher proportions of mental health visits than Hispanic and black students between ages 12 and 15. Students with no health insurance (22.5%) had lower proportions of mental health visits than students covered by Medicaid (34.3%) or private insurance (33.9%). The percentage of mental health visits by students with private insurance was highest (37.2%‐49%) in the 13‐15 age range. CONCLUSIONS Usage patterns for mental health issues show pronounced, nonrandom variation relative to age and other demographic characteristics especially with 8‐year‐old boys.

  July 09, 2017   doi: 10.1111/josh.12528   open full text
• Attitudes, Norms, and the Effect of Social Connectedness on Adolescent Sexual Risk Intention.
  Julie A. Cederbaum, Aubrey J. Rodriguez, Kathrine Sullivan, Kandice Gray.
  Journal of School Health / The Journal of School Health. July 09, 2017
  BACKGROUND Risky sexual behaviors put adolescents at increased risk of adverse outcomes. Parents, school‐based adults, and peers play important roles in influencing these sex intentions. METHODS This work explored the influence of parent‐child sex communication on adolescent attitudes, perceived norms, and intentions to have sex, including the moderating role of social support from school‐based adults, in a sample of 21,731 adolescents in California. RESULTS Although increased parent‐child sex communication was associated with intentions to have sex, it also exhibited protective effects, increasing abstinence attitudes among youth that led to decreased intention directly and via support from school‐based adults. CONCLUSIONS Although many factors influencing sexual behaviors are largely intrapersonal, these findings indicate the importance of an ecological approach to reducing adolescent sexual risk behaviors through engagement of parents and increased school connectedness.

  July 09, 2017   doi: 10.1111/josh.12532   open full text
• The Association of School Climate, Depression Literacy, and Mental Health Stigma Among High School Students.
  Lisa Townsend, Rashelle Musci, Elizabeth Stuart, Anne Ruble, Mary B. Beaudry, Barbara Schweizer, Megan Owen, Carly Goode, Sarah L. Johnson, Catherine Bradshaw, Holly Wilcox, Karen Swartz.
  Journal of School Health / The Journal of School Health. July 09, 2017
  BACKGROUND Although school climate is linked with youth educational, socioemotional, behavioral, and health outcomes, there has been limited research on the association between school climate and mental health education efforts. We explored whether school climate was associated with students' depression literacy and mental health stigma beliefs. METHODS Data were combined from 2 studies: the Maryland Safe Supportive Schools Project and a randomized controlled trial of the Adolescent Depression Awareness Program. Five high schools participated in both studies, allowing examination of depression literacy and stigma measures from 500 9th and 10th graders. Multilevel models examined the relationship between school‐level school climate characteristics and student‐level depression literacy and mental health stigma scores. RESULTS Overall school climate was positively associated with depression literacy (odds ratio [OR] = 2.78, p < .001) and negatively associated with stigma (Est. = −3.822, p = .001). Subscales of engagement (OR = 5.30, p < .001) and environment were positively associated with depression literacy (OR = 2.01, p < .001) and negatively associated with stigma (Est. = −6.610, p < .001), (Est. = −2.742, p < .001). CONCLUSIONS Positive school climate was associated with greater odds of depression literacy and endorsement of fewer stigmatizing beliefs among students. Our findings raise awareness regarding aspects of the school environment that may facilitate or inhibit students' recognition of depression and subsequent treatment‐seeking.

  July 09, 2017   doi: 10.1111/josh.12527   open full text
• A Review of Implementation Outcome Measures of School‐Based Physical Activity Interventions.
  Sonam Shah, Kenneth R. Allison, Nour Schoueri‐Mychasiw, Beata Pach, Heather Manson, Karen Vu‐Nguyen.
  Journal of School Health / The Journal of School Health. May 02, 2017
  BACKGROUND Measuring the implementation of school‐based physical activity (PA) interventions is an important prerequisite in assessing their impact. Prior to conducting a study to assess the implementation of the daily physical activity (DPA) policy in Ontario, Canada, a literature review was conducted to identify existing survey instruments to measure 5 implementation outcomes: adoption, fidelity, implementation cost, reach, and sustainability. METHODS A search for survey instruments to assess these implementation outcomes at the teacher and school administrator levels was conducted in 7 bibliographic databases, as well as the gray literature. Each survey instrument was coded as assessing 1 of the 5 implementation outcomes if it included at least 1 item measuring the construct. RESULTS Twenty‐three survey instruments were identified. None of the instruments were specifically developed to measure the implementation outcomes. Fidelity was the most common implementation outcome measured, followed by adoption. The least common implementation outcome measured was sustainability. Thirty‐five percent of survey instruments assessed were previously tested for validity and 26% were previously tested for reliability. CONCLUSIONS Based on this review, a gap in available instruments to measure implementation outcomes of school‐based PA programs was identified. An adapted theoretical framework, presented here, has potential application in future implementation studies.

  May 02, 2017   doi: 10.1111/josh.12514   open full text
• Implementing a Nutrition and Physical Activity Curriculum in Head Start Through an Academic‐Community Partnership.
  Whitney E. Zahnd, Tracey Smith, Susan J. Ryherd, Melissa Cleer, Valerie Rogers, David E. Steward.
  Journal of School Health / The Journal of School Health. May 02, 2017
  BACKGROUND Schools may be an effective avenue for interventions that prevent childhood obesity. I am Moving I am Learning/Choosy Kids© (IMIL/CK) is a curriculum recommended by Head Start (HS) for education in nutrition, physical activity, and healthy lifestyle habits. METHODS We formed an academic‐community partnership (ACP), the Springfield Collaborative for Active Child Health, to promote prevention of childhood obesity, in part, to implement the IMIL/CK curriculum in local HS sites. The ACP included a medical school, HS program, public school district, and state health department. RESULTS Community‐based participatory research principles helped identify and organize important implementation activities: community engagement, curriculum support, professional teacher training, and evaluation. IMIL/CK was piloted in 1 school then implemented in all local HS sites. All sites were engaged in IMIL/CK professional teacher training, classroom curriculum delivery, and child physical activity assessments. Local HS policy changed to include IMIL/CK in lesson plans and additional avenues of collaboration were initiated. Furthermore, improvements in physical activity and/or maintenance or improvement of healthy weight prevalence was seen in 4 of the 5 years evaluated. CONCLUSIONS An ACP is an effective vehicle to implement and evaluate childhood obesity prevention programming in HS sites.

  May 02, 2017   doi: 10.1111/josh.12515   open full text
• Trend Analysis of Bullying Victimization Prevalence in Spanish Adolescent Youth at School.
  Inmaculada Sánchez‐Queija, Irene García‐Moya, Carmen Moreno.
  Journal of School Health / The Journal of School Health. May 02, 2017
  BACKGROUND We analyze trends in bullying victimization prevalence in a representative sample of Spanish adolescent schoolchildren in 2006, 2010, and 2014. METHODS We distinguish between reported bullying, which is assessed via the global question in the Revised Bully/Victim Questionnaire by Olweus, and observed bullying, which is a measure developed from the answers that the adolescents gave to specific items that refer to different types of bullying that have been codified as physical, verbal, and relational bullying. RESULTS For 2006 and 2010/2014, the results show stability in the assessment of reported bullying and an increase in observed bullying, analyzed both globally and within the 3 categories: physical, verbal, and relational. CONCLUSIONS A valid, reliable, and accurate measure to detect cases of bullying is necessary, as is the importance of continuing efforts devoted to raising awareness and the prevention of this phenomenon.

  May 02, 2017   doi: 10.1111/josh.12513   open full text
• School and Neighborhood Predictors of Physical Fitness in Elementary School Students.
  David Kahan, Thomas L. McKenzie.
  Journal of School Health / The Journal of School Health. May 02, 2017
  BACKGROUND We assessed the associations of 5 school and 7 neighborhood variables with fifth‐grade students achieving Healthy Fitness Zone (HFZ) or Needs Improvement‐Health Risk (NI‐HR) on aerobic capacity (AC) and body composition (BC) physical fitness components of the state‐mandated FITNESSGRAM® physical fitness test. METHODS Data for outcome (physical fitness) and predictor (school and neighborhood) variables were extracted from various databases (eg, Data Quest, Walk Score®) for 160 schools located in San Diego, California. Predictor variables that were at least moderately correlated (|r| ≥ .30) with ≥1 outcome variables in univariate analyses were retained for ordinary least squares regression analyses. RESULTS The mean percentages of students achieving HFZ AC (65.7%) and BC (63.5%) were similar (t = 1.13, p = .26), while those for NI‐HR zones were significantly different (AC = 6.0% vs BC = 18.6%; t = 12.60, p < .001). Correlations were greater in magnitude for school than neighborhood demographics and stronger for BC than AC. The school variables free/reduced‐price lunch (negative) and math achievement (positive) predicted fitness scores. Among neighborhood variables, percent Hispanic predicted failure of meeting the HFZ BC criterion. CONCLUSIONS Creating school and neighborhood environments conducive to promoting physical activity and improving fitness is warranted.

  May 02, 2017   doi: 10.1111/josh.12516   open full text
• Effect of Forced Sexual Intercourse on Associations Between Early Sexual Debut and Other Health Risk Behaviors Among US High School Students.
  Richard Lowry, Leah Robin, Laura Kann.
  Journal of School Health / The Journal of School Health. May 02, 2017
  BACKGROUND Previous research on associations between early sexual debut and other health risk behaviors has not examined the effect of forced sexual intercourse on those associations. METHODS We analyzed data from a nationally representative sample of 19,240 high school students in the United States, age ≥16 years, to describe the effect of forced sexual intercourse on associations between early sexual debut and other health risk behaviors using adjusted prevalence ratios (APR). RESULTS Early sexual debut and forced sexual intercourse were simultaneously and independently associated with sexual risk‐taking, violence‐related behaviors, and substance use. For example, even after controlling for forced sexual intercourse and race/ethnicity, students who experienced their first sexual intercourse before age 13 years were more likely than students who initiated sexual intercourse at age ≥16 years to have had ≥4 sexual partners during their lifetime (girls, APR = 4.55; boys, APR = 5.82) and to have not used a condom at last sexual intercourse (girls, APR = 1.74; boys, APR = 1.47). CONCLUSIONS Associations between early sexual debut and other health risk behaviors occur independently of forced sexual intercourse. School‐based sexual health education programs might appropriately include strategies that encourage delay of initiation of sexual intercourse, and coordinate with violence and substance use prevention programs.

  May 02, 2017   doi: 10.1111/josh.12512   open full text
• Understanding Perceptions of School Administrators Related to School Breakfast in a Low School Breakfast Participation State.
  Natoshia M. Askelson, Elizabeth H. Golembiewski, Ann Bobst, Patti J. Delger, Carrie A. Scheidel.
  Journal of School Health / The Journal of School Health. May 02, 2017
  BACKGROUND The National School Breakfast Program (SBP) is a federally funded program that allows states to offer nutritious breakfast to K‐12 students. However, rates of SBP participation are low in some rural states, and the reasons are not well understood. The purpose of the study was to explore administrators' perceptions, attitudes, and beliefs related to the SBP, and factors they identify as barriers or facilitators to increased participation. METHODS Data were collected from a cross‐sectional, online survey of K‐12 school administrators (N = 152) in a rural, midsized Midwestern state fielded over an academic year. Descriptive statistics were calculated and open‐ended questions were coded and analyzed for relevant themes. RESULTS Administrators identified busing schedules, time constraints, and a lack of flexibility within the school schedule to accommodate breakfast as primary structural barriers to SBP participation. Administrators described family‐centered norms as reasons for low participation in rural areas. Administrators are at varying stages of readiness to work on improving participation. CONCLUSIONS Low SBP participation can be explained in part by a convergence of factors related to access, community norms, and structural barriers. Results may be used to inform ways in which administrators at the state, district, and school level can work to increase participation.

  May 02, 2017   doi: 10.1111/josh.12511   open full text
• Strategies to Address Unmet Needs and Facilitate Return to Learn Guideline Adoption Following Concussion.
  Vivian H. Lyons, Megan Moore, Roxanne Guiney, Rajiv C. Ayyagari, Leah Thompson, Frederick P. Rivara, Robin Fleming, Deborah Crawley, Dawn Harper, Monica S. Vavilala.
  Journal of School Health / The Journal of School Health. May 02, 2017
  BACKGROUND Many students do not receive return to learn (RTL) services upon return to academics following a concussion. METHODS Using a mixed‐methods approach, we conducted a survey of RTL practices and experiences in Washington State schools between January 2015 and June 2015. We then held a statewide summit of RTL stakeholders and used a modified Delphi process to develop a consensus‐based RTL implementation model and process. RESULTS Survey participants included 83 educators, 57 school nurses, 14 administrators, and 30 parents, representing 144 schools in rural and urban areas. Unmet need domains and recommendations identified were (1) a current lack of school policies; (2) barriers to providing or receiving accommodations; (3) wide variability in communication patterns; and (4) recommendations shared by all stakeholder groups (including desire for readily available best practices, development of a formal school RTL policy for easy adoption and more training). Using stakeholder input from RTL summit participants and survey responses, we developed an RTL implementation model and checklist for RTL guideline adoption. CONCLUSIONS Washington State children have unmet needs upon returning to public schools after concussion. The student‐centered RTL model and checklist for implementing RTL guidelines can help schools provide timely RTL services following concussion.

  May 02, 2017   doi: 10.1111/josh.12510   open full text
• Response of School Districts to the New York State Concussion Awareness and Management Act: Review of Policies and Procedures.
  Maria Kajankova, Jennifer M. Oswald, Lauren M. Terranova, Michael V. Kaplen, Anne F. Ambrose, Lisa A. Spielman, Wayne A. Gordon.
  Journal of School Health / The Journal of School Health. May 02, 2017
  BACKGROUND By 2014, all states implemented concussion laws that schools must translate into daily practice; yet, limited knowledge exists regarding implementation of these laws. We examined the extent to which concussion management policies and procedure (P&P) documents of New York State school districts comply with the State's Concussion Awareness and Management Act (the Act). We also aimed to identify barriers to compliance. METHODS Forty‐seven school districts provided P&P documents. We examined compliance with the Act and the relationship between compliance and each district's demographics. RESULTS Compliance varied across school districts, with higher overall compliance in large city school districts compared to county districts. However, there was low compliance for several critical items. We found no statistically significant relationship between compliance and demographics. CONCLUSIONS School districts need to increase compliance with concussion legislation to ensure the adequate implementation necessary for the law to impact health and educational outcomes. The results provide important information to individuals charged with the responsibility of implementation and ultimately reducing the negative outcomes associated with brain injuries in schools.

  May 02, 2017   doi: 10.1111/josh.12508   open full text
• School‐Based Sleep Education Programs for Short Sleep Duration in Adolescents: A Systematic Review and Meta‐Analysis.
  Ka‐Fai Chung, Man‐Sum Chan, Ying‐Yin Lam, Cindy Sin‐Yee Lai, Wing‐Fai Yeung.
  Journal of School Health / The Journal of School Health. May 02, 2017
  BACKGROUND Insufficient sleep among students is a major school health problem. School‐based sleep education programs tailored to reach large number of students may be one of the solutions. A systematic review and meta‐analysis was conducted to summarize the programs' effectiveness and current status. METHODS Electronic databases were searched up until May 2015. Randomized controlled trials of school‐based sleep intervention among 10‐ to 19‐year‐old students with outcome on total sleep duration were included. Methodological quality of the studies was assessed using the Cochrane's risk of bias assessment. RESULTS Seven studies were included, involving 1876 students receiving sleep education programs and 2483 attending classes‐as‐usual. Four weekly 50‐minute sleep education classes were most commonly provided. Methodological quality was only moderate, with a high or an uncertain risk of bias in several domains. Compared to classes‐as‐usual, sleep education programs produced significantly longer weekday and weekend total sleep time and better mood among students at immediate post‐treatment, but the improvements were not maintained at follow‐up. CONCLUSIONS Limited by the small number of studies and methodological limitations, the preliminary data showed that school‐based sleep education programs produced short‐term benefits. Future studies should explore integrating sleep education with delayed school start time or other more effective approaches.

  May 02, 2017   doi: 10.1111/josh.12509   open full text
• The Association of Physical Activity and Academic Behavior: A Systematic Review.
  Rachel A. Sullivan, AnnMarie H. Kuzel, Michael E. Vaandering, Weiyun Chen.
  Journal of School Health / The Journal of School Health. April 06, 2017
  BACKGROUND In this systematic review, we assessed the existing research describing the effects of physical activity (PA) on academic behavior, with a special focus on the effectiveness of the treatments applied, study designs, outcome measures, and results. METHODS We obtained data from various journal search engines and 218 journal articles were downloaded that were relevant to PA and academic performance topics. The abstracts of all the articles were independently peer reviewed to assess whether they met the inclusion criteria for further analysis. The literature search was ongoing. Of the reviewed articles, 9 were chosen on the topic of PA effects on academic behavior. Each article was analyzed and summarized using a standard summary template. RESULTS Overall, PA interventions commonly found positive effects on academic behavior, with few exceptions. There were additional unique findings regarding differences in outcome measures and PA treatments. CONCLUSIONS The findings from these studies are significant and support the implementation or continuation of PA in schools to improve academic behavior and associated performance. More research needs to be conducted using the effective aspects of the treatments from this review with consistent outcome measures.

  April 06, 2017   doi: 10.1111/josh.12502   open full text
• A Multidisciplinary Research Framework on Green Schools: Infrastructure, Social Environment, Occupant Health, and Performance.
  Sheryl Magzamen, Adam P. Mayer, Stephanie Barr, Lenora Bohren, Brian Dunbar, Dale Manning, Stephen J. Reynolds, Joshua W. Schaeffer, Jordan Suter, Jennifer E. Cross.
  Journal of School Health / The Journal of School Health. April 06, 2017
  BACKGROUND Sustainable school buildings hold much promise to reducing operating costs, improve occupant well‐being and, ultimately, teacher and student performance. However, there is a scarcity of evidence on the effects of sustainable school buildings on health and performance indicators. We sought to create a framework for a multidisciplinary research agenda that links school facilities, health, and educational outcomes. METHODS We conducted a nonsystematic review of peer review publications, government documents, organizational documents, and school climate measurement instruments. RESULTS We found that studies on the impact of physical environmental factors (air, lighting, and thermal comfort) on health and occupant performance are largely independent of research on the social climate. The current literature precludes the formation of understanding the causal relation among school facilities, social climate, occupant health, and occupant performance. CONCLUSIONS Given the average age of current school facilities in the United States, construction of new school facilities or retrofits of older facilities will be a major infrastructure investment for many municipalities over the next several decades. Multidisciplinary research that seeks to understand the impact of sustainable design on the health and performance of occupants will need to include both an environmental science and social science perspective to inform best practices and quantification of benefits that go beyond general measures of costs savings from energy efficiencies.

  April 06, 2017   doi: 10.1111/josh.12505   open full text
• Improving School Experiences for Adolescents With Type 1 Diabetes.
  Saori S. Kise, Amanda Hopkins, Sandra Burke.
  Journal of School Health / The Journal of School Health. April 06, 2017
  BACKGROUND Diabetes mellitus (diabetes) is one of the most common metabolic diseases in children worldwide and the incidence of type 1 diabetes (T1D) is growing. T1D is complicated to manage and adolescents with diabetes face unique, age‐specific challenges. The purpose of this article is to discuss ways in which schools can create a positive environment and improve the experiences and outcomes for adolescents with T1D. METHODS The Cumulative Index of Nursing and Allied Health Literature (CINAHL) and PubMed databases were searched and yielded a total of 27 articles that were used in this integrative literature review. RESULTS Common concerns identified by students with T1D and their parents included a lack of full‐time school nurses, lack of teacher knowledge of diabetes, lack of access to diabetes tools, lack of freedom to perform diabetes self‐care, lack of nutritional information in cafeterias, and lack of communication between parents and school personnel. Students who are unable to attend school on a daily basis may not be able to achieve their academic potential. CONCLUSIONS Implications for school health including specifics for school nurses, teachers, students, and school environment were identified.

  April 06, 2017   doi: 10.1111/josh.12507   open full text
• Reported Motivations for and Locations of Healthy Eating Among Georgia High School Students.
  Gayathri S. Kumar, Michael Bryan, Rana Bayakly, Cherie Drenzek, Caitlin Merlo, Geraldine S. Perry.
  Journal of School Health / The Journal of School Health. April 06, 2017
  BACKGROUND Understanding how youth perceive eating healthy foods can inform programs and policies that aim to improve healthy eating. We assessed the reasons for and the most common locations of eating healthy foods among Georgia's (GA) high school (HS) students. METHODS Using the 2013 GA HS Youth Risk Behavior Survey, we examined motivations for and locations of eating healthy foods by sociodemographic characteristics and daily fruit and vegetable intake. Weighted chi‐square tests were used to examine differences in responses for each perception. RESULTS Nineteen percent of GA HS students consumed fruit ≥3 times/day and 11% consumed vegetables ≥3 times/day. The most frequently chosen response to motivations for eating healthy foods was the desire to be healthy (42%), followed by enjoying their taste (18%). The most likely location to eat healthy foods was at home (80%), followed by at school (13%). CONCLUSIONS GA HS students are most motivated to eat healthy foods by the desire to be healthy and their enjoyment of the taste of healthy foods. Incorporating messages that align with students' motivations to eat healthy foods could be considered when developing promotional programs/policies targeting healthy eating.

  April 06, 2017   doi: 10.1111/josh.12503   open full text
• Patterns in Vegetable Consumption: Implications for Tailored School Meal Interventions.
  Marietta Orlowski, Miryoung Lee, William Spears, Roopsi Narayan, Rebecca S. Pobocik, Julie Kennel, Erin Krafka, Susan Patton.
  Journal of School Health / The Journal of School Health. April 06, 2017
  BACKGROUND Vegetable consumption is a challenging behavioral target; consumption rates are below recommended levels and when interventions produce improvements, increases in vegetable consumption are typically a fraction of the change in fruit consumption. We describe vegetable consumption within Ohio school meals and examine how fruit selection, the more popular item, impacts vegetable consumption. METHODS Fruit and vegetable waste was collected on 11,250 trays from 17 elementary and 16 middle/high schools, using the quarter‐waste visualization method. RESULTS One in 4 students ate at least a one‐fourth of a cup of vegetables with their school lunch. Consumption was the highest (30.8%) in elementary school buildings with a majority of regular priced meals. Fruit selection was associated with vegetable consumption (p < .001). Middle/high school students who consumed a fruit were 88% more likely to consume a vegetable as oppose to waste it (95% CI: 1.45‐2.42). Fruit selection was also associated with not selecting a vegetable, but the association was of a lower magnitude (odds ratio 1.32; 95% CI: 1.06‐1.64). Trends were similar in elementary schools. CONCLUSIONS Fruit and vegetable consumption should be approached as 2 distinct behaviors with particular attention given to vegetables. Fruit items can be leveraged, though, as a means to encourage vegetable selection.

  April 06, 2017   doi: 10.1111/josh.12504   open full text
• Effectiveness of a Playground Intervention for Antisocial, Prosocial, and Physical Activity Behaviors.
  Carlene A. Mayfield, Stephanie Child, Robert G. Weaver, Nicole Zarrett, Michael W. Beets, Justin B. Moore.
  Journal of School Health / The Journal of School Health. April 06, 2017
  BACKGROUND We examined the effectiveness of Peaceful Playgrounds™ (P2) to decrease antisocial behaviors (ASB) while increasing physical activity (PA) and prosocial behaviors (PSB) in elementary school children. METHODS A longitudinal, cluster‐randomized design was employed in 4 elementary school playgrounds where students (third to fifth) from 2 intervention and 2 control schools were observed during recess periods. The intervention included environmental changes (eg, marked surfaces) and student education. Data were collected using systematic observations of youth behavior and semistructured interviews conducted with key informants. Mixed‐effects regression models controlling for scans nested within days nested within schools estimated the interaction of measurement period and treatment condition on children's PA, PSB, and ASB. It was hypothesized that children in intervention, but not control schools, would demonstrate increased PA/PSB and decreased ASB. RESULTS Contrary to the hypotheses, intervention and control schools showed favorable changes for all dependent variables except for PSB, but 1 intervention and 1 control school drove these effects. Follow‐up interviews indicated variability in implementation and lack of adherence to the control condition. CONCLUSIONS P2 may promote increased PA during recess, but these results demonstrate the complexity of intervention implementation and the need for rigor when measuring intervention fidelity in real‐world settings.

  April 06, 2017   doi: 10.1111/josh.12506   open full text
• Association of School Characteristics and Implementation in the X:IT Study—A School‐Randomized Smoking Prevention Program.
  Lotus S. Bast, Pernille Due, Annette K. Ersbøll, Mogens T. Damsgaard, Anette Andersen.
  Journal of School Health / The Journal of School Health. April 06, 2017
  BACKGROUND Assessment of implementation is essential for the evaluation of school‐based preventive activities. Interventions are more easily implemented in schools if detailed instructional manuals, lesson plans, and materials are provided; however, implementation may also be affected by other factors than the intervention itself—for example, school‐level characteristics, such as principal support and organizational capacity. We examined school‐level characteristics of schools in groups of high, medium, and low implementation of a smoking prevention intervention. METHODS The X:IT study is a school‐randomized trial testing a multicomponent intervention to prevent smoking among adolescents. Our data came from electronic questionnaires completed by school coordinators at 96.1% of participating intervention schools (N = 49) at first follow ‐up. RESULTS Schools that implemented the X:IT intervention to a medium or high degree had higher levels of administrative leadership (77.3% and 83.3% vs 42.9%), school climate/organizational health (95.5% and 91.7% vs 66.7%), mission‐policy alignment (90.9% and 100.0% vs 71.4%), personnel expertise (81.8% and 75.0% vs 46.7%), school culture (77.3% and 91.7% vs 53.3%), positive classroom climate (91.4% and 96.2% vs 82.9%) compared with low implementation schools. CONCLUSION Our findings highlight the importance of considering the school context in future health prevention initiatives.

  April 06, 2017   doi: 10.1111/josh.12500   open full text
• Relationships Among Student, Staff, and Administrative Measures of School Climate and Student Health and Academic Outcomes.
  Lauren N. Gase, Louis M. Gomez, Tony Kuo, Beth A. Glenn, Moira Inkelas, Ninez A. Ponce.
  Journal of School Health / The Journal of School Health. April 06, 2017
  BACKGROUND School climate is an integral part of a comprehensive approach to improving the well‐being of students; however, little is known about the relationships between its different domains and measures. We examined the relationships between student, staff, and administrative measures of school climate to understand the extent to which they were related to each other and student outcomes. METHODS The sample included 33,572 secondary school students from 121 schools in Los Angeles County during the 2014‐2015 academic year. A multilevel regression model was constructed to examine the association between the domains and measures of school climate and 5 outcomes of student well‐being: depressive symptoms or suicidal ideation, tobacco use, alcohol use, marijuana use, and grades. RESULTS Student, staff, and administrative measures of school climate were weakly correlated. Strong associations were found between student outcomes and student reports of engagement and safety, while school staff reports and administrative measures of school climate showed limited associations with student outcomes. CONCLUSIONS As schools seek to measure and implement interventions aimed at improving school climate, consideration should be given to grounding these efforts in a multidimensional conceptualization of climate that values student perspectives and includes elements of both engagement and safety.

  April 06, 2017   doi: 10.1111/josh.12501   open full text
• Marijuana and Alcohol Use as Predictors of Academic Achievement: A Longitudinal Analysis Among Youth in the COMPASS Study.
  Karen A. Patte, Wei Qian, Scott T. Leatherdale.
  Journal of School Health / The Journal of School Health. April 06, 2017
  BACKGROUND We tested the effect of initiating marijuana and alcohol use at varying frequencies on academic indices. METHODS In a sample of 26,475 grade 9‐12 students with at least 2 years of linked longitudinal data from year 1 (Y1: 2012‐2013), year 2 (Y2: 2013‐2014), and year 3 (Y3: 2014‐2015) of the COMPASS study, separate multinomial generalized estimating equations models tested the likelihood of responses to measures of academic goals, engagement, preparedness, and performance when shifting from never using alcohol or marijuana at baseline to using them at varying frequencies at follow ‐up. RESULTS Students who began using alcohol or marijuana were less likely to attend class regularly, complete their homework, achieve high marks, and value good grades, relative to their abstaining peers. Changing from abstaining to rare/sporadic‐to‐weekly drinking or rare/sporadic marijuana use predicted aspirations to continue to all levels of higher education, and initiating weekly marijuana use increased the likelihood of college ambitions, while more regular marijuana use reduced the likelihood of wanting to pursue graduate/professional degrees, over high school. CONCLUSIONS The importance of delaying or preventing substance use is evident in associations with student performance and engagement. The influence on academic goals varied by substance and frequency of initiated use.

  April 06, 2017   doi: 10.1111/josh.12498   open full text
• Substance Use Among Transgender Students in California Public Middle and High Schools.
  Kris Tunac De Pedro, Tamika D. Gilreath, Christopher Jackson, Monica Christina Esqueda.
  Journal of School Health / The Journal of School Health. April 06, 2017
  BACKGROUND Transgender adolescents face tremendous social stress in families and schools, which often leads to behavioral health disparities. This study assessed whether rates of substance use were higher among transgender adolescents when compared to nontransgender adolescents. METHODS This study is a secondary data analysis of the 2013‐2015 California Healthy Kids Survey (CHKS) that examines whether rates of substance use are higher among transgender youth when compared to nontransgender youth. Participants included 4778 transgender and 630,200 nontransgender students in middle and high schools in nearly all school districts in California. The study outcomes were lifetime, recent, and in‐school use of cigarettes, tobacco, alcohol, marijuana, cocaine, and ecstasy as well as nonmedical use of prescription painkillers, diet pills, Ritalin or Adderall, and cold medicine. RESULTS Transgender students were about 2‐1/2 times more likely as nontransgender students to use cocaine/methamphetamine in their lifetime (odds ratio [OR] = 2.53; 95% confidence interval [CI] = 2.18‐2.95) and about 2.8 times as likely to report past 30‐day inhalant use (OR = 2.80; 95% CI = 2.41‐3.26). Transgender students were more than twice as likely to report past 30‐day prescription pain medication use (OR = 2.19; 95% CI = 1.90‐2.53) and more than 3 times as likely to use cigarettes in school (OR = 3.37; 95% CI = 2.84‐3.99). CONCLUSIONS The study's findings indicate a need for community‐ and school‐based interventions that reduce substance use among transgender youth.

  April 06, 2017   doi: 10.1111/josh.12499   open full text
• Lessons Learned From the Implementation of Brighter Bites: A Food Co‐op to Increase Access to Fruits and Vegetables and Nutrition Education Among Low‐Income Children and Their Families.
  Shreela V. Sharma, Joanne Chow, Michael Pomeroy, Margaret Raber, David Salako, Christine Markham.
  Journal of School Health / The Journal of School Health. March 05, 2017
  BACKGROUND Food co‐op models have gained popularity as a mechanism for offering affordable, quality produce. We describe the challenges, successes, and lessons learned from implementation of a school‐based program using a food co‐op model combined with nutrition education to improve access to and intake of fresh fruits and vegetables among low‐income children and their families. METHODS Brighter Bites is a 16‐week intervention comprising of fresh produce deliveries, recipe demonstrations, and nutrition education. A mixed‐methods approach was used comprising survey and focus group data collected from Brighter Bites staff, parents, and teachers. Descriptive statistics and frequencies were computed for the survey data collected. RESULTS Brighter Bites was implemented across 9 schools, serving a total of 1530 predominantly low‐income families in the 2013‐2014 school year. Brighter Bites distributed an average 60.2 servings of fresh fruits and vegetables per family per week. Lessons learned included the importance of leveraging existing infrastructure of food banks and schools to implement the program, early school and parent engagement, and incorporating strategies to track and optimize engagement. CONCLUSIONS Clear expectations and reliable partnerships are keys to the delivery of the Brighter Bites program.

  March 05, 2017   doi: 10.1111/josh.12497   open full text
• Cost‐Effectiveness of Ready for Recess to Promote Physical Activity in Children.
  Hongmei Wang, Tao Li, Mohammad Siahpush, Li‐Wu Chen, Jennifer Huberty.
  Journal of School Health / The Journal of School Health. March 05, 2017
  BACKGROUND Many school‐based recess interventions have been shown to be effective in increasing physical activity but their relative efficiency compared to other school‐based programs are unknown. This study examined the cost‐effectiveness of Ready for Recess, a program designed to increase students' physical activity in 2 elementary schools. METHODS Standard cost‐effectiveness analysis method was used from a program's perspective for this study. Program effectiveness was measured as total metabolic equivalent (MET) hours gained. Program costs included equipment, training, and personnel costs during the 1‐year intervention. The cost‐effectiveness was measured as the ratio of program costs to total MET‐hours gained. RESULTS Ready for Recess cost $27,643.97 for the 2 schools in the first year of implementation. Physical activity increased by 1.8 MET‐hours per day per student. Approximately 32 cents were spent on Ready for Recess to produce an additional MET‐hour per student per school day in the 2008‐2009 school year. CONCLUSIONS Ready for Recess was cost‐effective in its first year of implementation using 35 cents as a benchmark and it was cost‐effective relative to other school‐based physical activity interventions. The program may be more cost‐effective if implemented for a longer time and on a larger scale.

  March 05, 2017   doi: 10.1111/josh.12495   open full text
• Aggressive and Violent Behavior and Emotional Self‐Efficacy: Is There a Relationship for Adolescents?
  Robert F. Valois, Keith J. Zullig, Asa A. Revels.
  Journal of School Health / The Journal of School Health. March 05, 2017
  BACKGROUND In this cross‐sectional study we explored relationships between aggressive and violent behaviors and emotional self‐efficacy (ESE) in a statewide sample of public high school adolescents in South Carolina (N = 3836). METHODS The US Centers for Disease Control and Prevention Youth Risk Behavior Survey items on aggressive and violent behavior items and an adolescent ESE scale were used. Logistic regression analyses and multivariate models constructed separately, revealed significant race by sex findings. RESULTS Results suggest that carrying a weapon to school (past 30 days) and being threatened or injured with a gun, knife, or club at school (past 12 months) were significantly associated (p < .05) with reduced ESE for specific race/sex groups. CONCLUSIONS Results have implications for school‐ and community‐based mental health services and social and emotional learning and aggression/violence prevention programs for adolescents. Measures of ESE as a component of comprehensive assessments of adolescent mental health, social and emotional learning and aggressive/violent behaviors in fieldwork, research, and program‐evaluation efforts should be considered.

  March 05, 2017   doi: 10.1111/josh.12493   open full text
• Sexuality and HIV Education in Charter Schools: An Exploratory Study With Principals in San Diego County, California.
  Eric R. Walsh‐Buhi, Brandon Dao, Linda Salgin, James Marshall, Rachel Miller, Doug Fisher, Margaret Walsh‐Buhi.
  Journal of School Health / The Journal of School Health. March 05, 2017
  BACKGROUND Schools can address critical sexual and reproductive health (SRH) issues among youth. However, little is known about SRH education being implemented in charter schools. Thus, our purpose was to explore implementation of SRH education in charter schools. METHODS Using purposive sampling, semistructured telephone interviews were conducted with 20 charter school principals in San Diego County, California. Questions were guided by the Kaiser Family Foundation National Survey of Public Secondary School Principals. Analyses followed a case‐oriented approach, examining aspects within each case (ie, a principal), and then a comparative analysis of a small number of cases (ie, all principals). RESULTS Overall, 17 principals acknowledged offering sexuality education in the previous 2 years. Over half of these schools had provided content on: sexually transmitted diseases/human immunodeficiency virus/acquired immune deficiency syndrome (STDs/HIV/AIDS), reproduction/pregnancy/birth, pregnancy prevention methods, delaying sex, and managing sexual pressure. Condom use, sexual assault, sexual orientation, talking with partners about STD/pregnancy prevention, talking with parents about relationships/sex, and using/where to get contraception were less commonly taught. Abortion was not addressed. When asked the grade they would assign to their schools' sexuality/HIV instruction, principals assigned 1 A, 7 Bs, 7 Cs, and 1 D. CONCLUSIONS Consistency between our findings and what has been reported elsewhere varies. As charter schools often have greater curricular flexibility than traditional schools, this study provides unique preliminary data to inform future innovative, or strengthen existing, SRH programming.

  March 05, 2017   doi: 10.1111/josh.12492   open full text
• Analyzing Who, When, and Where: Data for Better Targeting of Resources for School‐Based Asthma Interventions.
  Loren H. Raun, Laura A. Campos, Elizabeth Stevenson, Katherine B. Ensor, Gwen Johnson, David Persse.
  Journal of School Health / The Journal of School Health. March 05, 2017
  BACKGROUND Rates of uncontrolled asthma vary by demographics, space, and time. This article uses data on ambulance‐treated asthma attacks in children to analyze these variations so that school districts can improve their asthma management interventions. METHODS Incidence rates of 1826 ambulance‐treated asthma attacks for children aged 5‐18 years were calculated for school zones for elementary, middle, and high schools in the Houston (Texas) Independent School District (HISD). Zones with rates in the upper quartile were identified as the highest rate zones and were compared with other school zones in the district by demographics, location, and timing of attacks. RESULTS The ambulance‐treated asthma rate was respectively 5, 3, and 2 times greater in the highest rate school zones compared with all other school zones for those school levels. Ambulance‐treated asthma attacks in the high‐rate school zones occurred most at midday and in the evening and high‐rate zones were often geographically contiguous. Schools in the high‐rate zones had a higher percent of socioeconomically disadvantaged students and were more often without a school nurse. CONCLUSION Spatial and temporal analysis of ambulance data can be valuable tools for schools to focus policy and program interventions for the students in need of improved asthma management.

  March 05, 2017   doi: 10.1111/josh.12494   open full text
• Ten‐Year Secular Trends in Youth Violence: Results From the Philadelphia Youth Risk Behavior Survey 2003‐2013.
  Andrew C. Pool, Freda Patterson, Ingrid Y. Luna, Bernadette Hohl, Katherine W. Bauer.
  Journal of School Health / The Journal of School Health. March 05, 2017
  BACKGROUND Youth violence reduction is a public health priority, yet few studies have examined secular trends in violence among urban youth, who may be particularly vulnerable to numerous forms of violence. This study examines 10‐year secular trends in the prevalence of violence‐related behaviors among Philadelphia high school students. METHODS Repeated cross‐sectional data were analyzed from 5 waves of the Philadelphia Youth Risk Behavior Survey (YRBS) from 2003 to 2013. Sex‐specific multivariate regression models were used to examine secular trends in multiple types of violence, accounting for age, race/ethnicity, and sampling strategy. RESULTS In 2013, the most prevalent violent behavior was physical fighting among boys (38.4%) and girls (32.7%). Among girls, the prevalence of sexual assault and suicide attempts declined between 2003 and 2013 (β = −0.13, p = .04 and β = −0.14, p = .007, respectively). Among boys, significant declines in carrying a weapon (β = −0.31, p < .001), carrying a gun (β = −0.16, p = .01), and physical fighting (β = −0.35, p = .001) were observed. CONCLUSIONS Whereas the prevalence of some forms of violence stabilized or declined among Philadelphia youth during 2003‐2013 time span, involvement in violence‐related behaviors remains common among this population. Continued surveillance and evidence‐based violence reduction strategies are needed to address violence among urban youth.

  March 05, 2017   doi: 10.1111/josh.12491   open full text
• Association of Self‐Perceived Physical Competence and Leisure‐Time Physical Activity in Childhood—A Follow‐Up Study.
  Lotta Hamari, Olli J. Heinonen, Minna Aromaa, Riitta Asanti, Leena Koivusilta, Pasi Koski, Camilla Laaksonen, Jaakko Matomäki, Katja Pahkala, Anni Pakarinen, Sakari Suominen, Sanna Salanterä.
  Journal of School Health / The Journal of School Health. March 05, 2017
  BACKGROUND The basis of self‐perceived physical competence is built in childhood and school personnel have an important role in this developmental process. We investigated the association between initial self‐perceived physical competence and reported leisure‐time physical activity (LTPA) longitudinally in 10‐, 12‐, and 15‐year‐old children. METHODS This longitudinal follow‐up study comprises pupils from an elementary school cohort (N = 1346) in the city of Turku, Finland (175,000 inhabitants). The self‐perceived physical competence (fitness and appearance) and LTPA data were collected with questionnaires. The full longitudinal data were available from 571 pupils based on repeated studies at the ages of 10, 12, and 15 years in 2004, 2006, and 2010. We analyzed the association of self‐perceived physical competence and LTPA using regression models. RESULTS Self‐perceived physical competence was positively associated with LTPA at all ages (10 years p < .05, 12 years p < .0001, 15 years p < .0001). Increase in the self‐perceived physical fitness scores was likely to associate with higher LTPA at each age point (10 years [odds ratio, OR] = 1.18, 95% confidence interval, CI: 1.09‐1.27; 12 years [OR] = 1.27, 95% CI: 1.18‐1.37; and 15 years [OR] = 1.28, 95% CI: 1.19‐1.38). CONCLUSIONS Self‐perceived physical competence is associated with LTPA in children and adolescents, and the association is strengthened with age.

  March 05, 2017   doi: 10.1111/josh.12490   open full text
• Demographic Differences in District‐Level Policies Related to School Mental Health and Social Services—United States, 2012.
  Zewditu Demissie, Nancy Brener.
  Journal of School Health / The Journal of School Health. March 05, 2017
  BACKGROUND Mental health conditions among youth are a major concern. Schools can play an important role in supporting students affected by these conditions. This study examined district‐level school health policies related to mental health and social services to determine if they varied by district demographic characteristics. METHODS The School Health Policies and Practices Study (SHPPS) 2012 collected cross‐sectional data on school health policies and practices from a nationally representative sample of public school districts (N = 684). We used logistic regression to examine the association between district‐level demographic characteristics and school mental health policies. RESULTS Southern and low‐affluence districts had higher odds of requiring schools to have a specified counselor‐to‐student ratio as compared with Northeastern and average affluence districts, respectively. Northeastern and urban districts had higher odds of requiring educational and credentialing requirements for school mental health or social services staff, compared to other regions and rural districts, respectively. CONCLUSIONS Results describe the extent to which school mental health and social services programs in the United States are meeting various guidelines. More work is necessary to ensure that all schools have the resources needed to support their students' mental health and meet national guidelines, especially in districts with certain characteristics.

  March 05, 2017   doi: 10.1111/josh.12489   open full text
• Mediating Effect of Body Image Distortion on Weight Loss Efforts in Normal‐Weight and Underweight Korean Adolescent Girls.
  Jeong‐Sil Choi, Ji‐Soo Kim.
  Journal of School Health / The Journal of School Health. February 01, 2017
  BACKGROUND We explored the relationship between body mass index‐for‐age percentile, body image distortion, and unnecessary weight loss efforts in Korean adolescent girls who are underweight and normal weight and examined the mediating effect of body image distortion on weight loss efforts. METHODS This study used data from the 2013 Korea Youth Risk Behavior Web‐based Survey conducted by the Korea Centers for Disease Control and Prevention. The study sample comprised 29,633 Korean adolescent girls who are normal weight and underweight. Chi‐square tests and correlations were used to assess bivariate relationships between the variables. To assess the mediating effect of body image distortion on the relationship between body mass index‐for‐age percentile and weight loss efforts, a 3‐step regression analysis was used. RESULTS There was a significant correlation between body mass index‐for‐age percentiles and body image distortion, and both significantly correlated with weight loss efforts. In addition, a distorted perception of being overweight or obese was a significant mediating variable. CONCLUSIONS School‐based health education and intervention programs are needed to promote the formation of a positive body image, not only for obese adolescents, but also for normal‐weight and underweight adolescent girls.

  February 01, 2017   doi: 10.1111/josh.12483   open full text
• Social and Economic Impacts of School Influenza Outbreaks in England: Survey of Caregivers.
  Dominic Thorrington, Sooria Balasegaram, Paul Cleary, Catherine Hay, Ken Eames.
  Journal of School Health / The Journal of School Health. February 01, 2017
  BACKGROUND Influenza is a cause of considerable morbidity in England, particularly among children. A total of 39% of all influenza‐attributable general practitioner consultations and 37% of all influenza‐attributable hospital admissions occur in those aged under 15 years. Few studies have quantified the impact of influenza outbreaks on families. We assessed this impact during 2 influenza seasons. METHODS We used questionnaires to obtain data in primary schools that reported an outbreak of an influenza‐like‐illness (ILI). We sought data on the loss of productivity, costs borne by families and loss in health‐related quality of life (HRQoL). ILIs were identified using the symptoms criteria from the European Centre for Disease Prevention and Control and the UK Flusurvey. RESULTS For each child reporting ILI, mean school absence was 3.8 days (95% confidence interval [CI]): 3.0‐4.8) with mean work absence for caregivers reported as 3.7 days (95% CI: 2.7‐4.8). The mean loss in HRQoL was 2.1 quality‐adjusted life days (95% CI: 1.5‐2.7). The estimated total pediatric burden of disease for reported school‐based outbreaks during the 2 influenza seasons was 105.3 QALYs (95% CI: 77.7‐139.0). CONCLUSIONS This study shows the potential social and economic benefit of vaccination of children during mild influenza seasons.

  February 01, 2017   doi: 10.1111/josh.12484   open full text
• Age of Sexual Debut and Physical Dating Violence Victimization: Sex Differences Among US High School Students.
  Timothy O. Ihongbe, Susan Cha, Saba W. Masho.
  Journal of School Health / The Journal of School Health. February 01, 2017
  BACKGROUND Research has shown that early age of sexual debut is associated with physical dating violence (PDV), but sex‐specific associations are sparse. We estimated the prevalence of PDV victimization in high school students who have initiated sexual intercourse and examined sex‐specific association between age of sexual debut and PDV victimization. METHODS Data on 8637 students in grades 9 through 12 who had initiated sex was obtained from the 2009‐2011 national Youth Risk Behavior Survey. The association was examined using multiple logistic regression, accounting for the complex survey design, and stratified by sex. RESULTS Approximately 15% of sexually active students reported past‐year PDV victimization. The odds of PDV victimization among girls who had sexual debut at <12 years was 2.46 (95% CI = 1.50‐4.02) and 2.20 (95% CI = 1.42‐3.41) for boys, compared to those who initiated sex at 16 years and older. CONCLUSIONS Evidence supports the belief that early sexual debut is associated with higher odds of PDV victimization, particularly for girls. Healthcare providers, school counselors, and educators should be aware of this sex difference in the association between early sexual debut age and PDV victimization while focusing PDV interventions on adolescents with early sexual debut age.

  February 01, 2017   doi: 10.1111/josh.12485   open full text
• Preschool Daily Patterns of Physical Activity Driven by Location and Social Context.
  Chelsey R. Schlechter, Richard R. Rosenkranz, Bronwyn S. Fees, David A. Dzewaltowski.
  Journal of School Health / The Journal of School Health. February 01, 2017
  BACKGROUND Preschool children are recommended to spend at least 15 minutes/hour (25% time) in light‐to‐vigorous physical activity (total physical activity, TPA). Preschool provider practices, such as whether children are put in small group or whole‐group activities, are likely to affect children's TPA levels during preschool. The current study characterized the pattern of physical activity across the preschool day, and examined the relationship of location and social arrangement to TPA. METHODS Fifteen days from 8 preschool classrooms in 2 preschool centers were video‐recorded, and children (N = 73, age = 3‐6 years, M = 4.36 ± 0.85, Boys = 47%) wore accelerometers for the duration of the preschool day. We observed contextual variables of time (ie, morning or afternoon), location (ie, indoor or outdoor), and for a subsample, social arrangement (ie, activity centers, small group, whole group). RESULTS Across the whole day, children spent 69.5 ± 12.4% time sedentary/inactive and 30.5 ± 13.5% time in TPA. Children spent a significantly greater percentage of time in TPA outdoors, compared to indoors (t = 10.00, p < .001), and while in small groups compared to whole groups (t = 3.35, p = .009). CONCLUSION Children spent approximately 30% of the preschool day in TPA. Providing more time outdoors and restructuring preschool activities from whole group to small group could increase the amount of TPA that children accumulate during preschool.

  February 01, 2017   doi: 10.1111/josh.12486   open full text
• Combined Patterns of Risk for Problem and Obesogenic Behaviors in Adolescents: A Latent Class Analysis Approach.
  Sasha A. Fleary.
  Journal of School Health / The Journal of School Health. February 01, 2017
  BACKGROUND Several studies have used latent class analyses to explore obesogenic behaviors and substance use in adolescents independently. We explored a variety of health risks jointly to identify distinct patterns of risk behaviors among adolescents. METHODS Latent class models were estimated using Youth Risk Behavior Surveillance System (YRBSS) 2011 data. Behaviors in the models included substance use, physical fights, physical activity (PA), sedentary activity, sleep, fruit and vegetables (F&V) consumption, and weight‐related variables. Models were estimated separately by sex. Constrained and unconstrained models were computed for race. Age and perceived and calculated weight status were compared among emergent latent classes using latent multinomial logistic regressions. RESULTS Four and 5 latent class solutions emerged for boys and girls, respectively. Healthy, sedentary, and physically active (PA) groups were common in both boys and girls. The sample of boys also included a health risk behavior (HRB)/PA group and the sample of girls included HRB and HRB/F&V groups. CONCLUSIONS The results confirm that obesogenic and HRBs should be conceptualized as combined patterns of risk. Health education programming in schools should adopt a multiple health behavior approach to target the continuum of risks adolescents engage in simultaneously.

  February 01, 2017   doi: 10.1111/josh.12481   open full text
• A Multilevel, Statewide Investigation of School District Anti‐Bullying Policy Quality and Student Bullying Involvement.
  Amy L. Gower, Molly Cousin, Iris W. Borowsky.
  Journal of School Health / The Journal of School Health. February 01, 2017
  BACKGROUND Although nearly all states in the United States require school districts to adopt anti‐bullying policies, little research examines the effect of these policies on student bullying and health. Using a statewide sample, we investigated associations between the quality of school district anti‐bullying policies and student bullying involvement and adjustment. METHODS School district anti‐bullying policies (N = 208) were coded for their quality based on established criteria. District‐level data were combined with student reports of bullying involvement, emotional distress, and school connectedness from a state surveillance survey of 6th, 9th, and 12th grade students (N = 93,437). RESULTS Results indicated that policy quality was positively related to bullying victimization. Furthermore, students reporting frequent perpetration/victimization who also attended districts with high‐quality policies reported more emotional distress and less school connectedness compared with students attending districts with low quality policies. Although statistically significant, the magnitude of these associations was small. CONCLUSIONS Having a high‐quality school district anti‐bullying policy is not sufficient to reduce bullying and protect bullying‐involved young people. Future studies examining policy implementation will inform best practices in bullying prevention.

  February 01, 2017   doi: 10.1111/josh.12480   open full text
• Investigating How to Align Schools' Marketing Environments With Federal Standards for Competitive Foods.
  Michele Polacsek, Liam M. O'Brien, Elizabeth Pratt, Janet Whatley‐Blum, Sabrina Adler.
  Journal of School Health / The Journal of School Health. February 01, 2017
  BACKGROUND Limiting food and beverage marketing to children is a promising approach to influence children's nutrition behavior. School‐based marketing influences nutrition behavior and studies have consistently found marketing for nonnutritious foods and beverages in schools. No studies have examined the resources necessary to align school marketing environments with federal school nutrition standards. The purpose of this study was to determine how to improve school marketing environments so that they align with new federal competitive food nutrition standards. METHODS We assessed food marketing environments in 3 Portland, Maine schools using the Food and Beverage Marketing Survey (FBMS) and provided technical assistance to bring their marketing environments into conformity with the federal competitive food regulations, tracking resources and strategies for marketing removal. RESULTS Noncompliant marketing was significantly reduced pre‐ to postintervention. Intervention strategies were facilitated by the School Health Coordinator and school‐based wellness teams. CONCLUSIONS Low monetary resources were required to remove marketing not compliant with federal nutrition standards for foods sold in schools. Several key challenges remain to sustain efforts. This study provides timely information for policymakers to support crafting policies that address the realities of school nutrition environments and universal enforcement challenges.

  February 01, 2017   doi: 10.1111/josh.12488   open full text
• School and Parent Factors Associated With Steroid Use Among Adolescents.
  Rebecca L. Elkins, Keith King, Laura Nabors, Rebecca Vidourek.
  Journal of School Health / The Journal of School Health. February 01, 2017
  BACKGROUND Steroid use among adolescents is an increasing health concern. Literature examining factors related to steroid use is limited. METHODS We investigated steroid use among 9th through 12th grade adolescents in the Greater Cincinnati area. A total of 38,414 adolescents completed the PRIDE Questionnaire. Associations between demographics, school factors, parent factors, sport participation, and steroid use were examined. RESULTS A total of 2.6% of adolescents reported using steroids in the past year. Most prevalent was steroid use among male, Junior/Senior, African‐American, and Hispanic adolescents. Rates of steroid use differed significantly based on school and parent factors, but not sport participation. Adolescents who reported attendance at schools that frequently set and enforced rules for drug use or whose parents frequently set rules for drug use were at decreased odds for steroid use. School communication about drug use was negatively associated with steroid use. CONCLUSIONS School administration and staff, as well as parents, are uniquely positioned to deter steroid use among adolescents. Findings suggest that limiting steroid screening to student athletes might miss a substantial proportion of the population at risk. Thus, broad‐based screening and prevention programs may be more effective than programs targeting student athletes alone.

  February 01, 2017   doi: 10.1111/josh.12482   open full text
• Frequency of Guns in the Households of High School Seniors.
  Ann L. Coker, Heather M. Bush, Diane R. Follingstad, Candace J. Brancato.
  Journal of School Health / The Journal of School Health. February 01, 2017
  BACKGROUND In 2013, President Obama lifted the federal ban on gun violence research. The current study provides one of the first reports to estimate household gun ownership as reported by youth. METHODS In this cohort study of 3006 high school seniors from 24 schools, we examined the frequency of household guns ownership. RESULTS About 65% reported having at least 1 gun in their household. White males were more likely to have a gun and to have more guns than other demographically characterized groups. After adjustment for race and sex, those of higher income, who lived in suburban or rural areas, identified as being exclusively attracted to the opposite sex, and in a romantic relationship, were more likely to have a gun in their household. Having a gun was not associated with increasing symptoms of depression or current poor physical or mental health. CONCLUSIONS Whereas we cannot determine gun types or reasons for having a gun, this research indicates that high school seniors are aware of and may have access to guns for use other than their intended purpose. Household gun ownership among students at higher risk for violence may pose safety challenges for communities and schools.

  February 01, 2017   doi: 10.1111/josh.12479   open full text
• The Association Between Electronic Bullying and School Absenteeism Among High School Students in the United States.
  Erin Grinshteyn, Y. T. Yang.
  Journal of School Health / The Journal of School Health. January 11, 2017
  BACKGROUND We examined the relationship between exposure to electronic bullying and absenteeism as a result of being afraid. METHODS This multivariate, multinomial regression analysis of the 2013 Youth Risk Behavior Survey data assessed the association between experiencing electronic bullying in the past year and how often students were absent in the last month due to feeling unsafe at/in transit to school. The model controlled for other predictors of school absence including demographics, physical/behavioral health, and risk factors. Missing data were multiply imputed. RESULTS Electronic bullying was significantly associated with absences. Controlling for model covariates, the relative risk of missing 1 day of school was 1.77 times higher, the relative risk of missing 2 to 3 days of school per month increased by a factor of 2.08, and the relative risk of missing 4 or more days of school per month increased by a factor of 1.77 for those who experienced electronic bullying in the past year compared with those who were not electronically bullied. CONCLUSIONS Electronic bullying's association with absenteeism places it among already recognized negative influences such as depression and binge drinking, necessitating schools to implement policies to mediate the resulting harmful effects.

  January 11, 2017   doi: 10.1111/josh.12476   open full text
• Use of Treatment and Counseling Services and Mind‐Body Techniques by Students With Emotional and Behavioral Difficulties.
  Wasantha Jayawardene, Ryan Erbe, David Lohrmann, Mohammad Torabi.
  Journal of School Health / The Journal of School Health. January 11, 2017
  BACKGROUND School‐based treatment and counseling services (TCSs) can integrate mind‐body techniques (MBTs) to improve children's health, wellness, and academic performance. We aimed to describe the effect of school‐based TCS on MBT‐use among students experiencing difficulties with concentration, emotions, behaviors, and getting along (DCEBG). METHODS National Health Interview Survey data were utilized (N2007 = 1225; N2012 = 1835). Logistic regression examined associations between TCS‐type and MBT‐use, while propensity score matching controlled for confounders in the prematch sample. RESULTS Compared with children without DCEBG, MBT‐use was higher among children with DCEBG, but it decreased from 2007 (9.7%) to 2012 (5.1%). Receipt of school‐based TCS increased from 2007 (11.3%) to 2012 (33.9%). Receipt of school‐only TCS, compared with nonschool‐only TCS, was associated with lower MBT‐use (OR2007 = 0.20; OR2012 = 0.54). After matching, this difference remained for 2007 (tprematch = −2.77; tpostmatch = −2.00), but not 2012 (tprematch = −2.53; tpostmatch = −0.88). School‐only TCS‐use increased with family activity limitations; in 2012, it decreased with higher parental education. Mind‐body techniques‐use was higher in girls and associated with higher parental education and family activity limitations. CONCLUSIONS While the relative increase of MBT integration by school‐based TCS is commendable and further encouraged, school mental health practitioners should account for the differential effects of family‐level factors on TCS‐choice and MBT‐use.

  January 11, 2017   doi: 10.1111/josh.12475   open full text
• How Schools Can Promote Healthy Development for Newly Arrived Immigrant and Refugee Adolescents: Research Priorities.
  Clea A. McNeely, Lyn Morland, S. Benjamin Doty, Laurie L. Meschke, Summer Awad, Altaf Husain, Ayat Nashwan.
  Journal of School Health / The Journal of School Health. January 11, 2017
  BACKGROUND The US education system must find creative and effective ways to foster the healthy development of the approximately 2 million newly arrived immigrant and refugee adolescents, many of whom contend with language barriers, limited prior education, trauma, and discrimination. We identify research priorities for promoting the school success of these youth. METHODS The study used the 4‐phase priority‐setting method of the Child Health and Nutrition Research Initiative. In the final stage, 132 researchers, service providers, educators, and policymakers based in the United States were asked to rate the importance of 36 research options. RESULTS The highest priority research options (range 1 to 5) were: evaluating newcomer programs (mean = 4.44, SD = 0.55), identifying how family and community stressors affect newly arrived immigrant and refugee adolescents' functioning in school (mean = 4.40, SD = 0.56), identifying teachers' major stressors in working with this population (mean = 4.36, SD = 0.72), and identifying how to engage immigrant and refugee families in their children's education (mean = 4.35, SD = 0.62). CONCLUSION These research priorities emphasize the generation of practical knowledge that could translate to immediate, tangible benefits for schools. Funders, schools, and researchers can use these research priorities to guide research for the highest benefit of schools and the newly arrived immigrant and refugee adolescents they serve.

  January 11, 2017   doi: 10.1111/josh.12477   open full text
• Evaluating Active Parental Consent Procedures for School Programming: Addressing the Sensitive Topic of Suicide Prevention.
  Christine M. Wienke Totura, Krista Kutash, Christa D. Labouliere, Marc S. Karver.
  Journal of School Health / The Journal of School Health. January 11, 2017
  BACKGROUND Suicide is the second leading cause of death for adolescents. Whereas school‐based prevention programs are effective, obtaining active consent for youth participation in public health programming concerning sensitive topics is challenging. We explored several active consent procedures for improving participation rates. METHODS Five active consent methods (in‐person, students taking forms home, mailing, mailing preceded by primers, mailing followed by reminder calls) were compared against passive consent procedures to evaluate recruitment success, as determined by participation (proportion who responded yes) and response (proportion who returned any response) rates. RESULTS Participation acceptance rates ranged from 38 to 100% depending on consent method implemented. Compared with passive consent, active consent procedures were more variable in response and participation rates. In‐person methods provided higher rates than less interpersonal methods, such as mailing or students taking consents home. Mailed primers before or reminder calls after consent forms were mailed increased response but not participation rates. Students taking consents home resulted in the lowest rates. CONCLUSIONS Although passive consent produces the highest student participation, these methods are not always appropriate for programs addressing sensitive topics in schools. In‐person active consent procedures may be the best option when prioritizing balance between parental awareness and successful student recruitment.

  January 11, 2017   doi: 10.1111/josh.12473   open full text
• Classroom Nutrition Education Combined With Fruit and Vegetable Taste Testing Improves Children's Dietary Intake.
  Abby Gold, Mary Larson, Jared Tucker, Michelle Strang.
  Journal of School Health / The Journal of School Health. January 11, 2017
  BACKGROUND We tested the effectiveness of the Go Wild With Fruits and Veggies! (GWWFV) Extension curriculum on increasing fruit and vegetable (FV) intake of third graders. METHODS An intervention study was used testing self‐reported FV intake pre/post GWWFV. Recruited schools were randomized to control (12 schools, N = 369, third grade children) or intervention (14 schools, N = 378, third grade children). Measures included items from a validated FV food frequency survey. Access to the federal Fresh Fruit and Vegetable Snack Program (FFVSP), and taste testing within GWWFV were also measured. Between‐group differences in FV intake were evaluated using 1‐way ANOVA for unadjusted models and 1‐way ANCOVA for baseline adjusted models. The Tukey‐Kramer test was employed for post hoc comparisons. RESULTS Students with access to the FFVSP consumed more fruits (p < .01) and vegetables (p < .0001). Students who participated in the FFVSP and GWWFV with taste testing consumed more fruits and vegetables (p < .05) compared with students who participated in the FFVSP and GWWFV without taste testing, along with the control group. CONCLUSIONS The FFVSP and GWWFV with taste testing demonstrated a positive influence on FV intake in third grade children. Leveraging environmental approaches with interactive learning experiences create desired outcomes.

  January 11, 2017   doi: 10.1111/josh.12478   open full text
• Healthy Concessions: High School Students' Responses to Healthy Concession Stand Changes.
  Helena H. Laroche, Christine Hradek, Kate Hansen, Andrew S. Hanks, David R. Just, Brian Wansink.
  Journal of School Health / The Journal of School Health. January 11, 2017
  BACKGROUND A previous sales data analysis demonstrated success in selling healthier items at a concession stand. Questions remained regarding student satisfaction and whether the intervention reached non‐health‐conscious students. METHODS Cross‐sectional anonymous samples of students at a large midwestern high school were surveyed before and after an intervention improved the number of healthier items available at the concession stand. RESULTS The survey was completed by 301 students preintervention and 314 students postintervention. Satisfaction remained good (3.7 preintervention and 3.6 postintervention). Satisfaction with the variety and taste of foods increased. We compared students who felt having healthy items were important at the concessions to those who did not. Overall satisfaction with concessions did not differ between groups. The latter group (healthy items not important) reported improved satisfaction with food variety (2.8 to 3.1, p = .02) and the former reported improved satisfaction with healthy foods (2.5 to 2.9, p = .03) and overall taste (3.2 to 3.4, p = .02). Of the healthy items not important students 76% reported purchasing at least 1 new healthier food. CONCLUSIONS Adding healthier foods to school concession stands has positive effects on student satisfaction, sales, and reaches all students whether or not they care about having healthy items available.

  January 11, 2017   doi: 10.1111/josh.12472   open full text
• Disparities in Supports for Student Wellness Promotion Efforts Among Secondary Schools in Minnesota.
  Nicole Larson, Michael O'Connell, Cynthia S. Davey, Caitlin Caspi, Martha Y. Kubik, Marilyn S. Nanney.
  Journal of School Health / The Journal of School Health. January 11, 2017
  BACKGROUND We examined whether there are differences in the presence of supports for student wellness promotion (1) between schools in city, suburban and rural locations and, (2) among rural schools, according to distance from a metropolitan center. METHODS The analysis was conducted in a sample of 309 secondary schools using 2012 Minnesota School Health Profiles surveys and National Center for Educational Statistics Common Core Data. Scores for overall support addressed school health improvement coordination (range: 0‐29), collaboration on health education activities (range: 0‐5), and teachers' professional preparation (range: 0‐7). RESULTS Mean overall scores for health improvement coordination (10.5 ± 7.3), collaboration on health education activities (3.0 ± 1.5) and professional preparation (4.0 ± 1.9) indicated supports are lacking in schools across city, suburban, and rural locations. Comparison of overall scores did not identify disparities; however, weaknesses and strengths of particular relevance for rural schools were identified in examining specific aspects of support. For example, the proportion of rural schools having a written school improvement plan was 54.8% compared to 84.6% of city schools and 64.3% of suburban schools (p = .01). CONCLUSIONS Tailored training and technical assistance are needed to better support schools in implementing recommended wellness policies and practices.

  January 11, 2017   doi: 10.1111/josh.12471   open full text
• Effectiveness of IMPACT:Ability to Improve Safety and Self‐Advocacy Skills in Students With Disabilities—Follow‐Up Study.
  Eileen M. Dryden, Jeffrey Desmarais, Lisa Arsenault.
  Journal of School Health / The Journal of School Health. January 11, 2017
  BACKGROUND Research shows that individuals with disabilities are more likely to experience abuse than their peers without disabilities. Yet, few evidenced‐based abuse prevention interventions exist. This study examines whether positive outcomes identified previously in an evaluation of IMPACT:Ability were maintained 1 year later. METHODS A survey measuring safety and self‐advocacy knowledge, confidence, and behaviors among special education high‐school students was administered 12 months post‐training. Paired samples t‐tests were used to compare baseline to follow up and postsurvey to follow up and repeated measures analyses were conducted to test the effect of time across the 3 time points (baseline, post, and 1‐year follow up) (N = 47). RESULTS Follow‐up study participants had a range of disabilities, just over half were boys, and most were either black or Latino/Hispanic. Difference between scores at baseline and follow‐up for all the measures of interest represented gains from baseline. Statistically significant post‐training improvements in participants' safety and self‐advocacy knowledge and confidence were maintained 1‐year later. CONCLUSIONS These results provide additional support for the case that IMPACT:Ability is a promising safety and self‐advocacy training program for diverse groups of students with disabilities.

  January 11, 2017   doi: 10.1111/josh.12474   open full text
• School‐Based Positive Youth Development: A Systematic Review of the Literature.
  Tess Curran, Lisa Wexler.
  Journal of School Health / The Journal of School Health. December 04, 2016
  BACKGROUND The values, perspectives, and behavior patterns that begin in adolescence can continue throughout one's life. Because of these lifetime effects, much research has focused on adolescent risk and prevention, but a new body of knowledge investigates protective factors and strengths. Positive youth development (PYD) increases internal and external assets during adolescence and is often based within communities. This review, however, focuses on school‐based PYD interventions because these institutions are the largest youth‐serving institutions in the country. METHODS This review considered 711 PYD school‐based programs found using 4 databases. We included articles published after 2000, and did not review those reporting on regular school curriculum or activities. RESULTS The 24 remaining articles describe PYD programs that fall under 3 general categories: curriculum‐based, leadership development, and student‐based mentorship programs. CONCLUSIONS Evaluations indicate that programs increase intrapsychic measures of well‐being in youth as well as social confidence and healthy behaviors. However, it is important to not only include “at‐risk” persons in programming, because a mixed group of young people encourages a more positive peer‐to‐peer climate. In addition, peer mentorship activities should be actively facilitated by an adult supervisor to ensure positive communication and trust between the mentor and mentee.

  December 04, 2016   doi: 10.1111/josh.12467   open full text
• To Consent or Decline HPV Vaccination: A Pilot Study at the Start of the National School‐Based Vaccination Program in Sweden.
  Maria Grandahl, Tanja Tydén, Ragnar Westerling, Tryggve Nevéus, Andreas Rosenblad, Erik Hedin, Marie Oscarsson.
  Journal of School Health / The Journal of School Health. December 04, 2016
  BACKGROUND Parents' beliefs about human papillomavirus (HPV) vaccination influence whether they allow their daughters to be vaccinated. We examined the association between parents' refusal and sociodemographic background, knowledge and beliefs about HPV, and the HPV vaccination in relation to the Health Belief Model. METHODS The sample consisted of 200 (55%) parents of children aged 11‐12 years in the Swedish national vaccination program. Data were collected using a self‐reported questionnaire. Most parents (N = 186) agreed to the vaccination. Pearson's chi‐square, Fisher's exact test, and the Mann‐Whitney U test were used to analyze data. RESULTS Declining parents saw more risks and fewer benefits of HPV vaccination but no differences in beliefs regarding the severity or young girls' susceptibility to HPV were found. There was an association between refusing the HPV vaccine and lower acceptance of previous childhood vaccinations, and their main source of information was the Internet. Parents who declined the vaccine believed it could adversely affect condom use, the age of their daughter's sexual debut, and the number of sexual partners. CONCLUSION Parents should have the possibility to discuss HPV and HPV vaccine with a school nurse or other health care professionals, and should have access to evidence‐based information on the Internet.

  December 04, 2016   doi: 10.1111/josh.12470   open full text
• It Takes a Village: Promoting Parent and Family Education on Healthy Lifestyles for Minnesota Secondary Students.
  Mary O. Hearst, Qi Wang, Katherine Grannon, Cynthia S. Davey, Marilyn S. Nanney.
  Journal of School Health / The Journal of School Health. December 04, 2016
  BACKGROUND This study examines school strategies to educate parents over time about physical activity and nutrition and how those strategies are related to adolescent health behaviors. METHODS Data from the Minnesota School Health Profiles Lead Health Education Teacher survey (2008‐2012) and the Minnesota Student Survey (MSS, 2013) included provisions for parent education about physical activity and nutrition and student physical activity and dietary intake behaviors. Analyses were performed using SAS, version 9.3. A generalized estimating equation (GEE) was used to examine changes over time in school policies. Adjusted linear regression models examined cross‐sectional association between school policies (2012) and school‐level mean student outcomes (2013). RESULTS Parent education about physical activity and nutrition was constant over time, with the exception of a decrease in physical activity education in schools with low minority enrollment. There was a positive relationship between schools offering physical activity education for parents and the number of days a student meets physical activity and water consumption recommendations. There was no relationship between strategies for nutrition education and dietary intake. CONCLUSIONS School providing strategies for parent engagement around student physical activity and nutrition may increase parent engagement overall and improve adolescent and school‐related outcomes.

  December 04, 2016   doi: 10.1111/josh.12468   open full text
• Ethnic Disparities in School‐Based Behavioral Health Service Use for Children With Psychiatric Disorders.
  Jill Locke, Christina D. Kang‐Yi, Melanie Pellecchia, Steven Marcus, Trevor Hadley, David S. Mandell.
  Journal of School Health / The Journal of School Health. December 04, 2016
  BACKGROUND We examined racial/ethnic disparities in school‐based behavioral health service use for children with psychiatric disorders. METHODS Medicaid claims data were used to compare the behavioral healthcare service use of 23,601 children aged 5‐17 years by psychiatric disorder (autism, attention deficit hyperactivity disorder [ADHD], conduct/oppositional defiant disorder, and “other”) and by race/ethnicity (African‐American, Hispanic, white, and other). Logistic and generalized linear regression analyses were used. RESULTS Differences in service use by racial/ethnic group were identified within and across diagnostic groups, both for in‐school service use and out‐of‐school service use. For all disorders, Hispanic children had significantly lower use of in‐school services than white children. Among children with ADHD, African‐American children were less likely to receive in‐school services than white children; however, there were no differences in adjusted annual mean Medicaid expenditures for in‐school services by race/ethnicity or psychiatric disorders. Statistically significant differences by race/ethnicity were found for out‐of‐school service use for children with ADHD and other psychiatric disorders. There were significant differences by race/ethnicity in out‐of‐school service use for each diagnostic group. CONCLUSIONS Differences in the use of school‐based behavioral health services by racial and ethnic groups suggest the need for culturally appropriate outreach and tailoring of services to improve service utilization.

  December 04, 2016   doi: 10.1111/josh.12469   open full text
• RE‐AIM Analysis of a School‐Based Nutrition Education Intervention in Kindergarteners.
  Andrew L. Larsen, Yue Liao, Janel Alberts, Jimi Huh, Trina Robertson, Genevieve F. Dunton.
  Journal of School Health / The Journal of School Health. December 04, 2016
  BACKGROUND Few nutrition interventions in kindergarten classes have been evaluated, and none has been tested for program effectiveness, implementation, and dissemination. Building a Healthy Me (BHM) is a nutrition intervention for kindergarteners that is classroom‐based and includes a family component. This study evaluated the public health impact of BHM in California kindergarten classrooms using the RE‐AIM (reach, efficacy, adoption, implementation, and maintenance) framework. METHODS A quasi‐experimental design assessed pre‐to‐post changes in nutrition knowledge, dietary consumption, and parent behaviors of 25 intervention classrooms (414 students, 264 parents); and postintervention differences in nutrition knowledge between the intervention classrooms and 4 control classrooms measured at postintervention only (103 students). RESULTS Intervention students improved in knowledge of food groups and healthy breakfast/snack options, and scored higher than control students in food group knowledge at postintervention (ps < .05). Parents of intervention group children increased their use of food labels, and intervention group children increased intake of several healthy foods and decreased intake of candy and fried potatoes (ps < .05). The BHM program reached 41% of kindergarteners attending public schools in California, and teachers implemented most lesson material. CONCLUSIONS The BHM program was effective, implemented with fidelity, and broadly disseminated, highlighting its potential public health impact for kindergarteners.

  December 04, 2016   doi: 10.1111/josh.12466   open full text
• Nutrition Quality of US School Snack Foods: A First Look at 2011‐2014 Bid Records in 8 School Districts.
  Y. Claire Wang, Amber Hsiao, Peter Chamberlin, McKenzie Largay, Abbie Archibald, Andrew Malone, JoAnn Stevelos.
  Journal of School Health / The Journal of School Health. December 04, 2016
  BACKGROUND As part of the Healthy, Hunger‐Free Kids Act, snacks, and desserts sold in K‐12 schools as of the 2014‐2015 school year are required to meet the “Smart Snacks” nutritional guidelines. Although studies exist in tracking progress in local and national efforts, the proportion of snack food procured by school districts compliant with the Smart Snacks standard prior to its full implementation is unknown. METHODS We repurposed a previously untapped database, Interflex, of public bid records to examine the nutritional quality of snacks and desserts procured by school districts. We selected 8 school districts with at least 90% complete data each year during 2011‐2012, 2012‐2013, and 2013‐2014 school years and at locations across different regions of the United States. We quantified the amount of calories and sugar of each product contained in the won bids based on available online sources and determined whether the produce complied with Smart Snack guidelines. RESULTS In all 8 districts (snack expenditure analyzed ranging from $152,000 to $4.4 million), at least 50% of snack bids were compliant with the US Department of Agriculture Smart Snacks standard during the 2013‐2014 school year. Across sampled districts, we observed a general trend in lower caloric density (kcal per product) and sugar density (grams of sugar per product) over a 3‐year period. CONCLUSIONS Many districts across the country have made headway in complying with the Smart Snack guidelines, though gaps remain.

  December 04, 2016   doi: 10.1111/josh.12465   open full text
• Not Enough Time in the Day: A Qualitative Assessment of In‐School Physical Activity Policy as Viewed by Administrators, Teachers, and Students.
  Abigail Gamble, Sheryl L. Chatfield, Michael L. Cormack, Jeffrey S. Hallam.
  Journal of School Health / The Journal of School Health. December 04, 2016
  BACKGROUND In recent decades, the alignment of health and education has been at the forefront of school reform. Whereas the establishment of national in‐school physical activity (ISPA) recommendations and state‐level mandates demonstrates success, there has been less achievement in areas that address health disparities. The purpose of this investigation was to explore barriers and facilitators to implementing state‐mandated ISPA policies in the Mississippi Delta. METHODS Focus groups or interviews were conducted with district administrators, school principals, teachers, and students. A total of 2 semistructured moderator guides were developed to focus on (1) student ISPA practices and preferences and (2) facilitators and barriers to implementing ISPA policies and practices. RESULTS A total of 6 themes were developed. In that, 2 themes addressed participant‐described barriers (primary challenges and interferences and excuses). Three themes highlighted participant‐described facilitators (compromises, things that work, and being active at school). Finally, 1 theme encompassed the participant‐described need to address educating the whole child. CONCLUSIONS There is a critical need for meaningful and relevant solutions to circumvent challenges to implementing ISPA policies and practices in the Mississippi Delta. The Whole School, Whole Community, Whole Child model offers a broad means of visualizing rural, low‐income, racially concentrated schools to circumvent challenges and foster ISPA policies and practices.

  December 04, 2016   doi: 10.1111/josh.12464   open full text
• Teachers and Coaches in Adolescent Social Networks Are Associated With Healthier Self‐Concept and Decreased Substance Use.
  Rebecca N. Dudovitz, Paul J. Chung, Mitchell D. Wong.
  Journal of School Health / The Journal of School Health. December 04, 2016
  BACKGROUND Poor academic (eg, “I am a bad student”) and behavioral (eg, “I am a troublemaker”) self‐concepts are strongly linked to adolescent substance use. Social networks likely influence self‐concept. However, little is understood about the role teachers and athletic coaches play in shaping both academic and behavioral self‐concepts. METHODS We analyzed cross‐sectional surveys of 929 9th‐12th grade low‐income minority adolescents in Los Angeles assessing self‐concept, social networks, and 30‐day use of alcohol, marijuana and other drugs. We performed generalized estimating equations, accounting for clustering at the school level and controlling for family and peer influences and contextual factors. We also tested whether self‐concept‐mediated associations between relationships with teachers or coaches and 30‐day substance use. RESULTS More perceived teacher support was associated with lower odds of marijuana and other drug use and better academic and behavioral self‐concepts. Behavioral self‐concept mediated the associations between teacher support and substance use. CONCLUSIONS By facilitating relationships with adults and improving teachers' capacity to build supportive environments, schools may positively shape how adolescents see themselves, which might help reduce adolescent substance use.

  December 04, 2016   doi: 10.1111/josh.12462   open full text
• School Wellness Programs: Magnitude and Distribution in New York City Public Schools.
  Leanna Stiefel, Brian Elbel, Melissa Pflugh Prescott, Siddhartha Aneja, Amy E. Schwartz.
  Journal of School Health / The Journal of School Health. December 04, 2016
  BACKGROUND Public schools provide students with opportunities to participate in many discretionary, unmandated wellness programs. Little is known about the number of these programs, their distribution across schools, and the kinds of students served. We provide evidence on these questions for New York City (NYC) public schools. METHODS Data on wellness programs were collected from program websites, NYC's Office of School Food and Wellness, and direct contact with program sponsors for 2013. Programs were grouped into categories, nutrition, fitness, and comprehensive, and were combined with data on school characteristics available from NYC's Department of Education. Numbers of programs and provision of programs were analyzed for relationships with demographic and school structural characteristics, using descriptive statistics and multiple regression. RESULTS Discretionary wellness programs are numerous, at 18 programs. Little evidence supports inequity according to student race/ethnicity, income, or nativity, but high schools, new schools, co‐located schools, small schools, and schools with larger proportions of inexperienced teachers are less likely to provide wellness programs. CONCLUSIONS Opportunities exist to further the reach of wellness programs in public schools by modifying them for high school adoption and building capacity in schools less likely to have the administrative support to house them.

  December 04, 2016   doi: 10.1111/josh.12463   open full text
• Effectiveness of Universal School‐Based Mental Health Awareness Programs Among Youth in the United States: A Systematic Review.
  John P. Salerno.
  Journal of School Health / The Journal of School Health. November 08, 2016
  BACKGROUND: Stigmatizing attitudes toward mental illness and low mental health literacy have been identified as links to social adversity, and barriers to seeking and adhering to treatment among adolescents suffering from mental illness. Prior research has found that it is possible to improve these outcomes using school‐based mental health awareness interventions. The purpose of this study was to review empirical literature pertaining to universal mental health awareness interventions aiming to improve mental health related outcomes among students enrolled in US K‐12 schools, especially minorities vulnerable to health disparities. METHODS: PsycINFO, Cochrane Library, PUBMED, and reference lists of relevant articles were searched for K‐12 school‐based mental health awareness interventions in the United States. Universal studies that measured knowledge, attitudes, and/or help‐seeking pertinent to mental health were included. RESULTS: A total of 15 studies were selected to be part of the review. There were 7 pretest/post‐test case series, 5 nonrandomized experimental trial, 1 Solomon 4‐groups, and 2 randomized controlled trial (RCT) designs. Nine studies measuring knowledge, 8 studies measuring attitudes, and 4 studies measuring help‐seeking, indicated statistically significant improvements. CONCLUSIONS: Although results of all studies indicated some level of improvement, more research on implementation of universal school‐based mental health awareness programs is needed using RCT study designs, and long‐term follow‐up implementation.

  November 08, 2016   doi: 10.1111/josh.12461   open full text
• Schoolyard Characteristics, Physical Activity, and Sedentary Behavior: Combining GPS and Accelerometry.
  Dave H.H. Van Kann, Sanne I. de Vries, Jasper Schipperijn, Nanne K. de Vries, Maria W.J. Jansen, Stef P.J. Kremers.
  Journal of School Health / The Journal of School Health. November 08, 2016
  BACKGROUND Physical activity (PA) is decreasing among children, while sedentary behavior (SB) is increasing. Schoolyards seem suitable settings to influence children's PA behavior. This study investigated the associations between schoolyard characteristics and moderate‐to‐vigorous physical activity (MVPA) and SB of children aged 8‐11 years at schoolyards. METHODS Twenty primary schools in the Netherlands were involved. A total of 257 children wore an accelerometer and global positioning system (GPS) device for 5 consecutive days to objectively assess their PA levels and presence at the schoolyard, respectively. Accelerometer and GPS data were merged using the personal activity and location measurement system. Multilevel linear regression analyses were used to study correlates of MVPA and SB at schoolyards. RESULTS On average, children spent 54 minutes a day at the schoolyard, 9 minutes of which were spent in MVPA and 20 minutes in SB. Boys engaged in MVPA longer than girls at the schoolyard. Fixed equipment, such as high bars and soccer goals, teacher‐initiated activities, and the presence of a ball games policy were correlates of more MVPA and less SB. CONCLUSION Well‐designed schoolyards, including PA‐enhancing fixed equipment, a supportive PA climate created by teachers, and supportive schoolyard policies may contribute to increased PA and decreased SB during school recess among school‐aged children.

  November 08, 2016   doi: 10.1111/josh.12459   open full text
• Increasing Prevalence of US Elementary School Gardens, but Disparities Reduce Opportunities for Disadvantaged Students.
  Lindsey Turner, Meghan Eliason, Anna Sandoval, Frank J. Chaloupka.
  Journal of School Health / The Journal of School Health. November 08, 2016
  BACKGROUND We examined the prevalence of school garden programs at US public elementary schools. The study examined time trends, demographic and regional disparities, and associations with related programs such as farm‐to‐school. METHODS Annual surveys were gathered from nationally representative samples of elementary schools between 2006‐2007 and 2013‐2014. Annual samples ranged from 553 to 748 schools. RESULTS The prevalence of gardens increased steadily from 11.9% in 2006‐2007 to 31.2% in 2013‐2014 (p < .001). In multivariate logistic regressions the prevalence of garden programs varied significantly by school characteristics. Gardens were more prevalent in the west than in other regions. Gardens were less prevalent at schools serving higher proportions of lower‐income students, and were more prevalent at urban schools than in suburbs, towns, or rural areas. Gardens were more common at schools with farm‐to‐school programs. Gardens also were associated with offering formal classroom‐based nutrition education. CONCLUSIONS Garden programs in elementary schools have increased over time, but there is room for wider implementation, particularly at schools serving lower‐income students. Given the role of childhood in establishing food preferences and dietary consumption habits, such programs are important and can reinforce the messages imparted through nutrition education.

  November 08, 2016   doi: 10.1111/josh.12460   open full text
• Adolescent Healthcare Brokering: Prevalence, Experience, Impact, and Opportunities.
  Jennifer R. Banas, Lisa C. Wallis, James W. Ball, Sarah Gershon.
  Journal of School Health / The Journal of School Health. November 08, 2016
  BACKGROUND Limited health literacy disproportionately affects those with limited English proficiency (LEP). Parents with LEP might rely on their adolescent children to interpret health information. We call this adolescent healthcare brokering. This study uncovers the prevalence of brokering, kinds of tasks, emotional and academic impact, and desired support. METHODS We invited 165 students from health classes (in a community in which 29.8% are foreign‐born and 53.4% speak another language at home) to complete a survey. We used IBM SPSS to calculate descriptive statistics. RESULTS Of the 159 who received parental consent and assented, 54.1% (N = 86) assist with healthcare tasks. When brokering, 80.2% (N = 69) translate. Most common tasks were talking to a doctor, reading prescriptions, and searching on the Internet. Participants were most confident reading prescriptions and talking to a doctor and least confident finding healthcare services. Among brokers, 29.1% (N = 24) missed school; 33.7% did not complete homework. They most wanted to learn about filling out insurance forms and talking to doctors. CONCLUSIONS Despite assurances that children are not permitted to interpret, adolescents are acting as healthcare brokers. The impact can be academic and emotional. Findings indicate a need for further research and support for adolescents who want to learn about healthcare tasks.

  November 08, 2016   doi: 10.1111/josh.12456   open full text
• School‐Based HIV/STD Testing Behaviors and Motivations Among Black and Hispanic Teen MSM: Results From a Formative Evaluation.
  Elana Morris, Pablo Topete, Catherine N. Rasberry, Catherine A. Lesesne, Elizabeth Kroupa, Lisa Carver.
  Journal of School Health / The Journal of School Health. November 08, 2016
  BACKGROUND This evaluation explores experiences with, and motivations for, human immunodeficiency virus (HIV) and sexually transmitted disease (STD) testing among black and Hispanic school‐aged young men who have sex with men (YMSM). METHODS Participants were recruited at community‐based organizations that serve YMSM in New York City, Philadelphia, and San Francisco. Eligible participants were 13‐ to 19‐year‐old black or Hispanic males who reported attraction to or sexual behavior with other males and/or identified as gay or bisexual, and attended at least 90 days of school in the previous 18 months. Participants (N = 415) completed web‐based questionnaires and/or in‐depth interviews (N = 32). RESULTS In the past year, 72.0% of questionnaire participants had been tested for HIV, 13.5% of them at school or school clinic. Participants reported that they would be more likely to get an HIV test if they could be tested close to or at school (34.4%), and 64.4% would use HIV testing if offered in schools. Most interview participants reported willingness to use school‐based services if they were offered nonjudgmentally, privately, and confidentially by providers with experience serving YMSM. CONCLUSION Schools can provide opportunities to make HIV and STD testing accessible to school‐aged YMSM, but the services must be provided in ways that are comfortable to them.

  November 08, 2016   doi: 10.1111/josh.12457   open full text
• Do Substance Use, Psychosocial Adjustment, and Sexual Experiences Vary for Dating Violence Victims Based on Type of Violent Relationships?
  Janine M. Zweig, Jennifer Yahner, Meredith Dank, Pamela Lachman.
  Journal of School Health / The Journal of School Health. November 08, 2016
  BACKGROUND We examined whether substance use, psychosocial adjustment, and sexual experiences vary for teen dating violence victims by the type of violence in their relationships. We compared dating youth who reported no victimization in their relationships to those who reported being victims of intimate terrorism (dating violence involving one physically violent and controlling perpetrator) and those who reported experiencing situational couple violence (physical dating violence absent the dynamics of power and control). METHODS This was a cross‐sectional survey of 3745 dating youth from 10 middle and high schools in the northeastern United States, one third of whom reported physical dating violence. RESULTS In general, teens experiencing no dating violence reported less frequent substance use, higher psychosocial adjustment, and less sexual activity than victims of either intimate terrorism or situational couple violence. In addition, victims of intimate terrorism reported higher levels of depression, anxiety, and anger/hostility compared to situational couple violence victims; they also were more likely to report having sex, and earlier sexual initiation. CONCLUSIONS Youth who experienced physical violence in their dating relationships, coupled with controlling behaviors from their partner/perpetrator, reported the most psychosocial adjustment issues and the earliest sexual activity.

  November 08, 2016   doi: 10.1111/josh.12453   open full text
• Hand Hygiene Program Decreases School Absenteeism Due to Upper Respiratory Infections.
  Ernestina Azor‐Martinez, Elena Cobos‐Carrascosa, Maria Luisa Seijas‐Vazquez, Carmen Fernández‐Sánchez, Jenna M. Strizzi, Pilar Torres‐Alegre, Joaquin Santisteban‐Martínez, Francisco Gimenez‐Sanchez.
  Journal of School Health / The Journal of School Health. November 08, 2016
  BACKGROUND We assessed the effectiveness of a handwashing program using hand sanitizer to prevent school absenteeism due to upper respiratory infections (URIs). METHODS This was a randomized, controlled, and open study on a sample of 1341 children 4‐12 years old, attending 5 state schools in Almería (Spain), with an 8‐month follow‐up. The experimental group (EG) washed their hands with soap and water, together with using hand sanitizer, and the control group followed their usual handwashing procedures. Absenteeism rates due to URIs were compared between the 2 groups through a multivariate Poisson regression analysis. The percent of days missed in both groups were compared with a z test. RESULTS Overall, 1271 cases of school absenteeism due to URIs were registered. Schoolchildren from the EG had a 38% lower risk of absenteeism due to URIs, incidence rate ratio: 0.62, 95% confidence interval: 0.55‐0.70, and a decrease in absenteeism of 0.45 episodes/child/academic year, p < .001. Pupils missed 2734 school days due to URIs and the percentage of days absent was significantly lower in the EG, p < .001. CONCLUSIONS Use of hand sanitizer plus handwashing with soap accompanied by educational support is an effective measure to reduce absenteeism due to URIs

  November 08, 2016   doi: 10.1111/josh.12454   open full text
• School Context Matters: The Impacts of Concentrated Poverty and Racial Segregation on Childhood Obesity.
  Joy Rayanne Piontak, Michael D. Schulman.
  Journal of School Health / The Journal of School Health. November 08, 2016
  BACKGROUND Schools are important sites for interventions to prevent childhood obesity. This study examines how variables measuring the socioeconomic and racial composition of schools and counties affect the likelihood of obesity among third to fifth grade children. METHODS Body mass index data were collected from third to fifth grade public school students by teachers from 317 urban and rural North Carolina schools in 38 counties. Multilevel models are used to examine county‐, school‐, and individual‐level effects. RESULTS Low concentrations of poverty at the school level are associated with lower odds of obesity. Schools in rural counties had significantly higher rates of obesity, net the other variables in the model. Students in minority‐segregated schools had higher rates of obesity than those in more racially diverse schools, but the effect was not statistically significant once school‐level poverty was controlled. CONCLUSIONS Place‐based inequalities are important determinants of health inequalities. The results of this study show that school‐level variables related to poverty are important for understanding and confronting childhood obesity.

  November 08, 2016   doi: 10.1111/josh.12458   open full text
• Perceptions of Peer Sexual Behavior: Do Adolescents Believe in a Sexual Double Standard?
  Michael Young, Susan Cardenas, Joseph Donnelly, Mark J. Kittleson.
  Journal of School Health / The Journal of School Health. November 08, 2016
  BACKGROUND The purpose of the study was to (1) examine attitudes of adolescents toward peer models having sex or choosing abstinence, and (2) determine whether a “double standard” in perception existed concerning adolescent abstinence and sexual behavior. METHODS Adolescents (N = 173) completed questionnaires that included 1 of 6 randomly assigned vignettes that described male and female peer models 3 ways: (1) no information about model's sexual behavior, (2) model in love but choosing abstinence, and (3) model in love and having sex. Participants read the vignette to which they had been assigned and responded to statements about the peer model. Data were analyzed using multivariate analysis of variance. RESULTS Results did not show evidence of a sexual double standard among male participants, but did show some evidence of a sexual double standard among female participants. Additionally, both male and female participants evaluated more harshly peer models that were having sex than peer models that chose abstinence. CONCLUSIONS Findings provide insight concerning the lack of a sexual double standard among male participants, the existence, to some degree, of a sexual double standard among female participants, and demonstrate the existence of a social cost to both young men and young women for choosing to have sex.

  November 08, 2016   doi: 10.1111/josh.12455   open full text
• Socioeconomic Factors Influence Physical Activity and Sport in Quebec Schools.
  Pascale Morin, Alexandre Lebel, Éric Robitaille, Sherri Bisset.
  Journal of School Health / The Journal of School Health. October 06, 2016
  BACKGROUND School environments providing a wide selection of physical activities and sufficient facilities are both essential and formative to ensure young people adopt active lifestyles. We describe the association between school opportunities for physical activity and socioeconomic factors measured by low‐income cutoff index, school size (number of students), and neighborhood population density. METHODS A cross‐sectional survey using a 2‐stage stratified sampling method built a representative sample of 143 French‐speaking public schools in Quebec, Canada. Self‐administered questionnaires collected data describing the physical activities offered and schools' sports facilities. Descriptive and bivariate analyses were performed separately for primary and secondary schools. RESULTS In primary schools, school size was positively associated with more intramural and extracurricular activities, more diverse interior facilities, and activities promoting active transportation. Low‐income primary schools were more likely to offer a single gym. Low‐income secondary schools offered lower diversity of intramural activities and fewer exterior sporting facilities. High‐income secondary schools with a large school size provided a greater number of opportunities, larger infrastructures, and a wider selection of physical activities than smaller low‐income schools. CONCLUSIONS Results reveal an overall positive association between school availability of physical and sport activity and socioeconomic factors.

  October 06, 2016   doi: 10.1111/josh.12438   open full text
• Victims of Bullying and Tobacco Use Behaviors in Adolescents: Differences Between Bullied at School, Electronically, or Both.
  Kathleen R. Case, Maria Cooper, MeLisa Creamer, Dale Mantey, Steven Kelder.
  Journal of School Health / The Journal of School Health. October 06, 2016
  BACKGROUND Being a victim of bullying is associated with greater risk of youth substance use; however, research specifically examining whether tobacco use behaviors differ among adolescents who were bullied at school only, electronically only, or both at school and electronically is limited. METHODS We examined the associations between being a victim of bullying (at school only, electronically only, or both at school and electronically) and use of tobacco products using data from the 2013 national Youth Risk Behavior Survey. RESULTS Girls who were bullied both at school and electronically reported the highest odds of all tobacco use behaviors (ever use of cigarettes, current use of cigarettes, and current use of any tobacco product) as compared with girls who were not bullied after adjusting for covariates. Conversely, for boys, only the association between being bullied electronically only and ever use of cigarettes remained significant after adjusting for covariates. CONCLUSIONS Results from this study indicate that electronic bullying may differentially influence the odds of tobacco use in high school students as compared with bullying that occurs at school only. Confirmation of these findings could inform interventions to reduce both bullying and tobacco use in high school.

  October 06, 2016   doi: 10.1111/josh.12437   open full text
• Food Literacy at Secondary Schools in Australia.
  Rimante Ronto, Lauren Ball, Donna Pendergast, Neil D. Harris.
  Journal of School Health / The Journal of School Health. October 06, 2016
  BACKGROUND Food literacy can encourage adolescents to develop healthy dietary patterns. This study examined home economics teachers' (HET) perspectives of the importance, curriculum, self‐efficacy, and food environments regarding food literacy in secondary schools in Australia. METHODS A 20‐item cross‐sectional survey was completed by 205 HETs. The survey focused on the importance of aspects of food literacy, HETs' self‐efficacy, and attitudes toward food literacy and schools' food environments. Data were analyzed descriptively, and associations between participants' demographic characteristics and perceptions were investigated by chi‐square analyses. RESULTS HETs rated aspects of food literacy including preparing and cooking food, knowing about healthy foods and food safety and hygiene practices as very important. They indicated animal welfare, where food comes from, and plan and manage time for food shopping to be the least important aspects of food literacy. HETs reported that students' involvement in food literacy activities resulted in healthier diets and improved food practices, but the schools' food environments are not comprehensively supportive of food literacy. CONCLUSIONS HETs report that food literacy is very important for adolescents to learn. The focus is more on microaspects in comparison to macroaspects of food literacy. Schools' food environments are ideally positioned to shape dietary intake of adolescents but their potential is not being realized.

  October 06, 2016   doi: 10.1111/josh.12440   open full text
• Verbal Bullying Changes Among Students Following an Educational Intervention Using the Integrated Model for Behavior Change.
  Saloshni Naidoo, Benn K. Satorius, Hein Vries, Myra Taylor.
  Journal of School Health / The Journal of School Health. October 06, 2016
  BACKGROUND Bullying behavior in schools can lead to psychosocial problems. School‐based interventions are important in raising student awareness, developing their skills and in planning to reduce bullying behavior. METHODS A randomized controlled trial, using a school‐based educational intervention to reduce verbal bullying, was conducted among grade 10 students in 16 urban and rural schools in KwaZulu‐Natal, South Africa in 2013. Baseline and postintervention questionnaires, developed using the Integrated Model for Behavior Change theoretical model, were used to assess changes in verbal bullying. RESULTS Postintervention there were reduced verbal bullying experiences. Improved social norms and awareness of verbal bullying were associated with reduced verbal bullying experiences and behavior. Although less likely to bully others verbally, girls were more likely to experience verbal bullying. Students with no living father were more likely to bully others verbally. CONCLUSIONS The study findings indicate that a school‐based intervention can positively impact on verbal bullying experiences and behavior.

  October 06, 2016   doi: 10.1111/josh.12439   open full text
• Predictors of Obesity in a US Sample of High School Adolescents With and Without Disabilities.
  Mia A. Papas, Jillian C. Trabulsi, Michelle Axe, James H. Rimmer.
  Journal of School Health / The Journal of School Health. October 06, 2016
  BACKGROUND Childhood obesity is a major public health concern. Children with disabilities have a higher prevalence of obesity. OBJECTIVE We examined factors associated with obesity within a cross‐sectional study of US adolescents with and without disabilities. METHODS Data were obtained from the 2011 Youth Risk Behavior Survey. Logistic regression models were fitted to assess effects of dietary habits, physical activity, and unhealthy weight control behaviors on obesity. Effect modification by disability status was examined. RESULTS Twenty percent (1986 of 9775 participants) reported a disability. Adolescents with disabilities were more likely to be obese (odds ratio [OR] = 1.7; 95% confidence interval [CI]: 1.3‐2.1) and have at least 1 unhealthy weight control behavior (OR = 2.0; 95% CI: 1.6‐2.5), and were less likely to be physically active (OR = 0.5; 95% CI: 0.4‐0.6). Lack of physical activity, increased television watching/video game playing, and unhealthy weight loss behaviors were significantly associated with obesity regardless of disability status (p‐for‐interaction >.05). CONCLUSIONS Successful obesity interventions should target diet, physical activity, and weight control among adolescents with disabilities. Understanding barriers to healthier diet and physical activity for this population is critical to developing effective obesity prevention programs and reducing the prevalence of unhealthy weight control behaviors.

  October 06, 2016   doi: 10.1111/josh.12436   open full text
• Impact of an Education Intervention on Missouri K‐12 School Disaster and Biological Event Preparedness.
  Terri Rebmann, Michael B. Elliott, Deborah Artman, Matthew VanNatta, Mary Wakefield.
  Journal of School Health / The Journal of School Health. October 06, 2016
  BACKGROUND A 2011 nationwide school pandemic preparedness study found schools to be deficient. We examined the impact of a school nurse educational intervention aimed at improving K‐12 school biological event preparedness. METHODS Missouri Association of School Nurses (MASN) members were e‐mailed a survey link in fall 2013 (ie, preintervention), links to online education modules (ie, intervention) in late fall, and a postintervention survey link in spring, 2014. School biological event readiness was measured using 35 indicators, for a possible score range of 0‐35. A paired t‐test compared pre‐ to postintervention preparedness scores. RESULTS A total of 133 school nurses (33.6% response rate) completed a survey; 35.3% of those (N = 47) completed both pre‐ and postintervention survey that could be matched. Pre‐ and postintervention preparedness scores ranged from 5 to 28.5 (x‾ = 13.3) and 6.5 to 25 (x‾ = 14.8), respectively. Postintervention scores were significantly higher than preintervention scores for those who watched at least 1 module (t = −2.3, p < .05). CONCLUSION: The education intervention was effective at improving school preparedness, though the impact was small. The education intervention needs to be reassessed, especially in regard to providing a longer intervention period.

  October 06, 2016   doi: 10.1111/josh.12435   open full text
• Explaining Disparities in Youth Aerobic Fitness and Body Mass Index: Relative Impact of Socioeconomic and Minority Status.
  Yang Bai, Pedro F. Saint‐Maurice, Gregory J. Welk, Kelly Allums‐Featherston, Norma Candelaria.
  Journal of School Health / The Journal of School Health. October 06, 2016
  BACKGROUND To advance research on youth fitness promotion it is important to understand factors that may explain the disparities in fitness. METHODS We evaluated data from the FitnessGram NFL PLAY60 Partnership Project to examine school factors influencing aerobic capacity (AC) and body mass index (BMI) in schoolchildren. Individual observations for AC (157,971 students from 675 schools) and BMI (178,274 students from 630 schools) were aggregated to compute the percentage of students achieving the Healthy Fitness Zone (HFZ). We examined achievements using adjusted linear regression models with socioeconomic status (SES), minority status, region, enrollment, and grade as factors. RESULTS The mean HFZ for AC and BMI were 51.6% and 56.9%, respectively. SES, minority status, and enrollment were all significantly associated with AC HFZ among boys, and SES and enrollment were significant predictors of AC HFZ in girls. SES and location were significantly related to BMI HFZ among boys but only SES significantly predicted BMI HFZ in girls. Schools with higher SES had higher AC and BMI HFZ achievements. CONCLUSIONS SES was consistently associated with health‐related fitness, independent of sex, but not minority status.

  October 06, 2016   doi: 10.1111/josh.12434   open full text
• The Role of Ethnicity in School‐Based Obesity Intervention for School‐Aged Children: A Pilot Evaluation.
  Sabrina A. Karczewski, Jocelyn S. Carter, Draycen D. DeCator.
  Journal of School Health / The Journal of School Health. October 06, 2016
  BACKGROUND Rates of obesity have risen disproportionately for ethnic minority youth in the United States. School‐based programs may be the most comprehensive and cost‐effective way to implement primary prevention in children. In this study we evaluated the effect of a school‐based obesity prevention on the outcome of body mass index percentile (BMI%), with baseline weight class and ethnicity examined as moderators. METHODS Participants (N = 125), ages 7‐11 (56% female) from 4 urban, low‐income, ethnic minority (58% black, 42% Latino) schools were recruited. Two schools received the Urban Initiatives Work to Play health intervention, and 2 demographically matched schools served as wait‐list controls. RESULTS Hierarchical multiple regression was used to analyze the independent and interactive effects of key variables on BMI%. An interaction between intervention status and ethnicity revealed Latino youth in the intervention had lower BMI% than those in the control group. Participation did not cause BMI% outcomes to decrease for black participants. CONCLUSIONS The study demonstrates the intervention is effective, but that the effectiveness varies across ethnicity. Interventions can be made more efficient and cost‐effective by targeting youth of a common ethnicity that has shown empirical responsiveness to certain program elements.

  October 06, 2016   doi: 10.1111/josh.12433   open full text
• USDA Fresh Fruit and Vegetable Program Is More Effective in Town and Rural Schools Than Those in More Populated Communities.
  Yi‐Chun Lin, Alyce D. Fly.
  Journal of School Health / The Journal of School Health. October 06, 2016
  BACKGROUND We attempted to determine effects of the United States Department of Agriculture (USDA) Fresh Fruit and Vegetable Program (FFVP) on variety and frequency of fruit and vegetable intake by students in schools from different locales. METHODS Data were derived from the 2011‐2012 Indiana FFVP Student Survey completed by 4229 fourth‐sixth graders. Effects were studied within 2 groups, 39 city and suburb schools, and 12 town and rural schools. Differences in students' responses over time to 2 items measuring variety and 10 items measuring fruit and vegetable intake frequency were determined with multilevel regression models. RESULTS Town and rural students were 1.2 times more likely to eat different kinds of fruit (p = .04) and vegetables (p = .01) daily, and increased fruit (+1.0 time/day; p < .01) and vegetable intake frequency (+0.5 times/day; p = .03). City and suburb students increased fruit intake frequency (∼0.8 times/day; p < .01) but not vegetable intake frequency or daily variety (p > .05). CONCLUSIONS FFVP improved fruit and vegetable eating behaviors in the “town and rural” group, but was only partially effective in the “city and suburb” group. Strategies to implement FFVP may need to differ depending on school locale.

  October 06, 2016   doi: 10.1111/josh.12432   open full text
• The Effects of the Yes You Can! Curriculum on the Sexual Knowledge and Intent of Middle School Students.
  Joseph Donnelly, Robert R. Horn, Michael Young, Andrada E. Ivanescu.
  Journal of School Health / The Journal of School Health. September 12, 2016
  BACKGROUND The purpose of the study was to examine the effects of the “Yes You Can!” (YYC) curriculum on sexual knowledge and behavioral intent of program participants. METHODS Participants included students ages 10‐14 from schools in a northeast US urban area. Yes You Can! program lessons were designed to support healthy relationships. The curriculum was taught by trained instructors. The testing instrument was a 30‐item questionnaire, which included sexual knowledge and intent items. Students completed the questionnaire before program implementation, immediately following intervention, and a third time at follow‐up. Data were analyzed using analysis of covariance. Pretest knowledge scores were used as the covariate for the knowledge analyses. Pretest intent scores were used as the covariate for the intent analyses. RESULTS Results showed the intervention group had less intent to engage in sexual intercourse than the control group at post‐test (p < .001) and at follow‐up (p < .001). Similarly, the intervention group had higher knowledge scores than the control group at post‐test (p < .001) and at follow‐up (p < .001). CONCLUSIONS Results indicate that the YYC program had a statistically significant, positive impact on knowledge and sexual intent. These variables are important precursors to actual behavior. Future research should examine the effects of the program on changes in sexual behavior.

  September 12, 2016   doi: 10.1111/josh.12429   open full text
• Factors Associated With Intentions to Engage in Vaginal Intercourse Among Sexually Abstinent Missouri High School Freshmen.
  Timothy Watts, Kelly L. Wilson, Elisa B. McNeill, Brittany L. Rosen, Nancy Daley Moore, Matthew L. Smith.
  Journal of School Health / The Journal of School Health. September 12, 2016
  BACKGROUND We examine personal characteristics, alcohol consumption, normative beliefs, household factors, and extracurricular engagement associated with intentions to have intercourse before marriage among abstinent students. METHODS Data were analyzed from 245 freshmen enrolled in a school‐based abstinence‐only‐until‐marriage program. Two binary logistic regression analyses identified factors associated with intentions to engage in intercourse before marriage and within the next year. RESULTS Approximately 21% and 14% of participants reported intentions to have intercourse. Respondents participated in 2.2 (standard deviation [SD] = 1.2) extracurricular activities. Freshmen who were male, perceived their friends to approve of premarital sex, and consumed alcohol were more likely to report intentions to have intercourse. For every additional extracurricular activity in which freshmen participated, they were less likely to report intentions to have intercourse within the next year (odds ratio [OR] = 0.56). CONCLUSIONS Factors such as extracurricular activities provide youth with opportunities to build supportive relationships, connect with peers and role models, and positively engage in schools and communities. Extracurricular activities typically already exist, have funding, and are generally well‐supported. School‐based strategies can increase teenagers' autonomy by providing a variety of activities to participate in and reduce unsupervised time. This, in turn, has the potential to decrease sexual risk taking behaviors.

  September 12, 2016   doi: 10.1111/josh.12431   open full text
• Implementation of Local Wellness Policies in Schools: Role of School Systems, School Health Councils, and Health Disparities.
  Erin R. Hager, Diana S. Rubio, G. Stewart Eidel, Erin S. Penniston, Megan Lopes, Brit I. Saksvig, Renee E. Fox, Maureen M. Black.
  Journal of School Health / The Journal of School Health. September 12, 2016
  BACKGROUND Written local wellness policies (LWPs) are mandated in school systems to enhance opportunities for healthy eating/activity. LWP effectiveness relies on school‐level implementation. We examined factors associated with school‐level LWP implementation. Hypothesized associations included system support for school‐level implementation and having a school‐level wellness team/school health council (SHC), with stronger associations among schools without disparity enrollment (majority African‐American/Hispanic or low‐income students). METHODS Online surveys were administered: 24 systems (support), 1349 schools (LWP implementation, perceived system support, SHC). The state provided school demographics. Analyses included multilevel multinomial logistic regression. RESULTS Response rates were 100% (systems)/55.2% (schools). Among schools, 44.0% had SHCs, 22.6% majority (≥75%) African‐American/Hispanic students, and 25.5% majority (≥75%) low‐income (receiving free/reduced‐price meals). LWP implementation (17‐items) categorized as none = 36.3%, low (1–5 items) = 36.3%, high (6+ items) = 27.4%. In adjusted models, greater likelihood of LWP implementation was observed among schools with perceived system support (high versus none relative risk ratio, RRR = 1.63, CI: 1.49, 1.78; low versus none RRR = 1.26, CI: 1.18, 1.36) and SHCs (high versus none RRR = 6.8, CI: 4.07, 11.37; low versus none RRR = 2.24, CI: 1.48, 3.39). Disparity enrollment did not moderate associations (p > .05). CONCLUSIONS Schools with perceived system support and SHCs had greater likelihood of LWP implementation, with no moderating effect of disparity enrollment. SHCs/support may overcome LWP implementation obstacles related to disparities.

  September 12, 2016   doi: 10.1111/josh.12430   open full text
• Longitudinal Relationships of Fitness, Physical Activity, and Weight Status With Academic Achievement in Adolescents.
  Vivien Suchert, Reiner Hanewinkel, Barbara Isensee.
  Journal of School Health / The Journal of School Health. September 12, 2016
  BACKGROUND To examine associations of cardiorespiratory fitness, physical activity (PA) and weight status with academic achievement 1 year later. In addition, the mediating role of psychological variables was tested. METHODS Longitudinal analyses included 1011 German students (M = 14.1 years, SD = 0.6 years). Cardiorespiratory fitness was determined with the 20 m shuttle run test. Compliance with PA guidelines was assessed through questionnaire. Weight status was based on body mass index percentiles. As proxy of academic achievement students' self‐reported grades in Mathematics and German in their midterm report were averaged. Mediation analyses were conducted at follow‐up testing general self‐efficacy, depressed affect, and attention/hyperactivity problems. RESULTS High levels of cardiorespiratory fitness predicted higher educational attainment (p = .007), while we found no longitudinal association for PA and weight status (p > .253). However, students being insufficiently physically active at baseline but meet PA guidelines at follow‐up showed a significant improvement in educational attainment. The cross‐sectional association between PA and academic achievement was mediated by students' general self‐efficacy. CONCLUSION High fitness in adolescence is associated with higher subsequent academic achievement. The promotion of PA might benefit school performance because of enhanced fitness levels in the long‐term and positive influences of PA in the shortterm. The association between weight status and educational attainment remains controversial.

  September 12, 2016   doi: 10.1111/josh.12424   open full text
• Accelerometry‐Derived Physical Activity of First Through Third Grade Children During the Segmented School Day.
  R. Glenn Weaver, Anthony Crimarco, Timothy A. Brusseau, Collin A. Webster, Ryan D. Burns, James C. Hannon.
  Journal of School Health / The Journal of School Health. September 12, 2016
  BACKGROUND Schools should provide children 30 minutes/day of moderate‐to‐vigorous‐physical‐activity (MVPA). Determining school day segments that contribute to children's MVPA can inform school‐based activity promotion. The purpose of this paper was to identify the proportion of children accumulating 30 minutes/day of school‐based MVPA, and to identify school day segments' contribution to children's MVPA. METHODS First‐third graders (N = 323 [173 girls and 150 boys]) accelerometer‐derived sedentary behaviors, light activity, and MVPA were measured for 1 to 5 school days. Children's activity was estimated during class time, lunch, physical education (PE), and recess. To explore disparities in MVPA, children were stratified into high/low‐active groups. RESULTS Girls and boys accumulated 30.4 and 34.4 minutes/day of MVPA on PE days and 23.5 and 27.3 minutes/day of MVPA on non‐PE days. This translated to 36.5 and 44.1% of girls and boys accumulating 30 minutes of MVPA on PE days and 16.3 and 36.5% on non‐PE days. On PE days, PE contributed the most MVPA for girls and boys (11.8 and 13.0 minutes/day), followed by class time (11.4 and 12.5 minutes/day), recess (5.2 and 6.5 minutes/day), and lunch (2.0 and 2.4 minutes/day). Disparities between high/low children were greatest during PE and class time. CONCLUSIONS Most children were not accumulating 30 minutes/day of MVPA. PE and class time are promising school day segments for promoting MVPA.

  September 12, 2016   doi: 10.1111/josh.12426   open full text
• Evidence of the Value of the Smoking Media Literacy Framework for Middle School Students.
  Melinda C. Bier, Lara Zwarun, Stephen A. Sherblom.
  Journal of School Health / The Journal of School Health. September 12, 2016
  BACKGROUND Susceptibility to future smoking, positive beliefs about smoking, and perceptions of antismoking norms are all factors that are associated with future smoking. In previous research, smoking media literacy (SML) has been associated with these variables, even when controlling for other known risk factors for smoking. However, these studies were performed with older teenagers, often in high school, not younger teens at a crucial developmental point with respect to the decision to begin smoking. METHODS This study uses survey data collected from 656 American public middle school students representing multiple zip codes, schools, and school districts. RESULTS Smoking media literacy levels for middle school students were similar to those of high school students in earlier studies. Higher SML levels were associated with lower susceptibility to future smoking and predicted susceptibility to smoke when controlling for other risk factors. This suggests that the same relationships found with teenagers may exist with middle school students. CONCLUSIONS Although follow‐up studies using larger and more controlled administrations of the SML scale are warranted, this study suggests the utility of the SML framework and scale in the development and investigation of media literacy as a prevention strategy in students this age.

  September 12, 2016   doi: 10.1111/josh.12425   open full text
• Mental Health Stigma Prevention: Pilot Testing a Novel, Language Arts Curriculum‐Based Approach for Youth.
  Hannah L. Weisman, Maryam Kia‐Keating, Ann Lippincott, Zachary Taylor, Jimmy Zheng.
  Journal of School Health / The Journal of School Health. September 12, 2016
  BACKGROUND Researchers have emphasized the importance of integrating mental health education with academic curriculum. The focus of the current studies was Mental Health Matters (MHM), a mental health curriculum that is integrated with English language arts. It is taught by trained community member volunteers and aims to increase knowledge and decrease stigma toward individuals with mental health disorders. METHODS In Study 1, 142 sixth graders participated in MHM and completed pre‐ and postprogram measures of mental health knowledge, stigma, and program acceptability. Teachers also completed ratings of acceptability. Study 2 (N = 120 seventh graders) compared participants who had participated in MHM the previous year with those who had not using the same measures. RESULTS Sixth grade students and teachers rated the program as highly acceptable. Participants significantly increased their knowledge and decreased their levels of stigma. Seventh graders who had participated in MHM had significantly more mental health knowledge than peers who had not, but there were no differences in stigma. CONCLUSIONS The model appears to be acceptable to students and teachers. Future research is needed to assess the long‐term effectiveness of integrating mental health education with other academic curriculum such as language arts or science.

  September 12, 2016   doi: 10.1111/josh.12427   open full text
• A School‐Based Program for Overweight and Obese Adolescents: A Randomized Controlled Trial.
  Lori Pbert, Susan Druker, Bruce Barton, Kristin L. Schneider, Barbara Olendzki, Mary A. Gapinski, Stephen Kurtz, Stavroula Osganian.
  Journal of School Health / The Journal of School Health. September 12, 2016
  BACKGROUND Given the dramatic increase in adolescent overweight and obesity, models are needed for implementing weight management treatment through readily accessible venues. We evaluated the acceptability and efficacy of a school‐based intervention consisting of school nurse‐delivered counseling and an afterschool exercise program in improving diet, activity, and body mass index (BMI) among overweight and obese adolescents. METHODS A pair‐matched cluster‐randomized controlled school‐based trial was conducted in which 8 public high schools were randomized to either a 12‐session school nurse‐delivered cognitive‐behavioral counseling intervention plus school‐based after school exercise program, or 12‐session nurse contact with weight management information (control). Overweight or obese adolescents (N = 126) completed anthropometric and behavioral assessments at baseline and 8‐month follow‐up. Main outcome measures included diet, activity, and BMI. Mixed effects regression models were conducted to examine differences at follow‐up. RESULTS At follow‐up, students in intervention compared with control schools were not different in BMI, percent body fat, and waist circumference. Students reported eating breakfast (adjusted mean difference 0.81 days; 95% confidence interval [CI] 0.11‐1.52) on more days/week; there were no differences in other behaviors targeted by the intervention. CONCLUSIONS While a school‐based intervention including counseling and access to an after‐school exercise program is theoretically promising with public health potential, it was not effective in reducing BMI or key obesogenic behaviors. Our findings are important in highlighting that interventions targeted at the individual level are not likely to be sufficient in addressing the adolescent obesity epidemic without changes in social norms and the environment.

  September 12, 2016   doi: 10.1111/josh.12428   open full text
• Association Between Physical Fitness and Academic Achievement in a Cohort of Danish School Pupils.
  Mikkel P. Andersen, Rikke N. Mortensen, Henrik Vardinghus‐Nielsen, Jesper Franch, Christian Torp‐Pedersen, Henrik Bøggild.
  Journal of School Health / The Journal of School Health. August 05, 2016
  BACKGROUND Time spent on physical activity in elementary school has been altered to improve core academics. However, little is known about the relationship between physical fitness and academic achievement. We examined the association between physical fitness and academic achievement and investigated the influence of parental socioeconomic status and ethnicity. METHODS Participants were 542 girls and 577 boys aged 13 to 15 residing in the Danish municipality of Aalborg. A watt‐max cycle ergometer test was completed to evaluate physical fitness as represented by VO2max (mL·kg−1·min−1). Academic achievement was measured 1 school year later through a series of mandatory exams within the humanities, sciences, and all obligatory defined exams. Parental income and education were drawn from nationwide registers. Linear regression models were used to investigate the association. RESULTS Adjusting for ethnicity and parental socioeconomic status, the effect size of the humanities was 0.08 grad/VO2max (95% Cl: 0.05 to 0.11) for girls and 0.06 grad/VO2max (95% Cl:0.03 to 0.08) for boys. The effect size of the sciences was 0.09 grad/VO2max (95% Cl:0.05 to 0.13) for girls and 0.06 grad/VO2max (95% Cl:0.03 to 0.09) for boys. The effect size of the defined exams was 0.09 grad/VO2max (95% Cl:0.06 to 0.11) for girls and 0.06 grad/VO2max (95% Cl:0.03 to 0.08) for boys. CONCLUSION We found a statistically significant positive association between physical fitness and academic achievement after adjusting for ethnicity and parental socioeconomic status.

  August 05, 2016   doi: 10.1111/josh.12422   open full text
• Reliability and Validity of the PAQ‐C Questionnaire to Assess Physical Activity in Children.
  Javier Benítez‐Porres, Iván López‐Fernández, Juan Francisco Raya, Sabrina Álvarez Carnero, José Ramón Alvero‐Cruz, Elvis Álvarez Carnero.
  Journal of School Health / The Journal of School Health. August 05, 2016
  BACKGROUND Physical activity (PA) assessment by questionnaire is a cornerstone in the field of sport epidemiology studies. The Physical Activity Questionnaire for Children (PAQ‐C) has been used widely to assess PA in healthy school populations. The aim of this study was to evaluate the reliability and validity of the PAQ‐C questionnaire in Spanish children using triaxial accelerometry as criterion. METHODS Eighty‐three (N = 46 boys, N = 37 girls) healthy children (age 10.98 ± 1.17 years, body mass index 19.48 ± 3.51 kg/m2) were volunteers and completed the PAQ‐C twice and wore an accelerometer for 8 consecutive days. Reliability was analyzed by the intraclass correlation coefficient (ICC) and the internal consistency by the Cronbach's α coefficient. The PAQ‐C was compared against total PA and moderate to vigorous PA (MVPA) obtained by accelerometry. RESULTS Test‐retest reliability showed an ICC = 0.96 for the final score of PAQ‐C. Small differences between first and second questionnaire administration were detected. Few and low correlations (rho = 0.228‐0.278, all ps < .05) were observed between PAQ‐C and accelerometry. The highest correlation was observed for item 9 (rho = 0.311, p < .01). CONCLUSIONS PAQ‐C had a high reliability but a questionable validity for assessing total PA and MVPA in Spanish children. Therefore, PA measurement in children should not be limited only to self‐report measurements.

  August 05, 2016   doi: 10.1111/josh.12418   open full text
• Implementation in Practice: Adaptations to Sexuality Education Curricula in California.
  Abigail Arons, Mara Decker, Jennifer Yarger, Jan Malvin, Claire D. Brindis.
  Journal of School Health / The Journal of School Health. August 05, 2016
  BACKGROUND Local implementation of evidence‐based curricula, including sex education, has received increasing attention. Although there are expectations that practitioners will implement evidence‐based programs with fidelity, little is known regarding the experiences of instructors in meeting such standards. During 2005 to 2009, the California Department of Public Health funded local agencies through its Teen Pregnancy Prevention Programs (TPP) to provide comprehensive sex education. METHODS To improve understanding of how agencies implemented curricula, in‐depth telephone interviews with 128 coordinators were conducted in 2008 to 2009. Qualitative data were analyzed for content and themes. Selected data were quantified and analyzed to examine differences in curriculum adaptations across settings and curricula type. RESULTS Whereas over half of the TPP agencies (59%) implemented evidence‐based curricula, most agencies (95%) reported adapting the curriculum, with the majority (83%) adding content. Reasons for adaptations included ensuring that the material was accurate and appropriate; responding to logistical or time constraints; and other factors, such as parental and institutional support. CONCLUSION These adaptations reflected agencies' efforts to balance state and local requirements, maintain curriculum fidelity, and provide more up‐to‐date and accessible information. These experiences highlight the need for guidelines that enable appropriate adaptations, while maintaining fidelity to the core components of the original curriculum.

  August 05, 2016   doi: 10.1111/josh.12423   open full text
• Support for Offering Sexual Health Services Through School‐Based Health Clinics.
  Michele Johnson Moore, Elissa Barr, Kristina Wilson, Stacey Griner.
  Journal of School Health / The Journal of School Health. August 05, 2016
  BACKGROUND Numerous studies document support for sexuality education in the schools. However, there is a dearth of research assessing support for sexual health services offered through school‐based health clinics (SBHCs). The purpose of this study was to assess voter support for offering 3 sexual health services (STI/HIV testing, STI/HIV treatment, condom distribution) through SBHCs. METHODS The survey was developed after review of existing surveys on support for sexuality education and sexual health services. The university's Public Opinion Research Laboratory used random‐digit‐dialing to administer the survey to participants (N = 311) including residential and cell phone numbers. RESULTS Most participants were supportive of offering sexual health services at both middle schools (MS) and high schools (HS): testing for STIs/HIV (61% MS, 76% HS), treatment for STIs/HIV (60% MS, 75% HS), and provision of condoms (44% MS, 63% HS). Analyses showed significant differences in support for sexual health services by a few demographic variables, opinions about sexuality education, and the percentage of students perceived to have had sexual intercourse. CONCLUSIONS Results document support for offering sexual health services through SBHCs. These findings may benefit other communities looking to implement similar clinics. Such services have great potential for positively impacting the sexual health of youth.

  August 05, 2016   doi: 10.1111/josh.12421   open full text
• Bigger ≠ Better: The Comprehensiveness and Strength of School Wellness Policies Varies by School District Size.
  Jessica Meendering, Emily Kranz, Tara Shafrath, Lacey McCormack.
  Journal of School Health / The Journal of School Health. August 05, 2016
  BACKGROUND District size has been shown to impact the anticipated barriers to wellness policy creation and implementation. Therefore, the purpose of the present study was to determine if strength and comprehensiveness of wellness policies differs among school districts of varying size. METHODS Wellness policies were collected from 10 large, 29 medium, and 31 small school districts in a rural Midwest state. District size was categorized by the average daily membership in grades 9‐11. Polices were coded using the Wellness School Assessment Tool (WellSAT). Strength and comprehensiveness of the full policy and policy sections were compared among small, medium, and large districts using 1‐way analyses of variance (ANOVAs). Data are presented as mean ± SD. Statistical significance was set at p ≤ .05. RESULTS There was a difference in the total combined (p = .041), total comprehensiveness (p = .043), and total strength scores (p = .031) based on school district size, such that small districts had stronger, more comprehensive wellness policies than large districts. Section comparisons revealed the section focused on Standards for United States Department of Agriculture School Meals was primarily responsible for these differences. CONCLUSIONS These data suggest smaller districts write policies that are more comprehensive to governmental standards and use more definitive language than larger districts.

  August 05, 2016   doi: 10.1111/josh.12419   open full text
• “Headache Tools to Stay in School”: Assessment, Development, and Implementation of an Educational Guide for School Nurses.
  Lori Lazdowsky, Jonathan Rabner, Alessandra Caruso, Karen Kaczynski, Sarah Gottlieb, Elyse Mahoney, Alyssa LeBel.
  Journal of School Health / The Journal of School Health. August 05, 2016
  BACKGROUND Headache is the most common type of pain reported in the pediatric population, and chronic headache is an increasingly prevalent and debilitating pain condition in children and adolescents. With large numbers of students experiencing acute headaches and more students with chronic headache reentering typical school settings, greater availability of tailored evidence‐based practice guidelines for school nurses is imperative. METHODS A 2‐armed study was developed to assess the need for and evaluate the use and favorability of a headache‐driven school nurse guide. Students and their parents were first surveyed on their school nurse's headache knowledge and management skills. School nurses were also interviewed on their desire for a headache educational tool. This feedback aided in developing a headache resource guide. Next, the guide was distributed to school nurses who provided feedback after a 3‐month trial. RESULTS Results indicate that “Headache Tools to Stay in School” is a useful resource in facilitating communication among health care providers, students, families, and school personnel on how to best meet the complex needs of students with headaches. CONCLUSIONS Given the guide's favorability, we encourage school nurses to demand the creation of additional evidence‐based resources. Continued dissemination of this guide may improve students' headache management under the informed care of school nurses, and may encourage the development of more evidence‐based guides across various medical conditions.

  August 05, 2016   doi: 10.1111/josh.12420   open full text
• Associations Between Adolescents' Weight and Maladjustment Differ With Deviation From Weight Norms in Social Contexts.
  Carolyn Sutter, Adrienne Nishina, Melissa R. Witkow, Amy Bellmore.
  Journal of School Health / The Journal of School Health. August 05, 2016
  BACKGROUND In line with the reflected self‐appraisal hypothesis, previous research finds associations between weight and maladjustment are strongest when there is a mismatch between individuals' weight and the weight norm of their social contexts. However, research has not considered associations in more proximal social contexts. We examined differences in associations between weight and maladjustment for 2 proximal social contexts: grade‐level peers and friendship groups. METHODS We used sixth‐graders (N = 565; Mage = 12 years) self‐reported height and weight (used to calculate body mass index (BMI) z‐score), experiences of peer victimization, and depressive symptoms. Deviation from the normative weight was calculated as the students' BMI z‐score minus the average BMI z‐score for the context (grade‐level peers or friendship group). RESULTS Considering deviations from grade‐level peers, greater BMI z‐scores were associated with more self‐reported peer victimization only for students above the weight norm. For the friendship group, greater weight was associated with more self‐reported depressive symptoms only for those who were above the normative weight. CONCLUSIONS Being heavier during adolescence may be especially problematic for students who differ from the norm in their proximal social contexts. Intervention efforts focused on weight and maladjustment may want to consider the contexts involved in adolescents' self‐appraisals.

  August 05, 2016   doi: 10.1111/josh.12417   open full text
• Strength and Comprehensiveness of School Wellness Policies in Southeastern US School Districts.
  Melissa J. Cox, Susan T. Ennett, Christopher L. Ringwalt, Sean M. Hanley, James M. Bowling.
  Journal of School Health / The Journal of School Health. August 05, 2016
  BACKGROUND In 2004, Congress passed legislation mandating that all public school districts participating in federal school meal programs develop a school wellness policy (SWP) to direct efforts related to nutrition and physical activity. We examined the extent to which SWPs varied in comprehensiveness and strength in a representative sample of school districts in the southeastern United States, the area of the country with the highest rates of childhood obesity. METHODS Policies were assessed using an established 96‐item coding tool by 2 raters to ascertain the comprehensiveness and strength of the policies as a whole, and across distinct subsections specified by federal legislation. In addition, variability in SWP comprehensiveness and strength was assessed based on district sociodemographic characteristics. RESULTS Overall, SWPs in the southeastern states are weakly written, fragmented, and lack requirements necessary for healthy school environments. District size, which was the only sociodemographic factor related to policy characteristics, yielded an inverse association. CONCLUSIONS To encourage continued promotion of healthy school environments, school districts will require technical support to improve the quality of their school wellness policies.

  August 05, 2016   doi: 10.1111/josh.12416   open full text
• Associations of Teen Dating Violence Victimization With School Violence and Bullying Among US High School Students.
  Alana M. Vivolo‐Kantor, Emily O'Malley Olsen, Sarah Bacon.
  Journal of School Health / The Journal of School Health. July 03, 2016
  BACKGROUND Teen dating violence (TDV) negatively impacts health, mental and physical well‐being, and school performance. METHODS Data from a nationally representative sample of high school students participating in the Centers for Disease Control and Prevention (CDC)'s 2013 Youth Risk Behavior Survey (YRBS) are used to demonstrate associations of physical and sexual TDV with school violence‐related experiences and behaviors, including bullying victimization. Bivariate and adjusted sex‐stratified regressions assessed relationships between TDV and school violence‐related experiences and behaviors. RESULTS Compared to students not reporting TDV, those experiencing both physical and sexual TDV were more likely to report carrying a weapon at school, missing school because they felt unsafe, being threatened or injured with a weapon on school property, having a physical fight at school, and being bullied on school property. CONCLUSIONS School‐based prevention efforts should target multiple forms of violence.

  July 03, 2016   doi: 10.1111/josh.12412   open full text
• Certified School Nurse Perspectives on State‐Mandated Hearing Screens.
  Deepa L. Sekhar, Jessica S. Beiler, Eric W. Schaefer, Antoinette Henning, Judith F. Dillon, Beth Czarnecki, Thomas R. Zalewski.
  Journal of School Health / The Journal of School Health. July 03, 2016
  BACKGROUND Approximately 15% of children in the United States 6‐19 years of age have hearing loss. Even mild, unilateral hearing loss may adversely affect educational success. In 2014, the Pennsylvania Department of Health (PA DOH) began updating the 2001 regulations on state‐mandated school hearing screens. To inform the updates, a needs assessment was conducted with PA‐certified school nurses (CSNs) regarding current screening practice and potential barriers to making changes. METHODS A 42‐item electronic survey of CSNs developed with pediatricians, audiologists, nurses, and the PA DOH was administered in October 2014. RESULTS There were 536 completed surveys. Most CSNs (50.8%) screened 251‐500 students annually. Only 35.8% strictly followed PA DOH protocol, while 51.6% followed protocol and added nonguideline frequencies. Over half of screens (60.2%) were conducted in places where other people were present. Most CSNs (82.5%) reported annual audiometer calibration, but 92.4% were unsure whether the calibration was exhaustive or limited. Reported barriers to change included time, cost, and staffing. CONCLUSIONS As most CSNs added frequencies to the PA DOH hearing screen, an update with added frequencies should be well accepted. Clarification regarding test environment and exhaustive audiometer calibration is needed. Adherence to best practice may be optimized by addressing CSN reported barriers to change.

  July 03, 2016   doi: 10.1111/josh.12415   open full text
• Evaluation of the LiveWell@School Food Initiative Shows Increases in Scratch Cooking and Improvement in Nutritional Content.
  Daniel J. Schober, Leah Carpenter, Venita Currie, Amy L. Yaroch.
  Journal of School Health / The Journal of School Health. July 03, 2016
  BACKGROUND The purpose of this evaluation was to examine the effects of the LiveWell@School Food Initiative (LW@SFI), a Colorado‐based childhood obesity prevention program that partners with school districts to enable them to serve more scratch cooked foods through culinary training, action planning, and equipment grants. METHODS This evaluation used a quasi‐experimental design that examined menu cycles prior to entering the LW@SFI and approximately 1 year later. A review of school menus with food service directors from 9 Colorado school districts was conducted. RESULTS Data show that districts changed an average of 17.4 entrées and 19.7 side dishes over the course of the year. Changes to serving scratch cooked foods were highest for sauces (an increase of 40.5%). No districts were cooking beans/legumes from scratch during baseline or at follow‐up. Across the 9 districts, 7 observed statistically significant pre‐post reductions in sodium, 4 in fat, 5 in saturated fat, and 3 in calories. CONCLUSIONS Within a year of implementing the LW@SFI, school districts increased the proportion of fresh, scratch cooked foods they offered and this was associated with some decreases in calories, fat, saturated fat, and sodium, contributing to healthier school food environments.

  July 03, 2016   doi: 10.1111/josh.12413   open full text
• Effectiveness of an Adaptation of the Project Connect Health Systems Intervention: Youth and Clinic‐Level Findings.
  Penny S. Loosier, Shelli Doll, Danielle Lepar, Kristin Ward, Ginger Gamble, Patricia J. Dittus.
  Journal of School Health / The Journal of School Health. July 03, 2016
  BACKGROUND The Project Connect Health Systems Intervention (Project Connect) uses a systematic process of collecting community and healthcare infrastructure information to craft a referral guide highlighting local healthcare providers who provide high quality sexual and reproductive healthcare. Previous self‐report data on healthcare usage indicated Project Connect was successful with sexually experienced female youth, where it increased rates of human immunodeficiency virus (HIV) and sexually transmitted disease (STD) testing and receipt of contraception. This adaption of Project Connect examined its effectiveness in a new context and via collection of clinic encounter‐level data. METHODS Project Connect was implemented in 3 high schools. (only 2 schools remained open throughout the entire project period). Participant recruitment and data collection occurred in 5 of 8 participating health clinics. Students completed Youth Surveys (N = 608) and a Clinic Survey (paired with medical data abstraction in 2 clinics [N = 305]). RESULTS Students were more likely than nonstudents to report having reached a clinic via Project Connect. Nearly 40% of students attended a Project Connect school, with 32.7% using Project Connect to reach the clinic. Students were most likely to have been referred by a school nurse or coach. CONCLUSIONS Project Connect is a low‐cost, sustainable structural intervention with multiple applications within schools, either as a standalone intervention or in combination with ongoing efforts.

  July 03, 2016   doi: 10.1111/josh.12414   open full text
• After‐School Program Implementation in Urban Environments: Increasing Engagement Among Adolescent Youth.
  Allison Pelcher, Sonali Rajan.
  Journal of School Health / The Journal of School Health. July 03, 2016
  BACKGROUND After‐school programs (ASPs) play a crucial role in supplementing the present school day. However, implementing ASPs in the urban environment and among adolescents (grades 6‐12) poses unique challenges. The purpose of this study was to conduct a systematic literature review to identify evidence‐based barriers and facilitators to after‐school programming in urban school environments. METHODS Twenty‐five publications meeting the authors' inclusion criteria over the past 10 years were reviewed and synthesized. RESULTS Results demonstrated that the demand for ASPs is increasing. Several barriers, including staffing, funding, resources, transportation, and space, were identified. Specific challenges regarding the implementation of ASPs for adolescents in urban areas were also determined. A number of best practices were identified along with benefits for academic engagement and social‐emotional coping skill development. CONCLUSIONS Efforts to address these specific barriers and facilitators to ASP implementation may contribute to improving broader health and academic outcomes among adolescent youth.

  July 03, 2016   doi: 10.1111/josh.12411   open full text
• Planning Adolescent Mental Health Promotion Programming in Saskatoon.
  Jennifer Cushon, Cheryl Waldner, Christina Scott, Cordell Neudorf.
  Journal of School Health / The Journal of School Health. July 03, 2016
  BACKGROUND We assessed associations between key demographic risk factors and the outcome of depressed mood in Saskatoon, Saskatchewan, to inform the planning and implementation of mental health promotion programming in schools. METHODS In the 2008/2009 school year, 3958 students from grades 5 through 8 from 76 elementary schools completed questions regarding depressed mood on the Student Health Survey administered by the Saskatoon Health Region. The demographic risk factors for depressed mood considered in this study included age, sex, cultural status, and neighborhood income, as well as the role of school and age cohorts or grades within schools. RESULTS We found Aboriginal students were significantly more likely to report moderate/severe depressed mood than other students. We also found older female adolescents were significantly more likely to report moderate/severe depressed mood. Neighborhood income explained the largest proportion (40%) of depressed mood differences between schools. CONCLUSIONS These results can inform the planning and implementation of mental health promotion programming by the health sector in Saskatoon's elementary schools, including an appropriate balance between targeted and population‐based interventions that address both the distal and proximal determinants of depressed mood in adolescents.

  July 03, 2016   doi: 10.1111/josh.12410   open full text
• School Breakfast‐Club Program Changes and Youth Eating Breakfast During the School Week in the COMPASS Study.
  Scott T. Leatherdale, Jennifer M. Stefanczyk, Sharon I. Kirkpatrick.
  Journal of School Health / The Journal of School Health. July 03, 2016
  BACKGROUND Despite the importance of breakfast consumption, breakfast skipping is common among Canadian youth. This study examines how changes to school‐based breakfast programs are associated with breakfast‐skipping behavior. METHODS Using school‐level longitudinal data from Year 1 (Y1: 2012‐2013) and Year 2 (Y2: 2013‐2014) of the COMPASS study, quasi‐experimental methods evaluated the impact over time that changes to school‐based breakfast programs had on breakfast skipping or participating in school‐based breakfast program. RESULTS Between Y1 and Y2, the school‐level prevalence of breakfast skipping (54.5%‐54.9%) and breakfast program participation (12.3%‐13.6%) increased. Of the 43 participating schools, 5 implemented a new school breakfast program. Among the intervention schools, 1 school (School 4) observed a significant, and 1 school (School 3) observed a significant increase in the school‐level prevalence of skipping breakfast; there was no significant change in the other 3 intervention schools. CONCLUSIONS Despite the availability of free school breakfast programs, the majority of youth skipped breakfast at least once a school week. Owing to the variation in the types of programs implemented, additional evaluation evidence is necessary to determine which students benefited the most from these programs.

  July 03, 2016   doi: 10.1111/josh.12408   open full text
• Weight Control Behavior as an Indicator of Adolescent Psychological Well‐Being.
  Paul E. Yeatts, Scott B. Martin, Trent A. Petrie, Christy Greenleaf.
  Journal of School Health / The Journal of School Health. July 03, 2016
  BACKGROUND Adolescence is a critical time for the development of psychological well‐being. Weight gain and the emergence of body image concerns during this period can lead to the development of negative psychological states. To explore this issue, we examined the relationship between weight control behavior (WCB; ie, trying to lose, gain, stay the same, or do nothing about weight) and levels of depression and self‐esteem. METHODS Adolescents (508 boys, 502 girls; Mage = 12.32 ± .88 years) completed a survey that assessed WCB, depression, and self‐esteem. Descriptive discriminant analysis was used to analyze WCB group differences on psychological well‐being. Multivariate post hoc analysis further examined group differences. Structure coefficients indicated the relative importance of each dependent variable in boys and girls. RESULTS Results indicated that, among both sexes, WCB was significantly related to depression and self‐esteem. Individuals trying to lose weight had lower levels of psychological well‐being than the other groups. CONCLUSIONS Adolescents trying to lose weight reported the lowest psychological well‐being scores whereas those not doing anything to control weight reported the highest levels of psychological well‐being. These findings have important implications for screening and education programs designed to monitor and support adolescent psychological well‐being.

  July 03, 2016   doi: 10.1111/josh.12409   open full text
• Project ReFresh: Testing the Efficacy of a School‐Based Classroom and Cafeteria Intervention in Elementary School Children.
  Hee‐Jung Song, Stephanie Grutzmacher, Ash L. Munger.
  Journal of School Health / The Journal of School Health. June 01, 2016
  BACKGROUND The purpose of this study was to assess the effect of a school‐based nutrition program using a cafeteria environment intervention and classroom nutrition education on self‐reported fruit and vegetable (FV) consumption, self‐efficacy to select FV, and preference for healthy foods. METHODS Using quasi‐experimental pre‐post design with 3 study conditions, a total of 665 fourth‐ and fifth‐grade students participated in the study. The comprehensive intervention included a behavioral economics cafeteria intervention and weekly classroom nutrition education for 1 academic year. The intervention was designed and delivered by the extension system. RESULTS The comprehensive group showed significant improvement in some indicators including eating vegetables for lunch (p = .007), number of days eating vegetables (p < .001) and fruits (p < .001) in the last week, and self‐efficacy in preparing FV at home (p = .034) compared to the control and cafeteria groups. Food preference of some food items, including oatmeal (p = .036 for cafeteria group, p < .001 for comprehensive group), whole grain noodles (p = .011 for comprehensive group), and vegetables (p = .003 for comprehensive group), significantly improved in the cafeteria and/or comprehensive group. CONCLUSIONS Classroom nutrition education combined with cafeteria improvement has the potential to improve diet‐related behavior of elementary school children. Also, collaborative partnership between schools and extension can enhance program sustainability.

  June 01, 2016   doi: 10.1111/josh.12404   open full text
• Adoption of Preventive Measures and Attitudes Toward the H1N1 Influenza Pandemic in Schools.
  Anna Pérez, Tània Rodríguez, Maria José López, Xavier Continente, Manel Nebot.
  Journal of School Health / The Journal of School Health. June 01, 2016
  BACKGROUND This study describes the perceived impact of H1N1 influenza and the adoption of the recommended measures to address the pandemic in schools. METHODS A cross‐sectional self‐reported survey was conducted in 433 schools in Barcelona addressed to the school principal or the H1N1 influenza designated person. A descriptive analysis was performed, stratifying by educational level and type of school. A logistic regression analysis also was conducted. RESULTS Around 70% of the respondents reported that there had been H1N1 influenza cases among students, being this percentage significantly higher among those schools offering primary education (74.4%) (p < .05). The main measures (single‐use paper towels, availability of sanitizer solutions and 15 minutes ventilation per day of enclosed spaces) were implemented in most of the centers. However, the correct adoption of the main measures took place in around 30% of the schools, being the percentage lower in those offering only secondary education (Odds ratio [OR]: 0.518; 95% confidence interval [CI]:0.272‐0.986) and those located in medium (OR: 0.438, 95% CI: 0.234‐0.811) or low socioeconomic status (SES) districts (OR: 0.321, 95% CI: 0.159‐0.649). CONCLUSIONS Despite the climate of social alarm, the perceived impact of H1N1 influenza in most schools was moderate. In future potential threats, the educational level and the SES of the school should be considered, especially when measures requiring purchasing any product are recommended but not provided.

  June 01, 2016   doi: 10.1111/josh.12406   open full text
• Feasibility and Effects of Short Activity Breaks for Increasing Preschool‐Age Children's Physical Activity Levels.
  Sofiya Alhassan, Ogechi Nwaokelemeh, Albert Mendoza, Sanyog Shitole, Elaine Puleo, Karin A. Pfeiffer, Melicia C. Whitt‐Glover.
  Journal of School Health / The Journal of School Health. June 01, 2016
  BACKGROUND We examined the effects of short bouts of structured physical activity (SBS‐PA) implemented within the classroom setting as part of designated gross‐motor playtime on preschoolers PA. METHODS Preschools were randomized to SBS‐PA (centers, N = 5; participants, N = 141) or unstructured free playtime (UPA) (centers, N = 5; participants, N = 150). SBS‐PA consisted of structured PA implemented in the classroom during the first 10 minutes of gross‐motor playtime followed by 20 minutes of free playtime. UPA consisted of 30 minutes of unstructured free playtime. Teachers implemented both conditions for 5 days/week for 6 months. PA was assessed with accelerometers (preschool‐day) and direct observation (30‐minute sessions). Generalized linear mixed models were used to examine the impact of the intervention. RESULTS Regarding the 30‐minute sessions, significant group main effects were observed for intervals spent at light (p < .001) and moderate‐to‐vigorous PA (MVPA, p < .001). Regarding the preschool‐day PA, significant group by visit interaction was observed for percent time spent in total preschool‐day MVPA (F (2, 254) = 3.54, p = .03). Percent of time spent in MVPA significantly decreased in both groups at 3 months and at 6 months. CONCLUSION SBS‐PA can be implemented in classroom settings; however, further research is needed to examine its impact on preschoolers PA levels.

  June 01, 2016   doi: 10.1111/josh.12403   open full text
• Promoting Fitness and Safety in Elementary Students: A Randomized Control Study of the Michigan Model for Health.
  James M. O'Neill, Jeffrey K. Clark, James A. Jones.
  Journal of School Health / The Journal of School Health. June 01, 2016
  BACKGROUND In elementary grades, comprehensive health education curricula have demonstrated effectiveness in addressing singular health issues. The Michigan Model for Health (MMH) was implemented and evaluated to determine its impact on nutrition, physical fitness, and safety knowledge and skills. METHODS Schools (N = 52) were randomly assigned to intervention and control conditions. Participants received MMH with 24 lessons in grade 4 and 28 more lessons in grade 5 including material focusing on nutrition, physical fitness, and safety attitudes and skills. The 40‐minute lessons were taught by the classroom teacher who received curriculum training and provided feedback on implementation fidelity. Self‐report survey data were collected from the fourth‐grade students (N = 1983) prior to the intervention, immediately after the intervention, and 6 weeks after the intervention, with the same data collection schedule repeated in fifth grade. Analysis of the scales was conducted using a mixed‐model approach. RESULTS Students who received the curriculum had better nutrition, physical activity, and safety skills than the control‐group students. Intervention students also reported higher consumption of fruits; however, no difference was reported for other types of food consumption. CONCLUSION The effectiveness of the MMH in promoting fitness and safety supports the call for integrated strategies that begin in elementary grades, target multiple risk behaviors, and result in practical and financial benefits to schools.

  June 01, 2016   doi: 10.1111/josh.12407   open full text
• Policy Actions to Address Weight‐Based Bullying and Eating Disorders in Schools: Views of Teachers and School Administrators.
  Rebecca M. Puhl, Dianne Neumark‐Sztainer, S. Bryn Austin, Young Suh, Dorothy B. Wakefield.
  Journal of School Health / The Journal of School Health. June 01, 2016
  BACKGROUND Weight‐related bullying is prevalent among youth and associated with adverse health consequences, including increased risk for body dissatisfaction and disordered eating behaviors, which are risk factors for eating disorders. Although concerns about these problems have stimulated calls for broader intervention efforts in schools, actions thus far have been limited. This study examined educators' perspectives about potential policy actions to address these issues in schools. METHODS Educators (N = 240) completed an online questionnaire assessing their support for 11 potential school‐based policy actions to address weight‐related bullying and eating disorders. Participants also rated policies according to their feasibility and potential for positive impact. RESULTS Forty‐eight percent of participants observed weight‐related bullying in their school and 99% expressed the importance of intervening in such incidents. A large majority (75%‐94%) supported 8 of the 11 policies, especially actions requiring school‐based health curriculum to include content on eating disorder prevention (94%), and addressing weight‐bullying through antibullying policies (92%), staff training (89%), and school curriculum (89%). Strongly supported policies were viewed by participants as being the most impactful and feasible to implement. CONCLUSIONS Educators recognize weight‐related bullying and eating disorders as problems in their schools that warrant improved prevention and intervention efforts at the policy level.

  June 01, 2016   doi: 10.1111/josh.12401   open full text
• Exploring Categorical Body Mass Index Trajectories in Elementary School Children.
  Geraldine Moreno‐Black, Shawn Boles, Deb Johnson‐Shelton, Cody Evers.
  Journal of School Health / The Journal of School Health. June 01, 2016
  BACKGROUND Studies of body mass index (BMI) change have focused on understanding growth trajectories from childhood to adolescence and adolescence to adulthood, but few have explored BMI trajectories solely in elementary (grades K‐5) school children. This report complements these studies by exploring changes in obesity status using analytic methods developed to investigate categorical changes in life‐course events. METHODS Sequences of a 4‐state BMI variable (underweight, normal, overweight, and obese) were calculated using height and weight data collected annually (2008‐2013) from 414 kindergarten and first‐grade students participating in the Community and Schools Together (CAST) project. These sequences were explored using the TraMineR software package to investigate the distribution of sequences and states, calculate transition rates among states, and examine clustering of sequences. RESULTS Aggregated cluster solutions were identified consisting of either 4 clusters (normal, stepped, mixed, and obese) or 3 clusters (aggregation of obese cluster cases into stepped cluster) with membership in the former predicted by ethnicity and socioeconomic status (SES) and the latter by SES alone. Transition rate patterns among states varied markedly by cluster and state. CONCLUSION The finding of early emergence of stable obesity states, especially in Hispanic children confirms the need for early childhood interventions to influence BMI.

  June 01, 2016   doi: 10.1111/josh.12402   open full text
• Availability of Reproductive Health Care Services at Schools and Subsequent Birth Outcomes Among Adolescent Mothers.
  Aubrey S. Madkour, Yiqiong Xie, Emily W. Harville.
  Journal of School Health / The Journal of School Health. June 01, 2016
  BACKGROUND Adverse birth outcomes are more common among adolescent versus adult mothers, but little is known about school‐based services that may improve birth outcomes in this group. METHODS Data from Waves I and IV of the National Longitudinal Study of Adolescent Health were analyzed. Girls and women who gave birth to singleton live infants after Wave I and before age 20, were still in secondary school while pregnant, and had complete data (N = 402) were included. Mothers reported infants' birthweight and gestational age. School administrators reported whether family planning counseling, diagnostic screening (including sexually transmitted diseases [STDs]), STD treatment, and prenatal/postpartum health care were provided on‐site at school at Wave I. Multilevel models adjusted for individual and school characteristics were conducted. RESULTS Few schools offered reproductive health care services on‐site. In multilevel analyses, availability of family planning counseling (Est. β = 0.21, 95% confidence interval [CI] 0.04‐0.38 p < 0.05) and prenatal/postpartum health care (Est. β = 0.21, 95% CI 0.02‐0.40 p < 0.05) were significantly associated with increased infant birthweight. No services examined were significantly associated with increased gestational age. CONCLUSIONS Some school‐based reproductive health services may improve subsequent birth outcomes among adolescent mothers. Future analyses should examine the mechanisms by which services impact birth outcomes.

  June 01, 2016   doi: 10.1111/josh.12399   open full text
• Improving Pre‐Service Elementary Teachers' Self‐Reported Efficacy for Using the Professional Teacher Standards in Health Education.
  Jeffrey K. Clark, Susan E. Clark, Rebecca A. Brey.
  Journal of School Health / The Journal of School Health. June 03, 2014
  BACKGROUND The effectiveness of health education methods courses for pre‐service elementary teachers has not been assessed for improving the pre‐service elementary teacher's self‐efficacy for using the professional teacher standards in health education (PTSHE). METHODS A quasi‐experimental design was used to assess pre‐service elementary teachers' self‐efficacy toward using the PTSHE. Four institutions whose elementary education programs provide a health education methods course were recruited to participate in the study. Students were recruited to participate and they completed the Pre‐service Health Education National Standards Self‐efficacy (PHENSS) Scale at the beginning and end of the semester. Data were analyzed using SPSS (version 15) software. RESULTS A significant increase in the PHENSS Scale scores indicated that a 3‐credit health education methods course could improve the pre‐service elementary teacher's self‐efficacy to use the national standards in their teaching of health education. Further analysis indicated statistically significant improvement of the participants' PHENSS scores in 2 of the 7 standards. CONCLUSION Teacher self‐efficacy can be a useful measure of the pre‐service elementary teachers' ability to use the national standards for health education. The design of the methods course may affect the PHENSS scores.

  June 03, 2014   doi: 10.1111/josh.12166   open full text
• Profits, Commercial Food Supplier Involvement, and School Vending Machine Snack Food Availability: Implications for Implementing the New Competitive Foods Rule.
  Yvonne M. Terry‐McElrath, Nancy E. Hood, Natalie Colabianchi, Patrick M. O'Malley, Lloyd D. Johnston.
  Journal of School Health / The Journal of School Health. June 03, 2014
  BACKGROUND The 2013‐2014 school year involved preparation for implementing the new US Department of Agriculture (USDA) competitive foods nutrition standards. An awareness of associations between commercial supplier involvement, food vending practices, and food vending item availability may assist schools in preparing for the new standards. METHODS Analyses used 2007‐2012 questionnaire data from administrators of 814 middle and 801 high schools in the nationally representative Youth, Education, and Society study to examine prevalence of profit from and commercial involvement with vending machine food sales, and associations between such measures and food availability. RESULTS Profits for the school district were associated with decreased low‐nutrient, energy‐dense (LNED) food availability and increased fruit/vegetable availability. Profits for the school and use of company suppliers were associated with increased LNED availability; company suppliers also were associated with decreased fruit/vegetable availability. Supplier “say” in vending food selection was associated with increased LNED availability and decreased fruit/vegetable availability. CONCLUSIONS Results support (1) increased district involvement with school vending policies and practices, and (2) limited supplier “say” as to what items are made available in student‐accessed vending machines. Schools and districts should pay close attention to which food items replace vending machine LNED foods following implementation of the new nutrition standards.

  June 03, 2014   doi: 10.1111/josh.12165   open full text
• Investigating Mental Fitness and School Connectedness in Prince Edward Island and New Brunswick, Canada.
  Donna Murnaghan, William Morrison, Courtney Laurence, Brandi Bell.
  Journal of School Health / The Journal of School Health. June 03, 2014
  BACKGROUND As youth struggle with anxiety and depression, promoting positive mental fitness is a primary concern. Canadian school‐based mental health programs that focus on positive psychology and positive mental health initiatives emphasize safe and supportive environments, student engagement, resilience, and self‐determination. This study examined predictors of mental fitness and its 3 components (autonomy, competence, and relatedness). METHODS School Health Action Planning and Evaluation System‐Prince Edward Island (SHAPES‐PEI) and the New Brunswick Student Wellness Survey (NB SWS) are data collection and feedback systems that survey youth about 4 health behaviors. Grade 7‐12 students in Prince Edward Island (N = 3318) and New Brunswick (N = 7314) completed a mental fitness questionnaire in 2008‐2009 (PEI) and 2006‐2007 (NB). Four linear regression models were conducted to examine student characteristics associated with mental fitness, autonomy, competence, and relatedness. RESULTS Positive associations were found between school connectedness (p < .0001) and mental fitness, as well as autonomy, competence, and relatedness. There were also significant relationships between affect, pro‐social and antisocial behaviors, tried smoking, and mental fitness. CONCLUSION A better understanding of adolescent health and its predictors is needed. By identifying core parameters for mental fitness, we can inform how to address students' needs through appropriate programs and policies supporting healthy school environments.

  June 03, 2014   doi: 10.1111/josh.12169   open full text
• Optimizing Violence Prevention Programs: An Examination of Program Effectiveness Among Urban High School Students.
  Amanda C. Thompkins, Lisa M. Chauveron, Ofer Harel, Daniel F. Perkins.
  Journal of School Health / The Journal of School Health. June 03, 2014
  BACKGROUND While demand for youth violence prevention programs increases, the ability of the school‐day schedule to accommodate their time requirements has diminished. Viable school‐based prevention programs must strike a balance between brevity and effectiveness. This article reports results from an effectiveness trial of a 12‐session curriculum‐based universal violence prevention program that promotes healthy conflict resolution skills among urban adolescents. METHODS Using a review of program record data and a multisite quasi‐experimental study design, we examined the effectiveness of a New York City‐based violence prevention program entitled the Violence Prevention project (VPP) optimized to meet school needs. We analyzed survey data from 1112 9th‐ and 10th‐grade students in 13 New York City public high schools across 4 consecutive school years. Both participants and nonparticipants were surveyed. RESULTS Review of program record data indicated that the program was implemented with acceptable fidelity to the core component structure, and that participant responsiveness to the model was high. Multilevel modeling indicated that VPP participation was protective for academic self‐concept and promoted conflict resolution skills. CONCLUSIONS Findings indicate that semester‐long violence prevention programs optimized to meet the needs of a typical high school can be effective at promoting healthy conflict resolution skills in urban adolescents.

  June 03, 2014   doi: 10.1111/josh.12171   open full text
• Are Students With Asthma at Increased Risk for Being a Victim of Bullying in School or Cyberspace? Findings From the 2011 Florida Youth Risk Behavior Survey.
  Linda Gibson‐Young, Mary P. Martinasek, Michiko Clutter, Jamie Forrest.
  Journal of School Health / The Journal of School Health. June 03, 2014
  BACKGROUND Adolescents with asthma are at risk for psychological and behavioral problems. The aim of this study was to determine whether high school students with asthma are at increased risk for bullying in school and cyberspace, and to explore the role of depressive symptoms in moderating this association. METHODS A secondary data analysis was completed with the 2011 Florida Youth Risk Behavior Survey. Participant included a random sample of adolescents in grades 9 through 12 who attended public high schools in Florida. Descriptive and inferential statistics were conducted using SPSS software. RESULTS We examined data from 6212 high school adolescents and found a significant relationship between current asthma and cyberbullying in adolescents. Of the sample diagnosed with asthma, 15.6% reported bullying and 17% cyberbullying (versus 10.2% and 11% of nonasthmatics). We further examined data using depressive symptoms as a mediating and moderating variable and found significance on all accounts. CONCLUSIONS Adolescents with asthma are at increased risk for being victims of bullying in school and cyberspace. Our findings suggest that adolescents with asthma who also report depressive symptoms are particularly at high risk for bullying than adolescents with asthma who did not report depressive symptoms. Efforts to increase education and decrease all types of bullying at the high school level for both students with and without asthma are warranted.

  June 03, 2014   doi: 10.1111/josh.12167   open full text
• Examining the Association Between Bullying and Adolescent Concerns About Teen Dating Violence.
  Katrina J. Debnam, Sarah L. Johnson, Catherine P. Bradshaw.
  Journal of School Health / The Journal of School Health. June 03, 2014
  BACKGROUND The school environment is an important context for understanding risk factors for teen dating violence. This study seeks to add to the growing literature base linking adolescent experiences with bullying and involvement with teen dating violence. METHODS Data were collected from 27,074 adolescents at 58 high schools via a Web‐based survey. RESULTS Three‐level hierarchical linear models indicated that adolescents who had been bullied were more concerned about both physical and emotional dating violence among students at their school. Schools that were perceived by students as safer were rated as having lower levels of teen dating violence. Older students and male students consistently reported greater concerns about dating violence. CONCLUSIONS These results suggest that adolescents who experience bullying may also have concerns about violence in teen dating relationships. Findings also indicate that schools perceived as being unsafe may be an important context for targeting dating violence prevention efforts.

  June 03, 2014   doi: 10.1111/josh.12170   open full text
• Improving Sexuality Education: The Development of Teacher‐Preparation Standards.
  Elissa M. Barr, Eva S. Goldfarb, Susan Russell, Denise Seabert, Michele Wallen, Kelly L. Wilson.
  Journal of School Health / The Journal of School Health. April 21, 2014
  BACKGROUNDTeaching sexuality education to support young people's sexual development and overall sexual health is both needed and supported. Data continue to highlight the high rates of teen pregnancy, sexually transmitted disease, including human immunodeficiency virus (HIV) infections, among young people in the United States as well as the overwhelming public support for sexuality education instruction. In support of the implementation of the National Sexuality Education Standards, the current effort focuses on better preparing teachers to deliver sexuality education. METHODSAn expert panel was convened by the Future of Sex Education Initiative to develop teacher‐preparation standards for sexuality education. Their task was to develop standards and indicators that addressed the unique elements intrinsic to sexuality education instruction. RESULTSSeven standards and associated indicators were developed that address professional disposition, diversity and equity, content knowledge, legal and professional ethics, planning, implementation, and assessment. CONCLUSIONSThe National Teacher‐Preparation Standards for Sexuality Education represent an unprecedented unified effort to enable prospective health education teachers to become competent in teaching methodology, theory, practice of pedagogy, content, and skills, specific to sexuality education. Higher education will play a key role in ensuring the success of these standards.

  April 21, 2014   doi: 10.1111/josh.12156   open full text
• Sex Differences in Associations of School Connectedness With Adolescent Sexual Risk‐Taking in Nova Scotia, Canada.
  Donald B. Langille, Mark Asbridge, Sunday Azagba, Gordon Flowerdew, Daniel Rasic, Amber Cragg.
  Journal of School Health / The Journal of School Health. April 21, 2014
  BACKGROUNDAssociations of lower school connectedness have been seen with adolescent sexual risk behaviors, but little is known about gender differences with respect to these relationships. Understanding any such differences could contribute to better supporting the school environment to promote youth sexual health. METHODSWe used provincially representative cross‐sectional data from 1415 sexually active students in grades 10 to 12 in Nova Scotia, Canada, to determine whether lower school connectedness was associated with students' sexual risk behaviors using multivariate logistic regression, stratifying by sex. RESULTSIn boys, lower connectedness was associated with three risk behaviors, having ≥2 partners in the previous year (odds ratio [OR] 1.07; 95% confidence interval [CI] 1.01‐1.13), no condom use at last intercourse (OR 1.06; 95% CI 1.01‐1.12), and having unplanned intercourse due to substance use (OR 1.09; 95% CI 1.03‐1.15). No such associations were seen in girls. CONCLUSIONSThese results demonstrate that gender differences may exist for associations of school connectedness and sexual risk behaviors; connectedness may be more important for boys than for girls in this area of adolescent health. Educators should consider gender differences when designing interventions to maximize youth sexual health through school‐based interventions. Further research on school connectedness and risk‐taking should examine genders separately.

  April 21, 2014   doi: 10.1111/josh.12161   open full text
• Feasibility of Providing Sexually Transmitted Infection Testing and Treatment in Off‐Campus, Nonclinic Settings for Adolescents Enrolled in a School‐Based Research Project.
  Mariam R. Chacko, Christine Markham, Melanie Thiel, Stacy M. Crandall, Melissa F. Peskin, Ross Shegog, Susan Tortolero.
  Journal of School Health / The Journal of School Health. April 21, 2014
  BACKGROUNDThis study examined the acceptability and feasibility of using a biological outcome measure to evaluate a school‐based sexuality education program. Confidential field‐delivered sexually transmitted infection (STI) testing by nonmedical field staff and STI treatment by medically trained field staff was assessed in off‐campus and off‐clinic settings for adolescents enrolled in the trial. METHODSAfter parental and adolescent consent were obtained, a convenient time and location was identified to collect urine to test for chlamydia (Chlamydia trachomatis, CT), gonorrhea (Neisseria gonorrheae, NG), and trichomonas (Trichomonas vaginalis, TV) infection and to treat students with positive results. RESULTSA total of 391 of 1742 students had permission to participate (22%); 353 (90%) provided urine samples; 28 (8%) had positive test results: CT(18), NG(5), and TV(8). Testing and treatment occurred at home for 92% and 59% of students, respectively; on weekdays (for 69% and 96%, respectively) and between noon and 8 pm (for 76% and 88%, respectively). All students who tested positive were treated. Several lessons and strategies that may improve the likelihood that students will participate in field‐delivered STI testing and treatment emerged. CONCLUSIONSTI testing and treatment are feasible for students enrolled in a school‐based sexuality education program. However, obtaining parental consent may be challenging.

  April 21, 2014   doi: 10.1111/josh.12159   open full text
• Opportunities for Increasing Human Papillomavirus Vaccine Provision in School Health Centers.
  Jennifer L. Moss, Ashley L. Feld, Brittany O'Malley, Pamela Entzel, Jennifer S. Smith, Melissa B. Gilkey, Noel T. Brewer.
  Journal of School Health / The Journal of School Health. April 21, 2014
  BACKGROUNDUptake of human papillomavirus (HPV) vaccine remains low among adolescents in the United States. We sought to assess barriers to HPV vaccine provision in school health centers to inform subsequent interventions. METHODSWe conducted structured interviews in the fall of 2010 with staff from all 33 school health centers in North Carolina that stocked HPV vaccine. RESULTSCenters had heterogeneous policies and procedures. Out‐of‐pocket costs for children and youth to receive privately purchased HPV vaccine were a key barrier to providing HPV vaccine within school health centers. Other barriers included students not returning consent forms, costs to clinics of ordering and stocking privately purchased HPV vaccine, and difficulty using the statewide immunization registry. Most (82%) school health centers were interested in hosting interventions to increase HPV vaccine uptake, especially those that the centers could implement themselves, but many had limited staff to support such efforts. Activities rated as more likely to raise HPV vaccine uptake were student incentives, parent reminders, and obtaining consent from parents while they are at school (all ps < .05). CONCLUSIONSAlthough school health centers reported facing several key barriers to providing HPV vaccine, many were interested in partnering with outside organizations on low‐cost interventions to increase HPV vaccine uptake among adolescents.

  April 21, 2014   doi: 10.1111/josh.12158   open full text
• Correlates of High School Freshman Girls' Reported Reasons for Engaging in Sexual Intercourse.
  Matthew Lee Smith, Kelly Wilson, Mindy Menn, Jairus C. Pulczinski.
  Journal of School Health / The Journal of School Health. April 21, 2014
  BACKGROUNDIntrapersonal and external factors, including social pressures and the desire for acceptance from peers, influence sexual activity among adolescents. This study examined how personal characteristics, risky behaviors, normative beliefs, household factors, and engagement in extracurricular activities were related to high school freshman girls' reported reasons for having sexual intercourse. METHODSBaseline data were analyzed from 158 girls enrolled in high school‐based abstinence‐only‐until‐marriage education programs during their freshman year. Binary logistic regression was performed to identify factors associated with Pressures and Reasons for Engaging in Sex Scale (PRESS) scores. RESULTSResults indicate that girls with high PRESS scores were significantly more likely to have had sex (OR = 4.29), consumed alcohol within the previous year (OR = 6.13), reported strict household rules (OR = 1.49), and thought more girls their age had sex (OR = 1.67). CONCLUSIONSchool‐ and family‐based interventions should be developed to encourage and strengthen parent‐teen communication within the household and reinforce self‐worth and positive self‐perceptions among adolescent girls.

  April 21, 2014   doi: 10.1111/josh.12162   open full text
• Effect of Food Service Nutrition Improvements on Elementary School Cafeteria Lunch Purchase Patterns.
  Patricia A. Cluss, LuAnn Fee, Rebecca J. Culyba, Kiran B. Bhat, Kay Owen.
  Journal of School Health / The Journal of School Health. April 21, 2014
  BACKGROUNDSchools can play a major role in prevention and intervention for childhood obesity. We describe changes in elementary school cafeteria lunch sales patterns resulting from nutritional improvements in menu offerings that were part of a community‐wide focus on health. METHODSElementary school lunch sales data were collected for 1 week in each of 7 years in a district serving a predominantly poor, rural, and Caucasian student population, with high rates of obesity. Post hoc data analyses described lunch sales patterns and related food service costs over the project years. RESULTSThe percentage of high calorie/low nutrition foods sold decreased from 22% of all sales in 2005 to 0% in 2011. High‐calorie snack purchases decreased from 535 items to 0 items. The sale of fresh fruits increased by 12%. There was only a slight decline in the percentage of children who purchased cafeteria lunches over the years and a 15.2% cost increase for purchasing healthier food supplies. CONCLUSIONSElementary school children purchased healthier lunches when healthier menu items were offered and when less healthy foods were eliminated from the menu. There was no significant decline in the number of students who purchased lunches as nutritional improvements were made.

  April 21, 2014   doi: 10.1111/josh.12157   open full text
• School‐Based Programs Aimed at the Prevention and Treatment of Obesity: Evidence‐Based Interventions for Youth in Latin America.
  Felipe Lobelo, Isabel Garcia de Quevedo, Christina K. Holub, Brian J. Nagle, Elva M. Arredondo, Simón Barquera, John P. Elder.
  Journal of School Health / The Journal of School Health. July 23, 2013
  BACKGROUND Rapidly rising childhood obesity rates constitute a public health priority in Latin America which makes it imperative to develop evidence‐based strategies. Schools are a promising setting but to date it is unclear how many school‐based obesity interventions have been documented in Latin America and what level of evidence can be gathered from such interventions. METHODS We performed a systematic review of papers published between 1965 and December 2010. Interventions were considered eligible if they had a school‐based component, were done in Latin America, evaluated an obesity related outcome (body mass index [BMI], weight, %body fat, waist circumference, BMI z‐score), and compared youth exposed vs not exposed. RESULTS Ten studies were identified as having a school‐based component. Most interventions had a sample of normal and overweight children. The most successful interventions focused on prevention rather than treatment, had longer follow‐ups, a multidisciplinary team, and fewer limitations in execution. Three prevention and 2 treatment interventions found sufficient improvements in obesity‐related outcomes. CONCLUSIONS We found sufficient evidence to recommend school‐based interventions to prevent obesity among youth in Latin America. Evidence‐based interventions in the school setting should be promoted as an important component for integrated programs, policies, and monitoring frameworks designed to reverse the childhood obesity in the region.

  July 23, 2013   doi: 10.1111/josh.12080   open full text
• Data Collection Procedures for School‐Based Surveys Among Adolescents: The Youth in Europe Study.
  Alfgeir Logi Kristjansson, Jon Sigfusson, Inga Dora Sigfusdottir, John P. Allegrante.
  Journal of School Health / The Journal of School Health. July 23, 2013
  BACKGROUND Collection of valid and reliable surveillance data as a basis for school health promotion and education policy and practice for children and adolescence is of great importance. However, numerous methodological and practical problems arise in the planning and collection of such survey data that need to be resolved in order to ensure the validity of the data and to maximize the response rate without being prohibitively costly. METHOD This article builds on a 15‐yearlong experience of such annual data collections in Iceland and describes the preparation, process, and collection of data that provide a common methodologic framework for the school‐based survey, Youth in Europe, a population‐based survey of 14‐ to 16‐year‐old adolescents, being collected across 18 European cities now participating in the European Cities Against Drugs (ECAD) program. RESULTS We identified 11 critical steps for developing and implementing the surveys in light of the recent literature on the preparation and implementation practices in school‐based data collection among adolescents. CONCLUSION Limiting the disruption of daily operations in schools while at the same time ensuring both quality and clarity of data collection procedures in school‐based surveys are of paramount importance for researchers, school personnel, and students.

  July 23, 2013   doi: 10.1111/josh.12079   open full text
• Influencing Factors of Sedentary Behavior in European Preschool Settings: An Exploration Through Focus Groups With Teachers.
  Ellen De Decker, Marieke De Craemer, Ilse De Bourdeaudhuij, Katrien Wijndaele, Kristin Duvinage, Odysseas Androutsos, Violeta Iotova, Mina Lateva, Juan Miguel Fernández Alvira, Kamila Zych, Yannis Manios, Greet Cardon.
  Journal of School Health / The Journal of School Health. July 23, 2013
  BACKGROUND Sedentary behavior refers to activities involving sitting down and reclining (eg, watching TV, using the computer) and has been associated with different health outcomes. In preschool, children are sedentary for 50% to 80% of the time, in the classroom as well as during recess. Because of the absence of qualitative studies examining influencing factors of preschoolers' sedentary behavior in preschool settings, this study explored teachers' opinions on potentially influencing factors of this behavior. METHODS Eighty‐seven teachers of 4‐ to 6‐year‐old preschoolers from 6 European countries participated in a total of 18 focus groups between October 2010 and January 2011. Key findings were reported separately by country, and were independently analyzed by 2 researchers using qualitative content analysis. RESULTS Teachers perceive the lack of play space and small classroom size as being influential factors on preschoolers' sedentary behavior; increasing play equipment and using teachers' prompts are mentioned as ways to stimulate children to be less sedentary on the playground. Computer use is reported to be more common in preschool than watching TV. CONCLUSION Interventions should focus on increasing teachers' awareness of how sedentary preschoolers are during the preschool day. Teachers also should be informed about strategies to decrease sedentariness in the classroom and on the playground.

  July 23, 2013   doi: 10.1111/josh.12078   open full text
• Information and Communication Technology: Students' Health Education in 1st‐ to 6th‐Grade South Korea Elementary Schools.
  Eunjoo Lee, Hyejin Park, James Whyte, Eunhoe Jeong.
  Journal of School Health / The Journal of School Health. July 23, 2013
  BACKGROUND The purposes of this study were to (1) identify school nurses' awareness of information and communication technology (ICT) use in students' health education and (2) explore the barriers or reasons for the adoption of ICT in school nursing practice, while (3) presenting strategies to speed ICT diffusion and dissemination into practice. METHODS For data collection, 209 primary school nurses in K province of Korea were selected and e‐mailed the questionnaires. Collected data were analyzed as frequency, percentages, and chi‐square tests. RESULTS The major reasons to adopt ICT were increasing school nurses' confidence in providing health education and improving teaching methods using diverse multimedia. The major barriers to utilization of ICT were lack of time for preparation of educational materials, lack of software availability, and lack of computer skills of school nurses and students. Several strategies were suggested to speed the diffusion of ICT into students' health education, such as integrating a health education course into regular curriculum. CONCLUSIONS It is important to identify barriers and reasons for adoption of ICT in school nursing. In addition, strategies should be emphasized that result in more rapid diffusion of these technologies in school nursing practice.

  July 23, 2013   doi: 10.1111/josh.12077   open full text
• Effects of a 2‐Year School‐Based Intervention of Enhanced Physical Education in the Primary School.
  Rossella Sacchetti, Andrea Ceciliani, Andrea Garulli, Laura Dallolio, Patrizia Beltrami, Erica Leoni.
  Journal of School Health / The Journal of School Health. July 23, 2013
  Background This study aimed to assess whether a school‐based physical education intervention was effective in improving physical abilities and influencing daily physical activity habits in primary school children. The possible effect on body mass index (BMI) was also considered. Methods Twenty‐six 3rd‐grade classes were randomly selected stratifying by geographic location (city, plain, hills) and were assigned either to an intervention (127 boys; 120 girls) or to a traditional (129 boys; 121 girls) physical education program. At baseline (age: 8‐9 years) and after a 2‐year follow‐up (age: 10‐11 years), information was collected about sport participation and daily activity habits using a self‐administered questionnaire. Height, weight, and BMI were measured and physical performance was assessed by means of standardized tests. Results The enhanced program of physical education was effective in improving physical abilities of children and determining a decrease (boys: 10%; girls: 12%) in daily sedentary activities (preintervention versus postintervention, p < .05; intervention versus control group, p < .01). The percentages of overweight and obese children did not vary significantly, but the experimental group showed a significantly lower rise in BMI compared to the control group (p < .001). Conclusion The school proved to be an ideal setting for promoting physical activity and achieving the required daily activity levels.

  July 23, 2013   doi: 10.1111/josh.12076   open full text
• Fitness Change and Subsequent Academic Performance in Adolescents.
  Li‐Jung Chen, Kenneth R. Fox, Po‐Wen Ku, Chih‐Yang Taun.
  Journal of School Health / The Journal of School Health. July 23, 2013
  BACKGROUND This study examined the association between fitness change and subsequent academic performance in Taiwanese schoolchildren from 7th grade to 9th grade. METHODS The 7th graders from 1 junior high school district participated in this study (N = 669). Academic performance was extracted from school records at the end of each grade. Cardiovascular (CV) fitness, sit‐and‐reach flexibility, bent‐leg curl‐ups, and height and weight for calculating body mass index (BMI) were assessed at the start of each grade. RESULTS The results showed that improvement in CV fitness, but not muscular endurance or flexibility, is significantly related to greater academic performance. A weak and nonsignificant academic‐BMI relationship was seen. CONCLUSION CV fitness exhibits stronger longitudinal associations with academic performance than other forms of fitness or BMI for adolescents.

  July 23, 2013   doi: 10.1111/josh.12075   open full text
• Patterns of Physical Activity Outside of School Time Among Japanese Junior High School Students.
  Li He, Kaori Ishii, Ai Shibata, Minoru Adachi, Keiko Nonoue, Koichiro Oka.
  Journal of School Health / The Journal of School Health. July 23, 2013
  BACKGROUND Physical activity is beneficial for adolescent health. The physical activity patterns of Japanese adolescents are relatively unknown. Therefore, this study aimed to describe the current patterns of physical activity and to identify sex and grade differences among them. METHODS The participants comprised 714 Japanese adolescents aged 12 to 15 years old (boys N = 372, girls N = 342) from a public junior high school in Okayama, Japan. Physical activity at school, outside of school after hours, and during lunch recess as well as the total leisure time in a usual week was assessed with a 5‐item questionnaire. To assess the differences in the physical activity patterns by sex and grade, independent t tests and analysis of variance (ANOVA) were conducted, respectively. RESULTS Boys spent significantly more time in physical activity both inside and outside of school settings than girls (p < .05). Higher grade students were significantly less active than lower grade students (p < .05). Furthermore, the physical activity patterns across the grades differed between settings (at school, outside of school during the after‐school period, lunchtime recess, and at home). CONCLUSION To increase physical activity levels among Japanese adolescents, implementation of after‐school programs or environmental modifications developed within the school setting could be effective strategies.

  July 23, 2013   doi: 10.1111/josh.12074   open full text
• Associations Between Perceptions of School Connectedness and Adolescent Health Risk Behaviors in South African High School Learners.
  Kaymarlin Govender, Sara Naomi Naicker, Anna Meyer‐Weitz, Joanne Fanner, Avanya Naidoo, Wendy Leigh Penfold.
  Journal of School Health / The Journal of School Health. July 23, 2013
  BACKGROUND This study investigated the relationship between school connectedness and health risk behaviors, specifically, substance abuse, violence‐related behaviors, sexual risk behaviors, and suicidal ideation among school‐going adolescents. School connectedness was understood to encompass a range of aspects pertaining to a learner's sense of belonging to the school. We hypothesized that strong perceptions of school connectedness will more likely be associated with lower levels of risk behaviors among school‐going adolescents. METHODS The study was conducted in 2 neighboring public co‐educational schools in Durban, South Africa. Independent measures assessed school connectedness, substance abuse, violence‐related behaviors, sexual risk behaviors, and suicidal ideation. RESULTS Strong negative correlations were found between adolescents' perceptions of school connectedness and the 4 health risk behaviors, particularly suicidal ideation. The relative importance of risk factors was also evidenced in the sample. CONCLUSIONS Adolescents with lower perceptions of school connectedness were more likely to engage in various risk behaviors, supporting the literature that a lack of school connectedness can act as a risk factor for adolescent involvement in clustering of risk behaviors. Further the relative weighting of individual risk factors, it is argued, was an effect of the sociocultural context of the study.

  July 23, 2013   doi: 10.1111/josh.12073   open full text
• Healthy Buddies™ Reduces Body Mass Index Z‐Score and Waist Circumference in Aboriginal Children Living in Remote Coastal Communities.
  Rebecca Ronsley, Andrew S. Lee, Boris Kuzeljevic, Constadina Panagiotopoulos.
  Journal of School Health / The Journal of School Health. July 23, 2013
  BACKGROUND Aboriginal children are at increased risk for obesity and type 2 diabetes. Healthy Buddies™‐First Nations (HB) is a curriculum‐based, peer‐led program promoting healthy eating, physical activity, and self‐esteem. METHODS Although originally designed as a pilot pre‐/post‐analysis of 3 remote Aboriginal schools that requested and received HB training, one school did not implement the program and was used as a control group. Outcomes included changes in body mass index z‐score (zBMI), waist circumference (WC), blood pressure (BP), self‐esteem, health behavior, and knowledge over 1 school year in kindergarten to grade 12 children. RESULTS There was a significant decrease in zBMI (1.10 to 1.04, p = .028) and WC (77.1 to 75.0 cm, p < .0001) in the HB group (N = 118) compared with an increase in zBMI (1.14 to 1.23, p = .046) and a minimal WC change in the control group (N = 61). Prevalence of elevated BP did not change in the HB group, but increased from 16.7% to 31.7% in the control group (p = .026). General linear model analysis revealed a significant interaction between time, group, and zBMI (p = .001), weight status (p = .014), nutritious beverage knowledge (p = .018), and healthy living and self‐esteem score (p = .005). CONCLUSIONS The HB program is a promising school‐based strategy for addressing obesity and self‐esteem in Aboriginal children.

  July 23, 2013   doi: 10.1111/josh.12072   open full text
• Relationship Between Eating Behaviors and Physical Activity Among Primary and Secondary School Students: Results of a Cross‐Sectional Study.
  Pascale Morin, Sylvain Turcotte, Gino Perreault.
  Journal of School Health / The Journal of School Health. July 23, 2013
  BACKGROUND With a view toward developing concerted efforts in fostering healthy eating habits and a physically active lifestyle among young people, a study was carried out to explore associations between eating behavior and physical activity (PA). METHODS In the school district, questionnaires were completed at home by parents of primary school children (N = 8612) and by secondary school youth (N = 5250) during a break in the schedule. The rates of response were 79% and 83%, respectively. Inferential and descriptive analyses were performed. RESULTS The results indicate significant differences between the eating behaviors of young people who engage in 60 minutes of daily PA and those who are sedentary. The physically active children were generally more likely to eat fruit, vegetables, and whole‐grain products and to have breakfast (p < .05 among high‐school students). The lack of self‐confidence (55%) and not enjoying PA (46%) stood out as the greatest obstacles facing adolescents trying to lose weight. CONCLUSION There should be particular actions targeting students in the last half of primary school aimed at developing individual accountability and autonomy with respect to healthy eating and PA. These actions should also consider sex differences and those who have more sedentary lifestyles.

  July 23, 2013   doi: 10.1111/josh.12071   open full text