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Background: Although associations between social media use and adolescent mental health have been described, more information is needed on the potential components characterizing this complex exposure, in particular, those related to maintaining a public social media account., Objective: This study aims to investigate the association between having a public social media account and anxiety and depression in school-going adolescents., Methods: Overall, 80 secondary schools and further education colleges in England were sampled using a cross-sectional web-based survey as part of the 2023 OxWell Student Survey. Social media exposure was categorized among the adolescents as having a public social media account versus not having a public social media account. The risk of clinical anxiety and depression was determined using the Revised Child Anxiety and Depression Scale-11. Adolescents self-reported the content and platforms accessed in the previous 24 hours. Associations between having a public social media account and symptoms of anxiety and depression were assessed using logistic regression controlling for age, sex, the experience of being bullied, parental guidance of online behavior (describing perceived parental approaches to adolescents' online activity), the proportion of close friendships engaged with online, poverty status, and placement in statutory care. Age, sex, and parental guidance of online behavior were assessed for primary association effect modification., Results: Data collected from 16,655 adolescents (aged 11-18 y) were analyzed. Of these 16,655 adolescents, 6734 (40.43%) had a public social media account, while 9921 (59.57%) either had a private social media account or no social media account. Moreover, 32.6% (5429/16,655) of the adolescents screened positive for symptoms of anxiety and depression. Those with a public social media account had higher odds of anxiety and depression (odds ratio [OR] 1.41, 95% CI 1.32-1.50) than those without a public social media account in an unadjusted and fully adjusted model (OR 1.39, 95% CI 1.29-1.49). Adolescents reporting active parental guidance had lower odds of anxiety and depression (OR 0.85, 95% CI 0.75-0.93) than those reporting no parental guidance, and these parental approaches to online behaviors significantly modified the association between having a public social media account and symptoms of anxiety and depression (P=.004; χ 2 2 =11.1)., Conclusions: Our OxWell study findings suggest a potential mental health risk for adolescents with a public social media account. We show evidence indicating some protection from anxiety and depression among adolescents who do not have a public social media account and those reporting some form of parental guidance of their online behavior. This was pronounced in adolescents reporting active parental guidance compared to stricter regulatory approaches or no guidance at all. The specific roles that social media account choices and parental guidance of online behavior may play in supporting the mental health of adolescents are highlighted for further investigation., International Registered Report Identifier (irrid): RR2-10.1136/bmjopen-2021-052717., (©Wakithi Siza Mabaso, Sascha Hein, Gabriela Pavarini, The OxWell Study Team, Mina Fazel. Originally published in the Journal of Medical Internet Research (https://www.jmir.org), 17.12.2024.)

Existing studies suggest that mindfulness-based interventions (MBIs) can reduce ADHD symptoms when delivered as targeted clinical programs to young people diagnosed with ADHD. However, there is currently a lack of research on whether MBIs are effective in reducing elevated ADHD symptoms when delivered as universal programs to whole classes in schools. This study investigated the effects of a universal nine-week MBI (.b program) on students' elevated ADHD symptoms using an cluster randomized controlled trial (RCT) design. The modifying effects of pupils' baseline characteristics (gender, age, and socioeconomic status) and home-practice intensity were examined. A total of 3519 adolescents aged 12 to 15 years from Finnish schools were randomized into an MBI group, a relaxation-based active-control group, and a passive-control group. ADHD symptoms were measured at baseline (T0), at nine weeks (T9), and at 26-weeks (T26, follow-up) using parent-reported assessments. The study found no positive intervention effects on parent-reported ADHD symptoms in the MBI group compared to the control groups. Neither boys nor girls benefited from the MBI. The same was true of different age groups and socioeconomic levels. Moreover, regular home practice during the follow-up period did not strengthen the intervention effects. The results do not support the use of brief, universal MBIs in whole school classes as part of the routine curriculum to reduce elevated ADHD symptoms in adolescents. Further research is essential to identify optimal content and delivery methods for MBIs in schools. Particularly among adolescents with elevated ADHD symptoms, targeted MBIs, adapted to the unique needs of this subgroup, should be examined. Trial Registration: Healthy Learning Mind-a school-based mindfulness and relaxation program: a study protocol for a cluster randomized controlled trial (RCT) ISRCTN18642659 retrospectively registered on 13 October 2015. The full trial protocol can be accessed at http://rdcu.be/t57S., (© 2024 The Author(s). Scandinavian Journal of Psychology published by Scandinavian Psychological Associations and John Wiley & Sons Ltd.)

Excessive salt or sodium intake is strongly linked to increased blood pressure, which is a major risk factor for cardiovascular diseases. This study aimed to qualitatively explore the views of key stakeholders on salt intake reduction and barriers and facilitators to reducing salt intake in Malaysian schools. The stakeholders in this study were school administrators, food operators, and consumers. Their views were determined using in-depth interviews and focus group discussions, and data collected were analyzed using inductive thematic analysis. Salient barriers identified in this study were a lack of knowledge pertaining to salt intake reduction and foods sold outside the school. Meanwhile, key facilitators of salt reduction included few strategies such as public health campaigns, priority toward salt reduction policies, and school-based education programs, alongside support from other relevant stakeholders. Overall, the barriers and facilitators signal the need for implementing salt reduction programs and the collaborative efforts of different stakeholders., Competing Interests: Declaration of Conflicting InterestsThe author(s) declared the following potential conflicts of interest with respect to the research, authorship, and/or publication of this article: FJH is an unpaid member of Action on Salt and World Action on Salt, Sugar, and Health (WASSH). The other authors state that they have no competing interests.

There is an urgent need to improve mental health outcomes among young people. One approach taken to address this problem has been the design and delivery of universal school-based prevention, based on therapeutic models such as CBT and mindfulness. Such interventions are delivered to groups of young people, irrespective of risk or need. However, in this commentary, we argue that the initial appeal of universal interventions has not been supported by the evidence: universal school-based prevention is less effective than targeted approaches, often leads to null or unsustained positive effects, has the potential to elicit negative effects and is not well liked by young people themselves. In addition, many young people in each classroom already meet the criteria for a mental disorder, meaning that prevention approaches may not be appropriate or effective for this group. In this commentary, we respond to Birrell et al.'s (2025) paper by arguing that the field should move away from universal prevention and instead invest our limited resources in the refinement and dissemination of interventions with a stronger evidence base, such as one-to-one, targeted and indirect approaches., (© 2024 The Author(s). Child and Adolescent Mental Health published by John Wiley & Sons Ltd on behalf of Association for Child and Adolescent Mental Health.)

Background: Suicide is the third-leading cause of death among US adolescents aged 10-19 years, and about 10% attempt suicide each year. School-based universal prevention may reduce youth suicidal behavior. Sources of Strength uses a peer leader network diffusion model to promote healthy norms across a school population. A key challenge within schoolwide programs is reaching a large and diverse array of students, especially those less engaged with their peers. Motivated by this challenge, we developed and field-tested Text4Strength-a program of automated text messages targeting help-seeking attitudes and norms, social coping resources, and emotion regulation skills., Objective: This study conducted a pilot randomized controlled trial of Text4Strength in 1 high school as an extension of an ongoing schoolwide program (Sources of Strength), to test its impact on targets that have the potential to reduce suicidal behavior., Methods: Students at an upstate New York high school (N=223) received 1-2 text messages per week for 9 weeks, targeting strategies for coping with difficult feelings and experiences through clarifying emotions and focusing on positive affect concepts, awareness, and strengthening of youth-adult relationships; and positive help-seeking norms, skills, and resources. Surveys were administered at baseline, immediately post intervention and 3 months after texting ended. We measured proximal intervention targets (methods of coping during stressful events, ability to make sense of their own emotions, feelings of powerlessness during emotion management and recovery, relations with trusted adults at school, and help-seeking behaviors), symptoms and suicide ideation, and student replies to messages., Results: No significant effects were observed for any outcome at either follow-up time point. Results showed that if there is a true (but undetected) intervention effect, it is small. Students with fewer friend nominations did not interact any more or less with the text messages. Exploratory moderation analyses observed no interaction between the intervention condition and the number of friends or baseline suicide ideation at any time point., Conclusions: In contrast to a promising previous field test, these results suggest that Text4Strength is unlikely to have impacted the outcomes of interest and that undetected moderate or large effects can be ruled out with high confidence. Although motivated by the need to reach more isolated students, students with fewer friends did not engage more or show a greater effect than other participants. This study was conducted in a single high school that was already implementing Sources of Strength, so the bar for showing a distinct effect from texting alone was high. Many further channels for reaching youth through private messaging remain unexplored. Alternative delivery systems should be investigated, such as embedding messaging in gaming chat systems and other media. More sophisticated systems drawing on chatbots may also achieve better outcomes., Trial Registration: ClinicalTrials.gov NCT03145363; https://clinicaltrials.gov/study/NCT03145363., (©Anthony R Pisani, Peter A Wyman, Ian Cero, Caroline Kelberman, Kunali Gurditta, Emily Judd, Karen Schmeelk-Cone, David Mohr, David Goldston, Ashkan Ertefaie. Originally published in JMIR Mental Health (https://mental.jmir.org), 06.12.2024.)

Background: Digital information sources provide adolescents with quick access to health-related information. Schools are ideal for promoting digital health literacy and enabling students to handle such information safely. The aim of this paper is to present initial results from a representative study on learning digital health literacy in schools, with a focus on sociodemographic and socioeconomic differences., Methods: The cross-sectional study was conducted in Germany with 1448 students (aged 9 to 18 years) as part of the DURCHBLICKT!, Project: Bivariate and multivariate analyses were used to examine differences and relationships in the learning of digital health literacy in school and gender, age, migration background, and subjective social status., Results: Approximately 50% of students reported that they had not (or only to a limited extent) learned digital health literacy in school. The chi-square test reveals significant differences in terms of gender, age, migration background, and social status. Regression analyses indicate that age and subjective social status are significant factors for acquiring digital health literacy., Discussion: The high number of students who do not learn digital health literacy in school is concerning, especially given their often low levels of digital health literacy. The results highlight the need for targeted educational strategies-especially those tailored to gender and socioeconomic status-to promote digital health literacy and reduce social inequalities., Competing Interests: Einhaltung ethischer Richtlinien. Interessenkonflikt: D. Renninger, L. Stauch, L. Fischer, A. Hartmann, P. Rangnow, K. Dadaczynski und O. Okan geben an, dass kein Interessenkonflikt besteht. Alle beschriebenen Untersuchungen am Menschen wurden mit Zustimmung der zuständigen Ethik-Kommission (Technische Universität München, Nr. 2022-401-S-NP/050), im Einklang mit nationalem Recht sowie gemäß der Deklaration von Helsinki von 1975 (in der aktuellen, überarbeiteten Fassung) durchgeführt. Von allen beteiligten Patientinnen und Patienten liegt eine Einverständniserklärung vor., (© 2024. The Author(s).)

Background: Programs for mental health promotion and prevention of nonsuicidal self-injury (NSSI) in schools have gained increased focus during the last decades, but less is known about adolescents' experiences of such interventions., Methods: A whole-school preventive intervention targeting mental health and NSSI was delivered to six secondary schools. Adolescents participated in the Youth Aware of Mental Health program combined with an NSSI-focused psychoeducation module. Caregivers and teachers were given online psychoeducation on NSSI, and school health care staff were given a workshop on self-injury. Eleven group interviews (n = 65 participants) were conducted with adolescents (ages 13-15 years, 65% females) exploring participant experiences. Interviews were analyzed using thematic analysis and interpreted in light of a biopsychosocial understanding of adolescence., Results: The analysis generated two main themes. The first theme, Mental health in the context of adolescence, centered around adolescents' conception of mental health, after having taken part in the intervention, framed in a context of coping with external stressors. The dilemma of autonomy versus help-seeking was also identified as part of the first main theme. The second theme, The who, when, what, and how of the intervention, described adolescents' experiences of the intervention. This theme included increased awareness and knowledge of mental ill-health. The participants generally agreed that the topics included are important to adolescents and emphasized that the content needs to be relatable. Several factors that influence how a school-based program is received by adolescents were identified, such as who should be targeted and when. Adolescents also identified challenges and gave recommendations for future similar projects., Conclusions: Adolescents generally perceived addressing mental health and NSSI in schools as important. Help-seeking initiatives need to be balanced against adolescents' need for autonomy when planning mental health prevention and intervention., Competing Interests: Declarations. Ethics approval and consent to participate: The study was approved by the Swedish Ethical Review Authority (2021 − 01699, 2021–05049). Participating adolescents as well as their caregivers gave written informed consent before participating. Consent for publication: Not applicable. Competing interests: The authors declare no competing interests., (© 2024. The Author(s).)

Purpose: The COVID-19 pandemic prompted a global closing of schools that raised questions on the implications for students. This study examines the impact of remote education, and subsequent social isolation, on adolescent well-being among urban poor young adolescents worldwide., Methods: Qualitative data were collected through focus group discussions with urban poor adolescents in 7 countries and 8 sites, for a total sample size of 249 adolescents. Discussion guides addressed attitudes toward remote education strategies and its perceived impact on health, relationships, and learning. Analysis used an inductive thematic coding approach, with comparison by site and gender., Results: Adolescents experienced opposite extremes of remote education, with those from lower-income sites feeling abandoned by educators and systems and those from higher-income sites feeling increased external pressure and loneliness. Both boys and girls reported declining mental health, although boys reported more access to support structures than girls. All students missed connections with peers and teachers., Discussion: Although all adolescents struggled with remote education, their challenges differed by context and gender. School systems should consider conducting a student needs assessment to ensure future remote education is accessible and beneficial to adolescents in each site. Families and teachers should take a gender-equal approach to assistance, ensuring adolescents have equal opportunities and agency to reach out for, and receive, educational and emotional support., (Copyright © 2024. Published by Elsevier Inc.)

Background: Cystic Fibrosis (CF) is a genetic life limiting disease that impacts upon quality of life. An aim of CF care is to preserve lung function, with physical activity (PA) being an important part of daily airway clearance. Ensuring children have opportunities to engage in PA at school should be an important part of their daily routine. It is important to gain parental perspectives on this, as they manage the daily care for their children. This study aims to explore parents' perceptions of school-based PA for their children with CF., Methods: Parents of children with CF ( n  = 10), from three regions of the UK (England, Wales and Northern Ireland) took part in online semi-structured interviews. Data were analysed using Interpretative Phenomenological Analysis (IPA)., Results: Although parents recognized the benefits of school-based PA for their children, systemic barriers in the school setting often inhibit daily PA for children with CF, including teachers' misconceptions, emotional and physical barriers, and PA not being a priority., Conclusion: Recommendations for practice have been developed to help engage children with CF in daily school-based PA in an inclusive way, with the hope of maintaining health outcomes for children with CF.

Introduction: School-aged children play a major role in the transmission of many respiratory pathogens due to high rate of close contacts in schools. The validity and accuracy of proxy-reported contact data may be limited, particularly for children when attending school. We observed social contacts within schools and assessed the accuracy of proxy-reported versus observed physical contact data among students in rural Gambia., Methods: We enrolled school children who had also been recruited to a survey of Streptococcus pneumoniae carriage and social contacts. We visited participants at school and observed their contact patterns within and outside the classroom for two hours. We recorded the contact type, gender and approximate age of the contactee, and class size. We calculated age-stratified contact matrices to determine in-school contact patterns. We compared proxy-reported estimated physical contacts for the subset of participants (18 %) randomised to be observed on the same day for which the parent or caregiver reported the school contacts., Results: We recorded 3822 contacts for 219 participants from 114 schools. The median number of contacts was 15 (IQR: 11-20). Contact patterns were strongly age-assortative, and mainly involved physical touch (67.5 %). Those aged 5-9 years had the highest mean number of contacts [19.0 (95 %CI: 16.7-21.3)] while the ≥ 15-year age group had fewer contacts [12.8 (95 %CI: 10.9-14.7)]. Forty (18 %) participants had their school-observed contact data collected on the same day as their caregiver reported their estimated physical contacts at school; only 22.5 % had agreement within ±2 contacts between the observed and reported contacts. Fifty-eight percent of proxy-reported contacts were under-estimates., Conclusions: Social contact rates observed among pupils at schools in rural Gambia were high, strongly age-assortative, and physical. Reporting of school contacts by proxies may underestimate the effect of school-age children in modelling studies of transmission of infections. New approaches are needed to quantify contacts within schools., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 The Authors. Published by Elsevier B.V. All rights reserved.)

As outcomes and survival for children with chronic kidney disease (CKD) have improved over the last 30 years, there is an emerging need to characterize and understand later educational and employment outcomes across the spectrum of pediatric CKD severity-ranging from mild CKD to requirement for dialysis and kidney transplantation. Although large-scale research on the topic of long-term educational and employment outcomes in the pediatric CKD population is relatively scarce, the existing literature does support that children across the spectrum of CKD severity are at risk for education-related difficulties including chronic school absenteeism. These education-related difficulties are compounded by well-described neurocognitive deficits-particularly in the domain of executive functioning-that may potentially perpetuate the risk for academic underachievement. This is particularly concerning given that data from the general pediatric population suggest that childhood academic underachievement is associated with higher likelihood of un-/underemployment in adulthood. This review highlights what is known about educational and employment outcomes among persons with a history of childhood CKD, as well as suggestions for interventions to improve educational outcomes for this population., (© 2024. The Author(s), under exclusive licence to International Pediatric Nephrology Association.)

Ethnicity plays a significant role in adolescents' everyday lives, but there is a limited understanding of adolescents' own experiences with how ethnicity is addressed in different contexts. Three contexts of importance during adolescence are investigated in the present study: schools, social media, and sports. A closer contextual examination has the potential to provide insights into how multiple contexts shape experiences with ethnicity. The aim of the study was to understand more about adolescents' experiences of how ethnicity is addressed in schools, on social media, and in sports. Six focus groups with a total of 21 adolescents (M age  = 14.5, SD age  = 0.5, female = 76%) discussed their experiences. Data were transcribed verbatim and analyzed using a close-to-data, inductive thematic analysis. The analysis resulted in three main themes and seven subthemes, indicating that ethnicity was addressed differently in the three studied contexts. For the main theme of how ethnicity was addressed in schools, the subthemes were: Addressing ethnicity is important; Ethnicity is addressed through stereotypes and Everyday racism. The main theme of ethnicity on social media consisted of two subthemes: Sharing ethnic and cultural narratives and Hateful remarks. The main theme of ethnicity in sports also consisted of two subthemes: On equal terms and Clear consequences for racist behaviors. To better understand the multiple contexts, the results are discussed guided by the ecological systems theory. The adolescents highlighted that there are many benefits of addressing ethnicity and that it is important to do so in multiple contexts of adolescent life, just not in the same way. When ethnicity was addressed carelessly, such as through stereotypes or via racism masked as jokes, it had the potential to cause harm. When ethnicity was addressed with reflection, it instead had the potential to build understanding, lead to positive experiences, and provide learning opportunities., (© 2024 The Author(s). Scandinavian Journal of Psychology published by Scandinavian Psychological Associations and John Wiley & Sons Ltd.)

Aim: Adolescent mental ill-health is a common international challenge affecting both high- and lower-middle-income countries. The Republic of the Philippines enacted its first mental health law in 2019, underlining the importance of the promotion of adolescent mental health education in schools. In Japan, course instructions about mental ill-health were formulated in a Course of Study that reflects governmental curriculum guidelines. Embedded since 2022, the Course of Study aimed to promote an understanding of current issues of adolescent health. The National Center for Global Health and Medicine in Japan has been sharing experience of promoting public health practices and advancing medical technology in low- and middle-income countries, especially in the Western Pacific region. This paper describes the development process and content of these resources by an interdisciplinary team from Japan and the Philippines., Methods: The interdisciplinary team created an embedded mental health education programme using animated videos for the Philippine school curriculum to improve mental health literacy in adolescents., Results: Two six-minute animated videos of age-relevant stories were created. The animation scenarios illustrate: 1) mental health problems and recovery; and 2) major symptoms of mental illnesses, including depression, anxiety, and schizophrenia. Each animated video presents several items for discussion among students and/or teachers, both in class and online for students unable to attend school., Conclusion: Our efforts may provide good opportunities for enhancing adolescents' mental health activities in the Philippines. In the following steps, we should investigate the effectiveness of school-based MHL using these animated videos with rigorous evaluation methods., (© 2024 John Wiley & Sons Australia, Ltd.)

Purpose: Technical approaches (TAs) such as Direct Instruction are commonly utilized when teaching games in Physical Education (PE) classes, but game-based approaches (GBAs) such as Game Sense (GS) have gained greater interest over the past 30 years. However, little is known about which approach promotes more physical activity (PA). The aim of this study was to compare the PA of girls during single-gender PE classes in an invasion games unit utilizing either a GS approach or a TA. Methods: Two upper primary school PE classes were taught invasion games using a GS approach and two classes were taught using a TA. During each of the 7 lessons students wore a wearable GPS sensor (SPT2, Sport Performance Tracking, Australia) which measured total distance, distance in each speed zone, top speed and 3D load. Results: The GS group traveled a greater distance than the TA group (+203 m, p  < .001). This result was explained mostly by a greater distance covered in zone 2 speeds (0.6-1.7 m/s). The 3D load was also significantly higher in the GS group, but there were no group differences in top speed. Conclusions: Findings suggested that a GS thematic invasion unit was more effective in promoting PA levels in all-girl primary PE classes than a traditional sport-based invasion unit.

There is a need for careful examination of large volumes of collected (structured and unstructured) information related to school-based evaluation. There is also no published, comprehensive framework/s for evaluating complex interventions in Irish primary schools. The aim of this paper is to outline a methodology for process evaluation of an Irish primary school-based physical activity (PA) and nutrition intervention. Evaluation followed the three themes outlined by the British Medical Research Council: implementation, context, and mechanism of impact that we further divided into six dimensions. Methodological tools included questionnaires, PA logs, reflective journals, write and draw, and semi-structured interviews. We triangulated findings across these multiple tools to assess each dimension. We designed a unique framework to enable comparisons and offer researchers a template for evaluating complex health promotion interventions in primary schools. We present a methodology for evaluating a complex school-based health promotion intervention. The framework we propose integrates process and outcome data. It aims to enhance future result interpretation and facilitate informed comparisons among intervention schools., Competing Interests: Declarations. Conflict of interest: On behalf of all authors, the corresponding author states that there is no conflict of interest. Ethical approval: Ethical approval was granted via Cork Institute of Technology’s Research Ethics Committee. All participants provided signed assent and parental consent to participate in the study. The study was performed in accordance with the ethical standards as laid down in the 1964 Declaration of Helsinki and its later amendments or comparable ethical standards. Consent for publication: Not applicable., (© 2024. The Author(s).)

Background: This study aimed to assess the level of readiness among primary school teachers to handle sports injuries in Saudi Arabia., Methods:  A structured questionnaire was applied to collect information on teachers, training, knowledge, attitudes, and perceived barriers in managing common sports injuries. Descriptive analysis was performed for demographics and baseline information. Pearson's Chi-squared test and Fisher's exact test were used to assess the determinants of first-aid attitude. Multiple logistic regression was also used to evaluate the determinants of first-aid knowledge., Results: A total number of 535 teachers participated in this study. Most teachers (64.3%) reported an occurrence of sports injury once per month. Only 373 (67.72%) perceived the first aid kit to be readily accessible. The majority (95.89%) of teachers reported familiarity with conducting first aid and 87.38% expressed interest and willingness to learn. Social media was the primary resource of first aid knowledge (57.94%). Logistic regression showed that male sex (OR: 0.51, 95% CI: 0.26, 0.95; p-value = 0.036) and experiencing sports injuries once per month (OR: 0.39, 95% CI: 0.16, 0.84; p-value = 0.024) were associated with negative attitude toward first aid. However, having 10-20 years of experience (OR: 2.46, 95% CI: 1.09, 5.62; p-value = 0.031) or more than 20 years of experience was associated with more positive attitude toward first aid (OR: 6.47, 95% CI: 2.18, 19.8; p-value ≤ 0.001). Furthermore, accessing first aid information from digital media and healthcare professionals compared to books was significantly associated with increased knowledge about first aid. Easy accessibility to first aid was also significantly associated with increased knowledge about first aid., Conclusion: While many teachers feel prepared, the primary source of their first aid knowledge is unattributed social media content rather than certified training. Certified first aid training programs are needed to help in ensuring the quality emergency management of sports injuries., Competing Interests: The authors declare that they have no competing interests., (© 2024 Alharthy et al.)

Background: Few studies have shown that relatively younger children and adolescents (those born later in the same school year) were less likely to engage in physical activity in a phenomenon termed the relative age effect. Although these studies mainly targeted elementary and middle school students, no study has reported on the relative age effect on physical activity in ordinary high school students. Moreover, the relative age effect on sedentary behavior might show an opposite association with physical activity. Therefore, we aimed to clarify the relative age effects on physical activity and sedentary behavior across different school stages in Japanese children and adolescents., Methods: A cross-sectional questionnaire survey was conducted with 21,491 children and adolescents (elementary, middle, and high school students aged 10-18 years) in various Japanese regions from January 2018 to July 2019. Overall, 18,281 children and adolescents (10,299 boys and 7,982 girls) were finally included in our analysis. Data on the birth month, frequency and duration of their physical activity (vigorous, moderate, and moderate-to-vigorous intensity), and sedentary behavior (weekday and weekend total sedentary time, television viewing, playing video games, and Internet use) were obtained. We utilized two-part model regression analyses. Statistically significant association with birth month indicated that a relative age effect was observed., Results: The relatively younger individuals were less likely to engage in physical activity (especially vigorous physical activity (VPA)); this association was observed in middle and high school students. Conversely, the relatively younger boys spent more time during weekends with sedentary behaviors and Internet use. Based on school stage, the relative age effect on VPA time was observed in middle school boys (average margin effect (AME) = -0.74, p < 0.01) and high school students (boys: AME = -0.69, p < 0.01; girls: AME = -0.53, p < 0.05). The relative age effect on sedentary behavior was observed during weekends with sedentary behaviors (AME = 3.55, p < 0.01), playing video games (AME = 0.72, p < 0.05) and Internet use (AME = 2.46, p < 0.01) for male high school students and on television viewing (AME = 1.12, p < 0.05) for female middle school students., Conclusion: The relative age effect on physical activity can persist after middle school, and the relatively younger individuals are more likely to replace physical activity with sedentary behavior., Competing Interests: Declarations. Ethics approval and consent to participate: Ethics approval was obtained from the Ethics Committee of Doshisha University (approval number: 17095). The purpose, methods, benefits, and risks of our study were explained to the principals of the schools. We also obtained participants and their guardians by explaining that we would protect their personal information and that their answers were never related to their school records. Informed consent was obtained from all the participants and their legal guardians. Consent for publication: Not applicable. Competing interests: The authors declare no competing interests., (© 2024. The Author(s).)

Background: Acute upper respiratory tract infections are the most common infections among school children. Improving water, sanitation, and hygiene facilities in schools is an important intervention for the healthy development of children. The most important component of this intervention is hand washing, which is the primary infection control measure., Aim: This study aims to test the effect of the Theory of Planned Behavior (TPB) based hand hygiene intervention program on the health outcomes and school absenteeism of students., Method: The study is quasi-experimental with pretest-posttest control groups. The study was conducted with 159 students (intervention: 82, control: 77) in two separate primary schools that were assigned to intervention and control groups. The intervention group were applied a TPB-based hand hygiene intervention program for the school children. The data were collected using the Student Questionnaire, Hand Hygiene Assessment Question Form, and Surveillance Form., Findings: The mean Hand Hygiene Assessment Question Form Hand Hygiene Behavior scores did not differ between the groups in the pre- and posttest ( p > .05). In the posttest, the frequency of encountering a ten-week-upper respiratory tract infection symptom (U = 5277.50 p < .0001), school absenteeism days ( p = .046) and absenteeism episodes ( p = .043) was lower in the intervention group than in the control group., Conclusions: The findings suggest that was concluded that the TPB-based hand hygiene intervention program did not make a difference in creating hand hygiene behavior in school children compared to the classical education. The program was effective in reducing upper respiratory tract infections and school absenteeism due to these infections., Competing Interests: The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article., (© The Author(s) 2024.)

Background: Overweight prevalence in Spain reached critical levels before the COVID-19 pandemic, which likely exacerbated this issue. The PESCA (Programa Escolar de Salud Cardio-vascular) program is a multicomponent school-based intervention, launched in 2018 with the aim of tackling this health problem and reducing overweight rates in youth. Objectives: (1) To analyze the efficacy of the PESCA program intervention on body composition, overweight prevalence, physical activity (PA)/sport practice, resting time, and screentime before COVID-19 and (2) to evaluate the impact of COVID-19 and the associated lockdown measures on these parameters in the studied sample. Methods: This longitudinal study included 207 children and adolescents from schools in Madrid (aged 2.82 to 15.84 years; 44.4% girls), with measurements taken at three time points: two before COVID-19 and one after its onset. Overweight prevalence, body fat percentage diagnosis, physical activity, resting time, and screentime were assessed. Cochran's Q test and repeated-measures ANOVA were used to compare outcomes across the three assessment time points. Results: Overweight prevalence remained stable among children in the PESCA program before COVID-19 (17.87% to 19.81%). However, a significant increase was observed from point 2 to point 3, post-COVID-19 onset (19.81% to 26.57%). Similarly, healthy body composition significantly deteriorated from 63.16% at point 2 to 52.48% at point 3. PA/sport practice prevalence significantly increased until COVID-19 onset (80.19% to 91.22%) but declined thereafter (91.22% to 79.10% from point 2 to point 3). Although the differences were small, resting time significantly decreased post-COVID-19 onset (from 10.18 h at point 2 to 9.96 h at point 3), with no changes in the first period. Non-academic screentime showed a similar pattern: stable before COVID-19 and significantly increased after its onset (1.61 h at point 1; 1.70 h at point 2; 2.29 h at point 3). Conclusions: The PESCA program positively impacted PA/sport practice prevalence and may have provided some protection against overweight and related variables during the pre-COVID period. However, health authorities' restrictions and lockdown policies during COVID-19 negatively affected the health and lifestyle variables studied, offsetting previous improvements.

Introduction: Schools in the United Arab Emirates (UAE) witnessed an increase of 7% in bullying prevalence since 2005. This review aimed to map antibullying interventions in the UAE., Methods: A systematic search was performed in five electronic databases (EMBASE, PubMed, PsycINFO, Scopus and Eric) using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Review. Studies addressing antibullying interventions and grey literature in the UAE from 2010 to 2021 were included. Interventions were mapped using distribution across key sectors, public health practice levels, and organisation types., Results: Of the 2122 identified papers, only 2 were included. Both articles were published in 2019 and used qualitative methods. From the search of governmental and non-governmental websites, 22 multilevel interventions were included and presented on the three levels of public health practice across the different sectors and target stakeholders. Eight interventions were at the federal level, and six were by private stakeholders. The government funded 59% of all interventions. Four interventions addressed cyberbullying, and three used multisectoral collaboration., Conclusions: Although the UAE is building capacity for bullying prevention, we found limited knowledge of antibullying prevention efforts. Further studies are needed to assess current interventions, strategies and policies., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2024. No commercial re-use. See rights and permissions. Published by BMJ.)

Background: Children from low-income and racial/ethnic minority backgrounds are more prone to insufficient physical activity and heightened sedentary behaviors. This study aims to increase moderate to vigorous physical activity and decrease sedentary behaviors among high-risk children through an inclusive and transformative sport skill development physical education (PE) intervention., Methods: Elementary school-aged children were recruited from 3 public schools located in underserved communities in Houston, TX. Classrooms were randomly assigned to a sport-based PE class (intervention, 12 classrooms, n = 124) or a standard PE class (control, 13 classrooms, n = 133). The intervention was implemented at school by teachers over 10 weeks, whereas at home, the intervention group received equipment, virtual classes, and parent trainings. Activity behaviors were assessed using accelerometry (ActiGraph GT3X+) at baseline and post intervention. Multilevel linear mixed-effects models were conducted to examine changes in activity behaviors between the study conditions., Results: Participants were 9.33 (0.68) years old, and 46% were females, who identified as either Hispanic/Latino (48%) and/or Black (38%). The difference in minutes of weekend sedentary behavior change was 32 minutes between study conditions (P = .012). Specifically, intervention girls decreased weekend sedentary behavior by 37 minutes, whereas girls in the control condition increased by 8 minutes (P < .01). Despite the direction of change in overall, weekday, or weekend moderate to vigorous physical activity and overall or weekday sedentary behaviors in favor of the intervention, these effects did not reach the statistically significant level compared to the control condition., Conclusions: Sport-based PE intervention can be an important strategy to decrease child sedentary behaviors during out-of-school periods, particularly among girls.

School food has a major influence on children's diet quality and has the potential to reduce diet inequalities and non-communicable disease risk. Funded by the UK Prevention Research Partnership, we have established a UK school food system network. The overarching aim was to build a community to work towards a more health-promoting food and nutrition system in UK schools. The network has brought together a team from a range of disciplines, while the inclusion of non-academic users and other stakeholders, such as pupils and parents, has allowed the co-development of research priorities and questions. This network has used a combination of workshops, working groups and pump-priming projects to explore the school food system, as well as creating a systems map of the UK school food system and conducting network analysis of the newly established network. Through understanding the current food system and building network expertise, we hope to advance research and policy around food in schools. Further funding has been achieved based on these findings, working in partnership with policymakers and schools, while a Nutrition Society Special Interest Group has been established to ensure maximum engagement and future sustainability of the network. This review will describe the key findings and progress to date based on the work of the network, as well as a summary of the current literature, identification of knowledge gaps and areas of debate, according to key elements of the school food system.

Objective: Adolescents are particularly susceptible to developing an eating disorder (ED). Therefore, schools are in a unique position to assist in the prevention of EDs for this vulnerable group. To ascertain the current evidence-base for school-based ED prevention efforts, we conducted a systematic review and meta-analysis of randomised controlled trials that delivered a school-based ED prevention intervention and assessed the impact these interventions had on ED symptomatology., Method: Electronic databases (PsycINFO, MEDLINE, EMBASE, Web of Science, Scopus and CENTRAL) were searched for published randomised controlled trials of school-based ED prevention interventions from inception to 2024. Twelve studies from 11 articles were identified with 7935 participants (mean ages ranging from 12 to 17). Of these studies, six were included in meta-analyses., Results: Media literacy and dissonance-based interventions reported small to medium effects for ED symptomatology compared to controls at post-intervention. At three-to-six-month follow-up, intervention groups reported small negative to medium-sized positive effects compared to control groups on eating disorder symptomatology., Conclusions: While school-based ED prevention interventions can effectively reduce ED symptomatology post-intervention, the programs analysed in this review do not reliably demonstrate effectiveness across groups and time. Future research should build upon current interventions to increase effectiveness and include long-term follow-ups., (© 2024 Eating Disorders Association and John Wiley & Sons Ltd.)

Prior research provides little guidance on how to support return to school post-concussion. Peer support may be one strategy to enable adolescents to return to school post-concussion. The purpose of this study was to explore what high school students preferred in a school-based peer support program post-concussion. We conducted a qualitative instrumental case study in one high school in Calgary, Canada. Seven semi-structured focus groups were conducted with 53 high school students (16 boys, 36 girls, 1 preferring not to disclose gender; median age = 16 years, range = 15-18 years). All adolescents were enrolled in a sport medicine course and had either a history of concussion ( n  = 20) or were interested in supporting peers who had sustained a concussion ( n  = 33). Focus group questions aimed to solicit which factors the adolescents believed should be considered in the development of a post-concussion peer support program. We analyzed the focus group transcriptions using content analysis. Adolescents preferred a one-on-one Buddy Program. A one-on-one environment would provide a trusting and confidential relationship between the student with a concussion and their buddy. Peer support could include social support, advocacy support for academic accommodations, tutoring support, and concussion education. In future, the Buddy Program should be piloted in high schools.

Background: The objective of the current study was to estimate the prevalence and associated factors of overweight/obesity among Bangladeshi adolescents aged 15-19 y and to identify whether wealth-related inequality exists for overweight/obesity among Bangladeshi older adolescents., Methods: We analyzed publicly available national representative secondary data from the 2019-2020 Bangladesh Adolescent Health and Wellbeing Survey. This cross-sectional survey was carried out among 18 249 adolescents aged 15-19 y regardless of their marital status using a two-stage stratified sampling technique (the data of 9128 eligible adolescents were included in this analysis). The WHO reference population for body mass index-for-age (1+Z score) was considered as overweight/obesity., Results: We found that girls had significantly (p<0.05) higher prevalence of overweight/obesity (11.63%) than boys (8.25%); however, their biological sex as well their age were not significantly associated with higher odds of overweight/obesity. Those who were in their higher grade (grade 11 and higher) in the school and had been exposed to media were more likely (1.67 and 1.39 times, respectively) to be overweight/obesity compared with primary grade (0-5) and those who experienced no media exposure, respectively. Inequality analysis revealed that adolescents belonging to wealthy households had significantly higher rates of overweight/obesity than those in poorer households (concentration index=0.093)., Conclusions: The study exhibited the multifaceted nature of overweight/obesity among Bangladeshi older teenagers, revealing that their school grade, exposure to media content and wealth-related inequality emerged as significant contributing factors. The findings underscore the urgent need for targeted interventions and public health strategies to address the escalating burden of overweight and obesity in this age group., (© The Author(s) 2024. Published by Oxford University Press on behalf of Royal Society of Tropical Medicine and Hygiene.)

Functional Neurological Disorder (FND) can significantly impact school functioning. Symptoms may affect children and adolescents academically, socially, psychologically, and impact school attendance. This article reviews the importance of being able to continue in school despite FND symptoms and recommendations to support this. It will provide a guideline for communication and collaboration with schools and describe the type of information that is helpful to share with school teams. This article will also discuss various accommodations that can be helpful in the school setting. Finally, other resources, such as IEPs and 504 Plans as well as additional sources of information and support are briefly reviewed.

Background: The COVID-19 pandemic triggered a worldwide socio-sanitary crisis, continuing to impact societies worldwide. With many school systems shifted to online education, the current study presents a unique opportunity to investigate relevant phenomena related to serious health issues during the schooling and later in life, cyberbullying and bullying. This study began just before the COVID-19 lockdown was declared and resumed 5 months later allowing to explore 2 main objectives: first, to explore whether cyberbullying increased during the lockdown, and second, to analyze transitions from to time of bullying and cyberbullying., Methods: The participants included 792 students from sixth and seventh years of Primary Education (Mean age  = 10.81, SD = 0.85) in Ecuador. This is a quantitative longitudinal study. Cyberbullying and bullying scales were used for data collection before the lockdown in January and February 2020 (T1), and after 5 months of lockdown, at the end of the same academic year in July 2020 (T2). Descriptive, comparative and predictive analyses, a latent transition analysis was used to identify latent status of cyberbullying and bullying behavior at T1 and T2., Results: The results revealed a significant increase of cyberbullying after 5 months of the lockdown. Interestingly, only a small percentage of students who were uninvolved in cyberbullying and bullying in T1 remained uninvolved in T2., Conclusions: The discussion explores the dynamics of cyberbullying involvement and examines changes in the roles and groups of bullying and cyberbullying after 5 months of lockdown. The political- and school-related implications of these findings are thoroughly discussed., (© 2024 The Author(s). Journal of School Health published by Wiley Periodicals LLC on behalf of American School Health Association.)

The present study aims to measure the values of metal pollutants in the dust of schools in Mashhad metropolis, determine the source of metal pollution, evaluate the degree of pollution, assess the health risk (carcinogenicity/non-carcinogenicity) and evaluate the potential ecological risk. For this purpose, after measuring the concentration of metals using an inductively coupled plasma-mass spectrometer, from various indices including Geoaccumulation Index (I geo ), Pollution Load Index (PLI), Contamination Factors (CF), Potential Ecological Risk Index (PERI), Enrichment Factor (EF), and Health Risk Indices such as Hazard Quotient (HQ), Hazard Index (HI), Carcinogenic Risk (CR) were used. The average concentrations of iron, arsenic, cadmium, chromium, copper, nickel, lead, vanadium and zinc (Fe, As, Cd, Cr, Cu, Ni, Pb, V and Zn) were 6361.50, 5.96, 0.59, 61.89, 37.13, 61.31, 28.93, 25.64 and 142.00 µg g -1 , respectively. Based on CF, PLI and I geo indices, most of the findings for the studied elements were at the low pollution level. The results also showed that the most likely origin of the studied metals was anthropogenic sources. The results of PERI indices showed that potential ecological risk at only one of the collection sites. In contrast, a high ecological risk was obtained for Cd. Hazard Index values were below safe levels for all studied elements. CR levels for elements were also classified as negligible and acceptable or tolerable risk, although the highest CR value for Cr indicated possible harm to humans. The findings showed the need for more attention and continuous monitoring of the concentration of metals, especially chromium, to announce a possible warning and prevent their harmful effects. It should be noted that the present study is the first research with mentioned objectives in Mashhad city and also in Khorasan Razavi province., (© 2024. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Background: The rapid global spread of the SARS-CoV‑2 virus during the COVID-19 pandemic led to widespread non-pharmaceutical interventions, such as school closures, to curb infections. This study investigates the influence of school closures on the number of new infections to reduce the existing knowledge gap in this area., Methods: The effect of school closures starting on 16 December 2020, was quantified using COVID-19 infection data from the district and city of Landshut in Bavaria between November 2020 and January 2021. An interrupted time series (ITS) analysis was performed to analyze daily new infections among 6-18 year olds and the entire population in the region before and after the school closures using a negative binomial regression model., Results: The analysis showed that the trend of daily new COVID-19 infections among 6-18 year olds significantly decreased after the school closures (incidence rate ratio (IRR) 0.93; 95% confidence interval (CI): 0.89-0.96; p < 0.001). This was also true for the entire study population (IRR 0.95; 95% CI: 0.93-0.97; p < 0.001)., Discussion: In the context of various concurrent measures to contain the COVID-19 pandemic, the study provides evidence for a significant association between school closures and reduced COVID-19 infections. By optimizing the existing incomplete evidence base on the role of school closures in pandemic control, this finding can support involved stakeholders and contribute to strengthening future approaches to pandemic prevention., (© 2024. Springer-Verlag GmbH Deutschland, ein Teil von Springer Nature.)

Ethnic-racial identity formation has significant consequences for positive youth development. Existing findings support the efficacy of the Identity Project, a school-based ethnic-racial identity intervention, when delivered by researchers; however, effectiveness of the program when delivered by teachers is unknown. This study examined changes in adolescents' (N = 180; 42.2% male, 50.6% female, 6.7% another gender identity; M age  = 14.11, SD = 0.33; 38.3% Latinx, 33.9% White, 15.0% Black, 9.4% Asian American, 3.3% another ethnoracial background) ethnic-racial identity exploration as a function of their teachers' implementation of the Identity Project. Findings indicated that ethnic-racial identity exploration significantly increased from pretest to posttest, and this did not vary based on familial ethnic-racial socialization, student-teacher ethnoracial match/mismatch, gender, immigrant status, or ethnoracial background. This study provides preliminary evidence that U.S. educators can be trained to efficaciously implement the Identity Project with high school students and, furthermore, that this approach to program dissemination may not only facilitate scale-up but also result in greater gains for adolescents relative to research-led implementations., (© 2024. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

Cultural identity formation is a complex developmental task that influences adolescents' adjustment. However, less is known about individual variations in trajectories of cultural identity processes and how they relate to youth psychosocial outcomes. Using a person-centered approach, this study investigated patterns of change over a year in cultural identity exploration and resolution, respectively, among ethnically diverse adolescents in Italy. The sample included 173 high school students (M age  = 15 yrs, SD = 0.62, range = 14-17; 58.4% female; 26% immigrant background) who had participated in the Identity Project, a school-based intervention targeting ethnic-racial identity development. Longitudinal latent profile analysis revealed only one profile of change for exploration, whereas four unique profiles for resolution emerged ("stable low," "stable average," "increase low-to-average," "increase high-to-higher"). Overall, youth in the resolution-increase profiles reported the best outcomes. The findings highlight the heterogeneity of adolescents' resolution trajectories and the benefits of an increased sense of clarity concerning one's cultural identity for positive psychosocial functioning., (© 2024. The Author(s).)

Given the significance of heritage cultural identity for optimal adolescent development, it is imperative to investigate factors influencing the efficacy of interventions aimed at promoting heritage cultural identity. Using latent profile cluster analysis and multinomial logistic regressions, this longitudinal study examined how autonomy and relatedness need satisfaction at school (1) related to heritage cultural identity development trajectories, and (2) moderated effects of a school-based intervention. The study included N = 198 adolescents (M age  = 12.86 years, SD age  = 0.75, 52% female, 41% immigrant descent, 49% intervention group) in Germany. Teacher-student relationships played an important role in facilitating intervention effects on identity development trajectories, emphasizing the importance of the relational context when implementing school-based interventions to promote heritage cultural identity development., (© 2024. The Author(s).)

Background: The misuse of psychotropic medication has increased during the past decade, especially among adolescents. The aim of our study was to describe the prevalence and patterns of the nonmedical use of benzodiazepines (BDZ) and Z-hypnotics among school-aged adolescents through the lens of sex. In addition, we sought to analyze the temporal evolution of the nonmedical use of these drugs during the period 2016-2021., Methods: The temporal evolution of the nonmedical use of these drugs was analyzed based on survey data collected in 2016, 2018 and 2021, which includes the first years of the COVID-19 pandemic. To assess the possible effect of the COVID-19 pandemic, the year at survey was conducted was introduced as a categorical variable. We used data from the Spanish State Survey on Drug Use in Secondary Education, which covers drug use among students aged 14-18 years. Using multivariate logistic regression models, we estimated the independent effect of different variables (sociodemographic data, use of other psychoactive substances, risk perception and availability) on the nonmedical use of BDZ and Z-hypnotics., Results: In total, survey data from 95,700 adolescents were included in our analysis. The nonmedical use of BDZ and Z-hypnotics increased among adolescents during the study period. The adjusted odds ratio (AOR) from 2016 to 2018 was 1.11 (95% CI 0.94-1.31) and from 2018 to 2021 the AOR was 1.26 (95% CI 1.08-1.46), using 2016 and 2018, respectively, as reference years. The nonmedical use of BDZ and Z-hypnotics was more likely in adolescent girls than boys (AOR = 2.11). The nonmedical use of prescription opioids (AOR = 3.44), novel psychoactive substances and other illicit psychoactive drugs (AOR = 4.10) were risk factors for the nonmedical use of BDZ and Z-hypnotics in both sexes. Use of cannabis (AOR = 1.38) was a predictor of nonmedical use in female adolescents only., Conclusions: This study shows that the trend of the nonmedical use of BDZ and Z-hypnotics among school-aged adolescents in Spain increased between 2016 and 2021. Among adolescents aged 14 to 18, the probability of nonmedical use of these psychoactive substances was twice as high for female adolescents as for male adolescents., (© 2024 Association for Child and Adolescent Mental Health.)

While both the classroom cultural diversity climate and curriculum-based interventions can promote cultural identity development, they have not been studied together. Drawing on theories of ethnic-racial identity development, the current study aimed to understand the dynamic interplay of a curriculum-based intervention (the Identity Project) with the classroom cultural diversity climate (heritage culture and intercultural learning, critical consciousness socialization and equal treatment) on cultural identity exploration and resolution. Our sample included 906 mid-adolescents in Italy (32.36% immigrant descent, M age (SD) = 15.12 (0.68) years, 51.73% female), and 504 early adolescents in Germany (53.86% immigrant descent, M age (SD) = 12.82 (0.89) years, 42.37% female). Bayesian multivariate linear models show that the Identity Project and a stronger critical consciousness climate in the classroom before the intervention promoted cultural identity exploration at post-test in both countries. However, effects of the intervention and facets of the diversity climate on subsequent resolution were only observed in Italy. There was some evidence that the intervention could alter the classroom cultural diversity climate in Germany, while the intervention could compensate for a less positive diversity climate in the slightly older sample in Italy. Thus, it seems promising to systematically build in opportunities to engage with students' diverse heritage cultures and identities when developing new curricula, as well as to train teachers to implement such curricula., (© 2024. The Author(s).)

Passive cooling strategies were implemented in 11 school buildings in Barcelona within a pilot project to improve thermal conditions. The present study aimed to evaluate the intervention's impact on students' comfort and well-being at school. A quasi-experimental pre-post study based on mixed methods was conducted. Quantitative data were collected through self-reported questionnaires administrated to sixth-grade students in 21 schools (11 in an intervention group, IG, and 10 in a comparison group, CG). The authors measured changes in satisfaction with indoor temperature and indoor air quality (IAQ), the presence of bothering factors (temperature too high, temperature too low, unpleasant odours, and lighting problems), and students' well-being and performance. Difference-in-difference analysis was conducted to evaluate differences between the IG and CG in pre-post changes. Qualitative data were collected through photovoice-based sessions (59 sixth grade students) and interviews (7 teachers) in the IG. A thematic content analysis identified three main categories: changes in perceptions of indoor environmental conditions, indoor environment-related health and well-being, and indoor environment and their reported impact on learning. Quantitative findings show positive changes among the IG in perceived indoor temperature, air quality, and well-being at school, while suggest no significant changes in perceptions of temperature too low, lighting problems, and students' performance, in relation to the CG. Compared to the CG, students in the IG perceiving temperature too high significantly decreased among girls, while unpleasant odours decreased only among boys. In the qualitative assessment, participants reported that school transformations improved their indoor thermal and visual comfort, IAQ, and unpleasant odours. Participants also reported a reduction of fatigue, stress, irritability, and stifling sensation, as well as enhanced concentration. This study highlights the benefits of school passive design for student's comfort and well-being in Mediterranean climates and suggests the need to extend these interventions to other school buildings in similar contexts., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier B.V. All rights reserved.)

Schools and friendships represent important but distinct contexts for adolescent identity development. However, research has yet to explore the long-term interplay between these factors on ethnic/racial identity (ERI). This study included a sample of 640 adolescents from 9 public high schools in a diverse United States metropolis (M age  = 14.50, SD = 0.67; 44% Asian, 20% Black, 36% Latinx; female = 68%, male = 32%, non-binary = 0%). Latent growth curve modeling was conducted to investigate longitudinal associations in friendship ethnic/racial composition and ERI exploration. From the 9th-11th grades, same-race friends and ERI exploration increased linearly whereas friendship ethnic/racial diversity decreased linearly. Adolescents attending more ethnically/racially diverse schools maintained more ethnically/racially diverse friends over time but did not differ in changes in ERI exploration compared to adolescents in less diverse schools. There was no association between the rates at which adolescents' friendship ethnic/racial composition and ERI changed over time. More ethnically/racially diverse friends in the 9th-grade predicted faster increases in subsequent ERI exploration. The findings highlight important differences in the roles of friendship and school contexts on ERI, suggesting that friendship ethnic/racial diversity, but not school ethnic/racial diversity, facilitated ERI exploration over time. School ethnic/racial diversity did facilitate a slower decline in friendship ethnic/racial diversity, emphasizing the importance of school integration., (© 2024. This is a U.S. Government work and not under copyright protection in the US; foreign copyright protection may apply.)

The Break4Brain project aims to elucidate the effects of both acute and chronic physical activity (PA) on educational achievement in children with and without Attention Deficit Hyperactivity Disorder (ADHD). This study will be conducted in two phases: a cross-over design followed by a hybrid type 1 implementation-effectiveness trial, which includes both a cluster randomized controlled trial (RCT) and a qualitative study. In phase I, 60 children aged 10-12, with 30 each from ADHD and non-ADHD groups, will participate in a laboratory-based study over 4 days within 1 month. They will participate in three counterbalanced experimental conditions: (i) PA with cognitive engagement, (ii) PA without cognitive engagement, and (iii) a cognitively engaging control. This phase will assess acute changes in brain function, academic performance, working memory, inhibitory control, and sustained attention. Phase II will involve 600 children aged 10-12, randomly assigned to either a video-based PA program or a control group (300 children per group) in an 8-week cluster RCT. This phase will also incorporate a qualitative approach to explore the implementation context through pre- and post-intervention semi-structured interviews with teachers and school staff, and questionnaires for students. The outcomes of interest in this phase will include working memory, cognitive flexibility, selective attention, and academic performance. For the cross-over study, we hypothesize that PA conditions will enhance the studied outcomes compared to the control condition. In the RCT, we anticipate that the 8-week active breaks program will result in significant improvements in the selected outcomes compared to the control group. This study is expected to make pioneering contributions by including novel variables and focusing on the ADHD population. Furthermore, if the cluster RCT proves effective, it could offer a practical and cost-effective resource for integrating active breaks into daily school routines., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2024 Arenas, Bodi-Torralba, Oliver, Cantallops, Ponseti, Palou-Sampol, Collado, Flórez, Galvez-Pol, Terrasa, Sitges, Sánchez-Azanza, López-Penadés, Adrover-Roig and Muntaner-Mas.)

Background: Low academic achievement and low educational attainment in adolescence is associated with higher risks of internalizing disorders later in life. However, less is known regarding if these associations vary over time across cohorts. The aim of this study was to investigate temporal changes in the association between academic achievement or educational attainment and subsequent inpatient treatment for internalizing disorders among Swedish youths., Methods: Register data on all students graduating from compulsory school in Sweden between 1990 and 2010 (N = 2 252 703) were used. Students were followed for a maximum of 8 years using discrete time proportional hazard models. Internalized disorders were measured by specialized inpatient psychiatric care for depression or anxiety disorders. Academic achievement was measured by grades at the end of compulsory school, and educational attainment by completion of upper secondary school., Results: The positive association between inpatient treatment for internalizing disorders and both low compulsory school achievement and non-completion of upper secondary school became stronger in more recent cohorts. The results were completely driven by girls and native-born youth., Conclusions: Low compulsory school achievements and failure to complete upper secondary school has become more important risk factors for inpatient treatment for internalizing disorders, particularly in native-born youth and girls. More research is needed to establish whether youth with internalizing disorders increasingly fail in school or whether low achievement has become more harmful for mental health., (© 2024. The Author(s).)

Background: Despite the implementation of antibullying policies, schools in the United Arab Emirates (UAE) witnessed an increase in bullying prevalence. The aim of our study was to assess bullying victimization in schools in the UAE, types of bullying, and factors and outcomes related to bullying behavior., Methods: A cross-sectional survey was conducted in randomly selected private and public schools in Al Ain City. A structured, self-administered questionnaire was used to collect data from students in grades 6-8 (Ages 10-15). We adapted the US CDC 'Bully Survey' for cultural relevance in the UAE through feedback from focus group meetings with teachers. Data analysis, conducted using R software, involved stratified analysis by school type and utilized Chi-Squared and Fisher's exact tests to identify factors associated with school bullying., Results: The study sample consisted of 723 students of whom 68% were males, and 58% were Emirati nationals. The overall prevalence of bullying victimization in schools was 37%, with 40% in private schools and 35% in public schools. Cyberbullying was more prevalent in private schools (37%). Physical bullying was reported by 20% and verbal bullying by 12%, with a higher prevalence of physical bullying in private schools (24%) and among males (23%). The study's findings showed significant emotional and academic impacts of bullying, including feelings of sadness and learning difficulties, contributing to a rise in school absenteeism., Conclusions: The study reveals widespread bullying victimization in UAE schools, mainly in classrooms, with group exclusion and verbal abuse as key forms. It underscores bullying's psychological impact and the greater awareness of parents compared to teachers. The effective intervention strategies should not only involve students, teachers, and school staff, but also actively engage parents by fostering stronger communication channels between schools and families, and providing parents with resources and training to recognize and address bullying. These strategies should aim to create a cohesive network involving the entire school community, thus fostering a safer and more inclusive environment for students. The findings stress the need for inclusive antibullying programs involving the entire school community to foster a safer environment., (© 2024. The Author(s).)

Background: Adolescence is often seen as an important period for further personality development. In today's world, it is therefore important to keep track of current trends in adolescents. One of them is addictive behaviour in the context of the online environment. Spending too much time online can have a negative impact on the quality of life of adolescents. It is therefore important to pay increased attention to this phenomenon and to respond adequately to the current situation., Methods: Our study focuses on the prevalence of Internet addiction among Czech and Slovak adolescents. In total, 3,741 respondents participated in the project (N = 2,642 CZ; N = 1,099 SK); their ages ranged from 11 to 19 years (M = 14.38; SD ± 2.27). The research addressed differences among individual types of schools and between sexes in relation to Internet addiction. The research focused on adolescents attending secondary schools (ISCED 2 and 3) between the ages of 11 and 19 in the Czech and Slovak Republics. A questionnaire battery consisting of a sociodemographic questionnaire and the Internet Addiction Test (IAT) questionnaire was used for data collection., Results: In relation to the category of Internet use, girls did not score higher than boys either in the Czech group F(1, 2112) = .089, p = .765, or in the Slovak group F(1, 927) < .001 p = .994. There is a significant effect of school type both in the Czech group F(4, 2100) = 11.483, p < .001, and in the Slovak group F(4, 859) = 2.859, p = .023., Conclusions: Our research indicates that some adolescents, particularly boys, face issues with excessive Internet use, affecting social interactions. Further studies in the Czech Republic could explore the link between psychosocial factors and adolescent Internet use. This highlights the need to raise awareness among professionals about Internet addiction in Czech and Slovak adolescents., (© 2024. The Author(s).)

Background/Objectives: Migraine affects 10% of adolescents and children. Typical school protocols in the USA require pharmacological medications to be administered by school nurses, often resulting in treatment delays or omissions when migraine attacks occur during school hours. The Remote Electrical Neuromodulation (REN) wearable is an FDA-cleared smartphone-controlled device delivering acute and preventive treatment of migraine attacks in patients aged 8 and above, allowing safe, effective, discreet, and independent usage. Methods: This retrospective study (NCT06180577) evaluates treatment patterns, barriers, and preferences among school-age students. REN users < 18 years old were invited to complete an online survey. Participants signed an assent form, and their parents/legal guardians signed an informed consent form. Results: 332 patients aged 7-17 (15.5 ± 2.1) participated (80.4% female). After being prescribed the REN wearable, the percentage of students who treated their headaches at school increased from 78.3% to 89.8%. Most participants (65.4%) treated with either REN standalone (38.0%) or in combination with medications (27.4%). Common barriers to treatment included the need to leave class for the nurse's office (64.2%), concerns about standing out (42.2%), and one barrier unique to REN-permission needed to use a smartphone in class (22.9%). The most common reasons given for preferring REN treatment at school are the ability to avoid going to the nurse's office (42.5%) and to treat discreetly (39.2%). Conclusions: This study underscores the challenges of managing migraine at school while suggesting the importance of the REN wearable as a discreet and independently used first-line treatment for children and adolescents.

Objectives: School-age children are constantly at risk of unintentional injuries. School educational staff are the primary group responsible for maintaining student welfare and responding to emergency situations. The present study aims to evaluate the knowledge and attitudes, practice level, and contextual factors related to first aid among female educational staff in Riyadh, Saudi Arabia., Methods: A cross-sectional study was conducted with a convenience sampling of 1,060 female school staff at all educational levels in Riyadh. Participants completed a self-administered online questionnaire that contained items assessing sociodemographic data, knowledge, attitudes, and practice regarding first aid., Results: Most of the 1,060 participants reported above average knowledge level, with a mean score of 21 (max 35). On the other hand, positive attitude toward first aid was high ( μ  = 22.9; max 25). Approximately 33.4% of staff had previous first aid training, and 79.2% were willing to participate in future trainings. First aid knowledge was highest for choking and lowest for seizures., Conclusion: The attitudes toward first aid were generally positive, and the knowledge of first aid was above average among most participants but still unsatisfactory. Mandatory first aid courses are necessary to support children's health during their education., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2024 Abdelrahman, Aleyeidi, Alqahtani, Aldosari, Al Shammari, Alrusaini, Almahfouz, Altamimi, Alshehri, Alsubaie, Almuzaini, Innab and Alsuhaibani.)

Study Objectives: Since later school start times are associated with increased sleep duration, our objectives were to identify mean school start times, the proportion of schools that start at 08:30 am or later, and determine if rurality was associated with school start times., Methods: We conducted web searches for start times of 1759 standard schools in British Columbia (BC), Canada. Schools were categorized as elementary, elementary-middle, middle, middle-high, or high school and linked to an Index of Remoteness. We calculated descriptive statistics and used Analysis of Variance to assess for start time differences by grade category. We used Spearman's rank-order correlation to assess if there was a relationship between start time and rurality., Results: We found start times for 1553 (88.2%) of the included schools. The mean start time was 08:40 am ( SD  = 0:15) and ranged from 07:10 am to 09:45 am. There was a significant effect of grade category on start time, F (5, 1600) = 6.03, p  < .001, η 2 =.02, 95% CI [.006, .031] such that elementary-middle schools started significantly earlier ( M  = 0:17) than other grade categories. Overall, 1388 (86.4%) schools started at 08:30 am or later. Rurality was significantly correlated with school start time ( SD  = 0:17) than other grade categories. Overall, 1388 (86.4%) schools started at 08:30 am or later. Rurality was significantly correlated with school start time ( r = -.198), such that more rural schools started earlier., Conclusions: For the most part, school start times in BC meet recommendations that support childhood and adolescent sleep. Future research is needed to understand factors that promote the successful implementation of delayed school start times., (© The Author(s) 2024. Published by Oxford University Press on behalf of Sleep Research Society.)

Background and Aims: Mobile phone bans in secondary schools are claimed to reduce student distraction and promote learning and face-to-face socializing. Currently, the evidence on phone bans is limited. The aim of this preregistered study was to evaluate the South Australian mobile phone ban's effects on students' problematic phone use, academic engagement, school belonging, and bullying. The study also sought to identify student variables that predict phone ban compliance., Methods: As the ban was phased in over 2023, a 2 (phone ban: yes/no) × 2 (time: baseline, 1-month follow-up) repeated-measures design was employed. Students (n = 1,282 at baseline; n = 1,256 at follow-up) in Grades 7 to 12 were recruited from five public secondary schools. Surveys included measures drawn from the Longitudinal Study of Australian Children (LSAC) and the Programme for International Student Assessment (PISA)., Results: Problematic phone use was reported by 2.6% of the sample. Being older and a more frequent user of social media predicted lower phone ban compliance. Linear mixed models indicated that ban and no ban school groups did not differ significantly in terms of problematic phone use, academic engagement, and school belonging. There was slightly higher bullying in the ban group but bullying decreased significantly in both groups., Discussion: Imposing access restrictions may not affect the underlying psychological mechanisms that drive problematic phone use. Although these results indicate limited to no short-term benefits of the ban, further evaluation with more sensitive methodologies is recommended., Conclusions: Student-technology interactions in learning institutions should be continually monitored to determine the optimal balance to support student etiquette, learning, and wellbeing.

We studied the gender achievement gap in grades and standardised test scores in Finland, where the gender differences are largest among OECD countries. We compared the gender achievement gap in standardised test scores from PISA surveys and grades from high-quality school registers in literacy. Furthermore, we analysed how grades differ from standardised test scores by family background and students' SES composition of the schools. By using the Blinder-Oaxaca decomposition method, we explored how different characteristics between girls and boys explain gender differences in grading. Our findings indicate that boys' grades were lower than can be expected based on standardised test scores. The gender gap in grades was explained by boys' lower reading interests, effort put into schoolwork, and conscientiousness on homework. However, even adjusting for schooling characteristics and competence, boys have lower grades than test scores in schools that have low SES student composition., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2024 Lehti and Laaninen.)

Introduction: To increase the population's ability to handle emergencies, life-saving maneuvers should be universally acquired as an automatic skill starting from school through frequent and practical retraining. Teachers could be ideal multipliers, but it is necessary to design pathways that train and motivate them, since Basic Life Support and Defibrillation (BLSD) skills are not part of their academic curricula. This study explores innovative training solutions and facilitating factors to enhance BLSD education in schools by focusing on the training and motivation of teachers., Methods: In the 1st year, an in-service training program for teachers was provided and assessed in a lower middle school in central Italy. The study compared the skills of a group of students trained by teachers with those trained by certified instructors, immediately after the course and 6 months later. Both the procedural skills and the quality of cardiopulmonary resuscitation (CPR) were evaluated, through a hands-on simulation. Over the next 5 years, the project was expanded to three more schools, and a field study was conducted where researchers monitored the teachers in their classroom work, supporting them in resolving critical issues., Results: Quantitative assessments showed significant differences in student abilities immediately after the course, which diminished after 6 months. Qualitative evaluations indicated that teachers, initially reluctant, gained confidence and effectively taught BLSD skills. Over 5 academic years, the project expanded to additional schools, training 5,661 students in life-saving maneuvers with a ratio of 1 teacher for every 111 trained students, over the whole period of time. Sustainability factors included regular retraining of teachers, continually updated and free didactic materials and equipment, internal coordinators, allowing teachers the freedom to structure a customized course schedule in terms of timing and delivery methods., Conclusion: The study highlights the effectiveness of trained teachers as BLSD knowledge multipliers. Standardizing teacher training, including follow-up retraining, is crucial, but flexibility in student training is beneficial, allowing adaptation to the specific needs of schools. Future research should focus on the long-term sustainability of chain training in larger areas, identifying strategies to overcome organizational and motivational barriers., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2024 Calicchia, Capanna, De Rosa, Papaleo and Pera.)

Background: The benefits of healthy eating are well known, yet adolescent diet is often poor. School based interventions offer a promising option to promote healthy eating, however, evidence is unclear., Aim: This umbrella review synthesised the current evidence on school-based interventions for healthy eating in adolescents (10-19 years old)., Methods: Using Joanna Briggs Institute (JBI) umbrella review guidelines, a systematic search was conducted on 11 electronic databases (PubMed, CINHAL, EMBASE, Science Direct, PsycINFO, MEDLINE, Scopus, ERIC, Web of Science, Cochrane Register of Systemic Review and JBI Evidence Synthesis) to identify reviews published between January 2000 and December 2023. Methodological quality was assessed using JBI critical appraisal tool. A narrative synthesis was conducted informed by the World Health Organisation's Health Promoting School (HPS) framework that categorises school-based interventions into three components i.e., health education, school environment changes, and family and community involvement., Results: Seventeen reviews were identified (including 347 unique primary studies) that were published between 2008 and 2023. 87% of the reviews were based on interventions in high- income countries, limiting applicability to low- and middle-income countries. Fourteen reviews were rated as high, two as moderate, and one was rated as low methodological quality. Evidence from 71% of the reviews (n = 14 reviews, 13 = high methodological quality) found that multi-component interventions (i.e., interventions incorporating more than two components of the HPS framework) improved adolescents' knowledge and behaviour concerning healthy eating. At the individual level, tech-driven healthy eating curricula effectively improved eating behaviours of adolescents. These individual-level interventions proved to be more effective and sustainable when supported by system-level changes, such as modifying school environments including increased availability of healthy foods and involving parents to promote healthy eating for adolescents. However, limited evidence from only three reviews suggests mixed feasibility for technology-based interventions and lower feasibility for multi-component interventions. The lack of information on stakeholder involvement in intervention design is another critical evidence gap., Conclusion: School-based multi-component healthy eating interventions that combine individual-level interventions with system-level changes are effective in promoting healthy eating behaviours among adolescents. Future reviews should assess the effectiveness of participatory approaches in intervention design, feasibility and scale-up studies, and analysing evidence from low- and middle-income countries., (© 2024. The Author(s).)