Search

Professional Development (PD) programs in Pakistan typically follow a standardized approach, often overlooking the diverse strengths and weaknesses of various teacher groups, which may not adequately address their specific needs. This study aims to evaluate teacher competencies among different groups from the perspective of school principals in Pakistan's public schools, with the goal of enhancing the effectiveness of PD programs. Initially, the study identifies three key themes of 21st-century teacher competencies through an extensive review of recent literature. An interview guide, based on these competencies, was used to gather data from seven public school principals via structured interviews. The data were analyzed using a deductive content analysis approach, with MAXQDA software employed for theme coding. The findings revealed notable differences in teacher competencies from the principals' perspectives. Female and younger teachers exhibited more competencies compared to their male and senior counterparts. These insights provide crucial information for planning and customizing Teacher Professional Development (TPD) programs, emphasizing an objective evaluation of teachers rather than self-assessment. Tailored PD programs based on these findings can more effectively enhance teachers' professional growth and competence.", Competing Interests: Declaration of Competing Interest No competing interest., (Copyright © 2024 Elsevier Ltd. All rights reserved.)

This study aims to provide a bibliometric overview of quality assurance (QA) research in higher education institutions (HEIs) from 1993 to 2022 and to identify significant trends. Scopus was utilised to retrieve data from 321 selected articles from 191 different sources. The methodology included science mapping with bibliometric indicators such as citations, co-citation analysis, and bibliometric coupling. Analysis of the data was done using VOSviewer and R-package using Biblioshiny. The findings indicate an increase in the number of articles and authors per paper that highlight QA key issues, the most promising QA practices, and the topics for future research. This study has significant importance to orient HEI's QA process towards the assessment of the university's societal impact., Competing Interests: Declaration of Competing Interest The authors declare that they have no conflict of interest., (Copyright © 2023 Elsevier Ltd. All rights reserved.)

Schools have closed worldwide as part of measures to prevent SARS-CoV-2 transmission but are beginning to reopen in some countries. Various measures are being pursued to minimise transmission but existing guidance has not developed a comprehensive framework or theory of change. We present a framework informed by the occupational health hierarchy of control and a theory of change informed by realist approaches. We present measures focused on elimination, substitution, engineering, administration, education and personal protective equipment. We theorise that such measures offer a means of disrupting SARS-CoV-2 transmission via routes involving fomites, faeco-oral routes, droplets and aerosols., (Copyright © 2020 Elsevier Ltd. All rights reserved.)

Introduction: Attending school and working are consistently associated with positive outcomes for juvenile offenders returning to the community., Methods: Using longitudinal data from the Pathways to Desistance Study, we used structural equation modeling to test whether better school experiences while incarcerated was positively connected to adjustment upon release among serious juvenile offenders (91% male) in the U.S. Adjustment was assessed as attending school for 310 legal minors (<18 years), and engaging in work for 259 emerging adults (≥18 years), as well as self-reported delinquency for all participants., Results: Accounting for incarceration and school history, results showed that facility school attachment, but not grades, was associated with decreased delinquency 12 months after release across sex in both age groups. Additionally, facility school attachment predicted engagement in school for returning minors. However, facility school experience was not related to engaging in work for returning emerging adults., Conclusions: Results indicate that facility school climate matters for all juvenile offenders returning to their communities and that correctional education done right presents an important opportunity to reconnect returning minors with school, an important normative context of development. Conversely, results suggest that returning offenders who have 'aged out' of high school are a separate vulnerable group who may need additional support for successful reentry., (Copyright © 2019 The Foundation for Professionals in Services for Adolescents. Published by Elsevier Ltd. All rights reserved.)

Introduction: The aim of the present study is to examine gender identity disparities in different kinds of weight-related health behaviors, including physical activity, participation in physical education at school, and healthy and unhealthy eating habits, and to investigate the relationship between school safety and such behaviors in a sample of transgender and non-transgender students., Method: We analyzed a statewide sample of 31,609 students (M age  = 14.04, SD = 1.70; 1.1% transgender). We used multilevel regression models to examine the interactive effects of gender identity and perceptions of school safety on the 4 different outcome variables (physical activity, physical education, healthy and unhealthy eating habits). All models included student- and school-level characteristics as controls., Results: Findings indicated that transgender students, when compared to non-transgender students, reported (a) feeling less safe at school; (b) more physical activity, but less participation in physical education at school; and (c) both more healthy as well as unhealthy eating behaviors. Adjusted regression models showed a significant interaction between gender identity and perceived school safety on healthy eating behaviors; simple slopes indicated that transgender students have healthier eating behaviors when the school context is perceived as safe compared to those who perceived the school as less safe., Conclusions: School interventions are needed to improve school safety for transgender youth and to reduce gender identity-related disparities in healthy eating and physical activity. Research implications and limitations are discussed., (Copyright © 2019 The Foundation for Professionals in Services for Adolescents. Published by Elsevier Ltd. All rights reserved.)

Background: In Fall 2012, updated US Department of Agriculture school meal standards went into effect and did not result in increased food waste overall. However, consumption of school foods, especially fruits and vegetables, remains low. Therefore, strategies to improve school meal consumption are necessary., Objective: This study evaluated the combined impact of the updated school meal standards and chef-enhanced, healthier meals, and the removal of flavored milk on students' school food selection and consumption compared with students in control schools., Design: The Project MEALS (Modifying Eating and Lifestyles at School) study was a cafeteria-based quasi-experimental intervention conducted during the 2012 to 2013 school year., Participants/setting: Participants were students (n=1,309) in grades 3 through 8 attending four intervention and four control schools in two low-income, urban school districts., Intervention: Chef-enhanced school meals and the removal of flavored milk combined with the updated US Department of Agriculture school meal standards., Main Outcome Measures: Changes in school meal selection and consumption were examined using plate waste methodology., Statistical Analyses Performed: Logistic regression and mixed-model analysis of variance adjusting for student demographics and schools/students as a random effect (students nested within schools) were used to examine differences in selection and consumption before (Fall 2012) and after (Spring 2013) a chef-based intervention with the updated school meal standards., Results: After the chef-based intervention was implemented, there were no significant differences in entrée, vegetable, or fruit selection. Significantly fewer students selected milk compared with students in control schools (56.8% vs 94.0%; P<0.0001) and milk consumption was significantly lower (54.8% vs 63.7%; P=0.004). However, consumption was significantly greater for vegetables (62.2% vs 38.2%; P=0.005) and fruits (75.2 vs 59.2%; P=0.04) in the intervention schools compared with control schools. There were no significant differences in entrée consumption., Conclusions: Schools collaborating with chefs can be an effective method to improve the consumption of fruits and vegetables with the updated US Department of Agriculture school meal standards. Further research should examine the longer-term impact of the removal of flavored milk from schools to determine whether the lower selection and consumption rates persist., (Copyright © 2019 Academy of Nutrition and Dietetics. Published by Elsevier Inc. All rights reserved.)

Background: In the United States, the National School Lunch Program (NSLP) is the healthiest lunch option for students, yet participation is suboptimal and fruit and vegetable waste remains high. Improving school meal convenience, engaging teachers in the school-lunch program, and enhancing the cafeteria environment are promising strategies to improve participation and dietary intake, yet little evidence is available on their impact., Methods/design: The Multi-Pronged Intervention to Increase Secondary Student Participation in School Lunch (MPI) is a 3-year quasi-experimental study in a large urban school district in California. A total of 24 middle and high schools participated in the study: half received the intervention and half served as controls. The intervention consisted of additional school lunch points of sale (vending machines and mobile carts), a school meal outreach program for teachers, and cafeteria redesigns. School meal participation, student-reported fruit and vegetable consumption, and school lunch plate waste were assessed at baseline and in years 1 and 2 of the intervention. Change in meal participation and fruit and vegetable consumption were compared between intervention and control arms to determine the impact of the intervention on school meal participation and dietary intake., Discussion: This study is positioned to provide evidence on the feasibility and efficacy of a multi-level intervention to increase school meal participation and consumption of fruits and vegetables., (Copyright © 2019 Elsevier Inc. All rights reserved.)

Introduction: Future orientation (FO) refers to individuals' beliefs and feelings about their future. Earlier research has primarily investigated correlates of FO at the individual and family level, but it seems likely that FO is also shaped by other central agents or institutions, such as the school. Earlier studies have found positive associations between "school effectiveness" and student performance, and negative associations in relation to e.g., bullying, delinquency, and health risk behaviors. The current study investigated three teacher-reported features of school effectiveness - school leadership, teacher cooperation and consensus, and school ethos - and their links with student-reported FO., Methods: Survey data were collected in 2016 among 5131 students (aged 17-18 years) and 1061 teachers in 46 upper secondary schools in Stockholm, Sweden, and merged with school-level register data. Two-level binary logistic regression analyses were performed., Results: The analyses showed that higher teacher ratings of school leadership and school ethos were associated with a greater likelihood of reporting an optimistic FO among students. Teacher cooperation and consensus was however not associated with students' FO., Conclusion: The findings indicate that the school environment contributes to shaping students' beliefs about their future. Thus, enhancing features of school effectiveness may be a way of promoting a positive development and brighter objective future prospects for the young, via pathways such as good student-teacher relations and academic motivation and achievement., (Copyright © 2018 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Purpose: The purpose of the study was to examine the consistency and variation in content of high school written traumatic brain injury (TBI) policies in relation to the three key tenets of youth sports TBI laws., Methods: A content analysis was conducted on written TBI policies retrieved from 71 high schools currently participating in High School Reporting Information Online. Each policy was independently analyzed by two trained coders. The number and percent of the policies reflecting the three key tenets of state youth sports TBI laws were described and compared on policy enforcement (i.e., strictness of language), policy description (i.e., details and definitions of the requirements), and policy implementation steps (i.e., specific steps for implementing the requirements). Direct quotes were identified to support quantitative findings., Results: All 71 high school TBI policies contained at least two of the three main TBI law tenets, where 98.6% (n = 70) included the return to play tenet, 83.1% (n = 59) included the removal from play tenet, and 59.2% (n = 42) specified the distribution of TBI information sheets to student-athletes and their parents. Nearly half of the policies (49.3%, n = 35) required parents' signature while only 39.4% (n = 28) required students' signature on the TBI information sheet. The language exhibited wide variance across the 71 TBI policies regarding policy enforcement, policy description, and policy implementation specifications., Conclusions: All 71 TBI policies covered at least two of the three youth sports TBI law tenets, but with considerable variation. Future research should assess variations by schools within the same state and their impact on TBI rates in school athletics., (Copyright © 2017 Society for Adolescent Health and Medicine. Published by Elsevier Inc. All rights reserved.)

This paper analyses the importance of evaluating the various components of the programmes or actions carried out by education organisations. It highlights the need to assess the impact of the intervention on the organisation and consider how changes are consolidated over time in interaction with the context. We propose an impact evaluation model and as an example have chosen the implementation of Quality Management Systems in schools. The paper analyses the results obtained in 40 schools in three regions (Spanish Autonomous Communities) with varying levels of implementation. The results show overall impact on these education centres as the teachers and management teams of the centres perceive it. This impact is more evident in some of the dimensions considered in the study than in others. The results also confirm the differences between regional contexts., (Copyright © 2017 Elsevier Ltd. All rights reserved.)

Purpose: Despite numerous calls to improve training in adolescent health, there is little known about the prevalence or effectiveness of specialized training in adolescent health., Methods: A two-stage random sampling cluster design was used to collect nationally representative data from 8,500 students from 91 high schools. Student data were linked to data from a survey of school health clinicians from participating schools on their level of training in youth health. Multilevel models accounting for demographic characteristics of students were used to estimate the association between nurses and physicians training in youth health and health outcomes among students., Results: Almost all nurses and physicians reported some training in youth health, either having attended lectures or study days in youth health (n = 60, 80%) or completed postgraduate papers in youth health (n = 13, 17.3%). Students in schools where the nurses and physicians had received postgraduate training in youth health were less likely than students from schools with clinicians having attended lectures or study days in youth health to report emotional and behavior difficulties (11.8 vs. 12.7, p = .002) and binge drinking (19.6% vs. 24.9%, p = .03). There were no significant associations between depressive symptoms, suicide risk, cigarette, marijuana, contraception use, or motor vehicle risk behaviors among students and level of training among clinicians in their schools' health service., Conclusions: Postgraduate training in youth health among nurses and physicians in school health services is associated with fewer students reporting mental health difficulties and binge alcohol use. These findings support specialized training in youth health for clinicians working predominantly with young people., (Copyright © 2016 Society for Adolescent Health and Medicine. Published by Elsevier Inc. All rights reserved.)

Purpose: Providing children and youth with safe, adequate drinking water access during school is essential for health. This study used objectively measured data to investigate the extent to which schools provide drinking water access that meets state and federal policies., Methods: We visited 59 middle and high schools in Massachusetts during spring 2012. Trained research assistants documented the type, location, and working condition of all water access points throughout each school building using a standard protocol. School food service directors (FSDs) completed surveys reporting water access in cafeterias. We evaluated school compliance with state plumbing codes and federal regulations and compared FSD self-reports of water access with direct observation; data were analyzed in 2014., Results: On average, each school had 1.5 (standard deviation: .6) water sources per 75 students; 82% (standard deviation: 20) were functioning and fewer (70%) were both clean and functioning. Less than half of the schools met the federal Healthy Hunger-Free Kids Act requirement for free water access during lunch; 18 schools (31%) provided bottled water for purchase but no free water. Slightly over half (59%) met the Massachusetts state plumbing code. FSDs overestimated free drinking water access compared to direct observation (96% FSD reported vs. 48% observed, kappa = .07, p = .17)., Conclusions: School drinking water access may be limited. In this study, many schools did not meet state or federal policies for minimum student drinking water access. School administrative staff may not accurately report water access. Public health action is needed to increase school drinking water access., (Copyright © 2016 Society for Adolescent Health and Medicine. Published by Elsevier Inc. All rights reserved.)

Many education systems are developing towards more lateral structures where schools collaborate in networks to improve and provide (inclusive) education. These structures call for bottom-up models of network evaluation and accountability instead of the current hierarchical arrangements where single schools are evaluated by a central agency. This paper builds on available research about network effectiveness to present evolving models of network evaluation. Network effectiveness can be defined as the achievement of positive network level outcomes that cannot be attained by individual organizational participants acting alone. Models of network evaluation need to take into account the relations between network members, the structure of the network, its processes and its internal mechanism to enforce norms in order to understand the achievement and outcomes of the network and how these may evolve over time. A range of suitable evaluation models are presented in this paper, as well as a tentative school inspection framework which is inspired by these models. The final section will present examples from Inspectorates of Education in Northern Ireland and Scotland who have developed newer inspection models to evaluate the effectiveness of a range of different networks., (Copyright © 2016 Elsevier Ltd. All rights reserved.)

The problem of environmental health hazards around schools is serious but it has been neglected by researchers and analysts. This is concerning because children are highly susceptible to the effects of chemical hazards. Some ecological studies have demonstrated that higher school-level pollution is associated with lower aggregate school-level standardized test scores likely, related to increased respiratory illnesses and/or impaired cognitive development. However, an important question remains unexamined: How do school-level exposures impact individual children's academic performance? To address this, we obtained socio-demographic and grades data from the parents of 1888 fourth and fifth grade children in the El Paso (Texas, USA) Independent School District in 2012. El Paso is located on the US-side of the Mexican border and has a majority Mexican-origin population. School-based hazardous air pollution (HAP) exposure was calculated using census block-level US Environmental Protection Agency National Air Toxics Assessment risk estimates for respiratory and diesel particulate matter (PM). School-level demographics were obtained from the school district. Multi-level models adjusting for individual-level covariates (e.g., age, sex, race/ethnicity, English proficiency, and economic deprivation) and school-level covariates (e.g., percent of students economically disadvantaged and student-teacher ratio) showed that higher school-level HAPs were associated with lower individual-level grade point averages. An interquartile range increase in school-level HAP exposure was associated with an adjusted 0.11-0.40 point decrease in individual students' grade point averages (GPAs), depending on HAP type and emission source. Respiratory risk from HAPs had a larger effect on GPA than did diesel PM risk. Non-road mobile and total respiratory risk had the largest effects on children's GPA of all HAP variables studied and only mother's level of education had a larger effect than those two variables on children's GPA. The five school-level demographic indicators were only weakly associated with GPA. The study findings indicate the need for regulations on school siting and adjacent land uses to protect children's environmental health., (Copyright © 2016 Elsevier Inc. All rights reserved.)

PBDE concentrations are higher in children compared to adults with exposure suggested to include dust ingestion. Besides the home environment, children spend a great deal of time in school classrooms which may be a source of exposure. As part of the "Ultrafine Particles from Traffic Emissions and Children's Health (UPTECH)" project, dust samples (n=28) were obtained in 2011/12 from 10 Brisbane, Australia metropolitan schools and analysed using GC and LC-MS for polybrominated diphenyl ethers (PBDEs) -17, -28, -47, -49, -66, -85, -99, -100, -154, -183, and -209. Σ11PBDEs ranged from 11-2163 ng/g dust; with a mean and median of 600 and 469 ng/g dust, respectively. BDE-209 (range n.d. -2034 ng/g dust; mean (median) 402 (217)ng/g dust) was the dominant congener in most classrooms. Frequencies of detection were 96%, 96%, 39% and 93% for BDE-47, -99, -100 and -209, respectively. No seasonal variations were apparent and from each of the two schools where XRF measurements were carried out, only two classroom items had detectable bromine. PBDE intake for 8-11 year olds can be estimated at 0.094 ng/day BDE-47; 0.187 ng/day BDE-99 and 0.522ng/day BDE-209 as a result of ingestion of classroom dust, based on mean PBDE concentrations. The 97.5% percentile intake is estimated to be 0.62, 1.03 and 2.14 ng/day for BDEs-47, -99 and -209, respectively. These PBDE concentrations in dust from classrooms, which are higher than in Australian homes, may explain some of the higher body burden of PBDEs in children compared to adults when taking into consideration age-dependant behaviours which increase dust ingestion., (Copyright © 2015 Elsevier Inc. All rights reserved.)

Background: During 2012, Massachusetts adopted comprehensive school competitive food and beverage standards that closely align with Institute of Medicine recommendations and Smart Snacks in School national standards., Objective: We examined the extent to which a sample of Massachusetts middle schools and high schools sold foods and beverages that were compliant with the state competitive food and beverage standards after the first year of implementation, and complied with four additional aspects of the regulations., Design: Observational cohort study with data collected before implementation (Spring 2012) and 1 year after implementation (Spring 2013)., Participants/setting: School districts (N=37) with at least one middle school and one high school participated., Main Outcome Measures: Percent of competitive foods and beverages that were compliant with Massachusetts standards and compliance with four additional aspects of the regulations. Data were collected via school site visits and a foodservice director questionnaire., Statistical Analyses Performed: Multilevel models were used to examine change in food and beverage compliance over time., Results: More products were available in high schools than middle schools at both time points. The number of competitive beverages and several categories of competitive food products sold in the sample of Massachusetts schools decreased following the implementation of the standards. Multilevel models demonstrated a 47-percentage-point increase in food and 46-percentage-point increase in beverage compliance in Massachusetts schools from 2012 to 2013. Overall, total compliance was higher for beverages than foods., Conclusions: This study of a group of Massachusetts schools demonstrated the feasibility of schools making substantial changes in response to requirements for healthier competitive foods, even in the first year of implementation., (Copyright © 2015 Academy of Nutrition and Dietetics. Published by Elsevier Inc. All rights reserved.)

Access to healthy foods among secondary school students is patterned by individual-level socioeconomic status, but few studies have examined how school nutrition policies and practices are patterned by school-level characteristics. The objective of our study was to examine school nutrition policies and practices by school characteristics (eg, location, racial/ethnic composition, and free/reduced priced lunch eligibility) in Minnesota secondary schools between 2008 and 2012. Data from the 2008 to 2012 Minnesota School Health Profiles survey were used to assess school nutrition policies and practices, and National Center for Educational Statistics data were used for school characteristics (n=505 secondary schools). Nutrition policies and practices included the availability of low-nutrient, energy dense (LNED) items, strategies to engage students in healthy eating, and restrictions on advertisements of LNED products in areas around the school. Among school-level characteristics, school location was most strongly related to school nutrition policies. Across all years, city schools were less likely than town/rural schools to have vending machines/school stores (prevalence difference [PD] -13.7, 95% CI -25.0 to -2.3), and less likely to sell sport drinks (PD -36.3, 95% CI -51.8 to -20.7). City schools were also more likely to prohibit advertisements for LNED products in school buildings (PD 17.7, 95% CI 5.5 to 29.9) and on school grounds (PD 15.6, 95% CI 1.7 to 29.5). Between 2008 and 2012, the prevalence of some healthy eating policies/practices (eg, limiting salty snacks, offering taste testing, and banning unhealthy food advertisements in school publications) declined in city schools only, where these policies/practices had previously been more common. Monitoring of these trends is needed to understand the influence of these policies on student outcomes across school settings., (Copyright © 2015 Academy of Nutrition and Dietetics. Published by Elsevier Inc. All rights reserved.)

Prior theoretical and empirical research suggests that multiple aspects of an organization's context are likely related to a number of factors, from their interest and ability to adopt new programming, to client outcomes. A limited amount of the prior research has taken a more community-wide perspective by examining factors that associate with community readiness for change, leaving how these findings generalize to community organizations that conduct prevention or positive youth development programs unknown. Thus for the current study, we examined how the organizational context of the Cooperative Extension System (CES) associates with current attitudes and practices regarding prevention and evidence-based programming. Attitudes and practices have been found in the empirical literature to be key indicators of an organization's readiness to adopt prevention and evidence-based programming. Based on multi-level mixed models, results indicate that organizational management practices distinct from program delivery may affect an organization's readiness to adopt and implement new prevention and evidence-based youth programs, thereby limiting the potential public health impact of evidence-based programs. Openness to change, openness of leadership, and communication were the strongest predictors identified within this study. An organization's morale was also found to be a strong predictor of an organization's readiness. The findings of the current study are discussed in terms of implications for prevention and intervention.

Purpose: Understanding how to mitigate the present black-white obesity disparity in the United States is a complex issue, stemming from a multitude of intertwined causes. An appropriate but underused approach to guiding policy approaches to this problem is to account for this complexity using simulation modeling., Methods: We explored the efficacy of a policy that improved the quality of neighborhood schools in reducing racial disparities in obesity-related behavior and the dependence of this effect on social network influence and norms. We used an empirically grounded agent-based model to generate simulation experiments. We used a 2 × 2 × 2 factorial design that represented the presence or absence of improved neighborhood school quality, the presence or absence of social influence, and the type of social norm (healthy or unhealthy). Analyses focused on time trends in sociodemographic variables and diet quality., Results: First, the quality of schools and social network influence had independent and interactive effects on diet behavior. Second, the black-white disparity in diet behavior was considerably reduced under some conditions, but never completely eliminated. Third, the degree to which the disparity in diet behavior was reduced was a function of the type of social norm that was in place; the reduction was the smallest when the type of social norm was healthy., Conclusions: Improving school quality can reduce, but not eliminate racial disparities in obesity-related behavior, and the degree to which this is true depends partly on social network effects., (Copyright © 2014 Elsevier Inc. All rights reserved.)

This study explored how psychosocial features of the schoolwork environment are associated with students' mental health. Data was drawn from 3699 ninth grade (15 year-old) Swedish students participating in the Health Behaviour in School-Aged Children survey. Using Structural Equation Modelling, perceived school demands, decision control and social support from teachers, classmates and parents were examined in relation to students' emotional and conduct problems. Higher demands were associated with greater emotional symptoms and conduct problems. Although weaker social support predicted emotional symptoms and conduct problems, the relative influence of teachers, classmates and parents differed. Teacher support was more closely associated with conduct problems, particularly for girls, while classmate support was more strongly related to emotional symptoms. The findings indicate that while excessive school pressure is associated with poorer mental health, social support can assist in optimising adolescents' emotional health and adaptive behaviour, as well as shaping perceptions of demands., (Copyright © 2014 The Foundation for Professionals in Services for Adolescents. Published by Elsevier Ltd. All rights reserved.)

Objective: To assess the impact on food-related cost of meals to fulfill the new compulsory dietary standards for primary schools in France., Design: A descriptive study assessed the relationship between the level of compliance with the standards of observed school meals and their food-related cost. An analytical study assessed the cost of series of meals published in professional journals, and complying or not with new dietary standards. The costs were based on prices actually paid for food used to prepare school meals., Main Outcome Measure: Food-related cost of meals., Analysis: Parametric and nonparametric tests from a total of 42 and 120 series of 20 meals in the analytical and descriptive studies, respectively., Results: The descriptive study indicated that meeting the standards was not related to cost. The analytical study showed that fulfilling the frequency guidelines increased the cost, whereas fulfilling the portion sizes criteria decreased it. Series of meals fully respecting the standards (ie, frequency and portion sizes) cost significantly less (-0.10 €/meal) than series not fulfilling them, because the standards recommend smaller portion sizes., Conclusions and Implications: Introducing portion sizes rules in dietary standards for school catering may help increase dietary quality without increasing the food cost of meals., (Copyright © 2013 Society for Nutrition Education and Behavior. Published by Elsevier Inc. All rights reserved.)

Health outcomes vary between schools and it is theorised that this may be partly attributable to variation in the school environment. Existing systematic reviews have not drawn authoritative conclusions because of methodological limitations in the review or studies available. We identified 42 multi-level studies, ten of which were judged of sufficient quality to narratively synthesize. There was consistent evidence that schools with higher attainment and attendance than would be expected from student intake had lower rates of substance use. Findings on the influence of smoking/alcohol policies were mixed. Three studies examined the health effects variously associated with school campus area and observability, year structure, school size and pupil-to-teacher ratio with mixed findings. The studies reviewed support the potential influence of the school environment on student health., (Copyright © 2012 Elsevier Ltd. All rights reserved.)

Teacher education programs in the United States face increasing pressure to demonstrate their effectiveness through pupils' learning gains in classrooms where program graduates teach. The link between teacher candidates' learning in teacher education programs and pupils' learning in K-12 classrooms implicit in the policy discourse suggests a one-to-one correspondence. However, the logical steps leading from what teacher candidates have learned in their programs to what they are doing in classrooms that may contribute to their pupils' learning are anything but straightforward. In this paper, we argue that the logic model approach from scholarship on evaluation can enhance research on teacher education by making explicit the logical links between program processes and intended outcomes. We demonstrate the usefulness of the logic model approach through our own work on designing a longitudinal study that focuses on examining the process and impact of an undergraduate mathematics and science teacher education program., (Copyright © 2012 Elsevier Ltd. All rights reserved.)

This paper presents a mixed-method approach to measuring the functioning of Safe Schools/Healthy Students (SS/HS) Initiative partnerships. The SS/HS national evaluation team developed a survey to collect partners' perceptions of functioning within SS/HS partnerships. Average partnership functioning scores were used to rank each site from lowest to highest. Sites with the most favorable perceptions of partnership functioning were defined as having average scores in the top 10% (n=10) and sites with the least favorable perceptions of partnership functioning were defined as having average scores in the bottom 10% (n=10). Qualitative data for these 20 sites were inductively open coded for emergent themes and analyzed for patterns using grounded theory approach. Six themes emerged that distinguished sites reporting the most favorable and least favorable perceptions of partnership functioning: partner engagement, facilitators, barriers, shared decision making, partnership structure, and sustainability. Sites reporting the most favorable perceptions of partnership functioning effectively utilized collaboration processes that facilitate coalition building, such as shared decision making, effective communication, and developing a clearly defined structure. Qualitative themes from this analysis provide evidence of validity for the partnership functioning scale used and illustrate distinguishing features between sites with the most favorable and least favorable perceptions of partnership functioning., (Copyright © 2011. Published by Elsevier Ltd.)

The Safe Schools/Healthy Students (SS/HS) national evaluation seeks to assess both the implementation process and the results of the SS/HS initiative, exploring factors that have contributed to or detracted from grantee success. Each site is required to forge partnerships with representatives from education, mental health, juvenile justice, and law enforcement, coordinating and integrating their efforts and working together to contribute to comparable outcomes (e.g., reduced violence and alcohol and drug use, improved mental health services). The evaluation uses multiple data collection techniques (archival data, surveys, site visits, interviews, and focus groups) from a variety of sources (project directors, community partners, schools, and students) over several years. Certain characteristics of the SS/HS initiative represent unique challenges for the evaluation, including the absence of common metrics for baseline, outcome data, and lack of comparison group. A unifying program theory was required to address these challenges and synthesize the large amounts of qualitative and quantitative information collected. This article stresses the role of program theory in guiding the evaluation., (Copyright © 2011 Elsevier Ltd. All rights reserved.)

The Safe Schools/Healthy Students (SS/HS) Initiative has awarded over $2 billion in grants to more than 350 school districts in partnership with local mental health, law enforcement, and juvenile justice agencies. To estimate the impact of grantee characteristics, grant operations, and near-term outcomes in reducing violence and substance use, promoting mental health, and enhancing school safety, logged odds ratios (LORs) were calculated contrasting Year 3 with Baseline performance from grantee-provided data on seven outcome measures. After comparing grantee performance across outcomes and outcomes across grantees, the LORs were entered as dependent variables in a series of meta-regressions in which grantee characteristics, grant operations, and near-term outcomes were tested after controlling for pre-grant characteristics. Findings indicate that the SS/HS Initiative significantly improved most outcomes, that within-grantee performance varied greatly by outcome, and that random-effects meta-regression appreciably decreased the variance available for modeling. The approach demonstrates that the SS/HS Initiative is effective and that locally collected performance data can be used to estimate grantee success in improving youth outcomes., (Copyright © 2011 Elsevier Ltd. All rights reserved.)

This article illustrates the application of the Impact Evaluation Process for the design of a performance measurement and evaluation framework for an urban high school. One of the key aims of this framework is to enhance decision-making by providing timely feedback about the effectiveness of various performance improvement interventions. The framework design process is guided by the Impact Evaluation Process, and included the participation of key stakeholders including administrative and teaching staff who all contributed to the performance measurement and evaluation framework design process. Key performance indicators at the strategic, tactical, and operational levels were derived from the school vision, and linked to specific interventions to facilitate the continuous evaluation and improvement process., (Copyright © 2011 Elsevier Ltd. All rights reserved.)

A three-level growth-curve model was applied to estimate perceived impact growth trajectories, using multi-year data from project and school surveys on outcome and program implementation collected from 59 sites and approximately 1165 participating schools in the Safe Schools and Healthy Students Initiative. Primary interest is to determine whether and how project-level and school-level correlates affect schools' perceptions of the Initiative's effectiveness over time when the effects of the pre-grant environmental conditions, grant operations, and near-term outcomes are considered. Coordination and service integration, comprehensive programs and activities for early childhood development, and change in school involvement were found to be significant predictors of school-perceived overall impact when the effect of poverty was considered. Partnership functioning, perceived importance of school resources, and school involvement were found to be significant predictors of school-perceived impact on substance use prevention when the effect of poverty was considered., (Copyright © 2011 Elsevier Ltd. All rights reserved.)

The Safe Schools/Healthy Students (SS/HS) Initiative offers a unique opportunity to conduct large-scale, multisite, multilevel program evaluation in the context of a federal environment that places many requirements and constraints on how the grants are conducted and managed. Federal programs stress performance-based outcomes, valid and reliable data, addressing important problems, ensuring efficiency and fiscal responsibility, reducing burden on federal staff and grantees, and developing and disseminating useful solutions and recommendations. MANILA Consulting Group, Inc., (MANILA), in partnership with Battelle Centers for Public Health Research and Evaluation (Battelle) and RMC Research Corporation (RMC), has been conducting the SS/HS national cross-site evaluation, which involves the coordinated efforts of federal Project Officers, local education agencies, technical assistance providers, communication specialists, and national and local evaluators across a diverse set of socioeconomic and cultural contexts. To date, the national cross-site evaluation has provided data indicating that the SS/HS Initiative is, in fact, meeting these goals. Findings revealed that fewer students reported they had experienced violence and fewer students reported they had witnessed violence. Fully 96 percent of school staff said SS/HS had improved school safety. There was a 263 percent increase in the number of students who received school-based mental health services and a 519 percent increase in those receiving community-based mental health services. In addition, more than 80 percent of school staff reported that they saw reductions in alcohol and other drug use among their students. These encouraging results stress the need for ongoing coordination at all levels of the Initiative to continue to ensure safer schools and healthier students. This article provides an overview of the initiative and introduces four articles in this special issue., (Copyright © 2011. Published by Elsevier Ltd.)

Objective: We surveyed school nurses on toileting conditions in schools, their level of understanding related to normal toileting patterns in school-age children, and whether they are in need of additional resources to promote healthy toilet habits for their students., Materials and Methods: An Institutional Review Board approved web-based survey with 34 questions was employed; 562 nurses completed the survey and 97% were currently employed as school nurses. Participants were invited via email blasts through national school nursing associations and the Iowa Department of Education., Results: Only 48% and 33% of respondents suspected an underlying health problem in children with frequent urination and bladder or bowel accidents, respectively. Despite 61% reporting never receiving information about children's normal elimination patterns, 43% had been asked to provide such information to teachers. Only 42% felt they had adequate resources to respond to such requests. School nurses requested information about treatment of dysfunctional elimination (67%), health effects of childhood toileting habits (65%), fluid intake guidelines (44%) and improvement of bathroom facilities (39%); 70% were unaware of local providers specially trained to treat children with these problems., Conclusions: Our survey results suggest that school nurses need additional information and resources in order to promote healthy elimination patterns in school children., (Copyright © 2011 Journal of Pediatric Urology Company. Published by Elsevier Ltd. All rights reserved.)

This study examined the relationship between state laws requiring minimum bussing distances, hazardous route exemptions, sidewalks, crossing guards, speed zones, and traffic control measures around schools and active travel to school (ATS) policies/practices in nationally representative samples of U.S. public elementary schools between 2007-2009. The state laws and school data were compiled through primary legal research and annual mail-back surveys of principals, respectively. Multivariate logistic and zero-inflated poisson regression indicated that all state law categories (except for sidewalks) relate to ATS. These laws should be considered in addition to formal safe routes to school programs as possible influences on ATS., (Copyright © 2011 Elsevier Ltd. All rights reserved.)

Walking school buses (WSB) increased children's physical activity, but impact on pedestrian safety behaviors (PSB) is unknown. We tested the feasibility of a protocol evaluating changes to PSB during a WSB program. Outcomes were school-level street crossing PSB prior to (Time 1) and during weeks 4-5 (Time 2) of the WSB. The protocol collected 1252 observations at Time 1 and 2548 at Time 2. Mixed model analyses yielded: intervention schoolchildren had 5-fold higher odds (p<0.01) of crossing at the corner/crosswalk but 5-fold lower odds (p<0.01) of stopping at the curb. The protocol appears feasible for documenting changes to school-level PSB., (Copyright © 2011 Elsevier Ltd. All rights reserved.)

The Child Nutrition and WIC Reauthorization Act of 2004 required school districts to establish a local school wellness policy by the first day of the 2006-2007 school year. To provide a baseline measure of the extent to which wellness-related policies were implemented in school districts nationwide in 2006, this study analyzed data from the 2006 School Health Policies and Programs Study (SHPPS). SHPPS used a cross-sectional design to measure policies and practices among a nationally representative sample of 538 public school districts. The authors applied a standardized wellness policy coding system to the data by matching each element to relevant questions from SHPPS and calculated the percentage of school districts meeting each element in the coding system. Statistical analyses included calculation of 95% confidence intervals for percentages and mean number of elements met in each area. In 2006, none of the districts met all elements included in the coding system for local wellness policies. In addition, the percentage of districts meeting each element varied widely. On average, districts met the greatest number of elements in the area of nutrition education and the least number of elements in the area of physical activity. By applying a coding system for district policies to an existing dataset, this study used a novel approach to determine areas of strength and weakness in the implementation of local school wellness-related policies in 2006., (Copyright © 2011 American Dietetic Association. Published by Elsevier Inc. All rights reserved.)

It is the position of the American Dietetic Association (ADA), School Nutrition Association (SNA), and Society for Nutrition Education (SNE) that comprehensive, integrated nutrition services in schools, kindergarten through grade 12, are an essential component of coordinated school health programs and will improve the nutritional status, health, and academic performance of our nation's children. Local school wellness policies may strengthen comprehensive nutrition services by encouraging multidisciplinary wellness teams, composed of school and community members, to work together in identifying local school needs, developing feasible strategies to address priority areas, and integrating comprehensive nutrition services with a coordinated school health program. This joint position paper affirms schools as an important partner in health promotion. To maximize the impact of school wellness policies on strengthening comprehensive, integrated nutrition services in schools nationwide, ADA, SNA, and SNE recommend specific strategies in the following key areas: nutrition education and promotion, food and nutrition programs available on the school campus, school-home-community partnerships, and nutrition-related health services.

To increase opportunities for healthy eating and physical activity, US school districts participating in the National School Lunch Program were required to create a Local Wellness Policy (LWP) by June 2006. The What's Working project described the initial influence of this mandate on nutrition environments and policies. In 2005 and 2007 (before and after the mandate went into effect), a survey about school features related to nutrition and physical activity was sent to a random sample of 45 low-income, rural elementary foodservice managers and principals. Schools averaged 204 students, 27% Hispanic. Districts' LWPs were coded for strength and comprehensiveness. In addition, key informant interviews were conducted with foodservice managers almost 2 years after the LWP went into effect. Three improvements were observed: increases in the percent of schools with policies stipulating predominantly healthy items be offered in classroom parties (21.4% in 2005 vs 48.7% in 2007), daily fresh fruit offerings in the lunchroom (0.80 choices in 2005 vs 1.15 choices in 2007), and the percent of schools using skinless poultry (27% in 2005 vs 59% in 2007). LWPs were weakly worded and rarely addressed energy content. Nutrition guideline elements most commonly addressed included vending machines, school stores, and à la carte food offerings. Seveny-three percent of foodservice managers were familiar with their district's LWP but did not perceive it changed lunchroom practices. Although LWPs offer a framework to support opportunities for healthy eating, few evidence-based practices were implemented as a direct result of the mandate. Schools need more information about evidence-based practices, as well as technical and financial assistance for implementation., (Copyright © 2010 American Dietetic Association. Published by Elsevier Inc. All rights reserved.)

It is the position of the American Dietetic Association (ADA), School Nutrition Association (SNA), and Society for Nutrition Education (SNE) that comprehensive, integrated nutrition services in schools, kindergarten through grade 12, are an essential component of coordinated school health programs and will improve the nutritional status, health, and academic performance of our nation's children. Local school wellness policies may strengthen comprehensive nutrition services by encouraging multidisciplinary wellness teams, composed of school and community members, to work together in identifying local school needs, developing feasible strategies to address priority areas, and integrating comprehensive nutrition services with a coordinated school health program. This joint position paper affirms schools as an important partner in health promotion. To maximize the impact of school wellness policies on strengthening comprehensive, integrated nutrition services in schools nationwide, ADA, SNA, and SNE recommend specific strategies in the following key areas: nutrition education and promotion, food and nutrition programs available on the school campus, school-home-community partnerships, and nutrition-related health services., (Copyright © 2010 Society for Nutrition Education. Published by Elsevier Inc. All rights reserved.)

The aim of this study was to develop, test, and employ an audit tool to objectively assess the opportunities for physical activity within school environments. A 44 item tool was developed and tested at 92 primary schools in the county of Norfolk, England, during summer term of 2007. Scores from the tool covering 6 domains of facility provision were examined against objectively measured hourly moderate to vigorous physical activity levels in 1868 9-10 year old pupils attending the schools. The tool was found to have acceptable reliability and good construct validity, differentiating the physical activity levels of children attending the highest and lowest scoring schools. The characteristics of school grounds may influence pupil's physical activity levels., (Copyright 2010 Elsevier Ltd. All rights reserved.)

States and school districts around the country are developing policies that set nutrition standards for competitive foods and beverages sold outside of the US Department of Agriculture's reimbursable school lunch program. However, few tools exist for monitoring the implementation of these new policies. The objective of this research was to develop a computerized assessment tool, the Food and Beverage Environment Analysis and Monitoring System (FoodBEAMS), to collect data on the competitive school food environment and to test the inter-rater reliability of the tool among research and nonresearch professionals. FoodBEAMS was used to collect data in spring 2007 on the competitive foods and beverages sold in 21 California high schools. Adherence of the foods and beverages to California's competitive food and beverage nutrition policies for schools (Senate Bills 12 and 965) was determined using the data collected by both research and nonresearch professionals. The inter-rater reliability between the data collectors was assessed using the intraclass correlation coefficient. Researcher vs researcher and researcher vs nonresearcher inter-rater reliability was high for both foods and beverages, with intraclass correlation coefficients ranging from .972 to .987. Results of this study provide evidence that FoodBEAMS is a promising tool for assessing and monitoring adherence to nutrition standards for competitive foods sold on school campuses and can be used reliably by both research and nonresearch professionals., (Copyright 2010 American Dietetic Association. Published by Elsevier Inc. All rights reserved.)

Purpose: This study identifies trends in the availability of various food choices in United States' middle and high schools from 2004 to 2007, and examines the potential associations between such food availability and students' self-reported eating habits and body mass index (BMI)-related outcomes., Methods: Data are based on nationally representative samples of 78,442 students in 684 secondary schools surveyed from 2004 to 2007 as part of the Youth, Education, and Society (YES) study and the Monitoring the Future (MTF) study. In the YES study, school administrators and food service managers completed self-administered questionnaires on their school's food environment. In the MTF study, students in the same schools completed self-administered questionnaires, providing data used to construct BMI and food consumption measures., Results: Overall, there was a decrease in the availability of regular-sugar/fat food items in both middle and high schools, and some indication of an increase in high school availability of reduced-fat food items through school lunch or a la carte. Some minimal evidence was found for relationships between the school food environment and student BMI-related outcomes and food consumption measures., Conclusions: United States secondary schools are making progress in the types of foods offered to students, with food items of lower nutritional value becoming less prevalent in recent years. Continued monitoring of food environment trends may help clarify whether and how such factors relate to youth health outcomes.

Purpose: To explore whether characteristics of the U.S. secondary school physical activity environment are associated with student body mass index (BMI) and physical activity., Methods: This report uses data from two studies: Monitoring the Future (MTF; an annual nationally representative survey of 8th-, 10th-, and 12th-grade public and private school students) and Youth, Education, and Society (a survey of administrators in schools that have completed their 2-year participation in the MTF study). School policies and programs related to various health issues, including physical education (PE) and sports activity, were examined for relationships with student self-reported height, weight, being active in sports, exercising vigorously, and participating in school athletics., Results: The results show that in 2004-2007, the percentage of students who attended schools that required PE in their grade differed sharply by grade level: 88% of 8th graders, 48% of 10th graders, and 20% of 12th graders. There were few statistically significant associations between school PE requirements and student BMI. The average percentage of students who participated in interscholastic or varsity sports was associated at the bivariate level with a lower percentage of students being overweight in all three grades. Other measures of PE and sports activity showed varying associations with BMI and physical activity measures., Conclusions: Relationships between the school physical activity environment and student BMI and physical activity were not uniformly strong. We conclude that, as currently practiced in schools, existing variations in physical activity policies may not be sufficient to produce discernible school-wide differences; thus, there is a need for more vigorous PE programming than is typically provided.

Purpose: To determine extent and factors associated with implementation of California's school nutrition standards 1 year after standards became active., Methods: Information on competitive foods and beverages available in schools was collected from a representative sample of 56 public high schools in California. Adherence to nutrition standards was calculated for each item and summarized for each school by venue. The association between schools' sociodemographic characteristics and adherence to standards was determined by multivariate analysis., Results: The majority of schools were adhering to the required beverage standards. None of the schools selling competitive foods were 100% adherent to the food standards. Adherence to both standards tended to be highest in food service venues. In univariate analyses, percent nonwhite enrollment, population density, percent free/reduced-price (FRP) meal eligibility, and school size were significantly correlated with the beverage adherence rate. Percent nonwhite enrollment and population density remained significant in the multivariate regression model. Percent nonwhite enrollment and percent FRP meal eligibility were significantly correlated with the food adherence rate in univariate analysis, but neither remained significant in the multiple regression model., Conclusions: California high schools are making progress toward implementation of the state nutrition standards. Beverage standards appear easier to achieve than nutrient-based food standards. Additional support is needed to provide schools with resources to implement and monitor these policies. Simpler standards and/or a reduction in the foods and beverages sold could better enable schools to achieve and monitor adherence.

Introduction: Fine particles (PM(2.5)) are an important component of air pollution. Epidemiological studies have shown health effects due to ambient air particles, particularly allergies in children. Since the main difficulty is to determine exposure to such pollution, traffic air pollutant (TAP) dispersions models have been developed to improve the estimation of individual exposure levels. One such model, the ExTra index, has been validated for nitrogen oxide concentrations but not for other pollutants. The purpose of this study was to assess the validity of the ExTra index to assess PM(2.5) exposure., Methods: We compared PM(2.5) concentrations calculated by the ExTra index to reference measures (passive samplers situated under the covered part of the playground), in 15 schools in Bordeaux, in 2000. First, we collected the input data required by the ExTra index: background and local pollution depending on traffic, meteorology and topography. Second, the ExTra index was calculated for each school. Statistical analysis consisted of a graphic description; then, we calculated an intraclass correlation coefficient., Results: Concentrations calculated with the ExTra index and the reference method were similar. The ExTra index underestimated exposure by 2.2 microg m(-3) on average compared to the reference method. The intraclass correlation coefficient was 0.85 and its 95% confidence interval was [0.62; 0.95]., Conclusions: The results suggest that the ExTra index provides an assessment of PM(2.5) exposure similar to that of the reference method. Although caution is required in interpreting these results owing to the small number of sites, the ExTra index could be a useful epidemiological tool for reconstructing individual exposure, an important challenge in epidemiology.

Passive ambient air sampling for nitrogen dioxide (NO(2)) and volatile organic compounds (VOCs) was conducted at 25 school and two compliance sites in Detroit and Dearborn, Michigan, USA during the summer of 2005. Geographic Information System (GIS) data were calculated at each of 116 schools. The 25 selected schools were monitored to assess and model intra-urban gradients of air pollutants to evaluate impact of traffic and urban emissions on pollutant levels. Schools were chosen to be statistically representative of urban land use variables such as distance to major roadways, traffic intensity around the schools, distance to nearest point sources, population density, and distance to nearest border crossing. Two approaches were used to investigate spatial variability. First, Kruskal-Wallis analyses and pairwise comparisons on data from the schools examined coarse spatial differences based on city section and distance from heavily trafficked roads. Secondly, spatial variation on a finer scale and as a response to multiple factors was evaluated through land use regression (LUR) models via multiple linear regression. For weeklong exposures, VOCs did not exhibit spatial variability by city section or distance from major roads; NO(2) was significantly elevated in a section dominated by traffic and industrial influence versus a residential section. Somewhat in contrast to coarse spatial analyses, LUR results revealed spatial gradients in NO(2) and selected VOCs across the area. The process used to select spatially representative sites for air sampling and the results of coarse and fine spatial variability of air pollutants provide insights that may guide future air quality studies in assessing intra-urban gradients.

Ambient, indoor, and personal PM2.5 concentrations were assessed based on an exhaustive study of PM2.5 performed in Ohio from 1999 to 2000. Locations in Columbus, one in an urban corridor and the other in a suburban area were involved. A third rural location in Athens, Ohio, was also established. At all three locations, elementary schools were utilized to determine outdoor, indoor, and personal PM2.5 concentrations for fourth and fifth grade students using filter-based measurements. Three groups of 30 students each were used for personal sampling at each school. Continuous ambient PM2.5 mass concentrations were also measured with tapered element oscillating microbalances (TEOMs). At all three sites, personal and indoor PM2.5 concentrations exceeded outdoor levels. This trend is consistent on all week days and most evident in the spring as compared to fall and winter. The ambient PM2.5 concentrations were similar among the three sites, suggesting the existence of a common regional source influence. At all the three sites, larger variations were found in personal and indoor PM2.5 than ambient levels. The strongest correlations were found between indoor and personal concentrations, indicating that personal PM2.5 exposures were significantly affected by indoor PM2.5 than by ambient PM2.5. This was further confirmed by the indoor to outdoor (I/O) ratios of PM2.5 concentrations, which were greater when school was in session than non-school days when the students were absent.

Objective: To assist high school and college athletic programs prepare for and respond to a sudden cardiac arrest (SCA). This consensus statement summarizes our current understanding of SCA in young athletes, defines the necessary elements for emergency preparedness, and establishes uniform treatment protocols for the management of SCA., Background: Sudden cardiac arrest is the leading cause of death in young athletes. The increasing presence of and timely access to automated external defibrillators (AEDs) at sporting events provides a means of early defibrillation and the potential for effective secondary prevention of sudden cardiac death. An Inter-Association Task Force was sponsored by the National Athletic Trainers' Association to develop consensus recommendations on emergency preparedness and management of SCA in athletes., Recommendations: Comprehensive emergency planning is needed for high school and college athletic programs to ensure an efficient and structured response to SCA. Essential elements of an emergency action plan include establishing an effective communication system, training of anticipated responders in cardiopulmonary resuscitation and AED use, access to an AED for early defibrillation, acquisition of necessary emergency equipment, coordination and integration of onsite responder and AED programs with the local emergency medical services system, and practice and review of the response plan. Prompt recognition of SCA, early activation of the emergency medical services system, the presence of a trained rescuer to initiate cardiopulmonary resuscitation, and access to early defibrillation are critical in the management of SCA. In any collapsed and unresponsive athlete, SCA should be suspected and an AED applied as soon as possible for rhythm analysis and defibrillation if indicated.

Objective: To assess the opinions and beliefs of parents and teachers of middle school students regarding the school food environment., Design: Surveys mailed to parents and placed in teachers' school mailboxes included questions about adolescents' eating practices, food choice at school, and school-related food policies and practices., Subjects/settings: A convenience sample of parents (n=350; response rate: 350/526=66%) and teachers (n=490; response rate: 490/701=70%) of middle school students from 16 schools in the St Paul-Minneapolis metropolitan area who participated in the Teens Eating for Energy and Nutrition at School study., Statistical Analysis: Descriptive statistics examined the prevalence of parents' and teachers' opinions and beliefs about adolescents' eating practices, food choice at school, and school-related food policies and practices., Results: Most parents and teachers agreed that the nutritional health of students should be a school priority. However, only 18% of parents and 31% of teachers believed schools give adequate attention to student nutrition. Among both parents and teachers, 90% agreed that more healthy snacks and beverages should be available in school vending machines and on school a la carte lines., Conclusions: Findings suggest that parents and teachers are concerned about the nutritional health of students and the "state of health" of the school food environment. Dietetic and other health professionals who work in school settings should actively engage parents and teachers in the process of affecting and monitoring policies and practices that foster a healthy school food environment.

Objective: To evaluate current food-handling practices, food safety prerequisite programs, and employee knowledge and food safety attitudes and provide baseline data for implementing Hazard Analysis and Critical Control Point (HACCP) systems in school foodservice., Design: One member of the research team visited each school to observe food-handling practices and assess prerequisite programs using a structured observation form. A questionnaire was used to determine employees' attitudes, knowledge, and demographic information., Subjects/setting: A convenience sample of 40 Iowa schools was recruited with input from the Iowa Department of Education., Statistical Analyses: Descriptive statistics were used to summarize data. One-way analysis of variance was used to assess differences in attitudes and food safety knowledge among managers, cooks, and other foodservice employees. Multiple linear regression assessed the relationship between manager and school district demographics and the food safety practice score., Results: Proper food-handling practices were not being followed in many schools and prerequisite food safety programs for HACCP were found to be inadequate for many school foodservice operations. School foodservice employees were found to have a significant amount of food safety knowledge (15.9+/-2.4 out of 20 possible points). School districts with managers (P=.019) and employees (P=.030) who had a food handler certificate were found to have higher food safety practice scores., Applications/conclusions: Emphasis on implementing prerequisite programs in preparation for HACCP is needed in school foodservice. Training programs, both basic food safety such as ServSafe and HACCP, will support improvement of food-handling practices and implementation of prerequisite programs and HACCP.