Search

ABSTRACT BACKGROUND METHODS RESULTS CONCLUSIONS We aimed to better understand the impact of statewide legislation removing personal belief exemptions (PBEs) for the measles, mumps, and rubella (MMR) school immunization requirement and factors associated with resulting health‐seeking behaviors.We used chi‐squared tests and logistic regression models to determine individual‐ and school‐level characteristics associated with holding a MMR PBE and with post‐law MMR immunization status among students linked to the Washington State Immunization Information System.Of students with a MMR PBE pre‐law change, 43.0% completed the MMR vaccine series and 40.4% sought another exemption type. Religious exemptions made up most new MMR exemptions signed (71.8%), followed by medical exemptions (18.5%), and religious membership exemptions (9.7%). Students were more likely to complete the vaccine series post‐law change if they attended a school with a low school‐level MMR exemption rate, a public school, or held a lower number of school‐required immunization exemptions.This study confirms previous concerns that parents might replace their PBE with another exemption type; however, nearly half the students in the cohort completed the MMR vaccine series. Our findings suggest that targeted immunization policies can increase MMR coverage 1‐year post‐law change but must account for a replacement effect when exemption categories are eliminated. [ABSTRACT FROM AUTHOR]

ABSTRACT Objective Methods Results Conclusion The objective of this study was to enhance the knowledge base of primary school children regarding earthquake preparedness through the implementation of an activity‐based earthquake awareness education program.The study was conducted as pre–posttest semi‐experimental design with one group of 333 children in a primary school between January and May 2024. A Descriptive Information Form and Earthquake Awareness Knowledge Level Form were the data collection tools. The children were provided with a 6‐week (modules) education program. Measurements were made before and after the education.The mean age of the children was 7.16 ± 0.73 years (6–9), 56.8% were girls, 43.2% were boys, and 25.8% were second‐grade children. Earthquake Awareness Knowledge Level Form total score was higher after the education (18.31 ± 1.52) than before (15.51 ± 3.73) (t = −16.144, p < 0.001). The study revealed an increase in children's knowledge regarding appropriate behaviors in the context of earthquakes, encompassing actions to be taken before, during, and after such events.Modular education and applied activities are effective in increasing children's knowledge levels in the context of teaching a concept such as earthquake preparedness, where the acquisition of life‐based skills is of paramount importance. [ABSTRACT FROM AUTHOR]

BACKGROUND: At the onset of the COVID‐19 pandemic, schools closed across the United States. Given the impact of virtual learning and lost access to school resources, schools eventually reopened with COVID‐19 mitigation protocols in place. This qualitative study sought to understand parental perceptions of school‐based COVID‐19 mitigation strategies. METHODS: Using a phenomenology approach, nine focus groups were completed with 40 parents of children in grades K‐8 representing eight Maryland counties. Based on acceptance of masking policies (as indicated on a survey), parents were sorted into 2 groups—lower and higher masking acceptance. A thematic analysis was conducted for each group and themes were compared between the 2 groups. RESULTS: The main themes were related to parents' general sentiments regarding COVID‐19, compliance, pandemic‐related changes over time, changes in personal opinions, and in‐person learning. Both groups described challenges related to inconsistent COVID‐19 mitigation policies and practices, the challenges of rapid and frequent changes in guidelines during the pandemic, and the benefits of in‐person learning. CONCLUSIONS: Parents of elementary and middle school children, regardless of general acceptance of masking policies, shared concerns about implementation and guidance regarding school‐based mitigation strategies. [ABSTRACT FROM AUTHOR]

ABSTRACT Background Methods Results Implications for School Health Policy, Practice, and Equity Asthma reliever medication access is critical, especially in schools. Policies that “stock” reliever inhalers in schools provide failsafe medication access. This research aims to understand barriers and facilitators to Illinois stock inhaler policy implementation.We conducted 18 semi‐structured interviews in 2021‐2022 with key school‐based and non‐school‐based partners (school administrators, nurses, governmental agencies, and advocacy leaders). Through Atlas.ti, code frequencies compared (Fisher's exact test), and a thematic analysis performed.Four themes emerged: facilitators, barriers, program rationale, and process considerations. The common facilitators were “Finding a provider,” having a “Champion,” and “Funding”. Barriers included “Not enough school nurses,” “Pharmacy refusal to fill prescriptions,” and “Feeling overwhelmed.” All were supportive of the rationale for stock inhalers. Non‐school‐based informants (p < .01) were more likely to mention medication donations, while school staff reported having enough nurses as a facilitator (p < .01). School staff reported concerns about children with asthma not having their medication significantly more than other partners (p = .02).Our analysis revealed that school partners recognize the value of stock inhalers. Barrier mitigation to support the funding, prescription access and processing, and training are essential to success of stock inhaler programming. Multilevel collaborative efforts through coalitions could be a potential solution. [ABSTRACT FROM AUTHOR]

BACKGROUND: Undergraduate majors in education, specifically in school health education (HE), have declined considerably in the United States. Reductions in state and federal funding for K‐12 public education and increased demands on educators to prioritize standardized academic outcomes versus focusing on the whole child encompass many factors leading to fewer qualified teachers and reduced quality of HE delivery within schools. METHODS: A content analysis of over 300 HE teacher preparation programs throughout the United States was conducted from 2019 to 2020 to assess available and required curriculum for pre‐service HE teachers. Seven curriculum areas were reviewed: nutrition, physical activity (PA) and physical education (PE), HE, chronic disease management (CDM), social emotional learning and mental health (SEL/MH), drug abuse and tobacco prevention (DA/TP), and a methods course in teaching HE. RESULTS: Findings indicated program type influenced course offerings, with stand‐alone HE and joint HE/PE programs providing the most comprehensive curriculum. Most programs required courses in general HE, PA and PE, and nutrition. Programs were deficient in offering courses in CDM, DA/TP, and SEL/MH. CONCLUSION: This article contains recommendations to improve the quality of HE delivery in public schools, for example by ensuring that school health educators are trained in providing skills‐based HE to youth, which can assist in addressing child and youth health outcomes (eg, CDM, mental health) for the nation. [ABSTRACT FROM AUTHOR]

Rural adolescents are at a greater risk for substance abuse and other mental health challenges. There is a need for enhanced evidence‐based prevention efforts. This case study evaluated both remote and in‐person instruction of Second Step®, a social‐emotional learning (SEL) curriculum aimed to improve school‐based prevention efforts. Second Step® was implemented in a rural Midwestern middle school from Fall 2020 to Spring 2022. Pre‐ and post‐surveys were given to 7th grade (n = 233) and 8th grade (n = 146) students. To evaluate program implementation, t‐tests were conducted. Post‐survey scores were compared to evaluate remote versus in‐person learning. Seventh grade students showed significant improvement of self‐efficacy in overcoming obstacles, and this was expanded via in‐person instruction. Eighth grade students increased knowledge of identifying and disrupting bullying, and the goal‐setting unit showed more success taught via remote instruction. Second Step® shows promise in increasing self‐efficacy and knowledge of SEL topics. Exploratory results suggest both in‐person and remote implementation should be considered. Practitioner Points: Social‐emotional learning (SEL) should be a component of middle school education as a measure for risky behavior prevention and mental health promotion.The Second Step® program may show promise in increasing confidence and knowledge in skills such as overcoming obstacles, goal setting, identity development, and bullying prevention.Both in‐person and remote implementation have potential for improving social‐emotional skills of middle school students. [ABSTRACT FROM AUTHOR]

ABSTRACT BACKGROUND CONTRIBUTIONS TO THEORY CONCLUSIONS AND IMPLICATIONS FOR SCHOOL HEALTH POLICY, PRACTICE, AND EQUITY The school climate concept has been promising, but has long‐standing critiques that have not been adequately addressed to date. The School as a Protective Factor approach represents one attempt to offer a new approach that builds on and extends beyond the concept of school climate while addressing previously identified limitations.The School as a Protective Factor approach offers a new framework for conceptualizing, measuring, and establishing protective school social and learning environments that co‐promote academic achievement and student health in schools, especially student mental health and substance use/abuse prevention. This new framework includes clear definitions, explicit goals, firmly established constructs, validated measures, and an intentionally parsimonious approach that prioritizes the implementation of well‐established, high‐impact constructs.The School as a Protective Factor approach presents a simple, easy‐to‐use means of ensuring a school social environment that meets the developmental, academic, and health needs of all children and adolescents while maximizing protection across a range of desired outcomes. Perhaps most importantly, it does so in a manner that is manageable and easily integrated into every aspect of schooling, resonates with the practical experience of school personnel, and includes brief, effective, and free measurement tools. [ABSTRACT FROM AUTHOR]

Aim: There is limited knowledge about the perceptions of HPV vaccination in middle‐school children. This qualitative study aimed to explore their views. Methods: We conducted focus group interviews with children, 10–11 years of age, who had been offered HPV vaccination through the school health services in mid‐north Sweden in spring of 2023. Data were analysed with qualitative content analysis. Results: This study included six focus group interviews with 49 children (boys n = 29; girls n = 20), mean of 11 years of age. Participating children expressed the need to feel safe to be of utmost importance and the means to do so was to be prepared and informed by someone the child trusted. The school nurse was perceived as the expert, best suited to provide factual information, support and motivation, both to children and their parents. Conclusion: We confirm that healthcare providers' recommendations are crucial for HPV vaccine acceptance also from the child's perspective. Improved information about HPV vaccination to children is necessary. Children's right to participate on their own terms is not fulfilled today. Vaccine promotion, both to children and parents, should be actively managed by the school nurse. [ABSTRACT FROM AUTHOR]

ABSTRACT BACKGROUND METHODS RESULTS CONCLUSIONS The conceptual framework for School as a Protective Factor approach was presented in a companion article in this issue of the journal. The current article describes the validation of the School as a Protective Factor‐Brief (SPF‐Brief), a 13‐item survey measuring the 3 core constructs and 13 defining characteristics of this framework.The SPF‐Brief was validated through 2 studies. The developmental study used a longitudinal design including 1349 participants who completed surveys over 5 semesters, while the validation study used a cross‐sectional design with 2775 participants. Both studies included middle and high school students. Factor analysis, growth model analysis, criterion‐related validation, and outcome analysis were employed.Analyses provided strong evidence supporting the reliability and validity of the instrument and conceptual framework. Higher SPF‐Brief scores were associated with higher math grades, English grades, and quality of life, as well as lower rates of anxiety, depression, conduct disorder, alcohol, e‐cigarette, tobacco, and cannabis use. Effect size estimates ranged from moderate to strong.These findings suggest the utility of the SPF‐Brief instrument and the School as a Protective Factor framework. Together, they may offer advantages to the traditional school climate approach. [ABSTRACT FROM AUTHOR]

ABSTRACT BACKGROUND METHODS RESULTS CONCLUSIONS The US government allocated over $2.5 billion in “Elementary and Secondary School Emergency Relief (ESSER)” funds to Washington State for COVID‐19 response and ventilation improvements. Despite available funding, gaps persist in supporting schools to successfully use portable air cleaners (PACs). We evaluated PAC needs within King County, Washington and characterized factors influencing schools' purchase and use of PACs.Public Health—Seattle & King County (PHSKC) assessed school's ventilation systems and IAQ improvements through a survey (N = 17). Separately, semi‐structured interviews (N = 13) based on the technology acceptance model (TAM) were conducted with school personnel. A thematic analysis using inductive and deductive coding was conducted and logistic regression models assessed the predictive capability of the TAM.The PHSKC survey findings informed our recommendations. Positive attitudes, knowledge, and beliefs in ease of use and effectiveness of PACs were facilitators to PAC use. While barriers included a lack of training, education, and concerns about PAC maintenance and sustainability. TAM constructs of perceived usefulness (PU) and perceived ease of use (PEU) were predictive of having the intention to use PACs in schools.There is a critical need for solutions to circumvent challenges to implementing PACs in schools. This characterization provides insight for promoting PAC use in IAQ‐impacted schools. [ABSTRACT FROM AUTHOR]

ABSTRACT BACKGROUND METHODS RESULTS CONCLUSIONS School‐based health centers (SBHCs) have been shown to offer substantial benefits to students but we know little about how the public thinks about them. We sought to assess US public attitudes about SBHCs and the provision of 7 health service lines—primary care, preventive care, vaccinations, preventive dental care, preventive vision care, mental health care, and nutrition counseling.We administered a national online survey (N = 4196) of US adults using Lucid, a large, internet‐based, opt‐in panel to assess public attitudes about SBHCs as well as 7 commonly offered health services in SBHCs. We then used t‐tests and weighted linear regression models to carry out our study objectives.Unadjusted analysis revealed that more than 2 in 3 respondents supported SBHCs in general as well as the provision of all health services in SBHCs. Regression analysis indicated that ideology, partisanship, and trust in public school principals served as consistent predictors of attitudes when controlling for demographic and health characteristics. The provision of vaccinations stood out as particularly controversial. Subanalysis of parents found even higher levels of support as well as a more subdued role of ideology and partisanship.The US public broadly supports the provision of health services in SBHCs. Our results should inform policymakers, advocates, and providers seeking to improve access to health care among school‐aged children, particularly for underserved populations. Increasing knowledge about SBHCs and providing stable funding should be a priority. In the immediate future, SBHCs may offer an important buffer against ongoing Medicaid disenrollments. [ABSTRACT FROM AUTHOR]

BACKGROUND: The COVID‐19 pandemic disrupted routine school operations, including school health programs. This study aims to describe the pandemic's impact on school health service delivery from the perspective of Maryland school health partners. METHODS: We conducted semi‐structured interviews with health service representatives from public schools (K‐12) between July and December 2021. Interviews were recorded, transcribed, and coded through an iterative process to develop analytic themes. RESULTS: Twenty school health partners from 15 Maryland school districts participated. Participants identified key impacts of COVID‐19 on school health: (1) COVID‐19 disrupted delivery of services such as dental, mental health, and preventative care, (2) COVID‐19 necessitated changes in service delivery platforms, (3) COVID‐19 affected school health staff through increased responsibilities and staffing shortages, and (4) COVID‐19 prompted schools to become hubs for community outreach and health education. IMPLICATIONS FOR SCHOOL HEALTH POLICY, PRACTICE, AND EQUITY: Consideration of school health service disruptions and the increased demands on service providers may inform future priorities for school administrators, health departments, and policymakers. CONCLUSIONS: COVID‐19 impacted the timing and method of service delivery as well as the roles of school health staff and schools themselves in public health and education. [ABSTRACT FROM AUTHOR]

Objective: This study was designed to measure health promotion behaviors, health literacy (HL) levels, and their predisposing factors among adolescents. Design: A cross‐sectional design was used. Sample: The study was completed by 1046 students aged 11–14 years. Measurements: Data were collected via the HL for School–Aged Children Scale and the Adolescent Health Promotion Scale. Results: HL was significantly associated with gender, participation in sport activities, and health promotion behaviors. There was no confounding factor for HL. Adolescent health promotion behaviors were significantly associated with academic level, weight perception, participation in sport activities, and HL. Conclusions: Nurses could improve communication and decision‐making skills related to health behaviors and learn how to obtain health‐related knowledge to promote the health of adolescents. [ABSTRACT FROM AUTHOR]

BACKGROUND: Adoption of the Whole School, Whole Community, Whole Child (WSCC) model has been slowed by a lack of available tools to support implementation. The Wellness School Assessment Tool (WellSAT) WSCC is an online assessment tool that allows schools to evaluate the alignment of their policies with the WSCC model. This study assesses the usability of the WellSAT WSCC. METHODS: Using a convergent mixed methods design, we collected qualitative and quantitative data from 5 school‐based participants with roles in development and evaluation of policy. Participants explored the platform while engaging in a think‐aloud procedure and scored a sample policy using the platform. They also completed the System Usability Scale and responded to open‐ended questions about the usability of the platform. RESULTS: Participants rated the WellSAT WSCC as an above‐average user experience, but data suggested several areas for improvement, including improved instructions, enhanced visual design of the platform, and guidance for subsequent policy changes. CONCLUSION: The WellSAT WSCC provides an above‐average user experience but can be improved to increase user experience. These improvements increase the potential for greater use to facilitate integration of the WSCC model into school policy. [ABSTRACT FROM AUTHOR]

Background: Exclusionary discipline (ED) has long been an educational equity concern, but its relationship with student health and protective factors is less understood. Methods: Using population‐based public school student data (N = 82,216), we examined associations between past‐month ED and positive depression and anxiety screening instrument results. We also assessed whether each of 9 potential protective factors moderated the ED‐mental health relationship by testing interaction effects. Results: Over 1 in 10 youth experienced past‐month ED, with variation by sex, gender identity, special education status, poverty, region, race/ethnicity, and adverse childhood experiences. Net of sociodemographic factors, youth who experienced ED had higher likelihood for current depression (adjusted odds ratio [AOR]: 1.64, 95% confidence interval [CI]: 1.55, 1.73) and anxiety (AOR: 1.49, 95% CI: 1.41, 1.58) symptoms. Significant associations were robust across 5 racial/ethnic groups, except for anxiety among American Indian/Alaska Native youth. Individual, interpersonal, and school‐level protective factors appeared to mitigate depression and anxiety regardless of disciplinary experience. Implications for School Health Policy, Practice, and Equity: Our findings document ED disproportionality and possible ramifications for emotional well‐being. Conclusions: In concert with structural efforts to reduce reliance on ED, strategies that bolster protective factors may support youth already impacted by ED and/or mental health problems. [ABSTRACT FROM AUTHOR]

Aim: Problematic externalising behaviours in adolescents are associated with high individual and societal burden. A school‐based multidisciplinary health clinic, Ngaramadhi Space (NS), was developed at Yudi Gunyi School, a specialised behavioural school in Sydney, Australia, to improve access to holistic health‐care and behavioural support. This evaluation aimed to describe the demographics, clinic attendance, health screening, recommendations made, and changes in Strengths and Difficulties Questionnaire (SDQ) scores of students attending the clinic. Methods: Retrospective evaluation of students including changes in SDQ scores using descriptive statistics (26 July 2016 to 14 May 2019; n = 79). Results: Prior to the assessment, few students engaged with a paediatrician or mental health professional (22.8%; 27.8%, respectively). Child protection services were involved with 76%. NS attendance was high (failure‐to‐attend = 7.6%; cancellations = 8.9%). New issues found at the assessment included: parental separation (31.6%); trauma history (27.8%); substance use (19%); emotional wellbeing concerns (16.5%), learning difficulties (12.7%), domestic violence (12.7%) and medical conditions (10.1%). SDQ teacher reports showed a significant decrease in total difficulties scores (M = 6.2, SD = 6.165, P < 0.05, eta squared = 1.013 (large effect)) and all subsets. No significant differences in parent and self‐reported SDQ. Conclusions: Students with problematic externalising behaviour have unmet health and social needs. The NS school‐based integrated health‐care model offers a novel, convenient and innovative way to engage these students. This approach has high initial attendance rates with teacher‐reported SDQ results showing some behavioural improvement. Further qualitative studies are required. [ABSTRACT FROM AUTHOR]

To illuminate adolescents' experiences of Help Overcoming Pain Early (HOPE), a person‐centred intervention delivered in a school setting by school nurses. Twenty‐one adolescents with chronic pain recruited from secondary school, who had completed the HOPE intervention, were included in the interview study. The HOPE intervention was built on person‐centred ethics and consisted of four meetings between school nurses and adolescents on the subject of stress and pain management. A qualitative method using content analysis with an inductive approach was employed. In the interviews, the adolescents describe how they reclaim their lives with the help of HOPE. They use different strategies and parts of the intervention to move on with their lives. A trustful relationship, as that with the school nurse, was essential to dare to change. The overarching theme summarizes in Becoming myself again and is built up by three sub‐themes: Trust a pillar for growth, Making sense of my life with pain, and Putting myself into the world again. A person‐centred intervention such as HOPE applied in a school context is promising for promoting confidence in adolescents with chronic pain. A trust‐building process emerged, in terms of both the adolescents' trust in the healthcare staff they meet and their confidence in their own ability to handle and influence their situation, which in the long term can promote trust in themselves as a person. [ABSTRACT FROM AUTHOR]

Objective: To assess the 1‐year impacts of a healthy marriage and relationship education (HMRE) program for high school students. Background: Research on HMRE programming for youth has found that programs can improve youth's relationship skills, attitudes, and knowledge around the time the program ends. However, there is less evidence on whether these impacts are sustained over time or when providers do not have enough time to deliver the full program. Method: A three‐arm cluster randomized trial involving 1,862 students from two schools. The two intervention groups received either a 12‐lesson HMRE curriculum or a shortened eight‐lesson version of the same curriculum. Students completed surveys at baseline and 1 year later. Results: Students in all three groups reported similar levels of relationship skills, attitudes, and knowledge for 9 of the 10 outcomes examined at the one‐year follow up. For the one exception, students offered the 12‐lesson curriculum were more likely than students in the control group to disagree that feelings of love are enough to sustain a happy marriage. Conclusion: We found limited evidence of sustained impacts and no evidence of an effect from shortening the curriculum. Implications: Offering HMRE to high school students might plant the seeds of healthy relationships, but more programming will probably be needed to sustain the types of short‐term impacts found in prior research. [ABSTRACT FROM AUTHOR]

Schools have been postulated as ideal environments to encourage physical activity (PA). This study aimed to assess the relationship between PA in school hours, motor competence, and screen time in a sample of Spanish preschool children. Fifty‐seven 4–5‐year‐old preschoolers (n = 32 girls) participated. The Garmin Vivofit wristband was used to measure the PA levels during school hours in a week. Sedentary behavior was estimated through screen‐time hours reported by preschoolers' families and motor competence was assessed by the Athletic Skills Track. The anthropometry (weight/height) and demographic data were also collected. We found that motor competence was significantly associated with PA both in minutes and in steps. Therefore, increased motor competence was related to higher engagement in PA during school hours. No association was found between screen time and PA or proficiency of motor competence. No gender differences were found in any variable assessed. Based on the relationship between motor competence proficiency and the amount of PA in preschool children, our findings support the need for specific strategies to promote fundamental movement skills and increase PA practice from early childhood. Practitioner points: A higher level of motor competence was related to greater participation in phyisical activity during school hours.Schools are the ideal environment to promote healthy habits,so specific strategies are needed to increase motor competence as it can have an impact on immediate and future health.It seems necessary to provide more physical activity opportunities throughout the preschool day to reduce sedentary time. [ABSTRACT FROM AUTHOR]

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

The education systems of the four UK nations are diverging, and the education system in Wales is undergoing major reform with substantially increased emphasis on health and wellbeing. Understanding the implementation of major policy and system reforms requires an understanding of system histories and starting points. This study aimed to explore the perceived roles of schools in contemporary society, and how this role has evolved over time; the aims of the reforms, with a particular focus on health and wellbeing; and perceived barriers and facilitators for implementation. Interviews were held with senior stakeholders in the Welsh education system who held a strategic role in shaping the reforms. These included senior members of government and schools with a remit in either design of the curriculum or educationalists' professional learning, Wales's school regulatory body, and those with a multidisciplinary remit in health and education. Interviews were subjected to thematic analysis, which produced a number of themes related to each objective, including 'a changing society and increasing expectations on schools', 'the perceived role of schools in supporting health and wellbeing', 'the aims of the reform', 'what will success look like?', 'national level barriers and facilitators' and 'community and school level barriers and facilitators'. Findings suggest that education system reform requires change at multiple levels of the education system. Consideration of each level, and the interactions between them, is necessary for achieving change. [ABSTRACT FROM AUTHOR]

Background: School nurses play a vital role in ensuring the health and well‐being of their students, but little is known about menstrual products and resources available in schools. This study assessed period product resources and needs in Missouri schools from the perspective of school nurses and analyzed differences by district enrollment characteristics. Methods: An electronic survey was emailed to public, charter, private, and parochial school nurses in Missouri who served fourth grade or older. From January through March 2022, 976 self‐administered surveys were completed (40% response rate). Logistic regressions examined the associations between student needs and district characteristics. Results: Among the sample, 70.7% knew students who could not afford period products, and 68.0% knew students who had missed school because of their period. When controlling for district size, race/ethnicity, and urban/rural classification, as the percentage free‐ or reduced‐lunch (FRL) eligibility increases in a school, awareness of students struggling to afford products increases (AOR = 1.008, 95% confidence interval 1.000, 1.015). Implications for School Health Policy, Practice, and Equity: School nurses need the resources and educational materials to support students to help reduce menstruation‐related absences. Conclusions: Issues of period poverty cut across districts of differing enrollment characteristics, yet FRL percentage is an important predictor. [ABSTRACT FROM AUTHOR]

Digital marketing of unhealthy foods and beverages to children and adolescents is pervasive, highly effective, undermines healthy eating, and contributes to health inequities. Expanded use of electronic devices and remote learning during the COVID‐19 pandemic has increased the urgency for policy interventions to limit digital food marketing in schools and on school‐issued devices. The US Department of Agriculture provides little guidance to schools for how to address digital food marketing. Federal and state privacy protections for children are inadequate. Considering these policy gaps, state and local education authorities can incorporate strategies to reduce digital food marketing into school policies for: content filtering on school networks and on school‐issued devices; digital instructional materials; student‐owned device use during lunch; and school use of social media to communicate with parents and students. Model policy language is provided. These policy approaches can leverage existing policy mechanisms to address digital food marketing from a variety of sources. [ABSTRACT FROM AUTHOR]

Background: Case investigation and contact tracing (CI/CT) are important public health tools to interrupt COVID‐19 transmission. Our study aims to understand how parents and school staff perceive COVID‐19 CI/CT. Methods: Using a mixed methods approach, we distributed a community survey and conducted 15 focus group discussions (FGDs) in English and Spanish between December 2020 and March 2021 with 20 parents and 22 staff from schools in San Diego County ZIP Codes with COVID‐19 rates in the top quintile as of August 2020. Results: One in 4 survey respondents reported that they would be reluctant to participate in CI/CT. FGDs revealed themes of mistrust in government authorities, overburdened institutions, unfamiliarity with CI/CT, and uncertainty about its reliability. School community members emphasized that parents trust schools to be involved in CI/CT efforts, but schools are overwhelmed with this added responsibility. Conclusions: Investing in schools as community hubs is necessary so they can become important partners in prevention and mitigation in public health. [ABSTRACT FROM AUTHOR]

Objectives: Evidence for affordable and pragmatic programmes to address the burden of untreated tooth decay in children in low‐ and middle‐income settings is limited. This study aimed to (1) assess the effect of a government‐run, school‐based daily group toothbrushing programme compared to standard school‐based oral health education on the incidence of dental caries and odontogenic infections in Filipino children over a period of 3 years; and (2) assess the additional preventive effect of on‐demand oral urgent treatment (OUT) and weekly fluoride gel application. Methods: A cluster‐randomized trial was conducted in Camiguin, Philippines. Schools in three regions were randomly assigned to one of three intervention groups: The Essential Health Care Programme (EHCP), which includes daily toothbrushing with fluoride toothpaste; EHCP plus twice‐yearly access to on‐demand urgent oral treatment (EHCP + OUT) and EHCP plus weekly application of high‐concentrated fluoride gel (EHCP + Fluoride). Schools in a nearby province with a similar child population were selected as external concurrent control group. Clinical oral examinations were performed by calibrated dentists from a random sample of 682 seven‐year‐old students who were examined at baseline and over the following 3 years. Outcome variables were the number of decayed primary teeth, the number of decayed, missing and filled permanent teeth (DMFT) and surfaces (DMFS), and the number of permanent teeth with pulpal involvement, ulcerations, fistula or abscess (PUFA). Data were analysed using multilevel mixed‐effects negative binomial regression. Results: Three years after implementation, increments in dental caries and odontogenic infections in permanent teeth did not significantly differ between the EHCP and control group, yet the incidence of DMFT was lower by 22% in children receiving EHCP. Compared to controls, children receiving EHCP + Fluoride had a significantly lower increment of DMFT, DMFS and PUFA by 40%, 40% and 47%, respectively. Children receiving EHCP + OUT had lower incidence rates of DMFT and DMFS than control children by 23% and 28%, respectively. A lower incidence rate was also found for PUFA, but the effect was not statistically significant. Conclusions: Findings suggest that the weekly application of fluoride gel and urgent oral treatment, in addition to daily school‐based toothbrushing with fluoride toothpaste, are realistic and effective strategies to lower the burden of dental caries in Filipino children. Implementation challenges may explain why no substantial caries‐preventive benefits were demonstrated for school‐based toothbrushing only. Intervention compliance should be considered in future programme implementation and evaluation research. [ABSTRACT FROM AUTHOR]

BACKGROUND: School‐based health centers (SBHCs) fill critical pediatric health care access gaps but typically require parental consent for enrollment. Families' responses to SBHC consent form outreach efforts may reflect broader school engagement. This study investigated whether SBHC consent form return predicted subsequent chronic absenteeism and school transition, indicators of student and family school engagement. METHODS: Multivariable logistic regression was used to compare the odds of being chronically absent or transitioning out of a US elementary/middle school (n = 1917) during 2015‐2016 and 2016‐2017 for those who declined SBHC enrollment or did not return a consent form, compared to those who enrolled. RESULTS: Compared to enrolled students, those who declined had 78% lower odds of chronic absenteeism [95% CI: 0.09, 0.54]. Families who did not respond had 2.8 times greater odds of their student transitioning out of school [95% CI: 2.15, 3.58] but were no more likely to be chronically absent. Conclusions: Consent form return may predict aspects of broader students and family school engagement. [ABSTRACT FROM AUTHOR]

BACKGROUND: The New Jersey Safe Schools Program (NJSS) offers an online professional development certification course, titled "Designing and Implementing Student Training Plans," for NJ high school (HS) teachers developing secondary school student work‐based learning (WBL) programs. WBL provides students opportunities to engage in career‐related field tasks, aligned to curricular instruction. METHODS: In January‐July 2021, during 7 cohorts of trainings, questions in the training's assignment gauged teacher and student concerns regarding worksite placements during the COVID‐19 pandemic, learning delivery format preferences, and alternative activities for WBL credit. RESULTS: In January‐July 2021, 68 of 134 HS teachers (51%) were concerned placing students in WBL and indicated "no" and "I don't know" (37% and 31%, respectively) about employer willingness to offer virtual mentorship during the pandemic. CONCLUSIONS: This preliminary study presents insights of newly credentialed WBL supervisory HS teachers regarding impacts of COVID‐19 on student health and workplace safety, preferred WBL formats, and potential implementation of COVID‐19 safety trainings. [ABSTRACT FROM AUTHOR]

PURPOSE: This study explored differences between lesbian, gay, and bisexual (LGB)‐housed and homeless students regarding substance use patterns on and off school grounds and the unique contribution of homelessness to substance use in school. METHODS: Data were from the 2013‐2015 California Healthy Kids Survey, a statewide survey of school protective factors and risk behaviors. A representative sample of 9th‐ and 11th‐grade students (N = 20,337) was used. Comparisons between housed (n = 19,456) and homeless (doubled up: n = 715; acute homeless: n = 166) LGB students were conducted. We used chi‐square tests to compare rates of lifetime, past‐30‐day, and in‐school substance use and conducted multivariate logistic regression models for each substance use variables. RESULTS: Chi‐square test results indicated significant differences in rates of substance use among students experiencing homelessness (both categories) and housed LGB students. Lesbian, gay, and bisexual students experiencing homelessness were more likely to report substance use off and on school grounds. Results from logistic regression analyses indicated that LGB students who experience homelessness were significantly more likely to report recent and in‐school substance use. For example, students experiencing acute homelessness were about 3 times as likely to report heavy episodic drinking (adjusted odds ratio [AOR] = 3.13; 95% confidence interval [CI] = 2.13, 4.26) and more than 5 times as likely to smoke marijuana in school (AOR = 5.38; 95% CI = 3.46, 8.36), compared to housed LGB students. CONCLUSIONS: LGB students who experience homelessness are at higher risk than housed LGB students of substance use on and off school grounds. Findings highlight the need to provide support in the school context for this subpopulation. [ABSTRACT FROM AUTHOR]

Public health nurses (PHN) are critical to ensuring the health of communities. Absent the most basic information on the PHN workforce in our state, we conducted interviews with 21 PHN and school health nurse (SHN) leaders and an online survey of PHNs and SHNs practicing in Maryland (N = 491). Our study identified an older, very experienced, and well‐educated workforce. Both the interviews and survey identified similar barriers: low salaries, recruitment and hiring challenges, limited funding for public health programs, and no opportunities for education or career advancement. Survey participants also identified barriers of inadequate leadership, recognition, and communication including PHNs not being represented at decision‐making tables or at the state leadership level. Strategies to promote public health nursing from leaders and survey participants were similar: increasing awareness about what public health and PHNs do and their value; improving advocacy and stakeholder engagement; improving access and availability of services; improving PHN leadership representation at the state level; a improving PHN salaries and benefits including tuition reimbursement. Although results were similar to national studies, comprehensive, granular workforce data is critical to ensure the public health workforce can meet current and emerging public health needs and that public health infrastructure and services are appropriately funded. [ABSTRACT FROM AUTHOR]

Objective: Adolescent suicide is a public health crisis. School connectedness, a protective factor, may be especially important in low‐income rural schools, with fewer resources and higher rates of suicide as compared to urban schools. The purpose of this study was to explore teacher perceptions of safety and school connectedness in a low‐income, rural middle school, and implications for collaborative practice between school nurses and teachers. Design and Sample: A qualitative secondary data analysis was used. Data were taken from transcripts from four focus groups comprised of middle school teachers (n = 20). Measurement: An inductive approach to content analysis was conducted using in vivo Coding and Venn diagrams. Results: Three themes were identified: (1) defiant and aggressive student behaviors were safety concerns, as teachers perceived they may be obscuring mental health needs; (2) teachers were sometimes placed in a position to assist students with safety management strategies; and (3) managing safety concerns was an obstacle to building connectedness, as reflected in safety and school connectedness. Conclusion: Collaborative strategies between school nurses and teachers are essential to identify student behaviors that may be masking mental health needs. Strategies have the potential to enhance school connectedness and support student safety. [ABSTRACT FROM AUTHOR]

BACKGROUND: The COVID‐19 pandemic has caused interruptions to the K‐12 US school landscape since spring 2020. METHODS: In summer 2020, we completed a pilot study utilizing interviews (n = 13) with school staff (ie, nurses, educators) from across the United States. We aimed to understand the status of school operation and re‐entry plans after the primary period of school closure, along with resources needed for students and staff during the COVID‐19 pandemic. RESULTS: All interviewees described their school's re‐entry plan as complete or in‐development. Ten plans included strategies to meet students' mental health needs. Only 3 clearly planned for staff mental health resources. Interviews suggest gaps in planning and execution of mental health resources for school staff, a group already vulnerable to stress, anxiety, and burnout. IMPLICATIONS FOR SCHOOL HEALTH: Several school staff mental health resources were developed as a result of the pandemic, though ongoing impacts necessitate integration of these supports into school operation plans. This is particularly important as schools continue to navigate periods of altered operation in response to elevated community COVID‐19 infection rates. CONCLUSIONS: As schools implement strategies to support students, similar consideration should be given to the adults in the school environment who teach and support school‐aged children. [ABSTRACT FROM AUTHOR]

BACKGROUND: Exposure to injury and violence early in life increases the risk of experiencing injury and violence later in life. In 2019, the top 3 leading causes of death among 15‐ to 18‐year‐olds in the United States were unintentional injury, suicide, and homicide. This study examines the extent to which schools promote injury and violence prevention. METHODS: This study examined injury‐ and violence‐related school policies and practices using nationally representative data from the 2014 School Health Policies and Practices Study. The social ecological model served as the theoretical framework to identify level of impact. RESULTS: For many injury‐related topics, more than 75% of schools nationwide had relevant policies and practices to address those topics. However, this study showed differences in schools' injury‐related policies and practices by urbanicity. CONCLUSIONS: Understanding and identifying gaps in school policies and practices is essential for reducing and preventing the injury and violence children experience. Collecting data on school policies and practices allows for better monitoring and evaluation to determine which are efficacious and aligned with the best available evidence. [ABSTRACT FROM AUTHOR]

BACKGROUND: The Whole School, Whole Community, Whole Child (WSCC) model offers a comprehensive framework for creating safe, healthy, and supportive school environments. However, few studies to date have examined the degree to which school policies represent a comprehensive and integrated approach to this goal beyond nutrition and physical activity. Therefore, the purpose of this study was to provide a baseline evaluation of the alignment of district‐level policies with the WSCC model within one state. METHODS: Fifty‐four Connecticut public school districts' policies were evaluated using the WellSAT WSCC, a new measure of how well district‐level policies address topic areas within each domain of the WSCC model. The comprehensiveness and strength of each district's policies were calculated and then averaged across districts to assess areas of strength and need. RESULTS: Districts' policies were most comprehensive in the domains of Social and Emotional Climate; Behavioral Supports (Counseling, Psychological, and Social Services); and Family Engagement. Policies were strongest for Safe Environment (Physical Environment); Behavioral Supports; and Health Services. CONCLUSIONS: School district policy coverage of the WSCC model within Connecticut varies by domain and is often fragmented. Comprehensive and coordinated policies modeled from WSCC domains are needed to better support safe, healthy, and supportive school environments. [ABSTRACT FROM AUTHOR]

Background: School health education, including sexual health education, plays a crucial role in shaping adolescents' protective health behaviors, experiences, and outcomes. Adolescents need functional knowledge and skills to practice, adopt, and maintain healthy behaviors for preventing sexually transmitted infections (STIs), including human immunodeficiency virus (HIV), and unintended pregnancy. Methods: The US Centers for Disease Control and Prevention's Division of Adolescent and School Health (CDC/DASH) has advanced school‐based approaches to STI/HIV and pregnancy prevention through surveillance, research and evaluation, and program partnership and collaboration for over 3 decades. Results: CDC/DASH uses systematic and innovative strategies to identify the breadth of adolescent sexual health evidence; characterize key elements of effective educational curricula; and provide practical guidance to support school‐based delivery. CDC/DASH's approach to effective health and sexual health education in schools has changed dramatically over the past 30 years and must continue to progress. Conclusion: This paper describes how and why that approach has evolved and outlines directions for the future. [ABSTRACT FROM AUTHOR]

Background: With the revision of the Japanese School Health and Safety Law in 2016, the use of growth and obesity curves has been recommended. This study aimed to determine the prevalence of growth and obesity curve creation in elementary and junior high schools using government-issued software in Japan between 2016 and 2019. Methods: A questionnaire survey was conducted with school nursing teachers in elementary and junior high schools in Osaka, Japan. The questionnaire was distributed and collected by e-mail between 1 and 31 March 2020. Results: The survey response rate was 87.1%. In total, 78.5% of the elementary schools, and 75.0% of the junior high schools had the software for creating the growth curves. The rate of adoption of growth curve creation using the software increased in elementary schools (from 16.2% in 2016 to 40.5% in 2019 and in junior high schools from 6.0% in 2016 to 33.6% in 2019. The detection rates of growth abnormalities also increased over the 4 years in elementary and junior high schools, as follows: short stature (2.48- and 3.81-fold, respectively), tall stature (2.77- and 4.77-fold, respectively), emaciation (2.62 and 4.85-fold, respectively), mild obesity (2.66 and 5.15-fold, respectively), moderate obesity (2.71- and 4.14-fold, respectively), and severe obesity (2.45- and 3.32-fold, respectively). The rates of receiving a recommendation slip and going on to consult a specialist for each growth abnormality were low. Conclusions: By utilizing these curves, the detection rate of physical development abnormalities increased, but the rate of recommending a specialist consultation and the rate of actual consultation with a specialist were still low. [ABSTRACT FROM AUTHOR]

Background: The WHO’s Health Promoting Schools (HPS) framework is based on an understanding of the reciprocal relationship between health and education, and the need to take a holistic approach to health promotion in schools. We aim to clarify the degree to which the HPS framework is reflected in the national policies of eight target countries and the issues surrounding its successful implementation. Methods: Date were collected through two expert workshops with participants from eight Asian countries: Cambodia, China, Japan, Korea, Lao PDR, Nepal, the Philippines, and Thailand. In the first workshop, data collected on national policy were mapped against the HPS framework. From this, key issues were identified, and follow-up data collection was conducted in each country for a second workshop. Results: We identified a policy shift toward the HPS framework in six out of the eight countries. Neither Japan nor Korea had changed their national policy frameworks to reflect an HPS approach; however, in the latter, model pro- grams had been introduced at a local level. We identified various barriers to successful implementation, especially in relation to mental health and wellbeing. Conclusion: Given the recent shift toward the HPS approach in six out of the eight countries in this study, there is a need to conduct research to assess the impact of this framework on the health and wellbeing of students and school staff. At the same time, we call for more dialog in the context of Japan to explore the possible benefits of introducing the HPS framework into schools. [ABSTRACT FROM AUTHOR]

Aim: This study examined the effects of a 12‐week school‐based "We Fit" weight control programme. Design: A nonequivalent control group was used, with a non‐synchronized pretest–posttest design. Methods: In total, 109 Korean high school adolescents participated. The programme comprised exergaming, diet diary and counselling, health education, and social networking service‐based group discussions. Anthropometric factors, physiological factors and physical activity (daily steps and sitting time) were measured in the intervention and the control groups before and after the intervention. Programme satisfaction was assessed post‐intervention. Data were analysed using descriptive statistics; the chi‐square, Mann–Whitney U and t tests; and generalized estimating equations. Results: The intervention group showed a significantly decreased waist circumference, increased skeletal muscle mass, increased high‐density lipoprotein cholesterol, decreased low‐density lipoprotein cholesterol and reduced weekend sitting time. Conclusion: This study adds to the evidence for the applicability and effectiveness of healthy weight control programmes using exergames for adolescents in school settings. [ABSTRACT FROM AUTHOR]

In Asia and the Pacific island region, strengthening of school health activities and measures is urgently recommended to deal with the impact of the increasing risk of potential school closures due to continuation of the coronavirus disease 2019 (COVID‐19) pandemic in 2021. As the incidence of COVID‐19 in 2020 was relatively low in these regions, many of the countries were able to avoid prolonged school closures. However, even if vaccination is expanded in the future and the pandemic tends to come to an end, the risk of SARS‐CoV‐2 variants spreading among children will also increase, and the possibility of having to close schools again will also increase. [ABSTRACT FROM AUTHOR]

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

BACKGROUND: Teacher instructional competency, the set of essential knowledge and skills needed to guide teaching practice, is critical to the successful implementation of school health education. The purpose of this paper is to introduce the Health Education Teacher Instructional Competency (HETIC) framework, a new conceptualization describing teacher characteristics, essential knowledge, and essential skills, which can influence instructional practice and improve student learning outcomes in health education. METHODS: Data from 17 publicly available guidance documents, professional standards, published reports, and empirical studies relevant to the fields of public education, school health education, and sexual health education were abstracted and analyzed using qualitative thematic content analysis. RESULTS: The framework describes 3 domains: personal characteristics, essential knowledge, and essential skills, which are believed to contribute to teachers' instructional competencies in delivering health education. The knowledge domain asserts 5 key categories, while the essential skills domain includes 3 categories (learning environments, content and delivery, and collaboration and learning) and contains 11 unique skills. Collectively, these domains are influenced by the learner, school/community, and policy‐level factors that shape health education curriculum and instruction. CONCLUSIONS: The HETIC framework presents a conceptual roadmap to guide quality health education preparation, job‐embedded training, and delivery. Improving teachers' instructional competencies strengthens learning and prosocial environments that are inclusive, responsive, and affirming of students' health and learning needs. Teacher who demonstrate instructional competency can help students to achieve desired education and health outcomes, specifically acquiring the knowledge and skills needed to adapt, practice, and maintain healthy behaviors throughout their lifetime. [ABSTRACT FROM AUTHOR]

There is extensive research in the area of school violence prevention that has collectively helped to illuminate trends, identify disparities in experiences with school violence across various subgroups, drawn connections between the implications of these experiences to health and learning outcomes across childhood, and subsequently informed specific safety policies and practices that schools have been able to adapt and implement in their efforts to keep their students not only safe from violence but also promote schools as a space where children are able to thrive. This paper draws on a rich set of recent literature and seeks to further this critical discussion by highlighting a conceptual framework at the intersection of public health and education and its role in shaping conversations on school safety. A discussion on the emergence of trauma‐informed school spaces and the ways in which attending to a child's mental and physical health are tied to learning outcomes is also presented. Moreover, this work draws connections to how other public health issues that also exist in school spaces have been addressed as effective examples for how to speak about, study, and respond to the issue of violence in K‐12 schools. Given the unique ways in which school gun violence has more recently shaped safety decisions in schools across the United States, implications specifically for school gun violence prevention are also presented. [ABSTRACT FROM AUTHOR]

BACKGROUND A majority of research findings have focused on recess as instrumental to achieving minutes of physical activity rather than focusing on the psycho‐social benefits associated with a high‐quality recess environment. The purpose of the current study was to examine the relationship between recess quality and teacher‐reported social, emotional, and behavioral outcomes in children. METHODS: Data were collected from 26 schools in 4 different regions of the United States. Teachers (N = 113) completed behavioral assessments for randomly selected children in their classrooms (N = 352). Data assessors conducted live observations of recess using the Great Recess Framework—Observational Tool. A series of 2‐level regression models were fit in Mplus v. 8.2 to assess how recess quality was associated with indicators of children's social, emotional, and behavioral health. RESULTS: Recess quality significantly predicted executive functioning problems (b = −.360, p =.021), resilience (b =.369, p =.016), emotional self‐control (b = −.367, p =.016), and a composite of adaptive classroom behaviors (b =.321, p =.030). CONCLUSION: Results of the present study demonstrate that recess quality impacts child developmental outcomes. Schools should ensure there is adequate training and resources to facilitate a positive and meaningful recess for students. [ABSTRACT FROM AUTHOR]

Public health nurses (PHNs) in Canada have the potential to significantly benefit the health and academic outcomes of school age children with its impact lasting into adulthood. Unfortunately, cuts in government funding over the years have diminished the presence of PHNs in schools and their ability to practice to their full scope. In the midst of a pandemic, having a strong nursing presence in schools may facilitate public health efforts and reduce the burden on teachers and administration. This discussion paper will explore the current role of nurses in Canadian schools in relation to school nurses in other parts of the world. An overview of the literature looking at the impact of the school nurse on school health (i.e., student health and academic outcomes) will be presented to provide evidence in support of rebuilding nursing capacity in Canadian schools. Finally, the Framework for 21st Century School Nursing Practice will be introduced as a viable nursing theory to facilitate rebuilding PHN capacity in schools. [ABSTRACT FROM AUTHOR]

BACKGROUND: In our society, children are particularly vulnerable to physical inactivity and excessive sedentary time (ST). The aim of this study was to evaluate the effectiveness of a school‐based intervention designed to promote physical activity (PA) and reduce ST in 6‐ to 10‐years‐old children from a disadvantaged neighborhood. METHODS: The first intervention of this randomized trial was carried out in School 1 in 2017/2018 and 2018/2019, School 2 benefited from the same intervention in 2018/2019. Baseline assessments were realized using accelerometers prior to the intervention (T1‐T2), after the first intervention (T3) and after the second intervention (T4). School‐based actions targeted children, parents, teachers, physical, and organizational environment of school and politics. The chi‐square test of independence was used to analyze the evolution of the moderate and vigorous physical activity (MVPA) and ST. RESULTS: For School 1, an increase in the percentage of very active children (over 40 minutes MVPA/day) and of having a very low ST (less 240 minutes/day) (p =.00) was found. No further evolution was revealed during the intervention (T2‐T3) and 1 year after (T3‐T4). For School 2, similar effects on PA and ST were found at T3 (p <.05). CONCLUSIONS: Positive effects occurred before the intervention in each school and then remained stable. [ABSTRACT FROM AUTHOR]

BACKGROUND School‐environments are thought to be strong influences of behavioral choices. There is limited research available on the role of physical activity (PA) and school success among children with special health care needs (CSHCN). The purpose of this study was to explore differences in PA among CSHCN and non‐CSHCN and how the school success index is related to PA in both groups. METHODS: Data were taken from new version of the National Survey of Children's Health (NSCH), which consolidated questions from the previous NSCH and the National Survey of Children with Special Health Care Needs (NS‐CSHCN). Chi‐square and logistic regression analyses were employed to examine group differences. RESULTS: There were significant differences among both subgroups, although most school‐aged children did not meet recommended PA guidelines. Chi‐squared analyses indicated; school engagement and the parent's perception of child safety at school were associated with the likelihood of meeting PA guidelines. Logistic regression analyses showed that the odds of meeting PA guidelines were associated with the school success index. CONCLUSIONS: Comprehensive school health programs should focus on PA both subgroups. School health educators should continue to advocate for safe and structured extracurricular activities to improve the child and adolescent's engagement and overall well‐being. [ABSTRACT FROM AUTHOR]

BACKGROUND During spring 2020, COVID‐19 forced widespread United States school building closures in an unprecedented disruption for K‐12 students and staff. Partnering with the American School Health Association (ASHA), we sought to identify areas of concern among school staff planning for school reopening with the goal of addressing gaps in resources and education. METHODS: This 16‐item web‐based survey was distributed via email to 7467 ASHA members from May to June 2020. Topics focused on 3 Whole School, Whole Community, Whole Child components: physical environment, health services, and mental health. Chi‐square tests were used to identify differences in responses by school characteristics and school role on each survey item. RESULTS: A total of 375 respondents representing 45 states completed the survey. The majority were female (91.7%), white (83.4%) and non‐Hispanic (92.2%), and school nurses (58.7%). Priority concerns were feasibility of social distancing (93.6%), resurgence of COVID‐19 (92.8%), and the availability of health supplies (88.8%). CONCLUSION: Understanding staff concerns in the context of the Whole School, Whole Community, Whole Child model better positions the school community to address ongoing gaps and changing needs as schools continue to address COVID‐19 complications. [ABSTRACT FROM AUTHOR]

BACKGROUND Evidence for the effectiveness of state‐mandated body mass index (BMI) screening programs in the United States has been inconclusive, and potential unintended consequences of the programs have been debated. The present review aims to understand parents' perceptions of and responses to school‐based BMI screening, and to highlight racial/ethnic differences. METHODS: We systematically identified studies published January 2003‐May 2019 examining parent and/or youth perceptions of and/or responses to US school‐based BMI screening. RESULTS: A total of 16 studies were included in the review. Studies suggested that while parents largely found BMI screening helpful, they held concerns regarding stigma, lack of privacy, and unhealthy behaviors and attitudes resulting from school‐based screening. Furthermore, parents did not frequently follow‐up with health care providers, although they reported some healthy behavior changes. CONCLUSIONS: Our review highlights existing parent perceptions of school‐based BMI screening including the potential for healthy behavior change and important concerns regarding weight‐stigma and disturbed eating attitudes/behaviors. Additionally, racial/ethnic differences in screening preferences and experiences were found. Limitations of existing literature included a need to understand youths' experiences and a lack of standardized, reliable outcomes research. Implications for future research and the role of parents, schools, and providers are discussed. [ABSTRACT FROM AUTHOR]

Background: The Global School‐based Health Survey showed that 20.6% of Indonesian students aged 13–17 years old were bullied. The proportion was lower than those reported from Southeast Asian countries (28.3–51.0%). School education was reported to contribute to the reduction of bullying, but no similar study has been done in Indonesia. This study aimed to explore the role of school‐based education in preventing bullying in high schools in Indonesia. Methods: In‐depth interviews with principals and focus group discussions with teachers from five schools in Mataram City were conducted in 2018. Data were transcribed and analyzed using thematic analysis. Participant observations and document reviews were conducted to verify the data. Results: Seven themes emerged: (i) Bullying as a problem; (ii) Causes of bullying; (iii) Effects of bullying; (iv) Curricular interventions; (v) Cultural interventions; (vi) Institutional interventions; and (vii) Challenges and recommendations regarding current interventions. Curricular interventions include Pancasila (state ideology or principles of the state's philosophy) and civic education, and religious education, while cultural interventions include cultural practices and extracurricular activities. The schools provide an enabling environment by maintaining a good physical environment and implementing policies to prevent bullying. These activities promote the prevention of school bullying. Conclusions: This study demonstrated that moral education in curriculum and cultural activities are avenues for the prevention of school bullying. The implementation of both religious education and civic education encouraged the creation of values among students. In Indonesia, current interventions should be continued and must be modified to respond with societal changes. [ABSTRACT FROM AUTHOR]

Aim: The purpose of this analysis was to examine the influence of weight and disability status on rates of bullying victimisation and perpetration among youth.Methods: Data from the 2016 National Survey of Children's Health, which included 2716 youth (aged 10-17) with and 23 195 without disabilities in the USA were utilised. Parent-reported measures of height and weight, bullying perpetration and victimisation, and demographic covariates analysed. Descriptive statistics, and multivariable logistic regressions with outcomes of bullying perpetration and victimisation, were generated.Results: In the multivariate analysis, overweight (adjusted odds ratio (aOR) = 1.26, 95% confidence interval (CI) 1.04-1.52), obesity (aOR = 2.25, 95% CI 1.83-2.77) and having a disability (aOR = 3.25, 95% CI 2.69-3.92) were related to greater odds of bully victimisation. Both obesity (aOR = 1.62, 95% CI 1.10-2.74) and disability (aOR = 2.74, 95% CI 2.00-3.75) were also related to greater odds of bully perpetration in the multivariate model; overweight status was not related to bully perpetration.Conclusions: Weight status was identified as a characteristic that may increase the risk of bullying victimisation, above and beyond disability. This analysis helps identify that youth with disabilities who are overweight or obese have greater risk factors for bullying and are in need of interventions to ameliorate bullying. [ABSTRACT FROM AUTHOR]

Objective: To investigate the association between the potential support of schools for oral health promotion and a set of oral health–related behaviours among adolescent students in Brazilian state capitals. Methods: A cross‐sectional study using individual and school environment data from the 2015 Brazilian National Adolescent School‐Based Health Survey (PeNSE) was conducted. The sample consisted of 51 192 students from 1339 public and private schools in the 27 Brazilian State Capitals, aged 11‐19 years old. The outcomes were six oral health‐related behaviours: dental visits; toothbrushing frequency; soft drink and sweets consumption; smoking and alcohol consumption. The explanatory variable was the Oral Health Promotion School Environment index (OHPSE). Covariates were the adolescents' sociodemographic characteristics and organizational aspects of the schools. A two‐level multilevel mixed‐effects Poisson regression analysis with fixed slopes and random intercepts was performed, considering the complex sample design. Results: The prevalence of risk behaviours was 28.0% for 'low frequency of annual dental visits', 6.9% for 'low daily toothbrushing frequency', 28.8% for 'high weekly soft drink consumption', 41.7% for 'high weekly sweet consumption', 18.9% for 'cigarette experimentation' and 52.6% for 'alcoholic beverage experimentation'. The schools were classified as low (36.3%), intermediate (30.4%) and high (33.3%) OHPSE. In the adjusted model, schools with 'high OHPSE' had lower prevalence of 'low frequency of annual dental visits' (PR = 0.94 [95% CI 0.90; 0.99]), 'high weekly frequency of soft drink consumption' (PR = 0.94 [95% CI 0.89; 0.99]) and 'sweet consumption' (PR = 0.96 [95% CI 0.93; 1.00]) than those with 'low OHPSE'. In addition, schools with 'intermediate OHPSE' had higher prevalence's of 'low daily toothbrushing frequency' (PR = 1.12 [95% CI 1.03; 1.23]) and 'cigarette experimentation' (PR = 1.08 [95% CI 1.01; 1.16]) than those with 'low OHPSE'. 'Alcoholic beverage experimentation' was not associated with OHPSE. Conclusions: The potential support of schools for oral health promotion was associated with most of the oral health–related behaviours among adolescent students. Those attending schools with higher OHPSE scores reported a higher annual frequency of dental visits and a lower weekly frequency of soft drink and sweet consumption, while those in schools with intermediate OHPSE had a lower daily toothbrushing frequency and a higher rate of cigarette experimentation. [ABSTRACT FROM AUTHOR]