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

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

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

A substantial fraction of k-12 schools and childcare facilities in the United States closed their in-person operations during the COVID-19 pandemic. These closures may have altered the labor supply decisions of parents of affected children due to a need to be at home and take care of their children during the school day. In this paper, we examine the impact of school and childcare facility closures on parental labor market outcomes. We test whether COVID-19 facilities closures have a disproportionate impact on parents of children under 18 years old. Our results show that both women's and men's work lives were affected by school closures, with both groups seeing a reduction in the likelihood of working, work hours and the likelihood of working full-time. We also find that closures had a corresponding negative effect on the earnings of fathers of children under 18 years old, but not on mothers. These effects are concentrated among parents without a college degree, parents working in occupations that do not lend themselves to telework, and parents without other family members living at home, suggesting that such individuals had a more difficult time adjusting their work lives to school and childcare facility closures. [ABSTRACT FROM AUTHOR]

Utilization of telehealth in school-based health centers (SBHCs) is increasing rapidly during the COVID-19 pandemic. This study used a quasi-experimental design to evaluate the effect on school absences and cost-benefit of telehealth-exclusive SBHCs at 6 elementary schools from 2015–2017. The effect of telehealth on absences was estimated compared to students without telehealth using negative binomial regression controlling for absences and health suite visits in 2014 and sociodemographic characteristics. The sample included 7,164 observations from 4,203 students. Telehealth was associated with a 7.7% (p = 0.025; 95% CI: 1.0%, 14%) reduction in absences (0.60 days/year). The program cost $189,000/yr and an estimated total benefit of $384,995 (95% CI: $60,416; $687,479) and an annual net benefit of $195,873 (95% CI: −$128,706; $498,357). While this cost-benefit analysis is limited by a lack of data on total healthcare utilization, the use of telehealth-exclusive SBHCs can improve student health and attendance while delivering cost savings to society. [ABSTRACT FROM AUTHOR]

BACKGROUND: National adherence to the recess recommendations of the Centers for Disease Control and Prevention (CDC) has not been comprehensively studied in the United States. METHODS: Data from 6 nationally representative data sets over the last decade (Classification of Laws Associated with School Students, Early Childhood Longitudinal Study, National Health and Nutrition Examination Survey, National Youth Fitness Survey, School Health Policies and Practices Survey, and the School Nutrition and Meal Cost Study) provided estimates for adherence to CDC recess guidelines. RESULTS: While approximately 65‐80% of elementary school‐children receive the recommended 20+ minutes of daily recess according to parent‐, principal‐, and school‐report, adherence declines by sixth grade, and little information is available for middle/high school students. Adherence to playground safety was high (90%), but adherence to recommendations about recess before lunch (<50%), withholding recess as punishment (∼50%), and training recess staff (<50%) were lower. CONCLUSIONS: School policy and practice should align with CDC recommendations, with the aim of providing sufficient quality recess to all youth, K‐12th grade. Comprehensive, on‐going national surveillance of multiple recess domains is needed to inform policy and ensure equitable provision of recess. [ABSTRACT FROM AUTHOR]

Purpose: The authors assessed common content knowledge of health-related fitness in a national representative sample of preservice physical education teachers in the United States. Methods: Six hundred and twenty-one preservice physical education teachers from 68 physical education teacher education (PETE) programs located in different regions in the United States completed the 40 multiple choice items health-related fitness knowledge test during the semester prior to their student teaching. In addition, each PETE program coordinator/department head completed the PETE Program Information Questionnaire. Results: The mean percentage correct on the test was 61.3% (M = 24.5, SD = 4.9). Analyses of variance and t-test analyses indicated that common content knowledge of health-related fitness was not a function of sex, program size, or region of the United States. Discussion/Conclusions: These data suggest that preservice physical education teachers in the United States lack common content knowledge of health-related fitness and warrant the attention of PETE programs. [ABSTRACT FROM AUTHOR]

Maintaining adolescents' engagement with STEM (science, technology, engineering, and math) in and out of school may help ensure that adolescents are prepared to enter the STEM workforce. This study aims to extend prior work by documenting internal and external factors that matter for both STEM class engagement as well as engagement with STEM outside of school through STEM activism. Participants included ninth and tenth grade students (N = 852) from ethnically diverse public schools in the Southeastern United States, approximately evenly divided by gender. Findings from regression analyses revealed that girls and participants who perceive educational barriers to STEM were less engaged in STEM classes, whereas those who reported learning about more male scientists in class, and those who reported higher levels of belonging, STEM growth mindset, and STEM motivation were more engaged in STEM classes. Those who reported higher critical motivation, critical action, belonging, and STEM motivation were more engaged in STEM activism outside of school. Findings suggest that STEM teachers and out‐of‐school program developers may learn new ways to engage students from each other. Further, findings highlight some factors that may promote engagement in STEM both in and out of schools such as belonging and STEM motivation. Practitioner points: While related, STEM engagement in school and out of school are driven by somewhat different factors.Educators in and out of school should foster belonging and motivation to engage adolescents in STEM.Critical consciousness may promote engagement in STEM out of school, whereas growth mindset may be more important for in school STEM engagement. [ABSTRACT FROM AUTHOR]

Background: Cognitive behavioral therapy (CBT) for pediatric anxiety is efficacious for reducing anxiety symptoms and improving functioning, but many children are unable to access CBT for anxiety in community settings. Schools are an important setting in which children access mental health care, including therapy for anxiety. In this setting, therapy is usually delivered by Masters-level therapists. Objectives: Friends for Life (FRIENDS), a 12-session, manualized, group CBT program for anxiety has demonstrated effectiveness when implemented in schools. However, prior research has also found challenges regarding feasibility and cultural fit when delivering FRIENDS in the urban school context. To address these challenges, we adapted FRIENDS for implementation in the school setting so that it might be more feasible and culturally appropriate for low-income, urban schools in the United States, while maintaining the core components of treatment. The current study uses a mixed-method approach to compare the effectiveness, cost-effectiveness, and perceived appropriateness of FRIENDS and CATS when delivered by Masters-level therapists with train-the-trainer support. Materials and methods: First, we compared change scores for student outcomes (i.e., child-report MASC-2 total score, parent-report MASC-2 total score, teacher-report Engagement and Disaffection subscale scores) from pre- to post- treatment between students receiving FRIENDS and students receiving CATS to assess whether the two conditions resulted in equivalent outcomes. Second, we compared the cost and cost-effectiveness between the groups. Finally, we used an applied thematic analysis to compare appropriateness of the interventions as perceived by therapists and supervisors. Results: The mean change score for the child-reported MASC-2 was 1.9 (SE = 1.72) points in the FRIENDS condition and 2.9 (SE = 1.73) points in the CATS condition; results indicated that the conditions were similar in their treatment effects, and symptom reductions were small in both groups. The modified protocol, CATS, was shown to cost significantly less to implement compared to FRIENDS and showed greater cost-effectiveness. Finally, compared to therapists and supervisors in the CATS condition, therapists and supervisors in the FRIENDS condition more strongly described aspects of the intervention that were not appropriate for their context and in need of more extensive adaptations. Conclusion: Relatively brief, group CBT for anxiety, with adaptations to improve cultural fit, is a promising approach to treat youth anxiety symptom when delivered by school-based therapists with train-the-trainer implementation support. [ABSTRACT FROM AUTHOR]

BACKGROUND: It is estimated that approximately 90% of children in foster care have experienced a traumatic event, with nearly half reporting exposure to 4 or more types of traumatic events. Educators must remain alert to indicators suggesting a history of trauma and understand the difficulties foster youth may face regulating their emotions and behavior while in school. METHODS: A framework for foster youth trauma in the public education system identifies the interplay between macro‐level forces, such as federal and state policy, and school and teacher micro‐level forces. RESULTS: The framework highlights the inadequacy of educators in identifying the manifestations of trauma, specifically in foster youth, and how the current implemented policy leads to misinterpretation of the outward behavioral displays of trauma as other behavioral issues. IMPLICATIONS FOR SCHOOL HEALTH POLICY, PRACTICE, AND EQUITY: Federal and state policies, school districts, teacher and principal practices, teacher and school administrator preparation programs must incorporate knowledge about trauma pervasiveness and the consequences of trauma on foster youth attitude and behavior in the classroom. CONCLUSION: The framework guides change efforts toward improving school climate and culture through preparing school professionals to meet the diverse needs of foster youth and tackling those policies and behaviors that exclude foster youth from schooling. [ABSTRACT FROM AUTHOR]

The current study aimed to examine racial, ethnic, and gender disparities in the receipt of special education services for students with a diagnosis of autism spectrum disorder (ASD) from a healthcare provider utilizing parent-report data from a large, nationally representative sample of U.S. youth. Binary logistic regression results indicated that females with ASD were significantly less likely to receive special education than their male peers; however, race and ethnicity were not significant predictors of school-based autism services. These results suggest that racial/ethnic disparities in educational support for ASD students may be improving, yet misunderstandings of the impact of gender on autism symptom presentation and school functioning persist. [ABSTRACT FROM AUTHOR]

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Background: State‐level laws governing recess policies vary widely across the United States. We characterize the presence of such laws and assess their associations with child‐level outcomes. Methods: The presence of a state recess law was determined using the Classification of Laws Associated with School Students (CLASS) database. Parents of 6‐ to 11‐year‐old children reported physical activity, overall health, school absences, school‐related problems, and ability to make/keep friends as part of the National Survey of Children's Health (NSCH). Logistic regression was used to compare outcomes in states with and without recess laws cross‐sectionally in 2018 and between 2003 and 2011/2012 using a difference‐in‐differences analysis. Results: In 2018, 20 states had a law recommending or requiring recess. Cross‐sectionally, the odds of being physically active every day (odds ratio, 95% confidence interval: 2.8, 1.2‐6.5) and having no difficulty making or keeping friends (2.9, 1.2‐7.2) were significantly higher for children residing in states with versus without a recess law. There were no significant associations in the difference‐in‐differences model. Conclusions: Significant cross‐sectional associations in 2018 were not confirmed by a difference‐in‐differences analysis of two waves of the NSCH. Short follow‐up time and the apparent weakness of existing state laws warrant further assessment of state‐level recess law. [ABSTRACT FROM AUTHOR]

While prior studies have addressed bullying experienced during school, limited research exists on the associations between participation in school-sponsored extracurricular activities and bullying victimization risk. The current study utilized data from the 2013, 2015, and 2017 National Crime and Victimization Survey's School Crime Supplement (n = 13,376) to examine the associations between participation in different types of extracurricular activities and three types of bullying victimization (physical, verbal, and relational) among middle and high school students. Results indicated that participation in performing arts, service clubs, and "other" activities was associated with all three types of victimization. Additionally, participation in athletics was associated with decreased risk for verbal victimization. Prevention strategies and implications for schools regarding how to reduce bullying among middle and high school students, especially in the context of extracurricular activities, are discussed. [ABSTRACT FROM AUTHOR]

Women and ethnic minoritized individuals are underrepresented in science, technology, engineering, and mathematics (STEM) domains in postsecondary education and in the workforce. The aim of the current study was to examine whether adolescents' perceptions of inclusivity, belonging, and discrimination in high school STEM classes are related to their STEM class engagement in and outside of school. In this study, ethnically diverse 9th–12th grade high school students from low‐income public schools in the United States (N = 523, Mage = 15.72, SD = 1.24, 49.4% female) completed measures of classroom inclusivity, perceived teacher discrimination, belonging, STEM classroom engagement, and STEM activism orientation. Path analyses revealed direct effects of inclusion and perceived discrimination on STEM activism orientation. Further, findings demonstrated direct effects of inclusion on belonging and on belonging and both STEM classroom engagement and STEM activism orientation. Finally, findings revealed a significant indirect effect of inclusion on STEM classroom engagement through belonging. [ABSTRACT FROM AUTHOR]

Objectives: In 2019 the United States experienced the largest outbreak of measles in 27 years, 19 years after the United States declared measles eliminated. The purpose of this paper was to present a population study of a measles outbreak within Orthodox Jewish communities in New York that led to the elimination of religious exemption for school mandated vaccines. Methods: Peer reviewed articles, news media, health department, and government resources were used to investigate environmental factors that led to this outbreak. State, county, and city immunization records were accessed to explore measles compliance rates before and after policy change. Results: Rockland County had low compliance rates compared to the rest of the state, and the elimination of religious exemptions raised compliance rate almost to state level. In all but one affected New York City zip codes, compliance following policy change rose to 97.95%–99.15%. Conclusions: Overall, changes in measles compliance rates reflect policy goals, but localized differences imply a need for more customized interventions for each unique community. Public health planning to promote vaccination should be sensitive to the concerns and perceptions of each community in order for health interventions to have a positive effect. [ABSTRACT FROM AUTHOR]

Background: Neurocognitive deficits from childhood cancer treatment are common, long-standing, and negatively impact multiple domains of life leading to challenges with schooling and education. The purpose of this study is to describe caregiver-reported experiences of neurocognitive effects from therapy and to understand the roles clinicians play in this domain in the United States. Methods: An explanatory mixed-methods study of 174 caregivers of children with cancer provided insight into how clinicians provided information on neurocognitive effects of treatment and their experiences with school-related resources. Clinicians provided descriptions of how they provide this information and assist families with accessing services or transition back to school after therapy. Results: Caregivers identified that physicians, nurses, and social workers primarily provide information regarding neurocognitive effects of treatment. Over half (55.9%) of families seek additional information elsewhere and 49.4% report doing so because the information they received from their team was inadequate. Nearly 40% of caregivers report accessing school supports feels like a constant fight and over 40% were not offered homebound educational services by their school. Qualitative interviews with providers found that clinicians focus on therapy-related physical symptoms of treatment and only discuss neurocognitive effects when prompted by families or when children are returning to school. Discussion: Clinicians' focus on physical symptoms and just-in-time thinking when it comes to providing education or school-related services may explain why families endorse infrequent education on the topic and challenges with school reintegration. Improved education for clinicians on this topic, integration of interdisciplinary teams, and new clinical practice models may improve the family experience. [ABSTRACT FROM AUTHOR]

Postsecondary education is one of the targeted outcomes for students with disabilities; however, few aspiring students with disabilities attend college, and fewer complete a degree program. The purpose of this qualitative study was to examine the perspectives of five undergraduate students with disabilities who attended college in the United States to identify factors (enablers) that facilitated successful transitions to college. Results suggest that participants' self‐determination allowed them to manage the effects of their impairments and settings to reach their educational goals and participate in postsecondary education. The implication is that increased attention to inclusion, transitions, and postsecondary education competencies should begin early in the schooling process. Key Points: Postsecondary education is a vital postschool outcome for students with disabilities. Disabled learners accounts are crucial to the reformation of institutional practices. Nurturance of self‐determination is essential human quality for disabled learners. Inclusion of disabled learners in regular schools have a positive postschool impact. [ABSTRACT FROM AUTHOR]

BACKGROUND Children with asthma should have immediate access to rescue medication. Yet, <15% of children have access to this life‐saving drug while at school. METHODS: A search was conducted in the all states database of Westlaw to identify which the US states, territories, and the District of Columbia have a law for K‐12 schools. Terms searched included (inhaler or asthma/s medic!) and school and (prescription or order) from conception to December 2020. Demographic data from states with and without a policy were compared. All policies were examined for the following components: (1) type of law (statute or regulation); (2) type of school (charter, private/parochial or public); (3) training requirements; (4) devices; (5) prescriptive authority/safe harbor; (6) medication requirements; and (7) mandated documentation, reporting and funding. RESULTS: Our systematic search revealed 15 locations with existing laws. States with a law had a higher percentage of children under 17‐years than states without a law (p =.02). Common components described were the applicability to various types of schools, training requirements for those empowered to administer, and civil liability protections for trained school personnel. CONCLUSIONS: Existing stock inhaler laws differ vastly across the United States that may impact access to stock albuterol for children at their schools. [ABSTRACT FROM AUTHOR]

The COVID-19 pandemic affected people across the life span, including children and adolescents. This study focuses on exploring the lived experiences of children and adolescents in the United States during the pandemic. We interviewed 12 children and adolescents in April 2020 and identified four themes: (a) change in school environment, (b) connection, (c) creative celebrations, and (d) hope. We discuss limitations, recommendations for future research, and implications for counseling. [ABSTRACT FROM AUTHOR]

This study draws on Michel Foucault's framework on power relations to explore the power of parents, as evidenced by various resistance strategies, in relating to teachers of their children with attention-deficit hyperactivity disorder (ADHD). This qualitative study had seven focus group interviews, involving 58 caregivers from 47 Chinese families of children with ADHD. Thematic analysis was used and three themes were identified: (1) cognitive resistance, (2) behavioral resistance, and (3) the transcendent vision of education. Resulting from the study, a culturally sensitive three-dimensional empowerment model is proposed for social workers to engage in advocacy that can facilitate a transformation of family–school power relations. [ABSTRACT FROM AUTHOR]

The rapid transition from face-to-face to online teaching due to the COVID-19 pandemic provided unprecedented experiences for Adapted Physical Education (APE) teachers while they have had many different emerging roles, demands, and expectations related to program delivery. The purpose of this study was to examine APE teachers' experiences teaching online during COVID-19. Participants included 11 APE teachers from the south region of the United States (8 females, 3 males). Data were collected through semi-structured interviews with each participant. Thematic analysis was used to analyse the data. Data analysis resulted in five themes: 'initial thought: how are we going to even do this?', 'challenges in teaching online', 'collaboration: key to overcome challenges', 'Parents' support is critical', and 'it's doable, but I am over it'. Despite the challenges experienced by the participants during COVID-19, they were able to navigate and adapt the online teaching; however, the quality and delivery of instruction declined. [ABSTRACT FROM AUTHOR]

As adolescent gender identity has expanded to encompass non-binary forms of gender identity in contemporary social contexts, scholars in music education have begun to examine the music learning experiences of transgender students and the role of the music teacher in fostering an environment that is affirming to gender-diversity. Anecdotal observations of choral music practices in schools in the United States have indicated some changes occurring in the naming of ensembles, the categories used to describe voicing of choral music, the gender terminology used by choral directors during instruction, and program policies and procedures. The purpose of this study was to examine school choral directors' experiences with gender-inclusive instructional practices and their level of confidence in teaching transgender students. A survey consisting of 39 items including questions regarding experience teaching singers who identify as transgender, gender-inclusive instructional practices, and level of confidence in teaching students who identify as transgender was developed for this study. Participants were choral directors (N = 227) with experience teaching in secondary schools in the United States. Results indicated that a majority of participants currently engaged in gender-inclusive teaching practices and had moderate confidence in the use of these approaches. Participants reported high confidence in the use of gender-inclusive language and low confidence regarding the impact of medical and non-medical interventions on the singing voice. Results also revealed that choral directors who engaged in formal training experiences reported higher levels of confidence in their ability to teach a singer who identified as transgender. [ABSTRACT FROM AUTHOR]

Objectives: At the peak of COVID-19, adolescent life was disrupted as schools adapted their instructional approaches such as online, in-person, or hybrid instruction. We and others have previously commented on how these shifts facilitated longer, later and (more developmentally appropriate) sleep. Here, we report how sleep contributed to associations between remote instruction and broader academic well-being (e.g., cognitive function, school connectedness, and stress)., Methods: Adolescents from all 50 U.S. states (n = 4068) completed online self-report surveys in fall 2020. Instructional approach was operationalized from fully in-person instruction to fully asynchronous online education. Sleep parameters included sleep timing and duration, sleep disturbances, and sleep-related impairments. Perceived academic well-being was defined as cognitive function, school connectedness, and school-related stress. Sleep and perceived academic well-being are examined across instructional approaches, in their association, and in structural models., Results: Sleep and perceived academic well-being differed between hybrid and online instruction groups. Less variable or disturbed sleep was associated both with in-person instruction, and with positive outcomes in cognitive function, school connectedness, and stress domains. Sleep mediated a substantial portion of variance in perceived academic well-being attributable to instructional approach., Conclusion: These data highlight the need to protect both healthy sleep and in-person instruction. Appropriate sleep timing and duration, fewer sleep disturbances and sleep-related impairments accounted for a substantial degree of variance in the association between remote instruction on academic outcomes. While many students experienced "lost learning" because of COVID-19, this study joins a broader discussion of ensuring developmentally appropriate school-start times to support both sleep and achievement., Competing Interests: Declaration of conflicts of interest None., (Copyright © 2024 National Sleep Foundation. Published by Elsevier Inc. All rights reserved.)

In March 2020, the majority of schools in the United States transitioned to distance learning in order to reduce the spread of COVID-19. Little data is available on the impact of this abrupt transition on youth, but many experts have expressed concerns about the implications of this major change in schooling on mental health and academic outcomes. The current study sought to gain insight on parent and school personnel (n = 515, n = 193) concerns about the impact of the COVID-19 pandemic related schools and the return to school within two cohorts (summer 2020, fall 2020). Primary concerns were student health, student academic development, personal health, and student mental health. These findings may assist schools in their preparation for the transitions related to COVID-19 and changes in the school year to provide resources for their families to promote their students' development and support their school personnel's health. Impact Statement The current study can assist school policy makers in considering how to address concerns and fears related to the COVID-19 pandemic for parents and school personnel. The findings can assist school mental health professionals in preparing to address potential school personnel and parent concerns related to the COVID-19 pandemic. School psychologists are going to be challenged to adapt their services based on concerns related to the pandemic; these findings may assist them in adapting those services to address the common concerns and fears of school personnel and parents. [ABSTRACT FROM AUTHOR]

Background Trends in junk food consumption, a risk for obesity, are not well established. Objectives We examined national trends in types of junk food (excluding beverages) and their sources (grocery, restaurants, schools, etc.), overall and in population subgroups. Methods We assessed 29,970 children (aged 2–19 y) and 44,501 adults (aged ≥20 y) with 24-h dietary recall data from 9 NHANES cycles (2001–2002 to 2017–2018). Trends in junk food were assessed over time using 1-d values for individuals with single recalls and 2-d means for others. Results From 2001 to 2018, percent energy (%E) from junk food remained stable for children (from 18.1% to 17.5%, P -trend = 0.25) and decreased for adults (14.1% to 13.0%, P -trend = 0.002). Among children, increases occurred in %E from crackers (1.19% to 1.35%) and snack/meal bars (0.38% to 0.69%) and decreases in candy (2.58% to 1.96%) and other desserts (3.11% to 2.48%) (all P -trends < 0.01). Among adults, increases occurred in snack/meal bars (0.31% to 0.78%, P -trend < 0.001) and decreases in candy (1.97% to 1.55%; P -trend < 0.001), sweet bakery products (5.52% to 4.98%; P -trend = 0.04), and other desserts (2.19% to 1.86%; P -trend = 0.001). In 2017–2018, grocery stores provided the largest proportion of junk food (72.7% for children, 77.1% for adults), followed by other sources (13.1%, 12.1%), restaurants (8.05%, 9.11%), schools (4.86%), and worksites (1.99%). In both children and adults, junk food intake was higher among non-Hispanic white and black Americans compared with Mexican Americans, among those with higher compared with lower education, among women compared with men, and among older compared with younger adults. In sensitivity analyses using only 1-d recalls, mean junk food intake each cycle was ∼0.8–1.0 and 0.3–0.4%E units higher in children and adults, respectively, with otherwise similar trends and subgroup differences over time. Conclusions From 2001 to 2018, %E from junk food represented nearly 1 in 5 calories among children, without change, and nearly 1 in 7 calories, with modest decrease, among adults, with disparities in subgroups. [ABSTRACT FROM AUTHOR]

With increasing rates of childhood obesity in the United States, it is important to develop effective curricula that helps children learn and practice healthy habits. Given the large percentage of children who spend time in away-from-home care, childcare centers are opportune contexts to implement such curricula. We sought insight from 35 teachers and childcare providers to identify barriers to implementing an already established healthy habits curriculum (Sprouts: Growing Healthy Habits). Of the 35 participants, 9 identified as teachers (preschool, kindergarten, first grade) while the other 26 identified as childcare providers or working in childcare (i.e., program directors). Each participant completed a semi-structured phone interview after reviewing the curriculum to examine their perspective on: (a) curriculum appeal, (b) barriers to implementing the lessons, and (c) adaptations that would be needed. Interviews were recorded then transcribed verbatim. Three researchers developed a codebook and reached reliability coding (Cohen's kappa >.70). Themes from initial codes were then used to interpret data. The results indicate that there is great appeal for implementing a healthy habits curriculum in childcare contexts. The barriers providers thought they might face were: behavioral management, parental connections, preparation time, and lack of resources. Additional recommendations suggested a need to incorporate more diversity into lessons. Differences in responses were also noted by participant demographics and childcare/school neighborhood demographics. Despite noted barriers, most providers expressed enthusiasm for using a healthy habits curriculum. This helpful feedback provided useful adaptions to the Sprouts curriculum for children 4–6 years old. [ABSTRACT FROM AUTHOR]

This article focuses on reviewing the most recent publications relating to immigration and helps raise educator awareness of mental health concerns for immigrant students, which is even more pressing given the results of the president elect for 2017. Moreover, coupled with lack of access to behavioral health care is a growing concern of mental health issues among undocumented immigrants residing in the United States. [ABSTRACT FROM AUTHOR]

Parent–practitioner engagement in the early years has become a key policy in remediating the negative effects of poverty upon children's early educational outcomes. Although this approach is shared across several developed countries, there has been limited attention upon how practitioners think about poverty and their engagement with parents in poverty. Our mixed methods study in England and the USA provides rare evidence addressing these issues. Among our practitioners in both countries 'parent blame' for poverty featured to some extent in the accounts of a majority of practitioners. We also found a relationship between the extent to which our practitioners felt individual parents are culpable for poverty and their reporting of more negative engagement with parents – particularly in England. We claim this is worthy of further study as a potential threat to the 'child–parent–practitioner triangle' and to remediation of poverty's effects within early educational contexts. [ABSTRACT FROM AUTHOR]

This document provides policy recommendations of the Council for Children with Behavioral Disorders (CCBD) regarding the use of physical restraint procedures in educational settings. It includes (a) an introduction with definitions of terminology; (b) a discussion of the problems with the use of physical restraint, policy on this topic, and the lack of research; (c) a Declaration of Principles; and (d) Recommendations Regarding the Use of Physical Restraint in educational settings. Although the policy recommendations in this document pertain to the United States, we believe the principles and nonpolicy recommendations are equally applicable to other countries. [ABSTRACT FROM AUTHOR]

Purpose: We examined how socioenvironmental risk factors unique to the United States-Mexico border, defined as border community and immigration stress, normalization of drug trafficking, and perceived disordered neighborhood stress, contribute to tobacco, alcohol, and marijuana use among adolescents residing there. Design: Cross-sectional design. Setting: The study was conducted at a high school on the United States-Mexico border. Subjects: A sample of 445 primarily Hispanic students (ages 14-18). Measure: Perceived Disordered Neighborhood Stress Scale, Border Community and Immigration Stress Scale, and Normalization of Drug Trafficking Scale. Analysis: Logistic regression assessed the association between the socioenvironmental risk factors and past 30-day tobacco, alcohol, and marijuana use. Results: Participants with higher border community and immigration stress scores were significantly more likely to have used tobacco (adjusted odds ratio [aOR] = 1.41, P <.01) and alcohol (aOR = 1.31, P <.01) in the past 30 days. Perceived disordered neighborhood stress also was associated with past 30-day alcohol use (aOR = 1.46, P <.00). The normalization of drug trafficking was associated with past 30-day marijuana use (aOR = 1.45, P <.05). Conclusions: Public health practitioners, educational institutions, and policy makers should consider the economic and normative environment of the United States-Mexico border for future substance use prevention and risk reduction efforts targeting border adolescents. [ABSTRACT FROM AUTHOR]

Children with autism spectrum disorder (ASD) often demonstrate problem behaviors that interfere with performance at school. Physical activity (PA) has been shown to improve a variety of behaviors in children with ASD, although little is known about the degree to which teachers incorporate PA into the school day. One hundred twenty-one Autism support teachers completed a survey aimed to: assess teacher knowledge and perceptions of the use of PA in children and adolescents with ASD, determine how PA is being incorporated throughout the school day for children and adolescents with ASD, and assess the barriers to implementing a PA program into their classroom. Ultimately, recommendations for Autism Support Classrooms were proposed based on findings. [ABSTRACT FROM AUTHOR]

This document provides policy recommendations of the Council for Children with Behavioral Disorders (CCBD) regarding the use of physical restraint procedures in educational settings. It includes (a) an introduction with definitions of terminology; (b) a discussion of the problems with the use of physical restraint, policy on this topic, and the lack of research; (c) a Declaration of Principles; and (d) Recommendations Regarding the Use of Physical Restraint in educational settings. Although the policy recommendations in this document pertain to the United States, we believe the principles and nonpolicy recommendations are equally applicable to other countries. [ABSTRACT FROM AUTHOR]

Because sexual minorities are an at-risk population, researchers conducted retrospective life story interviews with 191 sexual minority people comprising participants from a marriage equality cohort, an HIV/AIDS epidemic cohort, and a Stonewall rebellion cohort. The participants were located within 80 miles of four major metropolitan areas in the United States. Of the 191 participants interviewed, 90 participants talked about their school-age experiences and how they coped during elementary, middle, and high school. Five themes were identified in the interview data that were coded by the research team: (a) the influence of relationships, (b) experiencing emotions, (c) coming out, (d) coping behaviorally, and (e) coping cognitively. Implications for school counseling practice and future research are provided for educators, researchers, and helping professionals. [ABSTRACT FROM AUTHOR]

Background: Sleep and mood are critical factors that contribute to health and wellness and are of particular interest to collegiate athletes who are juggling high physical, academic, and social demands. The aim of this study was to examine how psychological measures, player status, and sex-related factors were associated with perceived sleep quality.Hypothesis: Higher levels of global sleep dysfunction will be related to poor mood and increased anxiety, and there will be differences in sleep dysfunction in male compared with female athletes as well as regarding playing status.Study Design: Prospective cohort study.Level Of Evidence: Level 4.Methods: During the 2016 through 2018 National Collegiate Athletic Association (NCAA) seasons, the Pittsburgh Sleep Quality Index (PSQI), Profile of Mood States, and Sports Anxiety Scale-2 questionnaires were administered to 230 soccer athletes at 6 separate time points throughout each season.Results: PSQI results yielded scores ≥5 in 54% of observations. Increased sleep dysfunction was significantly related to decreased vigor and increased tension, depression, anger, fatigue, somatic anxiety, worry, and concentration disruption, although effect sizes (ES) were trivial (ES, -0.03 to 0.15). The odds ratio (OR) of reporting global sleep dysfunction increased by 8%, 9%, and 25% for every 1-unit increase in tension (OR, 1.08; 95% CI, 1.02-1.16; P = 0.015), fatigue (OR, 1.09; 95% CI, 1.03-1.16; P = 0.002), and concentration disruption (OR, 1.25; 95% CI, 1.09-1.45; P = 0.002), respectively. The odds of reporting global sleep dysfunction were 55% lower for males than females (OR, 0.45; 95% CI, 0.25-0.79; P = 0.006).Conclusion: Global sleep dysfunction was prevalent in NCAA soccer players and was related to negative mental health outcomes. Female participants experienced increased odds of reporting global sleep dysfunction.Clinical Relevance: Regular monitoring allows for a greater understanding of the interrelatedness between sleep and mental health in athletes. [ABSTRACT FROM AUTHOR]

There is a need to examine collaborative mental health practices in geographic regions serving high populations of under-represented minority and low socio-economic status youth in order to reduce the barriers in access to care and support. In response, a counselor education program at a large land-grant university in the Southwestern United States worked in collaboration with a local school district to create a school-based mental health program. The program provides no-cost and timely mental health counseling services to students and their families using a practicum training model. This article presents process evaluation data that examine program level functioning during the implementation stage of the training model. Implications for program improvements in the next phase of implementation are discussed as well as implications of this type of service delivery model within the context of counselor education and social justice. [ABSTRACT FROM AUTHOR]

Six hundred and ninety-three young women, 18–25 years old, all of whom had attended United States high schools, were surveyed to ask about their need for and the availability of menstrual hygiene products (MHPs) in high school and the impact, if any, that lack of access to MHPs in school had for their attendance, academic performance, and health. Most (640, 92.35%) needed MHPs while at school, but only 292 (42.13%) attended schools that provided MHPs (and those that did often required students to pay for them). Lack of access to MHPs resulted in 88 (12.7%) having missed school, 104 (15.01%) having been late to school, and 165 (23.91%) having left school early for the day. Lack of access was also identified by 122 (17.6%) respondents as having impacted their ability to learn and having resulted in health issues for 53 (7.65%) of them. There are statistically significant correlations between a school's failure to provide MHPs and a student having missed school, having left school early, and negative impacts on their ability to learn. [ABSTRACT FROM AUTHOR]

This phenomenological study explored children's school life as it relates to their subjective well-being in the United States (N = 22). It was conducted as part of a multinational comparative study of children's well-being following a semi-structured qualitative interview protocol. Rural and urban children (aged 8–12 years) participated in an interview and mapping exercise that prompted them to illustrate and then describe aspects of and influences on their well-being. Interviews were transcribed and analysed using a phenomenological approach in which child verbal responses and mapped responses were analysed to explore (1) the essence of well-being from children's perspectives and (2) their perceptions of the role that school life and context played in their well-being. Three main themes emerged. Theme 1 was that school climate is important to their well-being. Subthemes included positive environment, school safety, appropriate teacher dispositions, and supportive programming and policies. Theme 2 was that relationships within the school context are important to their well-being. Subthemes included relationships with teachers, peers and other school personnel. Theme 3 was that children view the school setting as one context, two worlds: academic and social. Subthemes included the importance of academic life, the importance of peer interactions that are unstructured in the school context, and the challenge of academic and peer worlds colliding. Results are discussed in regard to children's self-report of the hedonic and eudaimonic aspects of their well-being, and in relation to what is currently known about the importance of school environments. Implications, strengths and weaknesses of the study are discussed. [ABSTRACT FROM AUTHOR]

During adolescence, schools and peers are salient agents of gender socialization. Specifically, bullying is a common experience for many adolescents. While existing research has examined how bullying differs for girls and boys, very little has examined the ways that bullying serves to reinforce masculinity. This study combines quantitative and qualitative data to examine how bullying reinforces a specific lens of masculinity. By focusing on the experiences of bullying among middle school boys across the United States, we find that the context of school, peers, and bullying contributes to the social construction of masculinity for adolescents. By conducting a content analysis of data provided by victims, we find that many of the experiences of bullying are grounded in, or interpreted through, hegemonic masculinity. Four key themes that emerged from the data include the importance of heterosexuality, physical dominance and intimidation, acceptance and normalization of violence, and how gender intersects with other social locations. Findings from this study offer insight into how adolescent bullying perpetuates notions of masculine dominance and gender inequalities. [ABSTRACT FROM AUTHOR]

Anxiety disorders continue to be a major mental health problem among Hispanic youth. A greater understanding of particular risk factors among this at-risk population may assist school health professionals in developing psychosocial interventions designed to mitigate this growing problem. The present study evaluated a variety of school factors related to anxiety among a national sample of Hispanic youth in the US. A secondary analysis of the 2016 National Children's Health Survey was conducted. A total of 2,138 of Hispanic adolescents aged 12- to 17-years-old participated in the study. A sizeable percentage (10.9%) of Hispanic youth reported anxiety. Results from the final multivariate regression model indicated that bullying others or excluding them, being bullied or excluded by others, not doing all required homework, and school contact to parents about their child's behavior were all significant risk factors for anxiety among Hispanic adolescents in the US. These risk factors should be considered when planning school health and psychology interventions for Hispanic adolescents in the US. [ABSTRACT FROM AUTHOR]

Background: Internationally, it has been recognised that parents need to advocate for their children with disabilities to receive services. However, many parents find advocacy difficult because of systemic and logistical barriers. As such, parents of children with disabilities may seek a special education advocate to help them understand their child's rights and secure services. Yet little research has been conducted about programmes to develop special education advocates. Methods: In this study, we conducted a comparison study to determine the association of an advocacy programme (i.e. the Volunteer Advocacy Project) on a primary outcome (i.e. special education knowledge) and other outcomes (i.e. family–school partnership, empowerment and parent well‐being). Specifically, in 2017, 34 participants, all mothers of children with disabilities, were recruited from disability organisations in the USA. Seventeen mothers participated in the intervention group (i.e. the advocacy training), while 17 mothers participated in the wait list control group. The Volunteer Advocacy Project is a 36 hr advocacy training for individuals to gain instrumental and affective knowledge to advocate for their own children with disabilities and for other families. All participants completed a pre‐survey and post‐survey; only intervention group participants completed a 6‐month follow‐up survey. Results: Compared with 17 wait list control group participants, the 17 intervention group participants demonstrated improvements in special education knowledge, P = 0.002, η2 = 0.32, and self‐mastery, P = 0.04, η2 = 0.15, and decreases in the quality of family–school partnerships, P = 0.002, η2 = 0.32. At the follow‐up survey, intervention group participants demonstrated increases in empowerment, P = 0.04, η2 = 0.29, and special education knowledge, P = 0.02, η2 = 0.38. Conclusions: Implications for research including the need for a randomised controlled trial are discussed; also, practitioners need to evaluate advocacy training programmes regarding their effectiveness. [ABSTRACT FROM AUTHOR]

Objective: The US Department of Agriculture's Summer Food Service Program and Seamless Summer Option (summer nutrition programmes (SNP)) aim to relieve food insecurity for children and teens during summer months. More needs to be known about when and where SNP are available, and how availability varies by community characteristics, particularly in rural areas where food insecurity and reduced food access are more prevalent.Design: The present study examined the geographic availability of SNP and summer meal uptake rates in 2016, using state-wide administrative claims data.Setting: Public schools and SNP in California, USA.ParticipantsSchools (n 8842) and SNP (n 4685).Results: Urban counties were more likely than rural counties to have higher summer uptake rates, calculated as the percentage of summer meals served relative to eligible students utilizing school meal programmes during the academic school year, but uptake overall was low at 18·2 % of target populations. Geographic availability analyses showed that 63·9 % of public urban schools had an SNP available within 1·6 km (1 mile), but availability was significantly higher within the proximity of larger, higher-poverty high schools with diverse or majority non-White students, and those with higher school-year breakfast participation rates. Availability of an SNP within 16 km (10 miles) of rural schools averaged 68·1 % but was significantly higher around larger schools, higher-poverty schools and those with diverse or majority non-White students.Conclusions: While many communities have SNP available, much more work is needed to increase the availability of these programmes to reduce summer food insecurity for children, particularly in rural communities. [ABSTRACT FROM AUTHOR]

Childhood and adolescent obesity are epidemic in the United States. Because of this crisis, schools in our nation have been challenged to develop strategies to decrease the number of overweight and obese youth, with many states passing legislation requiring body mass index (BMI) monitoring by the school. This may be done as a screening or surveillance program depending on the state, with some states requiring notification to parents. As school nurses are often the only health professional in the school, they are typically the employee tasked with leading the BMI screening programs. School nurses, both in states requiring and in states without requirements for BMI screening programs, must be knowledgeable about evidence-based programs and strategies that have promise in reversing the obesity epidemic. Indeed, school nurses are in a position to be an active participant in the fight against the obesity and overweight crisis. [ABSTRACT FROM AUTHOR]

Objectives: Adolescents in the United States face crucial sexual health behavior issues, including consequences of sexually transmitted infections and diseases, pregnancy, and sexual violence. Lesbian, gay, bisexual, and transgender youth are disproportionately affected by these issues. State policies about sex education in K-12 schools shape what is taught to students about sexual health. In this study, we analyzed the content of school-based sex education policies of all 50 states and focuses on sexual behaviors, relationships, and identities. Methods: Policies analyzed include state statutes, state board of education policies, and state department of education or public instruction curriculum standards. Data were analyzed using content analysis. Results: Most state policies emphasized abstinence from sexual behavior and did not require education about contraceptive and barrier methods. Few policies required detailed information about contraceptive and barrier methods to prevent pregnancy and sexually transmitted infections. Around half of states addressed relationship issues (ie, healthy relationships, sexual decision-making, and sexual violence); however, few states required content on communication about sexual consent. Eight state policies explicitly stigmatized homosexuality. Conversely, 12 states were inclusive of diverse sexual orientations and 7 states were inclusive of diverse gender identities. Conclusion: Sex education policies should be evidence-based and inclusive of sexual diversity. [ABSTRACT FROM AUTHOR]

Background: Adolescent substance use has been linked to numerous adverse health, social, and educational outcomes. While there have been intensive resources placed in school-based prevention programs, the association of these policies on prevention outcomes is still unclear. State variation in policies provides an opportunity to assess the influence of school-based prevention programs. Objectives: To examine the association between the strength of state high school-based prevention programing and the prevalence of substance use disorders among adolescents ages 14–17 in the United States. Methods: National Survey on Drug Use and Health (NSDUH) data with state-level identifiers were merged with National Association of State Boards of Education (NASBE) information on school-based prevention policy strength, categorized into "required," "recommended," and "no policy." Unadjusted comparisons and multilevel random intercept linear regression models were estimated to assess the change in rates of substance abuse or dependence from pre- to post- policy implementation, accounting for the nesting of individuals within states. Results: Rates of alcohol and tobacco abuse/dependence were significantly lower in states that required an alcohol prevention curriculum. After covariate adjustment, rates of alcohol abuse/dependence remained significantly lower in those states. Conclusions: Reinforcing alcohol prevention messaging in school appears to have a modest association with decreased rates of adolescent alcohol use disorders, possibly in part due to a different approach to the curriculum. For other substances, policy requirements appear to be less effective in reducing the prevalence of adolescent substance use disorders, suggesting that more targeted messaging with higher-risk students may be required. [ABSTRACT FROM AUTHOR]

As the United States becomes more diverse, the ways in which mainstream institutions recognize and address race and ethnicity will be increasingly important. Here, we show that one novel and salient characteristic of an institutional environment, that is, whether a school emphasizes the value of racial and ethnic diversity, predicts better cardiometabolic health among adolescents of color. Using a diverse sample of adolescents who attend more than 100 different schools in predominantly urban locations, we find that when schools emphasize the value of diversity (operationalized as mentioning diversity in their mission statements), students of color, but not white students, have lower values on a composite of five biomarkers of inflammation, have less insulin resistance and compensatory β-cell activity, and have fewer metabolic syndrome signs and score lower on a continuous metabolic syndrome composite. These results suggest that institutions that emphasize diversity may play an unacknowledged role in protecting the health of people of color and, thus, may be a site for future interventions to reduce health disparities. [ABSTRACT FROM AUTHOR]

Children and adolescents can engage in an active lifestyle by walking to school; however, several barriers may limit this behavior. This study estimates the prevalence of walking to school and related barriers as reported by U.S. parents. Data from the 2017 SummerStyles, a Web-based survey conducted on a nationwide sample of U.S. adults, were analyzed in 2017. Parents of children aged 5-18 years (n = 1137) were asked whether their youngest child walked to or from school during a usual school week and what barriers make this difficult. Frequencies are presented overall and by parent characteristics. About 1 in 6 parents (16.5%) reported their youngest child walks to or from school at least once during a usual week. Prevalence differed by parental race/ethnicity, marital status, region, and distance from school. The most common barrier was living too far away (51.3%), followed by traffic-related danger (46.2%), weather (16.6%), "other" barrier (14.7%), crime (11.3%), and school policy (4.7%). The frequency at which parents reported certain barriers varied by their child's walking status, distance to school, age of youngest child, race/ethnicity, education level, household income, and metropolitan statistical area status. However, the relative ranking of barriers did not differ by these characteristics. Prevalence of walking to school is low in the U.S., and living too far away and traffic-related danger are common barriers reported by parents. Implementing Safe Routes to School programs and other initiatives that utilize strategies to overcome locally-relevant barriers could help increase the prevalence of children walking to school. [ABSTRACT FROM AUTHOR]

Aim: The aim of the study is to evaluate the prevalence of dental caries and dental fluorosis among the school going children in Mahabubnagar district, and also to assess F- levels in drinking water from different areas of Mahabubnagar district. Materials and Methods: The study was carried out in 2,000 children of age group 6–12 years. The dental caries status was assessed by Decayed/missed filled tooth (DMFT)/deft index using WHO criteria 1997 and dental fluorosis status using Modified Dean's fluorosis index. Alizarin visual method was used to estimate F levels in water. Statistical Analysis: All data entered to an SPSS (18) program (IBM Corporation, Chicago, USA); both descriptive and analytic approaches were used in the data analysis. The correlation of deft with different F- levels using ANOVA test. The P < 0.005 was considered statistically significant. Results: The prevalence of dental caries in primary teeth and permanent dentition was 64.2% and 26.6%, respectively. Indicating that dental caries was more among 7–8 years old children and less in 11–12 years old children (P > 0.005). Dental fluorosis in primary dentition was 15% and 70.3% in the permanent dentition; it was more in 9–10-year-old children and less in 6-year-old children. Conclusion: The dental caries and dental fluorosis were more in Northern, Eastern region of Mahabubnagar district, whereas dental caries and dental fluorosis were less in local villages of Mahabubnagar district. The F- content in Northern, Eastern zone of Mahabubnagar district was about 2 mg/l, whereas in local villages of Mahabubnagar is 1.2 mg/l. [ABSTRACT FROM AUTHOR]

Purpose: To examine trends in single, dual, and polytobacco use between 2014-2020 for US youth and to identify disparities in these trends by grade level, sex, and race/ethnicity., Design: A secondary analysis of the National Youth Tobacco Survey (NYTS)., Subjects: A total of 122 566 students., Measures: Past 30-day exclusive use of cigarettes, e-cigarettes, other combustibles (cigars, little cigars, cigarillos, hookah, pipe tobacco, bidis) and smokeless tobacco (snus, smokeless, dissolvable); dual use of each product with e-cigarettes; polyuse with e-cigarettes; dual/polyuse without e-cigarettes., Analysis: Multivariable modified Poisson regression., Results: Compared to 2014, exclusive e-cigarette use (APR = 2.51, 95% CI: 1.96, 3.21) trended upward while exclusive cigarette (APR = .34, 95% CI: .23, .50), 'other' combustibles (APR = .47, 95% CI: .37, .58), and smokeless tobacco (APR = .40, 95% CI: .25, .65) use trended downward in 2020. Polytobacco use with and without e-cigarettes trended downward in 2020 compared to 2014. We also saw differences in trends across sociodemographic groups. Comparing 2020 to 2014, exclusive e-cigarette use was higher for females than males, 'other' combustible tobacco use remained stable for Non-Hispanic Black students but decreased for other racial/ethnic groups, and dual e-cigarette/cigarette use trended upward more for middle school students than high school students., Conclusions: Despite decreased trends in tobacco product use without e-cigarettes between 2014-2020, differences in tobacco product use trends by grade level, sex, and race/ethnicity were identified. Prevention efforts targeting disparities in tobacco product use are needed., Competing Interests: Declaration of Conflicting InterestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

The influence of individual macro- and micronutrients on absenteeism in the United States is largely unknown. The objective of this study was to determine whether nutritional status or nutrient intake were associated with absenteeism from school and work due to illness or injury. Data from NHANES 2003-2008 were used to assess nutrient intake from food and food plus supplements, nutritional biomarker levels, and school and work absenteeism per year in children and adults. Negative binomial regression models were used to predict mean days of missed work per year and to estimate incidence rate ratios (IRRs) of absenteeism by nutrient biomarker status. Of 7429 children, 77% reported missing school days (mean 4.0 days). Of 8252 adults, 51% reported missing work days (mean 4.9 days). Children and adults who reported more absent days had a significantly lower intake of protein and several essential micronutrients from the diet. When nutrients from supplements were included, this negative association was retained for protein, selenium, choline, and DHA in children and for protein, selenium, vitamin K, choline, potassium, fiber, octadecatrienoic acid, and lycopene in adults. Future studies are needed to ascertain whether dietary interventions, such as access to healthier food options and/or dietary supplements, can reduce absenteeism.