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Ongoing education on sexual health and other health promotion topics is critical as young people transition into adulthood. A booster round of education may be an effective strategy to reinforce information previously taught and expand to additional topics relevant later in adolescence. In partnership with a Youth Advisory Council, we co-designed READY, Set, Go!, a booster curriculum for older adolescents with modules covering adult preparation skills, sexual identity, relationships, reproductive health, and mental health. From November 2021 to January 2023, we provided the curriculum to 21 cohorts of 12th grade students (N = 433) in rural communities of Fresno County, CA, and conducted an implementation evaluation to assess its feasibility in school settings, acceptability by participants, and changes in short-term outcomes. Health educators completed implementation logs to track program adaptations. Youth completed pretest/posttest surveys to assess changes in outcomes and participant satisfaction. We used descriptive statistics to examine program adaptations and satisfaction. We used multivariable regression models to examine changes in outcomes, adjusted for sociodemographic characteristics. Health educators completed most activities as planned, with adaptations occurring in response to youth needs and scheduling limitations. Sexual health knowledge, confidence in adult preparation skills, awareness of local sexual and mental health services, and willingness to seek health services all increased significantly from pretest to posttest. Youth feedback was strongly positive. We conclude that booster sexual health education is a promising strategy to address critical knowledge gaps and support health promotion, especially in rural and other under-resourced communities.

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]

The professional experiences of school nurses who work outside of urban areas are not often described. We used data from a 2019 statewide survey of school nurses to describe differences between the urban and non-urban (urban cluster and rural) school nurse workforce in New Mexico. Non-urban school nurses were twice as likely as urban nurses to provide clinical services to multiple school campuses (P <.001) and more likely to serve both elementary and secondary school settings (P =.002). They were less likely than urban school nurses to be bachelor's prepared, or to have received recent continuing education on diabetes (P <.001), reproductive health (P = 0.02), LGBQ+ and transgender student health (P <.001, for each), and suicide risk assessment and screening (P =.012). Our findings underscore concerns about geographic differences in the school nursing workforce in terms of educational preparation and student access that could potentially limit the school nurse role in advancing child health equity. [ABSTRACT FROM AUTHOR]

Many school nurses experienced increased work burden and stress during the COVID-19 pandemic. This analysis examined data from a Centers for Disease Control and Prevention cross-sectional, nationwide survey of school nurses in March 2022 to examine associations between school nurses' ability to conduct their core responsibilities and selected nurse and school factors among school nurses during the 2021–2022 school year and COVID-19 pandemic. Perceived adequate staffing and financial compensation reduced the odds of reported difficulties across all core school nursing tasks. Nurses without a registered nurse license and with higher caseloads were more likely to report difficulty in implementing specific tasks. The impact of these factors varied, with inadequate financial compensation having the largest association with school nurses' difficulty implementing all the core responsibilities. The study results improve our understanding of school nurses' challenges in implementing core school nursing responsibilities during the COVID-19 pandemic in the 2021–2022 school year. [ABSTRACT FROM AUTHOR]

School nurses are pivotal to the safety of school-aged children, particularly those who receive medications in the school setting. The purpose of this study was to explore factors associated with medication administration errors in North Carolina school districts between 2012/2013 and 2017/2018. A longitudinal study using repeated measures analysis of school health services data collected in the North Carolina Annual School Health Services and Programs Survey was conducted. Over time, the number of medication errors (p =.001) and number of medication corrective action plans (p <.0001) trended upwards. There was also an increase in medication errors when the number of schools in a district was higher (p <.0001). Conversely, there was a decrease in corrective action plans when school nurses were directly employed by the school district (p =.0471). We implore school disticts to consider the important role of school nurses to keep kids safe, healthy, and ready to learn. [ABSTRACT FROM AUTHOR]

School nurses are critical components of school-based interdisciplinary teams supporting student behavioral health. The purpose of the present study is to understand the extent to which school nurses in New Mexico across grade levels manage emergencies related to behavioral health, violence, and trauma. The study also seeks to identify which topics the school nurses received continuing education (CE) for, and which topics they consider to be important to their practice. Analyses of 2019 statewide survey data show a considerable number of school nurses in New Mexico provide management for behavioral health, violence, and trauma-related emergencies, and nurses in secondary schools are significantly more likely than nurses in primary schools to report managing these emergencies and to have received CE on behavioral health topics. Our findings reaffirm the essential role of school nurses in addressing emergent student health issues and underscore the need for practice- and competency-based behavioral health CE opportunities. [ABSTRACT FROM AUTHOR]

Despite improvements in the awareness and acceptance of lesbian, gay, bisexual, transgender, queer, and other sexual and gender diverse (LGBTQ+) individuals, the LGBTQ+ community continues to experience discrimination, which can result in adverse health outcomes. In particular, LGBTQ+ youth have an increased risk of experiencing depression, substance abuse, and suicide. Societal stigma and rejection, bullying, and familial disapproval all contribute to these health disparities. In recognition of these inequities, an interprofessional team of biomedical faculty members, staff, and trainees from the Louisiana State University Health Science Center (LSUHSC) in New Orleans developed the needs-assessment evaluation, the Gender and Sexual Minority Youth Outreach Survey (GSMYO) for high school students. Health science centers have access to resources and experienced personnel who can provide support and education to high school students, teachers, and administrative staff. However, it is important to first determine the high schools' specific needs, attitudes towards LGBTQ+ acceptance, and their current resources. Faculty, staff, and trainees from the LSUHSC Science Youth Initiative (SYI) and the LSUHSC LGBTQ+ Organization, Tiger Pride, administered the short, anonymous survey to adolescents attending Southeast Louisiana high schools. English Language Learner (ELL) students received the survey in Spanish. Results from the GSMYO needs-assessment survey are presented. Other health science centers may adapt the presented survey to develop needs-based LGBTQ+ high school programs to address the educational and health inequities in their own communities, regardless of location or demographic region. [ABSTRACT FROM AUTHOR]

Background: School-based water, sanitation and hygiene (WASH) may improve the health and attendance of schoolchildren, particularly post-menarcheal girls, but existing evidence is mixed. We examined the impact of an urban school-based WASH programme (Project WISE) on child health and attendance. Methods: The WISE cluster-randomised trial, conducted in 60 public primary schools in Addis Ababa, Ethiopia over one academic year, enrolled 2–4 randomly selected classes per school (~ 100 pupils) from grades 2 to 8 (aged 7–16) in an 'open cohort'. Schools were assigned 1:1 by stratified randomisation to receive the intervention during the 2021/2022 or the 2022/2023 academic year (waitlist control). The intervention included improvements to drinking water storage, filtration and access, handwashing stations and behaviour change promotion. Planned sanitation improvements were not realised. At four unannounced classroom visits post-intervention (March–June 2022), enumerators recorded primary outcomes of roll-call absence, and pupil-reported respiratory illness and diarrhoea in the past 7 days among pupils present. Analysis was by intention-to-treat. Results: Of 83 eligible schools, 60 were randomly selected and assigned. In total, 6229 eligible pupils were enrolled (median per school 101.5; IQR 94–112), 5987 enrolled at study initiation (23rd November–22nd December 2021) and the remaining 242 during follow-up. Data were available on roll-call absence for 6166 pupils (99.0%), and pupil-reported illness for 6145 pupils (98.6%). We observed a 16% relative reduction in odds of pupil-reported respiratory illness in the past 7 days during follow-up in intervention vs. control schools (aOR 0.84; 95% CI 0.71–1.00; p = 0.046). There was no evidence of effect on pupil-reported diarrhoea in the past 7 days (aOR 1.15; 95% CI 0.84–1.59; p = 0.39) nor roll-call absence (aOR 1.07; 95% 0.83–1.38; p = 0.59). There was a small increase in menstrual care self-efficacy (aMD 3.32 on 0–100 scale; 95% CI 0.05–6.59), and no evidence of effects on other secondary outcomes. Conclusions: This large-scale intervention to improve school WASH conditions city-wide had a borderline impact on pupil-reported respiratory illness but no effect on diarrhoeal disease nor pupil absence. Future research should establish relationships between WASH-related illness, absence and other educational outcomes. Trial registration: ClinicalTrials.gov, number NCT05024890. [ABSTRACT FROM AUTHOR]

Informed by the social ecological model, which asserts that health behaviors and beliefs are the result of multiple levels of influence, we examined factors related to parents' support for in-school COVID-19 mitigation strategies. Using data from a survey of 567 parents/caregivers of public elementary and middle school students in eight Maryland counties, we employed regression models to examine relationships between parent-, child-, family-, school-, and community-level factors and acceptability of mitigation strategies. Acceptance of COVID-19 mitigation strategies was positively correlated with child- and family-level factors, including child racial identity (parents of Black children were more accepting than those of White children, odds ratio [ OR ]: 2.5, 95% confidence interval [CI] = [1.5, 4.1]), parent receipt of the COVID-19 vaccine (OR : 2.4, 95% CI = [1.5, 3.7]), and parent Democrat or Independent political affiliation (compared with Republican affiliation, OR : 4.2, 95% CI = [2.6, 6.7]; OR : 2.2, 95%CI = [1.3, 3.8], respectively). Acceptance was also positively associated with parents' perceptions of their school's mitigation approach, including higher school mitigation score, indicating more intensive mitigation policies (OR : 1.1, 95% CI = [1.0, 1.1]), better school communication about COVID-19 (OR : 1.7, 95% CI = [1.4, 1.9]) and better school capacity to address COVID-19 (OR : 1.9, 95% CI = [1.5, 2.4]). Community-level factors were not associated with acceptance. Child- and parent-level factors identified suggest potential groups for messaging regarding mitigation strategies. School-level factors may play an important role in parents' acceptance of in-school mitigation strategies. Schools' capacity to address public health threats may offer an underappreciated and modifiable setting for disseminating and reinforcing public health guidance. [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]

Peer bullying is widely observed across the world and continues to grow. Peer-bullying children and children exposed to peer bullying often display a fall in academic achievements, an increase in psychiatric problems, and problematic relationships with their parents. This study was conducted to identify the effects of demographic, health-related, and school-related characteristics in school-age children, including their grade, academic success, and status of liking their school, on their peer-bullying tendencies. This study was carried out as a cross-sectional study. The study was conducted in September–November 2023 with sixth- and seventh-grade students at four middle schools in Turkey. The sample size was calculated as 750 in a 95% confidence interval and with a 5% margin of error. The data were collected using a Health-Related Descriptive Characteristics Form and the Swearer Bullying Scale. Children who were seventh-grade students, those who had a family income above expenses, those who were obese, those who perceived their health status as good, those who had low academic achievement, and those who stated that they did not like their school had higher peer bullying tendencies (p < 0.05). In the multiple linear regression analysis, self-perceived health status, grade level, and academic achievement status were identified as factors that significantly affected the peer bullying tendencies of the children, and these factors explained 26.3% of the total variance in these tendencies. Self-perceived health status, grade level, and academic achievement status significantly affected the peer bullying tendencies of school children. To prevent peer bullying and mitigate its negative effects, it is extremely important that school nurses periodically identify the peer bullying tendencies of school children and associated factors. • Peer bullying is affected by health status, grade level and academic success. • School nurses have important responsibilities to prevent peer bullying and minimize its negative effects. [ABSTRACT FROM AUTHOR]

Background: Oral problems are a common occurrence among school-age children. In order to develop effective oral health interventions and services, it is essential to determine children's oral health behaviours using an internationally accepted standardised instrument that is child-friendly. However, no instrument currently exists to measure oral health according to the Theory of Planned Behaviour (TPB) in Turkish school-aged children. The aim of this study was to investigate the psychometric properties of the Oral Health Questionnaire, which includes the components of the theory of planned behavior such as attitude toward children's oral health, subjective norm, perceived behavioral control, and self-efficacy, for the Turkish population. Methods: This was a methodological–descriptive–correlational study conducted on 298 school children aged 9–10 years. Data were collected using The Oral Health Questionnaire. The data were evaluated using explanatory and confirmatory factor analysis, Cronbach's alpha, item-total score correlation, and Pearson product-moment correlation analysis. Results: Factor analysis confirmed the five-dimensional structure. The factor loads were greater than 0.30, and all fit indices were greater than 0.90. The model consistency indexes were found to be X2 = 146.95, RMSEA = 0.053, GFI = 0.94, CFI = 0.98, IFI = 0.97, and NNFI = 0.97. The Cronbach's alpha values of its sub-dimensions were 0.71 and 0.80. Conclusions: The Turkish version of Oral Health Questionnaire is considered a reliable and valid instrument that can be used by professionals to determine children's attitudes, subjective norms, perceived behavioral control, and oral and dental health intentions toward tooth brushing. [ABSTRACT FROM AUTHOR]

Background: Since no specific environmental cleaning instructions and methods have been developed for schools to tackle pandemics, and cleaning methods, this study aims to investigate the feasibility of a new effective school cleaning protocol in reducing the environmental contamination in kindergarten and primary school settings. Methods: This study implemented a cluster randomized controlled trial with three-arms, namely two intervention arms - groups A and B, and one control arm – group C. The first intervention arm included the cleaning staff who would participate in an educational workshop and be equipped with disposable wipes, while the second arm, group B, participated in the educational workshop only. The third arm, group C, received no treatments. Results: 1080 sample points were collected from pre-determined sites in the study within the 6 schools. At the 2-week follow-up post-intervention assessment, all sites were found to be clean for group A that used disposable wipes, while group B, without disposable wipes, were found to have left more sites contaminated. Staphylococcus aureus was found in the sites cleaned by group C. Conclusion: Based on the findings in this pilot study, a further study at a larger scale focusing on the education program with enhancement and use of the cleaning protocol can be conducted to train cleaning staff for effective environmental cleaning in a school setting. [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: Students in school are more likely to be sick from communicable diseases like diarrheal illnesses, acute respiratory infections, and other illnesses linked to poor personal hygiene. Poor hygiene practices are common among school children and put their health at risk, which in turn has several consequences. These include significant school absences, transmission of infectious diseases to other students, and missed workdays for parents and guardians. However, there is limited evidence on the level of personal hygiene practice and its associated factors among school students. Thus, this study was aimed at determining personal hygiene practice level and its associated factors among elementary school grade (5–8) students in Fiche town, Oromia, Ethiopia, in 2022. Methods: A cross-sectional study design was conducted from April 29 to May 29, 2022, in Fiche town, Oromia regional state, among 534 elementary school students. A multi-stage probability sampling technique was used to select the individual students. A structured questionnaire was used to collect the data. The data was entered into epi-data version 4.6 and analyzed by SPSS version 26.0. Variables that scored a p-value less than 0.2 during bivariate analysis were included in multilevel logistic regression models to determine factors associated with personal hygiene practice. The odds ratio with a 95% confidence interval was estimated, and the level of significance was set at 0.05. Results: The magnitude of good personal hygiene (scored above the mean) was 59.2% (95% confidence interval (CI)) (55.1–63.0). A considerable proportion of students scored more than 50% in latrine use (62.5%), regular hand-washing (55.4%), and oral hygiene (55.20%) practices. Being female, having good personal hygiene knowledge, doing hygiene inspections at school, and having latrine accessibility was significantly associated with good personal hygiene among elementary school students. Conclusion: Considerable proportion of elementary school students in Fiche town have score poor personal hygiene practice. Interventions aimed that target improving knowledge of personal hygiene and hygiene inspection at school are crucial to enhance the personal hygiene among elementary school students. [ABSTRACT FROM AUTHOR]

This qualitative descriptive study explored school nurses' experiences of exposure to reports of trauma from those in their care. Online interviews of school nurses practicing in NJ, USA, were recorded and transcribed verbatim. The study found that school nurses were exposed to reports of others' trauma to varying degrees, with those serving in urban settings reporting more stories of exposure than those in suburban settings. Reports included numerous, layered traumas at the community and individual levels, including students' poverty-related adversity and psychological distress. Qualitative content analysis revealed four categories: Health Office as Safe Haven, Challenges Working Within the School Model, Things That We Hear: Reports of Trauma, and The Ripple Effect of Trauma. School-based challenges included a lack of collaboration, misunderstanding of the school nurse's role, and workload issues such as competing demands and limited time and resources. School nurses reported focusing on the individual's immediate needs and processing the experience afterward. They acknowledged they can only do so much, and shared stories of coping and resilience. Additional education, resources, and support in addressing student trauma can enhance the provision of school nursing services and support the well-being of school nurses, students, and staff. Further research is warranted with a larger and more diverse sample of school nurses, including attention to school nurse wellness and resilience strategies. [ABSTRACT FROM AUTHOR]

A three-wave prospective study was conducted to provide a better understanding of the ability of the integrated model of self-determination theory (SDT) and the theory of planned behavior (TPB) to predict future physical activity (PA) engagement among adolescents. Nearly 2500 secondary school students from China were recruited to test the hypothesized pathway from autonomous motivation from SDT at baseline (T1) through the constructs of TPB one month later (T2) on leisure-time PA levels of secondary school students three months later (T3). The findings revealed that the structural equation models yielded excellent fit indices with χ2 = 1858.989, df = 257, CFI = 0.936, TLI = 0.926, RMSEA = 0.050 [90% CI = 0.048 to 0.052], and SRMR = 0.032. In particular, autonomous motivation at T1 was positively associated with attitude (R2 = 0.160), subjective norms (R2 = 0.160), and perceived behavioral control (PBC) (R2 = 0.173) at T2 (β = 0.395 to 0.414, p < 0.001) and subsequently associated with intention at T2 (R2 = 0.875, β = 0.112 to 0.478, p < 0.001). T2 intention was positively associated with leisure-time PA levels (R2 = 0.004) at T3. Our findings contribute to a better understanding of the motivational mechanisms and social cognition processes involved in predicting adolescents' leisure-time PA levels among adolescents. [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]

This study aimed to describe the profile and practices of school nurses working at a network of educational centers in Spain. This was a descriptive study of the documented actions of 107 school nurses between September 2018 and June 2021 in 54 educational centers (55.6% private and 44.4% subsidized). The profile of the school nurses was young (average age 33.8 [standard deviation (SD) = 7.7] years) and predominantly female (91.6%) with a diverse and multidisciplinary education, primarily at the postgraduate level (specialized mainly in emergency care, nursing/school health, and pediatrics/neonatology). They carried out 256,499 interventions. The most frequent types of incidents they treated were accidents (30.4%) and disease-related episodes (22.2%). The interventions were usually brief (average time 7.7 min) and were resolved by the school nurse (99.1%), and the main recipients were students (87.3%). The highest incidence of interventions occurs during breaks between classes. Acute interventions occupied most of the school nurses' time, leaving little opportunity for health education (0.3%). School nurses played an important role in preserving and promoting the health of school populations and cost-savings to healthcare systems with the actions that they performed. Descriptions of these actions are essential when advocating for the continuation and expansion of school nursing services. [ABSTRACT FROM AUTHOR]

Abstract Background School-based water, sanitation and hygiene (WASH) may improve the health and attendance of schoolchildren, particularly post-menarcheal girls, but existing evidence is mixed. We examined the impact of an urban school-based WASH programme (Project WISE) on child health and attendance. Methods The WISE cluster-randomised trial, conducted in 60 public primary schools in Addis Ababa, Ethiopia over one academic year, enrolled 2–4 randomly selected classes per school (~ 100 pupils) from grades 2 to 8 (aged 7–16) in an ‘open cohort’. Schools were assigned 1:1 by stratified randomisation to receive the intervention during the 2021/2022 or the 2022/2023 academic year (waitlist control). The intervention included improvements to drinking water storage, filtration and access, handwashing stations and behaviour change promotion. Planned sanitation improvements were not realised. At four unannounced classroom visits post-intervention (March–June 2022), enumerators recorded primary outcomes of roll-call absence, and pupil-reported respiratory illness and diarrhoea in the past 7 days among pupils present. Analysis was by intention-to-treat. Results Of 83 eligible schools, 60 were randomly selected and assigned. In total, 6229 eligible pupils were enrolled (median per school 101.5; IQR 94–112), 5987 enrolled at study initiation (23rd November–22nd December 2021) and the remaining 242 during follow-up. Data were available on roll-call absence for 6166 pupils (99.0%), and pupil-reported illness for 6145 pupils (98.6%). We observed a 16% relative reduction in odds of pupil-reported respiratory illness in the past 7 days during follow-up in intervention vs. control schools (aOR 0.84; 95% CI 0.71–1.00; p = 0.046). There was no evidence of effect on pupil-reported diarrhoea in the past 7 days (aOR 1.15; 95% CI 0.84–1.59; p = 0.39) nor roll-call absence (aOR 1.07; 95% 0.83–1.38; p = 0.59). There was a small increase in menstrual care self-efficacy (aMD 3.32 on 0–100 scale; 95% CI 0.05–6.59), and no evidence of effects on other secondary outcomes. Conclusions This large-scale intervention to improve school WASH conditions city-wide had a borderline impact on pupil-reported respiratory illness but no effect on diarrhoeal disease nor pupil absence. Future research should establish relationships between WASH-related illness, absence and other educational outcomes. Trial registration ClinicalTrials.gov, number NCT05024890.

Abstract Background Oral problems are a common occurrence among school-age children. In order to develop effective oral health interventions and services, it is essential to determine children's oral health behaviours using an internationally accepted standardised instrument that is child-friendly. However, no instrument currently exists to measure oral health according to the Theory of Planned Behaviour (TPB) in Turkish school-aged children. The aim of this study was to investigate the psychometric properties of the Oral Health Questionnaire, which includes the components of the theory of planned behavior such as attitude toward children's oral health, subjective norm, perceived behavioral control, and self-efficacy, for the Turkish population. Methods This was a methodological–descriptive–correlational study conducted on 298 school children aged 9–10 years. Data were collected using The Oral Health Questionnaire. The data were evaluated using explanatory and confirmatory factor analysis, Cronbach's alpha, item-total score correlation, and Pearson product-moment correlation analysis. Results Factor analysis confirmed the five-dimensional structure. The factor loads were greater than 0.30, and all fit indices were greater than 0.90. The model consistency indexes were found to be X2 = 146.95, RMSEA = 0.053, GFI = 0.94, CFI = 0.98, IFI = 0.97, and NNFI = 0.97. The Cronbach's alpha values of its sub-dimensions were 0.71 and 0.80. Conclusions The Turkish version of Oral Health Questionnaire is considered a reliable and valid instrument that can be used by professionals to determine children's attitudes, subjective norms, perceived behavioral control, and oral and dental health intentions toward tooth brushing.

Abstract Background Since no specific environmental cleaning instructions and methods have been developed for schools to tackle pandemics, and cleaning methods, this study aims to investigate the feasibility of a new effective school cleaning protocol in reducing the environmental contamination in kindergarten and primary school settings. Methods This study implemented a cluster randomized controlled trial with three-arms, namely two intervention arms - groups A and B, and one control arm – group C. The first intervention arm included the cleaning staff who would participate in an educational workshop and be equipped with disposable wipes, while the second arm, group B, participated in the educational workshop only. The third arm, group C, received no treatments. Results 1080 sample points were collected from pre-determined sites in the study within the 6 schools. At the 2-week follow-up post-intervention assessment, all sites were found to be clean for group A that used disposable wipes, while group B, without disposable wipes, were found to have left more sites contaminated. Staphylococcus aureus was found in the sites cleaned by group C. Conclusion Based on the findings in this pilot study, a further study at a larger scale focusing on the education program with enhancement and use of the cleaning protocol can be conducted to train cleaning staff for effective environmental cleaning in a school setting.

Abstract Background Students in school are more likely to be sick from communicable diseases like diarrheal illnesses, acute respiratory infections, and other illnesses linked to poor personal hygiene. Poor hygiene practices are common among school children and put their health at risk, which in turn has several consequences. These include significant school absences, transmission of infectious diseases to other students, and missed workdays for parents and guardians. However, there is limited evidence on the level of personal hygiene practice and its associated factors among school students. Thus, this study was aimed at determining personal hygiene practice level and its associated factors among elementary school grade (5–8) students in Fiche town, Oromia, Ethiopia, in 2022. Methods A cross-sectional study design was conducted from April 29 to May 29, 2022, in Fiche town, Oromia regional state, among 534 elementary school students. A multi-stage probability sampling technique was used to select the individual students. A structured questionnaire was used to collect the data. The data was entered into epi-data version 4.6 and analyzed by SPSS version 26.0. Variables that scored a p-value less than 0.2 during bivariate analysis were included in multilevel logistic regression models to determine factors associated with personal hygiene practice. The odds ratio with a 95% confidence interval was estimated, and the level of significance was set at $$\:\le\:$$ 0.05. Results The magnitude of good personal hygiene (scored above the mean) was 59.2% (95% confidence interval (CI)) (55.1–63.0). A considerable proportion of students scored more than 50% in latrine use (62.5%), regular hand-washing (55.4%), and oral hygiene (55.20%) practices. Being female, having good personal hygiene knowledge, doing hygiene inspections at school, and having latrine accessibility was significantly associated with good personal hygiene among elementary school students. Conclusion Considerable proportion of elementary school students in Fiche town have score poor personal hygiene practice. Interventions aimed that target improving knowledge of personal hygiene and hygiene inspection at school are crucial to enhance the personal hygiene among elementary school students.

Background: Physical education (PE) classes in schools are considered relevant to implement interventions, especially focused on physical activity. However, evidence overviews on how PE classes contribute to general health (physical, social, affective, and cognitive domains) are still needed. Thus, we summarized evidence synthesis (eg, systematic reviews) that addressed the contribution of PE classes to the health of school-aged children and adolescents. Methods: We performed a scoping review with searches in 8 databases and institutional websites to find systematic reviews or meta-analyses that answered this review's research question. Data charting form included the identification of the study, health outcomes, and PE classes' strategies (policies and environment, curriculum, appropriate instructions, and evaluation). An interactive process was performed to build the evidence summary. Results: An initial search yielded 2264 titles, and 49 systematic reviews (including 11 with meta-analysis) were included in this review. Most documents reported the main benefits of PE classes on physical domain outcomes (eg, physical activity, cardiorespiratory fitness, body mass index, and fundamental motor skills). However, evidence on the benefits of PE classes in affective (eg, enjoyment, motivation, and autonomy); social (eg, cooperation, problem-solving, and making friends); and cognitive (eg, memory, attention, concentration, and decision making) domains were found. Strategies on PE classes for health benefits were highlighted. Conclusions: These elements were detailed in the evidence summary, which may be considered to guide researchers, teachers, and practitioners to define research and practice priorities on PE class interventions for health in the school context. [ABSTRACT FROM AUTHOR]

Background: Active commuting to school (ACS) can be an important source of physical activity for children. Schools are an important setting for policy-related ACS promotion. The purpose of this study was to examine the association between school policies and ACS, and to assess whether this relation varied by grade. Methods: This cross-sectional study used data from schools recruited to the Safe Travel Environment Evaluation in Texas School study (n = 94). The percent of trips made by active travel modes was measured through tallies among third to fifth grade classrooms from 5 school districts in Central Texas in 2018–2019. School ACS policies and practices were measured through 8 survey items aggregated into a score. Linear mixed effects models were used to assess the association between policies and ACS. Results: School health policy surveys and ACS data were collected from 69 elementary schools. An average of 14.6% of trips to/from school was made using active travel modes. Schools with higher numbers of policies had significantly higher percentages of students using active travel modes (P =.03), and for each additional policy, the predicted percentage of trips made by active travel modes was 1.46% higher. There was a significant interaction effect between school policy and grade, with stronger correlations among higher grades (P =.002). Conclusions: Results from this study demonstrate a correlation between the school policies designed to support walking and biking and ACS. Results from this study can be used to justify the use of school-based policy interventions to promote ACS. [ABSTRACT FROM AUTHOR]

Background: Many school-based physical activity statutes and regulations have been enacted, with the expectation that schools will comply. However, policy alone does not equate to implementation, and many policies fail for a variety of reasons. The purpose of the study was to determine whether the strength of reported state, district, and school-level physical activity policies were associated with reported recess, physical education, and other school-based physical activity practices at elementary schools in Arizona. Methods: A modified Comprehensive School Physical Activity Program (CSPAP) Questionnaire was administered to staff at elementary schools across Arizona (N = 171). Summative indices of the number of school physical activity policies and best practices at the state, district, and school levels were created. Relationships between policy strength and best practices were examined using linear regression analyses stratified by recess, physical education, and other school-based physical activity practices. Results: Stronger physical activity-related policies were associated with a greater number of recess (F1,142 = 9.87, P <.05), physical education (F4,148 = 4.58, P <.05, Adj. R2 =.09), and other school-based physical activity (F4,148 = 4.04, P <.05, Adj. R2 =.07) best practices at all levels while controlling for school-level demographic factors. Conclusions: The strength of policies may improve opportunities for comprehensive physical activity for children in schools. Strengthening policy language (eg, specifying duration and frequency) may contribute to better physical activity practices in schools, improving children's health at the population level. [ABSTRACT FROM AUTHOR]

School recess is an evidence-backed approach to increase school-based opportunities for students to play, accrue necessary physical activity, and socialize with peers, to the benefit of their physical, academic, and socioemotional health. As such, the Centers for Disease Control recommend at least 20 min of daily recess in elementary schools. However, unequal provision of recess contributes to persistent health and academic disparities for students, which remain to be addressed. We analyzed data from the 2021-22 school year from a sample of low-income (Supplemental Nutrition Assistance Program Education-eligible) elementary schools (n = 153) across California. Just 56 % of schools reported providing more than 20 min of recess daily. Differences in daily recess provision were apparent, with students in larger and lower-income schools receiving less daily recess than students in smaller and higher income schools. These findings support the enactment of legislation mandating health-sufficient daily recess in California elementary schools. They also highlight the importance of, and need for, annually-collected data sources to enable monitoring of recess provision, and potential disparities, over time, in order to assist in identifying additional interventions to address this public health problem.

Population-level surveillance of student weight status (particularly monitoring students with a body mass index (BMI) ≥95th percentile) remains of public health interest. However, there is mounting concern about objectively measuring student BMI in schools. Using data from the nations largest school district, we determined how closely students self-reported BMI approximates objectively-measured BMI, aggregated at the school level, to inform decision-making related to school BMI measurement practices. Using non-matched data from n = 82,543 students with objective height/weight data and n = 7676 with self-reported height/weight from 84 New York City high schools (88% non-white and 75% free or reduced-price meal-eligible enrollment), we compared school-level mean differences in height, weight, BMI, and proportion of students by weight status, between objective and self-reported measures. At the school-level, the self-reported measurement significantly underestimated weight (-1.38 kg; 95% CI: -1.999, -0.758) and BMI (-0.38 kg/m2; 95% CI: -0.574, -0.183) compared to the objective measurement. Based on the objective measurement, 12.1% of students were classified as having obesity and 6.3% as having severe obesity (per CDC definition); the self-report data yielded 2.5 (95% CI: -1.964, -0.174) and 1.4 (95% CI: -2.176, -0.595) percentage point underestimates in students with obesity and severe obesity, respectively. This translates to 13% of students with obesity and 21% of students with severe obesity being misclassified if using self-reported BMI. School-level high school students self-reported data underestimate the prevalence of students with obesity and severe obesity and is particularly poor at identifying highest-risk students based on BMI percentile.

Bring Change 2 Mind (BC2M) high school clubs may destigmatize mental illness among club members, but clubs (1) reach and impact on non-club members at the same school, (2) connection to student help-seeking attitudes, and (3) mechanisms by which they destigmatize mental illness, are unknown. This community-partnered evaluation involved pre/post surveys of predominantly Latino (72%) students at three urban public schools and focus groups and interviews with a sample of club members (n = 26/65, 40%) and all club staff (n = 7, 100%). Multivariate regressions tested relationships between variables. In 84% of the student body responded in the Fall (n = 1,040) and Spring (n = 1,031). Non-club member engagement in BC2M (reach) increased from 25% (Fall) to 44% (Spring) (p < .01). Engagement with BC2M clubs was associated with decreased stigma among members (p < .05) but not non-members (p = .19). Decreased stigma was associated with help-seeking attitudes (p < .01). Possible BC2M mechanisms identified by students and staff include the following: (1) fostering a positive campus climate, (2) normalizing mental health discussions, (3) increasing peer support and help-seeking, and (4) increasing awareness of positive coping behaviors. While BC2M clubs likely reduce stigma for members, effects did not reach non-members, challenging the potential of BC2M clubs as a schoolwide strategy to destigmatize mental health services. Future projects could investigate how to reach non-BC2M members, complement BC2M with other school climate interventions to increase impact, and measure BC2M impact alongside other outcomes relevant to schools, such as academic achievement.

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]

Background: The School health programme is designed to promote the optimal physical, emotional, social and educational development of students. Teachers play a major role in the promotion and successful implementation of the Programme. Objective: To determine and compare teachers knowledge, attitude and practice of the school health programme in urban and rural schools in Ogun state, Nigeria. Methodology : This cross sectional descriptive study was conducted in public primary schools in Ifo (urban) and Ikenne (rural) Local Government Areas (LGAs) of Ogun State. A multistage sampling method was used to select teachers in each Local Government Area. Data was collected using self administered questionnaires and analysed using the EPIInfo 6 statistical software. Results: Although majority of the respondents in both LGAs were aware of the school health programme, (Ifo 97.4%, Ikenne 97.3%), more than half of the respondents, (Ifo 57.0%, Ikenne54.5%) had poor knowledge of school health. Majority of the respondents in Ifo (98.7%) and Ikenne(98.3%) felt that the school health programme is desirable and necessary. School health programme is in place in most schools in both LGAs ( Ifo 77.3%, Ikenne 73.2%). However many key components are poorly practiced. Conclusion: There was no statistically significant difference in the knowledge (p= 0.209) and practice (p=0.313) of school health in rural and urban LGAs. In service training on school health should be provided for teachers and the needed resources should be madeavailable for the full implementation of all components of school health in all schools.

Abstract Background Substance use is an escalating public health problem in South Africa resulting in risky behaviours and poor educational attainment among adolescents. There is a huge battle to overcome substance use among learners as more drugs become easily available with the mean age of drug experimentation reported to be at 12 years of age. It is important to continuously understand the trends in substance use in order to assess if there are positive changes and provide evidence for the development of context-specific effective interventions. This paper outlines the prevalence of substance use among selected high schools in a district in Limpopo province. Methods To determine the prevalence of substance use among selected high school learners in a district in Limpopo Province, a cross-sectional school survey of 768 learners was conducted. Data was analysed using SPSS v 26. Descriptive analysis was used to describe the independent and dependent variables and Chi-Square test was used to investigate associations between demographic characteristics and substance use among high school learners. Results The most abused substances by learners were alcohol (49%), cigarettes (20.8%) and marijuana (dagga/cannabis) (16.8%). In a lifetime, there was a significant difference (P

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]

Objective: In this paper, we evaluate the implementation of a knowledge translation strategy aimed at optimizing the use and deployment of the ÉKIP reference framework within both the education (preschool, primary, secondary) and the health and social services networks of the province of Quebec (Canada) and their partner organizations. Methods: We collected data on Web-based use of the reference framework (ÉKIP Online) and promotional newsletters in spring 2021. We then compared these with other data collected and analyzed in September 2022. We subsequently conducted 19 semi-structured interviews to explore the extent and nature of ÉKIP Online use, identify enabling and inhibiting factors, and extract recommendations for the project's continuance. Results: The increase in use of ÉKIP Online and its uptake tools suggested that communities had become increasingly interested in and informed about the reference framework. Nevertheless, the qualitative component of the evaluation offered a nuanced perspective on its use and deployment. Conclusion: The evaluation documented a series of levers to ensure the greatest possible reach of the reference framework and its use within the networks. Further efforts are necessary to reach more schools and support use and deployment. [ABSTRACT FROM AUTHOR]

Sexual health education should meet the needs of all students. One strategy educators can use to ensure instruction meets students' needs is to encourage the submission of anonymous questions, allowing students to gain information without fear of instructor or peer reactions. We investigated anonymous questions submitted by middle school (7th-grade, ages 12-13) students during a sexual health education curriculum in Ohio, USA. Questions (n=893) were organised into 12 categories: reproductive anatomy (n=186), LGBTQ+ topics (n=130), sexual behaviour (n=120), class-related questions (n=99), pregnancy (n=78), slang (n=52), STIs (n=44), protection/birth control (n=33), relationships (n=19), consent (n=14), health services (n=9), abstinence (n=1), and unrelated questions/comments (n=108). After categorising questions, we conducted thematic analysis with the three largest categories (reproductive anatomy, LGBTQ+ topics, sexual behaviour). Results revealed students wanted to know about the normality of the processes and functions of their bodies. Students also expressed concern and had internalised social norms about LGBTQ+ topics. Student questions about sexual behaviour suggested they wanted to learn more about the purposes and processes of sex, e.g., how people have intercourse. Findings underscore the need for inclusive, comprehensive and medically accurate sexual health education for early adolescents. We discuss implications for student health/well-being, educator development, and school staff. [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]

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One in four school-age children has a chronic health condition, with approximately 6% of them having multiple chronic health conditions. These students are at an elevated risk of individual health emergencies during school hours. While teachers receive online training to assist in these emergencies, they lack practicing with rescue medications. We developed a Quality Improvement (QI) program that had a) a live presentation; b) a hands-on workshop to practice using rescue medications for allergies, asthma, seizures, and diabetes; c) fliers with first-aid guidelines; and d) a web-based reference toolkit. Teachers' confidence and knowledge were measured using the Learning Self-Efficacy Scale and a knowledge questionnaire with a pre- and post-intervention survey. We also assessed their clinical skills using the rescue medications. 129 teachers took part in this QI program. We collected 95 pre- and 81 post-surveys, with 47 matched. We saw statistically significant increases in confidence, as well as in the individual cognitive, affective, and psychomotor domains. Teachers also increased their overall knowledge. Collaterally, other district-wide improvements developed. This evidence-based, hands-on QI program provided teachers the opportunity to put into practice clinical skills, increasing their confidence to help students when experiencing an individual health emergency. Furthermore, changes beyond the primary goal of this QI program were implemented, highlighting the lead role of the registered nurse as the public health advocate. Laypeople benefit from hands-on training to learn clinical skills. This program serves as a basis for improving health emergencies preparedness in schools. • Nurses in schools bring health equity to the most vulnerable citizens, children. • Hands on training increases teachers' confidence to assist during health emergencies. • Bridging health and education ensures children are safe attending school. [ABSTRACT FROM AUTHOR]

Introduction: Childhood health problems can lead to bigger problems in the future if not diagnosed early. Low socioeconomic levels are closely related to the health of children, and more health problems are expected. This study aims to identify the health problems of Syrian refugee and Turkish school-age children and evaluate the common problems to plan health services accordingly. Methods: The study was planned to be conducted at schools in determined districts. Informed consent forms were prepared in Turkish and Arabic and delivered to 14,514 Turkish and Syrian refugee children. The field visits of the study were completed between April-June 2019. A total of 12,603 children--2,101 Turkish and 10,502 Syrian--were examined by trained health personnel and doctors in 31 planned schools in the districts using the designed examination form. Results: 12,603 students underwent health examinations; 7,025 students were found appropriate for further examination and tests, and 3,961 students were referred to hospitals for treatment. The most common health problems were dental issues and upper respiratory tract diseases. Acute rheumatic fever was detected in four children, and mitral valve insufficiency was detected in two children. Discussion and Conclusion: Consequently, our study revealed the need to refer 10,986 of the 12,603 children for further examination, tests, or treatment. The study aimed to determine the health problems of school-age Syrian immigrants and Turkish children and to shed light on the health services to be provided. [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]

Road traffic injuries (RTIs) are a significant cause of death and disability among young people worldwide. Programs that use injury prevention strategies have been shown to effectively reduce the number of injuries. This systematic review aims to present the available evidence on the effectiveness of intervention programs in preventing RTIs among adolescents and young adults. Articles were identified and retrieved from databases including PubMed, Embase, Web of Science, Scopus, Science Direct, Magiran, SID, and Iran Medex. Two reviewers independently screened the articles. Articles published from the first year of publication until January 2018 that met the eligibility criteria were included in the review. These articles covered randomized controlled trials, pretest/post-test interventions, and controlled pretest/post-test interventions aimed at reducing RTIs among adolescents and young people aged 12-26 years. The framework, provided by Murphy and Haddon, were used to categorize the interventions. According to this framework, the interventions were categorized into five groups including education/behavior change, incentive, engineering/technology, legislation/enforcement, and multifaceted programs. The methodological quality of the studies was assessed using the Effective Public Health Practice Project. Of the initial 3165 findings, 13 studies met the inclusion criteria. Eleven of these studies used educational/behavioral approaches, while two employed multifaceted programs. In the educational/behavioral approach, participants' behaviors were considered as outcome variables. Only one of these studies was not successful. Multifaceted interventions were successful in changing behaviors. No studies were found on the effectiveness of other interventions. Eight studies were assessed as having moderate quality. The systematic review shows that educational/behavioral strategies and multifaceted programs are effective in reducing RTIs among young adults and adolescents. However, there is a lack of studies on other potential interventions. The quality of the included studies was moderate, suggesting a need for more rigorous research. [ABSTRACT FROM AUTHOR]

The purpose of this study was to investigate voluntary participation of lower-, average, and higher skilled children during parkour recess and MVPA in physical education, parkour recess and regular recess. In total 147 (55 girls, 92 boys) elementary children from seven schools participated. During (i.e., generalization) and after (i.e., maintenance) a 10-lesson parkour unit was taught, five parkour recess sessions were organized. Systematic observation was used to assess children’s physical activity levels. Average skilled children participated more (74%) in parkour recess compared to higher skilled children (55%; p=.002). No differences were found for MVPA between lower-, average -and higher skilled children in any of the settings. Regardless of skill level, children voluntarily participated in parkour recess with MVPA levels 15-20% higher compared to regular recess. These findings are especially important for lower-skilled children, who are more at risk for lower participation in physical activities and adhering to physical activity guidelines. [ABSTRACT FROM AUTHOR]

This study aimed to investigate the relationship between low-income elementary school students' physical activity enjoyment and physical activity behavior and to determine if their motor competence predicts their physical activity enjoyment and physical activity behavior. A total of 82 students (51.2% male; Mage = 10, SD = 0.861) from two Title I elementary schools in the western United States were involved in this study. The students completed the Physical Activity Enjoyment Scale (PACES), the Physical Activity Questionnaire for Children (PAQ-C), and the Test of Gross Motor Development–Third Edition (TGMD-3). The results of the correlation analysis showed that physical activity enjoyment and physical activity behavior among the students were significantly related, r(80) = 0.379, p < 0.001. Multiple regression models indicated that locomotor skills were a significant predictor of the level of physical activity enjoyment (F(2,79) = 8.334, p < 0.001; t = 3.76, p < 0.001), while motor competence did not predict the level of physical activity behavior. These findings illustrate the importance of both physical activity enjoyment and physical activity behavior and the significant role of locomotor skills in enhancing the level of physical activity enjoyment in this specific population of children. Motor competence should be considered a priority when designing and implementing physical education and physical activity programs for school-aged children from lower-income families. [ABSTRACT FROM AUTHOR]

Background: Substance use is an escalating public health problem in South Africa resulting in risky behaviours and poor educational attainment among adolescents. There is a huge battle to overcome substance use among learners as more drugs become easily available with the mean age of drug experimentation reported to be at 12 years of age. It is important to continuously understand the trends in substance use in order to assess if there are positive changes and provide evidence for the development of context-specific effective interventions. This paper outlines the prevalence of substance use among selected high schools in a district in Limpopo province. Methods: To determine the prevalence of substance use among selected high school learners in a district in Limpopo Province, a cross-sectional school survey of 768 learners was conducted. Data was analysed using SPSS v 26. Descriptive analysis was used to describe the independent and dependent variables and Chi-Square test was used to investigate associations between demographic characteristics and substance use among high school learners. Results: The most abused substances by learners were alcohol (49%), cigarettes (20.8%) and marijuana (dagga/cannabis) (16.8%). In a lifetime, there was a significant difference (P < 0.05) in cigarette smoking with gender, school, and grade; with more use in males (14.2%) than females (7.6%); in urban schools (14.6) than peri-urban (6.7%) and more in Grade 12 (6.4%). There was a significant difference (P < 0.05) in alcohol use with more use in Grade 10 (12.6%) and varied use among male and female learners but cumulatively more alcohol use in females (27.7%). Drug use varied, with an overall high drug use in urban schools (20.7%). Conclusions: Substance use is rife among high school learners in the district and health promotion initiatives need to be tailored within the context of socio-demographic characteristics of learners including the multiple levels of influence such as peer pressure, poverty, unemployment and child headed families. Additional research is required to investigate the factors leading to a notable gradual increase in use among female learners and into the environmental and family settings of learners in influencing substance use. [ABSTRACT FROM AUTHOR]

Despite the benefits of classroom physical activity breaks on student health and academic outcomes, more research is needed to understand what factors may be associated with classroom physical activity break implementation, to bolster buy-in from school stakeholders and increase implementation. This quantitative study examined frequency of classroom physical activity break implementation in relation to (1) objectively measured teachers' physical activity and sedentary behaviors, (2) confidence for leading classroom physical activity breaks, (3) social norms (perceptions of other teachers' classroom physical activity break implementation), and (4) teacher- and school-level demographics. In total, 153 classroom teachers in 20 elementary and middle schools completed a survey including classroom physical activity break frequency, confidence, and social norms, one item each, dichotomized (1 = "most/all the time" OR "agree/strongly agree"). Accelerometry assessed total activity and daytime sedentary behavior. Analyses included multilevel binary logistic regression. Teachers were 90% female, 68% White, and 55% in elementary schools. Odds of implementing classroom physical activity breaks were lower among middle school teachers, 14 times greater among those with greater confidence, and over 17 times greater when teachers perceived others frequently implementing classroom physical activity breaks. Teacher activity was not associated with classroom physical activity break implementation. Future interventions to increase classroom physical activity break implementation should focus on increasing teachers' confidence to lead classroom physical activity breaks and creating more buy-in from classroom teachers to enhance each school's culture of health. By enhancing teacher confidence and social norms for implementing classroom physical activity breaks, we may increase school-based physical activity opportunities. [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]