Effectiveness of Health-Related Behavior Interventions on Physical Activity-Related Injuries in Junior Middle School Students

The objective of this study was to determine the effectiveness of an intervention program based on Health-Related Behavior Theory (HRBT) in reducing physical activity-related injuries (PARIs) occurrence and individual risk-taking behaviors, as well as improving PA-related behaviors. A total of 1044 students from six junior middle schools in Shantou city were included and divided randomly into an intervention group (n = 550) and a control group (n = 494), respectively. The intervention group followed a prescribed PARIs intervention program based on HRBT, and the control group performed a common health education program, consisting of seven sessions and lasting seven months from May to November 2018. After the intervention, both groups showed a significantly lower prevalence of PARIs (intervention group: from 25.45% to 10.91%, control group: from 29.76% to 11.74%, both p < 0.05), but no significant between-group differences could be observed in the post-intervention PARIs prevalence (p > 0.05). Compared with the control group, students in the intervention group had a higher improvement in PA-related behaviors and a lower score of risk-taking behaviors (both p < 0.05). Thus, it could be concluded that the HRBT intervention program had a positive effect on PA-related and risk-taking behaviors in junior middle school students, though its effectiveness in reducing the occurrence of PARIs was not significant.

Effectiveness of Promotive and Preventive Psychosocial Interventions on Improving the Mental Health of Finnish-Born and Immigrant Adolescents

Background: Schools are considered natural environments in which to enhance students’ social–emotional skills and mental health in general, but they can be especially important for students with refugee and immigrant backgrounds. The current study tested the effectiveness of two school-based interventions in enhancing the mental health and wellbeing of adolescents of native, refugee, and immigrant backgrounds. It further analyzed the role of age, gender, daily stressors, and discrimination in affecting the interventions’ effectiveness. Methods: A three-arm cluster RCT with parallel assignment was applied among the 16 schools. Schools were randomized to three conditions of two active interventions and a waiting-list control condition. Students (n = 1974) filled in an online questionnaire at baseline before the interventions, after the interventions, and at follow-up an average of 9 months after the interventions. The effectiveness criteria were internalizing and externalizing problems, resilience, and prosocial behavior. Results: Interventions were generally not effective in decreasing mental health problems and increasing psychosocial resources. The expected positive intervention effects were dependent on students’ age and gender and exposure to socioeconomic daily stressors. Conclusion: Interventions enhancing teacher awareness and peer relationships at school should be carefully tailored according to the strengths and vulnerabilities of participating students, especially their daily stress exposure, but also age and gender.

Injury Prevention Education for Changing a School Environment Using Photovoice

According to a report by the Japan Sport Council, more than 1 million injuries occur in the school environment in Japan, which is a significant burden to society in terms of children's physical and psychological well-being as well as the costs of health care. Japanese people are becoming increasingly aware of school safety, but no effective safety education program has yet been established. In this study, we conducted a comprehensive safety education curriculum utilizing photovoice in a needs assessment of school safety and evaluated its use as a tool in student learning processes with regard to injury. The curriculum consists of two parts: (1) classroom lectures (three classes, 45 minutes each) and (2) a photovoice project (four classes, 45 minutes each). In total, 49 students participated in the education program, presenting 23 photovoice pictures. The use of photovoice enabled identification of locations of risk recognized by students and the associated photo R-map assisted students and teachers to deepen their learning about injury. We demonstrated four benefits of applying photovoice to school-based injury prevention education. These findings suggest that our photovoice-based injury prevention education program could positively impact children's research engagement by identifying school needs, and also empower them to affect social change.

A School Intervention's Impact on Adolescents' Health-Related Knowledge and Behavior

Background

Many factors can influence health behavior during adolescence, and the lifestyle of adolescents is associated with health behavior during adulthood. Therefore, their behavior can determine not only present, but also later health status.

Objective

We aimed to develop an intervention program to improve high school students' health behavior and to evaluate its effectiveness.

Methods

We performed our study at a secondary school in a rural town in East Hungary between 2016 and 2020. Sessions about healthy lifestyles were organized regularly for the intervention group to improve students' knowledge, to help them acquire the right skills and attitudes, and to shape their behavior accordingly. Data collection was carried out via self-administered, anonymous questionnaires (n = 192; boys = 49.5%; girls = 50.5%; age range: 14–16). To determine the intervention-specific effect, we took into account the differences between baseline and post-intervention status, and between the intervention and control groups using individual follow-up data. We used generalized estimating equations to assess the effectiveness of our health promotion program.

Results

Our health promotion program had a positive effect on the students' health-related knowledge and health behavior in the case of unhealthy eating, moderate to vigorous physical activity, and alcohol consumption.

Conclusion

Our findings suggest that school health promotion can be effective in knowledge transfer and lifestyle modification. To achieve a more positive impact on health behavior, preventive actions must use a complex approach during implementation.

‘Shall We Send a Panda?’ A Practical Guide to Engaging Schools in Research: Learning from Large-Scale Mental Health Intervention Trials

The substantial time that children and young people spend in schools makes them important sites to trial and embed prevention and early intervention programmes. However, schools are complex settings, and it can be difficult to maintain school engagement in research trials; many projects experience high levels of attrition. This commentary presents learning from two large-scale, mixed-methods mental health intervention trials in English schools. The paper explores the barriers and challenges to engaging schools in promotion or early intervention research and offers detailed recommendations for other researchers.

Trends in Asthma-Related School Health Policies and Practices in the US States

BACKGROUND

Asthma is one of the leading causes of school absenteeism. Schools can play an important role in coordinating asthma care. The purpose of this study was to assess the implementation of asthma-related school health policies and practices across states and how they have changed over time.

METHODS

Data were analyzed from 36 states that conducted School Health Profiles surveys during 2008 to 2018. Trends in 6 topics were analyzed by logistic regression and JointPoint trend test.

RESULTS

Trends in efforts to identify and track students with asthma and improve students' and parents' knowledge about asthma were stable or increased. Interest among lead health education teachers in receiving professional development on asthma trended downward in 35 of 36 states.

CONCLUSIONS

Stable to upward trends suggest that a majority of schools have maintained or improved their efforts to identify and track students with asthma and increase the knowledge of students and parents about asthma. However, further improvement is needed in referral of students with asthma to health care professionals and encouraging asthma-related professional development of lead health education teachers.

Persistence of Schistosoma haematobium transmission among school children and its implication for the control of urogenital schistosomiasis in Lindi, Tanzania

Background

Despite twelve rounds of school-based preventive chemotherapy for schistosomiasis in endemic areas of Tanzania such as Mtama district, Lindi: the burden of Schistosoma haematobium infection has remained highly conceivable due to re-infections. The factors associated with continuity of S.haematobium transmission in Mtama district, Lindi have not been fully established. This study investigated the burden and factors contributing to the ongoing transmission of S.haematobium infection in the endemic district of Mtama, Lindi.

Methods

A quantitative cross-sectional survey was carried out among 649 school-age children in the Mtama district to determine the burden and factors associated with continuity of S.haematobium infection transmission. A single urine specimen was obtained from each pupil and tested for macro- and microhaematuria, presence of S.haematobium ova, as well intensity of infection; this was complemented with a survey of Bulinus spp snail intermediate hosts and their infectivity. A structured questionnaire was employed to gather information on individual and environmental risk factors for S.haematobium transmission. Summary statistics were computed for individual variables; while a univariate and multivariate logistic regression analysis was performed to assess the association between risk factors with S.haematobium infection.

Results

Prevalence of S.haematobium infection by macro- and microhaematuria was 13.1% and 46.2% respectively. The prevalence of S.haematobium ova was 52.7%; intensity of infection was light in 53.1%, and heavy in 46.9%. Snail intermediate hosts were Bulinus globosus and B.nasutus, whose infectivity was 2.2% and 1.3%, respectively. Among the assessed risk factors, long residency (10–13 years) in the area was a significant risk factor for the continuity of S.haematobium transmission (AOR: 21.79, 95% CI: 1.37–346.4).

Conclusions

The observed 52.7% prevalence of S.haematobium infection represents unacceptably high prevalence after 12 rounds of preventive chemotherapy. Therefore, an urgent need for the implementation of integrated multiple control interventions in the Mtama district; is considered to be imperative.

App based education programme to reduce salt intake (AppSalt) in schoolchildren and their families in China: parallel, cluster randomised controlled trial

OBJECTIVE

To determine whether a smartphone application based education programme can lower salt intake in schoolchildren and their families.

DESIGN

Parallel, cluster randomised controlled trial, with schools randomly assigned to either intervention or control group (1:1).

SETTING

54 primary schools from three provinces in northern, central, and southern China, from 15 September 2018 to 27 December 2019.

PARTICIPANTS

592 children (308 (52.0%) boys; mean age 8.58 (standard deviation 0.41) years) in grade 3 of primary school (about 11 children per school) and 1184 adult family members (551 (46.5%) men; mean age 45.80 (12.87) years).

INTERVENTION

Children in the intervention group were taught, with support of the app, about salt reduction and assigned homework to encourage their families to participate in activities to reduce salt consumption.

MAIN OUTCOME MEASURES

Primary outcome was the difference in salt intake change (measured by 24 hour urinary sodium excretion) at 12 month follow-up, between the intervention and control groups.

RESULTS

After baseline assessment, 297 children and 594 adult family members (from 27 schools) were allocated to the intervention group, and 295 children and 590 adult family members (from 27 schools) were allocated to the control group. During the trial, 27 (4.6%) children and 112 (9.5%) adults were lost to follow-up, owing to children having moved to another school or adults unable to attend follow-up assessments. The remaining 287 children and 546 adults (from 27 schools) in the intervention group and 278 children and 526 adults (from 27 schools) in the control group completed the 12 month follow-up assessment. Mean salt intake at baseline was 5.5 g/day (standard deviation 1.9) in children and 10.0 g/day (3.5) in adults in the intervention group, and 5.6 g/day (2.1) in children and 10.0 g/day (3.6) in adults in the control group. During the study, salt intake of the children increased in both intervention and control groups but to a lesser extent in the intervention group (mean effect of intervention after adjusting for confounding factors -0.25 g/day, 95% confidence interval -0.61 to 0.12, P=0.18). In adults, salt intake decreased in both intervention and control groups but to a greater extent in the intervention group (mean effect -0.82 g/day, -1.24 to -0.40, P<0.001). The mean effect on systolic blood pressure was -0.76 mm Hg (-2.37 to 0.86, P=0.36) in children and -1.64 mm Hg (-3.01 to -0.27, P=0.02) in adults.

CONCLUSIONS

The app based education programme delivered through primary school, using a child-to-parent approach, was effective in lowering salt intake and systolic blood pressure in adults, but the effects were not significant in children. Although this novel approach could potentially be scaled up to larger populations, the programme needs further strengthening to reduce salt intake across the whole population, including schoolchildren.

TRIAL REGISTRATION

Chinese Clinical Trial Registry ChiCTR1800017553.

Stakeholders' views of supporting asthma management in schools with a school-based asthma programme for primary school children: a qualitative study in Malaysia

OBJECTIVE

The WHO Global School Health Initiative aimed to improve child and community health through health promotion programmes in schools, though most focus on preventing communicable disease. Despite WHO recommendations, no asthma programme is included in the Malaysian national school health service guideline. Therefore, we aimed to explore the views of school staff, healthcare professionals and policy-makers about the challenges of managing asthma in schools and the potential of a school asthma programme for primary school children.

DESIGN

A focus group and individual interview qualitative study using purposive sampling of participants to obtain diverse views. Data collection was guided by piloted semistructured topic guides. The focus groups and interviews were audiorecorded, transcribed verbatim and analysed using inductive thematic analysis. We completed data collection once data saturation was reached.

SETTING

Stakeholders in education and health sectors in Malaysia.

PARTICIPANTS

Fifty-two participants (40 school staff, 9 healthcare professionals and 3 policy-makers) contributed to nine focus groups and eleven individual interviews.

RESULTS

School staff had limited awareness of asthma and what to do in emergencies. There was no guidance on asthma management in government schools, and teachers were unclear about their role in school children's health. These uncertainties led to delays in the treatment of asthma symptoms/attacks, and suggestions that an asthma education programme and a school plan would improve asthma care. Perceived challenges in conducting school health programmes included a busy school schedule and poor parental participation. A tailored asthma programme in partnerships with schools could facilitate the programme's adoption and implementation.

CONCLUSIONS

Identifying and addressing issues and challenges specific to the school and wider community could facilitate the delivery of a school asthma programme in line with the WHO School Health Initiative. Clarity over national policy on the roles and responsibilities of school staff could support implementation and guide appropriate and prompt response to asthma emergencies in schools.

A National Review of State Laws for Stock Epinephrine in Schools

BACKGROUND

Anaphylaxis is a life-threatening allergic reaction with significant risk for children with allergies. Access to potentially life-saving medication is critical for these children. This review aims to describe state laws and policies guiding stock epinephrine in schools for allergic or anaphylactic events and detail recommendations for best practices.

METHODS

This paper is a comprehensive review of the 50 states and the District of Columbia's (DC) laws and policies for stock epinephrine at schools for children in pre-kindergarten through 12th grade.

RESULTS

All 50 states and DC allow undesignated epinephrine in schools to use for allergic or anaphylactic reactions. A key difference arises in whether states allow (N = 37) or mandate (N = 14) that schools stock epinephrine. States exhibit differences in the body responsible for developing stock epinephrine policy (N = 48), along with stakeholders responsible for developing procedures (N = 30) and implementing them (N = 19). Differences also exist in state epinephrine procurement, administration, training, and liability.

CONCLUSIONS

This review of stock epinephrine laws and policies highlights the significant variation in state legislation despite widespread adoption. Only one-quarter of states mandate that schools have stock epinephrine available for emergency use, underscoring need for a more unified approach with consistent guidelines, comprehensive training, and possible funding for implementation.

School-based health centers as a context to engage and serve communities

PURPOSE OF REVIEW

School-based health centers (SBHCs) primarily serve underserved students and families through removing barriers to care. The number of SBHCs have increased dramatically with investments from state-funding and federal-funding programs, including expanded funding from the American Rescue Plan. This article reviews findings on the perceived importance of school and community partnership. It also provides a critical review of the evidence base on impact on health, mental health, and education indicators.

RECENT FINDINGS

Recent findings underscore the importance of SBHCs engaging the school and community to build trust while identifying and responding to needs. Engagement supports planning, implementing, and sustaining SBHCs. Studies of impact find that SBHCs increase participation in preventive and routine health and decrease emergency department utilization and hospitalization. However, additional research needs to rigorously test for effects of SBHCs on symptoms and indicators of wellbeing, especially with respect to mental health and education.

SUMMARY

SBHCs increase participation of students from marginalized groups in preventive and routine care. School and community engagement are vital aspects of SBHCs, likely removing barriers related to trust. Additional rigorous evidence is needed testing efficacy of SBHCs when it comes to improving health, mental health, and education.

Monitoring of physical activity promotion in children and adolescents in the EU: current status and future perspectives

BACKGROUND

Policy action is required to address physical inactivity in boys and girls. This action can be supported by international data collection, comparisons and sharing of good practices. Thus, this study aims to present and discuss the ongoing monitoring of physical activity (PA) indicators in children and adolescents in the 28 EU Member States.

METHODS

Data on PA recommendations, PA prevalence, physical education (PE) and PA promotion programs for children and adolescents were provided by governments in a joint EU/WHO survey on the implementation status of the EU Council Recommendation on Health-Enhancing Physical Activity (HEPA) across Sectors.

RESULTS

In 23 countries, national recommendations on PA are available. Detailed PA prevalence data among children and adolescents was available in 27 countries, in most cases separately for sex/gender and age groups. The total amount of PE lessons in schools differed greatly between countries and lessons were predominantly mandatory. After-school HEPA promotion programs were mostly implemented in EU Member States (78.6%), followed by active school breaks (57.1%), active travel to school (57.1%) and active breaks during school lessons (53.6%).

CONCLUSIONS

This study summarizes the monitoring of PA indicators among children and adolescents in all EU Member States by providing a comprehensive overview of the status of PA promotion and monitoring across the region. Based on our findings, it could be concluded that the current EU monitoring system on PA promotion should be adapted to provide evidence that can inform future policy development.

Effectiveness of psychosocial school interventions in Finnish schools for refugee and immigrant children, "Refugees Well School" in Finland (RWS-FI): a protocol for a cluster randomized controlled trial

BACKGROUND

Schools are natural environments in which to enhance young people's social and emotional skills, mental health, and contact between diverse groups, including students from refugee and immigrant backgrounds. A layered or tiered provision of services is recommended as it can be effective to meet the needs of war-affected adolescents who variably show mental health problems (such as posttraumatic stress disorder (PTSD)). The current protocol describes the study design for a multi-layered intervention model. The study will test the effectiveness of two interventions: a teacher-training intervention In-Service Teacher Training (INSETT) combined with targeted cognitive-behavioral treatment-based Teaching Recovery Techniques (TRT) and a classroom-focused preventive intervention Peer Integration and Enhancement Resources (PIER). We analyze, first, whether the interventions are effective in decreasing psychological distress and increasing positive resources, i.e., prosocial behavior and resilience among refugee and immigrant students. Second, we analyze which student-, school-, and parent-related factors mediate the possible beneficial changes. Third, we look at which groups the interventions are most beneficial to.

METHODS

A three-arm cluster RCT with parallel assignment, with a 1:1:1 allocation ratio, is applied in 16 schools that agreed to participate in the Refugees Well School interventions and effectiveness study. Schools were randomized to three conditions of two active interventions and a waiting list control condition. Students, their parents, and teachers in intervention and control schools participated in the study at baseline before the interventions, after the interventions, and at 6 to 12 months after the interventions. The primary effectiveness criterion variables are psychological distress (SDQ) symptoms, resilience (CYRM-12), and prosocial behavior (SDQ).

DISCUSSION

The current study presents a recommended universal approach of layered interventions aiming to reduce psychological distress and increase resilience among refugee and immigrant students. A combination of promotive, preventive, and targeted interventions may offer a holistic, ecological intervention package for schools to better address the needs of the whole group.

TRIAL REGISTRATION

ISRCTN ISRCTN64245549 . Retrospectively registered on 10 June 2020.

Understanding the experience of the implementer: teachers' perspectives on implementing a classroom-based nutrition education program

School-based programs are widely implemented to combat childhood obesity, but these programs have mixed results. Dissemination and implementation science approaches to evaluation using qualitative methods can provide more robust details about program functioning that may be able to help explain the variation in the impact of these programs. Fourteen in-depth interviews were conducted with classroom teachers implementing a school-based program, the Integrated Nutrition Education Program (INEP), to explore their experience. Factors related to organization, individual and intervention levels emerged as facilitators and barriers to program implementation. Key factors were school culture at the organization level, individual perception and belief in the intervention at the individual level and program content, perceived complexity and adaptability at the intervention level. Socioeconomic status of the community and family involvement were contextual factors identified across all levels. Findings from this qualitative evaluation can be used for the quality improvement of INEP, but beyond this these can also be informative for other school-based programs to promote adoption, implementation and maintenance.

Effects of a school-based intervention on levels of anxiety and depression: a cluster-randomized controlled trial of the MindPower program in ten high schools in Norway

BACKGROUND

The previous decades have shown increased symptoms of depression and anxiety among adolescents. To promote mental health and reduce mental illness, the government of Norway has, as in other countries, pledged that all schools must incorporate life-skills education. We report results from an evaluation of MindPower, a modification of the Coping With Depression (CWD) course, delivered universally in the classroom to secondary high school students, aged 15-16 years, in one county in Norway. The aim of the study was to evaluate the effect of MindPower on symptoms of depression and anxiety.

METHODS

We utilized a two-groups` delayed intervention design where 110 first year high school classes were randomized into one of two intervention groups (IG1 and IG2). IG1 participated in MindPower while IG2 served as a control group for four months until the intervention started also in this group. IG1 and IG2 responded to questionnaires before and after the eight weeks course, at the start of the first and the second booster session, and at the five months follow up. Questionnaires, including online versions of the Hopkins Symptom Checklist (SCL-8) and the Reynolds Adolescent Depression Scale (RADS-2:SF), were administered to 1673 out of a total of 2384 students. SCL-levels were also compared with those from a large population study (UngData).

RESULTS

According to mixed model analyses, SCL-8 and RADS-2:SF showed significant baseline differences between IG1 and IG2. In IG1 and IG2, both SCL-8 and RADS-2:SF showed a small but significant increase in mean scores throughout the study period, with markedly lower mean scores among boys. The SCL-levels were first lower for both girls and boys and then after the completion of MindPower the SCL-levels, equal to the SCL-levels in UngData.

CONCLUSIONS

No effects of the intervention were found. This large universal school-based trial suffered from considerable drop-out of participants. Experiences from implementation and evaluation of universal mental health promotion and preventive school interventions are thoroughly discussed, including, preparation, resources, support, time, realistic expectations, teacher selection and training, implementation, research designs and more. Several empirically based, practical advices are presented. Clinical Trial registration 27/08/2018. Registration number NCT03647826.

A Day in the Life: Secondary School Students’ Experiences of School-Based Physical Activity in Ireland, Finland, and the United States

Internationally, there is an effort to have schools adopt a whole-school approach to physical activity promotion. Such a model includes physical activity opportunities throughout the whole school day, including physical education; before, during, and after school physical activity; and staff and community engagement. The purpose of this study was to describe the physical activity experiences of young people attending secondary schools in Finland, Ireland, and the United States where a whole-school approach to physical activity promotion was employed. One school in each country was identified based on its adoption of a national physical activity initiative (i.e., Finland—Finnish Schools on the Move; Ireland—Active School Flag; United States—Let’s Move Active Schools). Data were collected through observation with field notes, photos, and interviews with key stakeholders. The results are presented as analytic narrative vignettes that represent a “typical” school day. The results provide a glimpse into available physical activity opportunities for young people at each school and demonstrate an emphasis on active school culture.

[Evaluation of the effectiveness of a school-based alcohol and cannabis prevention programme among adolescents.]

OBJECTIVE

Alcohol and cannabis consumption in young people aged 14 to 18 years show high and stable prevalence and incidence. The Instituto de Adicciones de Madrid Salud (IAMS) within its prevention strategy aimed at adolescents and young people in Madrid, implements an universal 3-sessions school-based prevention program. To evaluate the effectiveness of a program aimed at alcohol and cannabis from the Theory of Planned Behavior (TPB, Ajzen, 1991), we analysed the changes in consumption and intention of consumption, attitudes and subjective norm as well as in the risk perception.

METHODS

Quasi-experimental design. Participants: Over 1,529 students belonging to 12 high schools in Madrid (M=15.36 years, DT=1.13, range: 13-18, 51.8% boys) Experimental group: N=790, intervention period October-December 2018. Control group: N=469. The Student's t test was used for the repeated means test. When the difference between the means was significant, the effect size was calculated using Cohen's d index.

RESULTS

Alcohol: consumption (t=2.08, p<0.05, d=0.07), intention (t=3.01, p<0.01, d=0.12), risk perception (t=-502, p<0.001, d=0.20), attitudes (t=5.77, p<0.001, d=0.21), subjective norm (t=2.17, p<0.05, d=0.08). Cannabis: intention (t=2.98, p<0.01, d=0.11), risk perception (t=-3.99, p<0.001, d=0.14), attitudes (t=6.19, p<0.001, d=0.23).

CONCLUSIONS

Students who received the intervention reduced the favourable attitudes and intention of alcohol and cannabis consumption and alcohol consumption, and increased the risk perception on both substances, with significant differences, but low effect sizes. Related to control group and regarding cannabis there were no significant differences. The program has been shown to be potentially effective, but would benefit from a review for fit to its theoretical framework.

The Landscape of State and Local School-Located Vaccination Clinics: Practices, Policies, and Lessons Learned for Providing COVID-19 and Routine Vaccinations

For decades, school-located vaccinations clinics (SLVs) have successfully offered influenza and routine childhood immunizations that have contributed to lowering the morbidity and mortality of vaccine-preventable diseases. These SLVs laid the foundation for state and local health departments and school districts to quickly implement SLVs in response to COVID-19. To support school nurses and immunization programs in implementing future SLVs during the COVID-19 pandemic, we explored the landscape of SLVs between August 2019 and late summer 2021 using publicly available information from school and health department websites, news articles reporting on SLVs, and internal documents provided by school nurses and immunization programs who hosted SLVs. Our scan identified variability in the reach, scope, and approach to SLVs, but consistent themes persist such as the importance of partnerships and SLVs as an opportunity to promote equitable access to vaccinations. Useful documents and resources for planning and hosting SLV clinics were compiled into a table. With COVID-19 vaccines now available to all school-age children, SLVs provide an even greater opportunity to improve school and community health. The included resources are designed to provide support for those interested in SLV implementation.

Key Challenges and Opportunities for Implementing School Located Vaccination Clinics for COVID-19 and Influenza: Roundtables With School Nurses and Immunization Programs

School-located vaccination clinics (SLVs) are an established strategy to offer influenza and routine vaccinations and improve student and community health. The COVID-19 pandemic has led many communities to expand SLVs to include COVID-19 vaccines. However, these SLVs are less documented than in the past due to the fast-paced nature of the pandemic and the additional pressures put on schools and public health organizations. We conducted five virtual roundtables with 30 school nurses and state immunization program managers from across the United States to gain insight into SLVs occurring during the COVID-19 pandemic. Roundtables explored participants' experiences planning and implementing SLVs, including factors influencing success and available resources. Findings highlighted SLVs as an opportunity to increase access and equity for vaccines. Participants shared strategies for School-located vaccination (SLV) funding, partnership building, vaccine storage and management, consent, data sharing, messaging, and promotion. These shared experiences offer useful insights for those interested in future and sustained SLV implementation.

Examining School Based Health Service Utilization Among Marginalized Youth in Connecticut During COVID

PURPOSE

This study examines how the coronavirus disease 2019 (COVID-19) is affecting utilization of medical and behavioral health services through school based health centers (SBHC s).

METHODS

We leveraged the electronic health records from one of the largest sponsors of SBHCs in the country, and tested differences in SBHC utilization with chi-square tests one year prior to the pandemic (pre-pandemic: March 2019-February 2020) compared to one year into the pandemic period (March 2020-February 2021).

RESULTS

A significant difference in SBHC utilization was found between pre-pandemic and pandemic periods (P <.001). 63.5% of SBHC patients accessed medical services pre-pandemic compared to 51.2% during the pandemic. In contrast, 36.5% of SBHC patients accessed behavioral services pre-pandemic compared to 48.8% during the pandemic, representing a 12.3% increase in SBHC behavioral service utilization since the pandemic.

CONCLUSIONS

SBHCs may serve as an invaluable means of ensuring youth, particularly those from disadvantaged communities, have access to needed behavioral health services during the current public health crisis.

Child Safety Matters: Randomized Control Trial of a School-Based, Child Victimization Prevention Curriculum

Recognizing the potential of classrooms as a context for identifying and addressing child victimization, several U.S. states now mandate the inclusion of child abuse prevention in school curricula. There are, however, a limited number of evidence-based and developmentally appropriate curricula designed for elementary. This study utilized a randomized control trial (RCT) design to evaluate the knowledge acquisition of children who received the Monique Burr Foundation's Child Safety Matters curriculum, a program designed to educate kindergarten to Grade 5 children about bullying, cyberbullying, four types of abuse (physical, sexual, emotional, and neglect), and digital dangers. Participants included 1,176 students from 72 classrooms in 12 Florida schools across eight counties. Schools were matched in pairs and randomly assigned to receive the program or be in a wait-list control. Knowledge was assessed with a questionnaire administered prior to the curriculum (T1) as well as approximately 3 weeks (T2) and approximately 7 months (T3) after implementation. Analyses were conducted with class means examining grade, treatment condition, and time. The interaction of treatment and time was significant, F(2, 90) = 17.024, p < .000. Children who received the curriculum increased their knowledge about potentially risky situations, and this knowledge was sustained over 7 months to the follow-up assessment. Children in the control schools did not have similar gains. The current classroom-based child maltreatment prevention education is a promising strategy to address children's vulnerability to abuse and its consequences.

Classroom Temperatures and Asthma-Related School-Based Health Care Utilization: An Exploratory Study

OBJECTIVE

Schools with aging infrastructure may expose students to extreme temperatures. Extreme outdoor temperatures have previously been linked to more asthma-related health care utilization. Explore the relationship between classroom temperatures and school-based health care visits for asthma in an urban school building with an outdated heating and cooling system.

METHODS

Participants were students in grades K-8 who received health care from a school-based health center (SBHC) (n = 647) or school nurse (n = 1244) in 2 co-located urban public schools between 2016 and 2018. The probability of an asthma visit to the SBHC or school nurse was modeled as a function of indoor temperature exposure using generalized estimating equations with covariates accounting for grade, sex, outdoor temperature, days at risk of asthma visit, nonasthma visits, month, and year fixed effects.

RESULTS

Classroom temperatures ranged from 48.0˚F to 100.6°F. Higher mean grade-level indoor temperatures from a baseline of approximately 70˚F to 76˚F were associated with increased rates of asthma-related visits to the SBHC or school nurse on same day of exposure. Model-generated estimates suggest that an increase of 10˚F in indoor temperature relative to a baseline of 75˚F was associated with a 53% increase in the rate of asthma-related SBHC visits.

CONCLUSIONS

Elevated classroom temperatures may be associated with more school-based health care utilization for asthma. Low-income and students from racial and ethnic minority groups have disproportionately higher rates of asthma and are also more likely to attend schools with poor infrastructure. The potential benefits of school infrastructure investments for student health, health care costs, and health equity merit further investigation.

A national effectiveness trial of an eHealth program to prevent alcohol and cannabis misuse: responding to the replication crisis

BACKGROUND

The burden of disease attributable to alcohol and other drug (AOD) use in young people is considerable. Prevention can be effective, yet few programs have demonstrated replicable effects. This study aimed to replicate research behind Climate Schools: Alcohol and Cannabis course among a large cohort of adolescents.

METHODS

Seventy-one secondary schools across three States participated in a cluster-randomised controlled trial. Year 8 students received either the web-based Climate Schools: Alcohol and Cannabis course (Climate, n = 3236), or health education as usual (Control, n = 3150). Outcomes were measured via self-report and reported here for baseline, 6- and 12-months for alcohol and cannabis knowledge, alcohol, cannabis use and alcohol-related harms.

RESULTS

Compared to Controls, students in the Climate group showed greater increases in alcohol- [standardised mean difference (SMD) 0.51, p < 0.001] and cannabis-related knowledge (SMD 0.49, p < 0.001), less increases in the odds of drinking a full standard drink[(odds ratio (OR) 0.62, p = 0.014], and heavy episodic drinking (OR 0.49, p = 0.022). There was no evidence for differences in change over time in the odds of cannabis use (OR 0.57, p = 0.22) or alcohol harms (OR 0.73, p = 0.17).

CONCLUSIONS

The current study provides support for the effectiveness of the web-based Climate Schools: Alcohol and Cannabis course in increasing knowledge and reducing the uptake of alcohol. It represents one of the first trials of a web-based AOD prevention program to replicate alcohol effects in a large and diverse sample of students. Future research and/or adaptation of the program may be warranted with respect to prevention of cannabis use and alcohol harms.

Knowledge of school teachers and the associating factors in the effective delivery of the school health programme in Nigeria

Introduction

the important position that teachers occupy in school settings make them indispensable in the effective delivery of the School Health Programme (SHP). This study assessed the SHP knowledge of primary school teachers and the perception of their roles in the successful delivery of the programme in Ondo State, Nigeria.

Methods

this was a cross-sectional descriptive study. A multi-stage sampling technique was used to select 400 teachers from 42 primary schools, from the study population. A semi-structured self-administered questionnaire was used to collect data. Each respondent´s aggregate score was classified as being poor knowledge, if it was < 50% of the maximum obtainable score and good knowledge, if it was equal or more than 50% of the maximum obtainable score.

Results

the majority of the teachers (76%) demonstrated poor knowledge of the programme. Yet, a good number of them, believe they have a part to play in the implementation of the SHP. Academic qualification was found to be statistically associated with SHP knowledge (p < 0.01). Length of time in teaching service (p= 0.035; OR=1.033; 95%CI = 1.002- 1.065) was found to be a predictor of adequate SHP knowledge.

Conclusion

the SHP knowledge of the teachers was found to be inadequate. Although, most of the teachers agreed that they had roles to play in the SHP delivery, a sizeable number of them could not state what those roles entailed. It is recommended, therefore, that government and all stakeholders in education and health sectors should conduct trainings on SHP, focusing on teachers´ roles in the school community.

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CONTEXT

Although there is strong evidence in the literature on the interest of the implementation of health policy and programs in schools, data on the determinants of the active participation of education professionals in health promotion programs remain scare.

OBJECTIVE

Our study was conducted in 2018-2019 in New Caledonia, a South Pacific archipelago rich in cultural diversity but marked by major inequalities in health and education. It aimed to identify the factors that explain the involvement of teachers in an intersectoral health promotion program (development of a health education pathway led by an intersectoral team). It involved 40 schools, which corresponds to 20% of primary schools of the archipelago.

RESULTS

Data show that of the 139 education professionals who were enrolled in the program by the education administration, 77 actively contributed. The work of these 60 teachers, 12 school principals and 5 district managers were studied in detail and categorized on the basis of the nature of their contribution.

CONCLUSION

Analysis of the factors impacting active participation showed that two main parameters play a key role in teacher engagement: support and leadership at the school level. This work confirms, on the one hand, the stakes for primary schools to have local support in health promotion and, on the other hand, the need to strengthen the role of school principals in the field of health.

Feasibility and Acceptability of 'VitaVillage': A Serious Game for Nutrition Education

Computer games have previously been used to improve nutrition knowledge in children. This paper describes the acceptability and feasibility of a serious game, "VitaVillage", for improving child nutrition knowledge. VitaVillage is a farming-style game in which the player undertakes quests and completes questions aimed at increasing several aspects of nutrition and healthy eating knowledge. Children aged 9-12 years in two primary schools (control vs. intervention) completed a nutrition knowledge questionnaire at baseline (T1) and after 1 week (T2). Participants at the intervention school (n = 75) played VitaVillage for 20 minutes on two occasions. Control participants (n = 94) received no nutrition education. Likeability question scores and written feedback from intervention participants was reported qualitatively. Paired sample t-tests were used to compare T1 and T2 nutrition knowledge changes between control and intervention participants. Engagement with VitaVillage improved children's overall nutrition knowledge (Mean increase of 2.25 points between T1 and T2, Standard Deviation (SD) 6.31, p = 0.035) compared to controls. The game was liked overall (mean score 77 (SD 24.6) on scale of 0-100) and positive feedback was given. Results indicate that VitaVillage has the potential to be successful as a nutrition education tool. In the future, VitaVillage's content and gameplay will be revised, extended and evaluated for its long-term impact on eating behaviour and knowledge changes.

Elementary Schools' Response to Student Wellness Needs during the COVID-19 Shutdown: A Qualitative Exploration Using the R = MC2 Readiness Heuristic

During spring of 2020, the COVID-19 pandemic and accompanying public health advisories forced K-12 schools throughout the United States to suspend in-person instruction. School personnel rapidly transitioned to remote provision of academic instruction and wellness services such as school meals and counseling services. The aim of this study was to investigate how schools responded to the transition to remote supports, including assessment of what readiness characteristics schools leveraged or developed to facilitate those transitions. Semi-structured interviews informed by school wellness implementation literature were conducted in the spring of 2020. Personnel (n = 50) from 39 urban and rural elementary schools nationwide participated. The readiness = motivation capacity² (R = MC²) heuristic, developed by Scaccia and colleagues, guided coding to determine themes related to schools' readiness to support student wellness in innovative ways during the pandemic closure. Two distinct code sets emerged, defined according to the R = MC² heuristic (1) Innovations: roles that schools took on during the pandemic response, and (2) Readiness: factors influencing schools' motivation and capacity to carry out those roles. Schools demonstrated unprecedented capacity and motivation to provide crucial wellness support to students and families early in the COVID-19 pandemic. These efforts can inform future resource allocation and new strategies to implement school wellness practices when schools resume normal operations.

Process evaluation of a pre-adolescent transdisciplinary health intervention for inter-generational outcomes

Background

The CIrCLE of Life Initiative was implemented to 537 grade 6 learners and their parents, in five Government-run South African primary schools. The transdisciplinary intervention was intended to increase knowledge and skills on HIV and obesity. The study aim was to assess and report on the implementation process.

Methods

Data was collected on an adapted Proctor’s taxonomy of implementation outcomes, and to assess participants’ experiences. Qualitative and quantitative data were collected through educator logbooks, researcher observations, and learner-parent workbooks.

Results

Differentiations between the various school contexts were observed. The process evaluation revealed high learner penetration (97.2%), but lower learner and parent exposure (44.3% and 55.5%, respectively). All educators thought that the intervention was a fit for both rural and urban schools, different socio-economic groups, and people of different ethnic and cultural backgrounds. The intervention was perceived to be sustainable, and there were recommendations for adoption into the school curriculum and scale-up if found to be effective.

Conclusion

The process evaluation facilitated the assessment of the implementation outcomes, described its processes, and acknowledged fundamental characteristics that could justify variability in the intervention impact and outcomes. The value of process evaluations and their benefit to the science of implementation were demonstrated.

Understanding for Which Students and Classes a Socio-Ecological Aggression Prevention Program Works Best: Testing Individual Student and Class Level Moderators

School-based aggression prevention programs may not be equally effective for all students and classes, depending on student and class characteristics. This study investigated moderators of a cluster randomized controlled socio-ecological aggression prevention program’s effectiveness (change from pretest to posttest, sample: 2,042 preadolescents, mean age = 11.7 years, SD = 0.09, 47.6% girls) and sustainability (change from posttest to follow-up test, sample: 659 preadolescents, mean age = 12.7 years, SD = 0.08, 47.9% girls). The program worked better in multicultural classes, as greater ethnic diversity strengthened the program’s effectiveness and sustainability. Moderating effects of a positive social class climate and higher baseline levels of aggressive behavior and victimization were also found. These results advance socio-ecological theorizing and can help develop more contextualized interventions.

Effectiveness of a pre-adolescent inter-generational intervention to address HIV and obesity in South Africa, using a pretest-posttest design

BACKGROUND

Strengthening pre-adolescents knowledge and skills through an age- and culturally-appropriate intervention could prevent health issues later in life. Early interventions could influence the trajectory of future risky behaviour, and may influence health behaviour amongst their parents. The CIrCLE of Life Initiative was developed to address HIV and obesity. We evaluated whether the combined intervention increased knowledge, enhanced skills, and/or promoted healthy behaviour among students (9-12 years old) and their parents.

METHODS

The study was conducted from May to December 2018. Trained educators delivered 30-min lessons over ten consecutive weeks with 537 Grade 6 students at five government-run schools, in a district, in South Africa. Schools were purposively selected based on socioeconomic status and urban-rural classification. Students communicated with parents through shared homework activities. A pretest-posttest study design was used, with a 3-month follow up. Both groups completed self-administered paper-based questionnaires. A score of subscales was used in analysis. The pretest and posttest scores were compared for students and parents using a dependent t-test. Differences in outcomes by school quintile were compared using one-way ANOVA.

RESULTS

Response rates were high for both students (80.6%) and their parents (83.4%). Statistically significant differences were observed in HIV knowledge in students pretest (mean 8.04, SD 3.10) and posttest scores (mean 10.1, SD 2.70; p < 0.01), and their parents (mean 10.32, SD 2.80 vs 11.0, SD 2.50; p < 0.01). For both students and parents, pre- and post-test obesity awareness mean scores were similar, 1.93, SD 0.92 and 2.78, SD 0.57; p < 0.01, for students; and 2.47, SD 0.82 and 2.81, SD 0.54; p < 0.01, for parents. In the posttest, statistically significant changes were also observed in both groups, enhancing skills in measuring body mass index and pulse rate, and interpreting food labels. Students had a high intention to share gained knowledge with parents who had a high intention to receive it (89.4 and 89.5%, respectively).

CONCLUSION

The intervention increased knowledge about HIV and obesity-related awareness, and it enhanced skills in selected outcomes among pre-adolescents and parents. Accurate messages and enhanced communication skills could support inter-generational knowledge transfer.

TRIAL REGISTRATION

ClinicalTrials.gov Identifier: NCT04307966 retrospectively registered on 12 March 2020.

Examining the Effectiveness of the WITS Programs in the Context of Variability in Trajectories of Child Development

This study has two objectives: (1) to report the results of a large-scale, longitudinal evaluation of the WITS Programs that included a large sample of elementary school children (n = 1967) from 27 rural schools (including 16 program schools) and (2) to examine and discuss the effects of average developmental trajectories and of heterogeneity in children's development on intervention outcomes. Data comprise baseline (spring) and four follow-up assessments (5 Waves) from children (N = 1967) and their parents and teachers. WITS stands for Walk away Ignore, Talk it out, and Seek Help ( www.witsprograms.com ). The children in the intervention schools declined more slowly than those in the control schools in their reports of relational victimization. Children in the intervention schools also declined faster in aggression and emotional problems relative to children in control schools. Moderation analyses showed that intervention group children with higher baseline levels of emotional problems declined faster in emotional problems than those with lower problems at baseline. In addition, children in grades 3 and over completed school climate questionnaire and children in control schools who had more negative perceptions of school climate at baseline showed greater increases in these negative perceptions compared to children in the intervention schools. We discuss the potential impact of average trajectories of child development and the within-child heterogeneity in assessments for the interpretation of the findings. We also conclude by highlighting evaluation design modifications that may improve our future ability to examine the effects of preventive interventions for elementary school children.

Diffusing Innovation and Motivating Change: Adopting a Student-Led and Whole-School Approach to Mental Health Promotion

BACKGROUND

Research suggests that a whole-school approach to mental health promotion can be more effective than a compartmentalized approach. In particular, student-led initiatives have demonstrated a positive impact on students' mental health, though not without systemic and individual barriers. Factors that lead to successful implementation and sustaining of student-led initiatives are currently not well understood.

METHODS

A case study is presented to demonstrate how a student-led intervention came about, inspired changes in the school organization and members, and transformed the school's approach to mental health promotion. Analysis of in-depth interviews with student leaders and adult advisors was informed by theories of innovation diffusion and human motivation.

RESULTS

Key factors and mechanisms of change were identified for the initiation, transformation, and institutionalization stages of the student-led initiative. Changes in students' identity and adult advisors' mindset were found to be integral to the successful conversion to a whole-school approach in mental health promotion.

CONCLUSIONS

This study confirms the value of mobilizing the student body as an active resource in promoting mental health in school and the importance of input from school management, advisors, and intervention expert. Recommendations on how to implement a student-led initiative and sustain the positive changes are given.

The Contribution of Physical Education to Physical Activity Within a Comprehensive School Health Promotion Program

Purpose: Little is known about the role of physical education (PE) in a school health promotion model, particularly where wellness is placed at the forefront. The purpose of this study was to understand how PE contributes to the overall amount of moderate to vigorous physical activity (MVPA) that children receive in a school recognized for health promotion. Methods: As part of an in-depth case study, participants in grades 4-8 (N = 105) wore ActiGraph wGT3X+ accelerometers over 7 days to assess activity levels. Data were scored using ActiLife software. Using SPSS statistics software, students were grouped into low, moderate, and high activity through calculating tertile splits of average daily MVPA. Two 2 × 2 ANCOVA (sex x activity level) tests were conducted to determine the ratio of MVPA in PE to school and daily MVPA, controlling for age. Results: Participants accrued 8 min MVPA on average during PE with differences among low (6.4 ± 2.5), moderate (8.3 ± 3.7), and highly active participants (10.1 ± 4.0). ANCOVA analyses revealed non-significant interactions between sex and activity level explaining variance in contribution of PE to school MVPA (F(2, 99) = .235, p = .791, partial ŋ² = .005) and daily MVPA (F(2, 99) = .299, p = .742, partial ŋ² = .006), but significant main effects between high and low activity for daily MVPA were observed F(2, 99) = 5.118 p = .008, partial ŋ² = .094. Conclusions: PE remains a priority in supporting children's PA, particularly for those least active. Despite relatively low levels of MVPA, findings provide rationale for policy change supporting more frequent PE in schools.

Beyond Co-Location: Development of a School Health Integration Measure

BACKGROUND

School-based health centers (SBHCs) can integrate health and educational services to achieve common goals of student wellness and success. As no method exists to quantify the degree of integration for clinics and partner schools, this study aimed to design such a measure.

METHODS

Measure items were drafted from the literature. Eleven school health experts from Los Angeles, CA, used a modified Delphi method to reach consensus around items for inclusion in a School Health Integration Measure (SHIM), evaluating each on its appropriateness, substantivity, and feasibility. Twenty-eight staff at 17 SBHC campuses pilot tested the SHIM to examine its psychometric properties.

RESULTS

From 36 items, the expert panel utilized 4 rounds to reach consensus on 12 items across 5 domains: health authority, integrated programming, marketing and recruitment, shared outcomes, and staff collaboration. In the SHIM pilot, scores ranged from 2.25 to 5 (possible 1-5, mean 3.53). The measure had high internal consistency (alpha = 0.9385) and was associated with participants' general assessment of integration at their sites (p = .001).

CONCLUSIONS

The SHIM provides a new tool to quantify health and educational service integration at SBHC sites, drive practice improvement, and test whether integration leads to better student outcomes.

Barriers, Enablers, and Possible Solutions for Student Wellness: A Qualitative Analysis of Student, Administrators, and Staff Perspectives

BACKGROUND

Child well-being, which includes physical, mental, and social health, has a critical effect on academic performance. Schools face many challenges in meeting needs for child well-being. Schools in low-resource areas, including the Mississippi Delta, face greater challenges when meeting student needs.

METHODS

Eleven focus groups with middle school students and 12 interviews with teachers, staff, and administration in one Mississippi Delta middle school were completed in 2019. The Social Ecological Model and Theory of Organizational Readiness for Change were used as a framework for the study.

RESULTS

Focus group data with middle school students and interviews with teachers, staff, and administrators show that academic stressors play a major role in student well-being; yet, teachers, staff, and administrators face immense pressure to achieve high test scores. However, students seem to be encouraged by a positive school environment, which could help minimize some stressors.

CONCLUSIONS

It seems that small improvements to the school environment could have a significant effect on student well-being, especially when school infrastructure and limited resources do not support comprehensive changes.

The Role of Schools in Early Adolescents' Mental Health: Findings From the MYRIAD Study

OBJECTIVE

Recent studies suggest mental health in youths is deteriorating. The current policy in the United Kingdom emphasizes the role of schools for mental health promotion and prevention, but little data exist on what aspects of schools influence mental health in pupils. This study explored school-level influences on the mental health of young people in a large school-based sample from the United Kingdom.

METHOD

Baseline data from a large cluster randomized controlled trial collected between 2016 and 2018 from mainstream secondary schools selected to be representative in relation to their quality rating, size, deprivation, mixed or single-sex pupil population, and country were analyzed. Participants were pupils in their first or second year of secondary school. The study assessed whether school-level factors were associated with pupil mental health.

RESULTS

The study included 26,885 pupils (response rate = 90%; age range, 11‒14 years; 55% female) attending 85 schools in the United Kingdom. Schools accounted for 2.4% (95% CI: 2.0%‒2.8%; p < .0001) of the variation in psychopathology, 1.6% (95% CI: 1.2%‒2.1%; p < .0001) of depression, and 1.4% (95% CI: 1.0%‒1.7%; p < .0001) of well-being. Schools in urban locations, with a higher percentage of free school meals and of White British, were associated with poorer pupil mental health. A more positive school climate was associated with better mental health.

CONCLUSION

School-level variables, primarily related to contextual factors, characteristics of pupil population, and school climate, explain a small but significant amount of variability in mental health of young people. This information might be used to identify schools that are in need of more resources to support mental health of young people.

CLINICAL TRIAL REGISTRATION INFORMATION

MYRIAD: My Resilience in Adolescence, a Study Examining the Effectiveness and Cost-Effectiveness of a Mindfulness Training Programme in Schools Compared With Normal School Provision; https://www.isrctn.com/; 86619085.

Disparities in Local Wellness Policies Implementation Across Maryland Schools

BACKGROUND

School-level implementation of district-level local wellness policies (LWPs) is needed to create school environments that promote nutrition and physical activity (PA). Disparities in classroom-specific LWPs implementation were examined.

METHODS

An administrator survey (N = 756 schools; 24/24 districts) included 6 classrooms LWP best-practice items (fully/not fully implemented: restricting food celebrations or rewards, incorporating PA breaks or integrating PA in curricula, restricting withholding or using PA as punishment). A sum score (alpha = .71; elementary and middle/high examined separately) was used to examine associations with student body income (free-and-reduced priced meals (FARMS): ≤40%, 41-75%, ≥75%), race/ethnicity, and school location (rural/urban/suburban), accounting for district-level clustering, with moderation examined.

RESULTS

Classroom implementation scores were: elementary = 3.1 ± 1.8 (range: 0-6/6 items) and middle/high = 2.3 ± 1.6 (range:0-5/5 items). Among elementary and middle/high schools, 65% and 55% had >40% FARMS, 39% and 46% had ≥50% white student body, and 24% and 23% were urban, respectively. Elementary schools with >40% of FARMS-eligible students and middle/high schools with <25% white students reported implementing fewer items. Location was not associated with classroom practices nor was moderation observed.

CONCLUSIONS

Disparities in classroom-specific LWP best practices implementation were observed by income and race/ethnicity. Tailored support may be needed to improve classroom LWP implementation in schools serving low-income students.

Existential Therapy for Children: Impact of a Philosophy for Children Intervention on Positive and Negative Indicators of Mental Health in Elementary School Children

Background: Philosophy for children (P4C) was initially developed in the 1970s and served as an educational program to promote critical thinking, caring, creative reasoning and inquiry in the educational environment. Quasi-experimental research on P4C, a school-based approach that aims to develop children’s capacity to think by and for themselves, has suggested it could be an interesting intervention to foster greater basic psychological need satisfaction in children in school settings. Objective: The goal of the present study was to evaluate the impact of P4C on basic psychological need satisfaction and mental health in elementary school students. Method: Students from grades one to three (N = 57) took part in this study and completed pre- and post-intervention questionnaires. A randomized cluster trial with a wait-list control group was implemented to compare the effects of P4C on students’ mental health. Results: Analyses of covariance (ANCOVAs) revealed a significant effect of group condition on levels of autonomy and anxiety, after controlling for baseline levels. Participants in the experimental group showed higher scores in autonomy, when compared to participants in the control group, and participants in the experimental group showed lower anxiety scores, when compared to participants in the control group. Conclusion: Overall, results from this study show that P4C may be a promising intervention to foster greater autonomy in elementary school children, while also improving mental health.

"Mummy, Can I Join a Sports Club?" A Qualitative Study on the Impact of Health-Promoting Schools on Health Behaviours in the Home Setting

Information regarding school-based health-promoting interventions' potential effects in the home environment is scarce. Gaining more insight into this is vital to optimise interventions' potential. The Healthy Primary School of the Future (HPSF) is a Dutch initiative aiming to improve children's health and well-being by providing daily physical activity sessions and healthy school lunches. This qualitative study examines if and how HPSF influenced children's and parents' physical activity and dietary behaviours at home. In 2018-2019, 27 semi-structured interviews were conducted with parents from two HPSFs. Interviews were recorded and transcribed, and data were coded and interpreted through thematic analysis. HPSF resulted in various behavioural changes at home, initiated by both children and parents. Parents reported improvements in healthy behaviours, as well as compensatory, unhealthy behaviours. Reasons for behavioural change included increased awareness, perceived support to adopt healthy behaviours, and children asking for the same healthy products at home. Barriers to change included no perceived necessity for change, lack of HPSF-related information provision, and time and financial constraints. Both child-to-adult intergenerational learning and parent-initiated changes play an important role in the transfer of health behaviours from school to home and are therefore key mechanisms to maximise school-based health-promoting interventions' impact.

Effects of a school-based intervention to reduce cardiovascular disease risk factors among secondary school students: A cluster-randomized, controlled trial

BACKGROUND

Cardiovascular diseases (CVDs) are the number cause of death worldwide. In Ghana CVD has been the leading cause of death since 2001. The prevalence of CVD risk factors among adolescents in Ghana has been increasing. This study seeks to develop, implement and evaluate the effects of a behavioral modification intervention program to reduce CVD risk factors among secondary school students in Brong Ahafo, Ghana.

METHODS

A cluster-randomized controlled trial was conducted with schools as clusters over a period of six-months with pre and post intervention evaluations. Participants were public secondary school students (14-19 years) from four schools in Brong Ahafo, Ghana. Students in the intervention group were trained by the researchers whereas those of the control group received no intervention. The intervention included health education and physical activity modules. Follow-up data using same questionnaire were collected within two weeks after the intervention was completed. Intention-to-treat analysis was performed after replacing missing values using the multiple imputation method. The generalized linear mixed model (GLMM) was used to assess the effects of the intervention study.

RESULTS

The GLMM analyses showed the intervention was effective in attaining 0.77(p<0.001), 0.72(p<0.001), 0.47(p<0.001), 0.56(p<0.001), and 0.39(p = 0.045) higher total physical activity, fruits, vegetables, seafood, and water scores respectively for the intervention group over the control group. The intervention was also significant in reducing -0.15(p<0.001),-0.23(p<0.001),-0.50(p<0.001),-0.32(p<0.001),-0.90(p<0.001),-0.87(p<0.001),-0.38(p<0.001), -0.63(p<0.001), -1.63(p<0.001), 0.61(p<0.001), and -1.53(p = 0.005) carbohydrates, fats and oils, fried eggs, fried chicken, carbonated drinks, sugar, sweet snacks, salted fish, weight, BMI, and diastolic BP. The odds of quitting alcohol use in the intervention group were 1.06 times more than the control group. There was no significant effect on reducing smoking and systolic BP.

CONCLUSION

There is an urgent need for the intervention program to be integrated into the existing curriculum structure of secondary school schools. Implementing the intervention will allow for longer and more consistent impact on the reduction of CVD risk factors among secondary school students.

Impacts of Re:MIX-A School-Based Teen Pregnancy Prevention Program Incorporating Young Parent Coeducators

BACKGROUND

Latinx adolescents are at increased risk of teen pregnancy. This study evaluates the impact of Re:MIX, a comprehensive sexuality education program cofacilitated by professional health educators paired with young parent educators implemented with primarily Latinx youth in Texas.

METHODS

A cluster randomized trial was conducted with students in grades 8-10 in 57 classrooms across three schools. Students completed baseline, post-test, and long-term follow-up surveys to determine the impact of the program on behavioral outcomes-sexual experience and unprotected sex-and on mediating factors including intentions, attitudes, knowledge, and self-efficacy related to sexual activity and contraception.

RESULTS

Re:MIX was implemented with fidelity and educators were well-received. At post-test, compared to control students, Re:MIX students were more likely to intend to use hormonal or long-acting contraceptive methods if they had sex, had greater reproductive health knowledge, had more confidence in their ability to ask for and give consent, and were more likely to know where to obtain contraception. Most findings were sustained at the long-term follow-up, but there were no impacts on behaviors.

CONCLUSIONS

The implementation and impact findings highlight the promising approach of pairing young parent educators with experienced health educators for teen pregnancy prevention among Latinx students.

Which Children Use School-Based Health Services as a Primary Source of Care?

BACKGROUND

School-based health centers (SBHCs) offer primary and preventive health care for children and adolescents. Using nationally representative data, we aimed to examine which child and family characteristics are associated with using school-based health care providers as the primary source of health care, and whether care received from these providers met the criteria for a medical home.

METHODS

Using data from the 2016-2018 National Survey of Children's Health (NSCH), we analyzed children's usual source of care (school-based provider, doctor's office or clinic, other location, or none), and whether they received care meeting medical home criteria.

RESULTS

Based on a sample of 64,710 children, 0.5% identified school-based providers as their primary source of health care. Children who were older, uninsured, or living in the Northeast were significantly more likely to report school-based providers as their usual source of care. Children whose usual source of care was a school-based provider were less likely to receive care meeting medical home criteria than children who usually received care at a doctor's office.

CONCLUSIONS

While SBHCs improve access to care, our findings indicate potential challenges with establishing a medical home for children who usually receive health care from a school-based provider.

Screening in High Schools to Identify, Evaluate, and Lower Depression Among Adolescents: A Randomized Clinical Trial

IMPORTANCE

Adolescent major depressive disorder (MDD) prevalence has nearly doubled in the past decade. The US Preventive Services Task Force endorses universal adolescent MDD screening in primary care; however, most adolescents lack preventive health care, resulting in worsening disparities in MDD screening and treatment.

OBJECTIVE

To evaluate the effectiveness of universal adolescent MDD screening in the school setting in an effort to reduce disparities and improve MDD identification and treatment initiation.

DESIGN, SETTING, AND PARTICIPANTS

This randomized clinical trial, conducted from November 6, 2018, to November 20, 2020, compared the usual school practice of targeted or selected screening based on observable behaviors of concern with universal MDD screening. Students within an identified school were randomized by grade to 1 of the 2 study groups. Study groups were compared using mixed-effects logistic regression. Participants included students in grades 9 through 12 enrolled at 1 of the 14 participating Pennsylvania public high schools.

INTERVENTIONS

In targeted screening, students with behaviors prompting concern for MDD were referred to the Student Assistance Program (SAP), mandated in all Pennsylvania schools. The SAP determined follow-up recommendations. In universal screening, all students completed the Patient Health Questionnaire-9 (PHQ-9); students with positive scores proceeded to SAP. The universal screening group could also have targeted referral to SAP for concerning behavior independent of the PHQ-9.

MAIN OUTCOMES AND MEASURES

The primary outcome was initiation of MDD treatment or services based on data collected by school SAP teams during the academic year.

RESULTS

A total of 12 909 students were included (median age, 16 years [range, 13-21 years]; 6963 male [53.9%]), of whom 2687 (20.8%) were Hispanic, 2891 (22.4%) were non-Hispanic Black, 5842 (45.3%) were non-Hispanic White, and 1489 (11.5%) were multiracial or of other race or ethnicity. A total of 6473 students (50.1%) were randomized to universal screening, and 6436 (49.9%) were randomized to targeted screening. Adolescents in the universal screening group had 5.92 times higher odds (95% CI, 5.07-6.93) of being identified with MDD symptoms, 3.30 times higher odds (95% CI, 2.49-4.38) of SAP confirming follow-up needs, and 2.07 times higher odds (95% CI, 1.39-3.10) of initiating MDD treatment. No differences were identified in initiation for planned subgroup analyses by sex or race and ethnicity.

CONCLUSIONS AND RELEVANCE

In this randomized clinical trial, universal school-based MDD screening successfully increased identification of MDD symptoms and treatment initiation among adolescents, confirming the value of this approach to address this rising public health concern.

TRIAL REGISTRATION

ClinicalTrials.gov identifier: NCT03716869.

Effectiveness of a Gamification Strategy to Prevent Childhood Obesity in Schools: A Cluster Controlled Trial

OBJECTIVE

The aim of this study was to examine the effectiveness of a school-based gamification strategy to prevent childhood obesity.

METHODS

Schools were randomized in Santiago, Chile, between March and May 2018 to control or to receive a nutrition and physical activity intervention using a gamification strategy (i.e., the use of points, levels, and rewards) to achieve healthy challenges. The intervention was delivered for 7 months and participants were assessed at 4 and 7 months. Primary outcomes were mean difference in BMI z score and waist circumference (WC) between trial arms at 7 months. Secondary outcomes were mean difference in BMI and systolic and diastolic blood pressure between trial arms at 7 months.  RESULTS: A total of 24 schools (5 controls) and 2,197 students (653 controls) were analyzed. Mean BMI z score was lower in the intervention arm compared with control (adjusted mean difference -0.133, 95% CI: -0.25 to -0.01), whereas no evidence of reduction in WC was found. Mean BMI and systolic blood pressure were lower in the intervention arm compared with control. No evidence of reduction in diastolic blood pressure was found.

CONCLUSIONS

The multicomponent intervention was effective in preventing obesity but not in reducing WC. Gamification is a potentially powerful tool to increase the effectiveness of school-based interventions to prevent obesity.

Educational Programs for the Promotion of Health at School: A Systematic Review

Context: Health promotion programs generate healthy changes in the educational community. However, not all of them meet the expected objectives due to multiple factors that affect their development, such as the teachers overload work, the lack of specific training, the lack of time to carry out health promotion activities, the lack of flexibility of the programs, and their non-inclusion in the training programs of the centers. Objective: To know the scope of the strategies and programs that promote healthy habits among students in compulsory educational stages. Data sources: a systematic review of articles in English, using the Web of Science (WOS), Medline, and PsycINFO databases.

Adaptation, Student Participation and Gradual Withdrawal by Researchers as Sustainability Strategies in the High School-Based Young and Active Intervention: School Coordinators' Perspectives

Ensuring the sustainability of school-based public health intervention activities remains a challenge. The Young and Active (Y&A) intervention used peer-led workshops to promote movement and strengthen students' sense of community in 16 Danish high schools. Peer mentors inspired first-year students to implement movement activities. To support sustainability, we applied a three-year stepwise implementation strategy using university students as peer mentors in year 1 and senior high school students in the following two years. This study explores the sustainability potential of Y&A, focusing on school coordinators' reflections on the intervention's fit to their schools and the student-driven approach, and we assess the three-step implementation strategy. The study is based on telephone interviews with coordinators (n = 7) from schools that participated in all three years and participant observations of four workshops (a total of approximately 250 participating students). Results were generated through an abductive analysis. Seven schools continued the intervention throughout the three years and adapted it to fit their priorities. The student-driven approach was perceived to be valuable, but few student-driven activities were initiated. Teacher support seemed crucial to support students in starting up activities and acting as peer mentors in workshops. The three-step implementation strategy proved valuable due to the peer-approach and the possibility of gradual adaptation. In future similar initiatives, it is important to address how the adequate staff support of students can be facilitated.