A School-Level Proxy Measure for Individual-Level Poverty Using School-Level Eligibility for Free and Reduced-Price Meals

Comparing the number of outdoor sugar-sweetened beverage and caffeinated beverage advertisements near schools by school type and school-level economic advantage

INTRODUCTION

Sugar-sweetened beverage and caffeinated beverage consumption are associated with a variety of health issues among youth. Food and beverage marketing has been shown to affect youth's preferences, purchases, and consumption of marketed products. Previous research suggests that outdoor food and beverage marketing differs by community demographics, with more advertisements in lower-income communities and near schools. The purpose of this study is to examine the density of sugar-sweetened and caffeinated beverage advertisements near schools by school type (middle vs. high school) and by school-level SES.

METHODS

Data are from the Outdoor Measuring and Evaluating the Determinants and Influence of Advertising (MEDIA)study, which documented and described all outdoor food and beverage advertisements near 47 middle and high schools in 2012. Beverage advertisements were categorized as: sugar-sweetened/caffeinated, sugar-sweetened/non-caffeinated, non-sugar-sweetened/caffeinated, or non-sugar-sweetened/non-caffeinated. Schools were categorized by type (middle vs high) and by SES as determined by the percentage of students qualifying for free or reduced-price lunch. Bootstrapped non-parametric Mann-Whitney U tests compared the number of advertisements in each category by school type and school-level SES (higher vs lower).

RESULTS

Compared to schools with higher SES, schools with lower SES had significantly more advertisements for sugar-sweetened/non-caffeinated beverages (Medianlow = 28.5 (IQR 17-69), vs Medianhigh = 10.5 (IQR 4-17) (p = 0.002)., sugar-sweetened non-caffeinated (Medianlow = 46 (IQR 16-99) vs Medianhigh = 13.5 (IQR 6-25), p = 0.002), -sugar-sweetened caffeinated (Medianlow = 12 (IQR 8-19) vs Medianhigh = 6 (IQR 2-8), p = 0.000), and non-sugar-sweetened non-caffeinated (Medianlow = 30 (IQR 13-65) vs Medianhigh = 14 (IQR 4-29), p = 0.045).There were no significant differences by school type.

CONCLUSION

This study adds to the literature demonstrating pervasive marketing of unhealthy products in lower-income communities. Disproportionate exposure to sugar-sweetened and caffeinated beverage advertisements in lower-income communities may contribute to the disparities in associated health outcomes by economic status.

School-level self-reported versus objective measurements of body mass index in public high school students

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 nation's 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.

Trends in school-neighbourhood inequalities and youth obesity: Repeated cross-sectional analyses of the public schools in the state of California

BACKGROUND

It is currently unknown whether the relationship between affluence of school neighbourhoods and prevalence of youth overweight/obesity is uniform across demographic subgroups and areal context in the United States.

METHODS

We examined association between school-neighbourhood income tertiles and school-level overweight/obesity (OVOB) prevalence, using data on body mass index of fifth, seventh, and nineth graders who attended public schools in California in 2001 and 2010 (n = 1 584 768), using multiple logistic regression models.

RESULTS

Overall, OVOB prevalence was higher in lower-income school neighbourhoods, with a steeper income-OVOB gradient for girls. Among boys, the gradient became steeper in 2010 than 2000. Among Asian and White girls, the negative gradients were steepest in rural areas. For African-American students in all areas and Latino boys in rural areas, there was less clear evidence of inverse income-OVOB gradients. Addition of fast-food restaurant availability to the models did not change the observed inverse school-neighbourhood income-obesity gradients.

CONCLUSIONS

The findings suggest the needs to investigate reasons for this variability with consideration to combinations of sociodemographic, economic, and environmental risk factors that may contribute to disparities in childhood obesity.

Context, importance, and process for creating a body mass index surveillance system to monitor childhood obesity within the New York City public school setting

The Office of School Health, a joint program of the Departments of Health and Education, administers New York City’s (NYC) body mass index (BMI) surveillance system to monitor childhood obesity. We describe the context, importance, and process for creating a multi-agency, school-based BMI surveillance system using BMI collected from annual FITNESSGRAM® physical fitness assessments conducted as part of a larger physical activity and wellness curriculum in NYC public schools. We also summarize our current system and methodology, highlighting the types of data and data sources that comprise the system and partnership between the Departments of Health and Education that enable data sharing. Strategies for addressing threats to data quality, including missing data, biologically implausible values, and imprecise/subjective weight or height equipment are discussed. We also review current and future surveillance data products, and provide recommendations for collecting, analyzing, interpreting, and reporting BMI data for childhood obesity surveillance. Collaboration between Departments of Health and Education as well as attention to safeguards of BMI reporting and data quality threats have enabled NYC to collect high quality BMI data to accurately monitor childhood obesity trends. These findings have implications for youth BMI surveillance systems in the United States and globally.

Plate Waste Evaluation of Plant-Based Protein Entrees in National School Lunch Program

OBJECTIVE

To assess plate waste of plant-based protein entrees compared with regularly served meat-based entrees in the National School Lunch Program (NSLP).

DESIGN

Plate waste data were collected before and after introducing the plant-based entrees, using digital photography and the quarter-waste method.

PARTICIPANTS

National School Lunch Program participants in grades 6-8.

INTERVENTION

Two newly developed plant-based protein entrees were introduced into the menu cycle by replacing 2 regularly served meat-based entrees.

MAIN OUTCOME MEASURE

Student plate waste of plant-based entrees compared with entrees regularly served in the NSLP meal pattern.

ANALYSIS

A total of 4,138 meal observations were analyzed. Ordinary least-squares regressions and 2-sample unpaired t tests were used to determine significant differences in waste.

RESULTS

National School Lunch Program participants wasted plant-based entrees more than all other entrees served during lunch. Students wasted all or none of the plant-based entrees more than partial servings. There were no significant differences in waste between demographic groups for the plant-based entrees.

CONCLUSIONS AND IMPLICATIONS

Plant-based entrees served as a part of the NSLP may lead to increased plate waste than meat-based entrees. Novel food pairings and visibility of legumes may have led to increased plate waste.

School-Level Poverty and Rurality Associated With Differences in Sexual Risk Behaviors Among U.S. Public High School Students

PURPOSE

This study examined associations between student sexual behaviors and both school-level socioeconomic status and metropolitan status.

METHODS

National Youth Risk Behavior Survey data from 2017 (N = 14,765, response rate = 60%) and 2019 (N = 13,677, 60%) were combined. School-level socioeconomic status (low-, mid-, and high-poverty based on the percentage of students eligible for free or reduced-price meals) and metropolitan status (urban, suburban/town, or rural) were identified for students attending public high schools. Sexual behaviors included currently sexually active, four or more lifetime sexual partners, condom use during the last sexual intercourse, hormonal birth control use during the last sexual intercourse, condom and hormonal birth control use during the last sexual intercourse, and drank alcohol or used drugs before the last sexual intercourse. Adjusted prevalence ratios were calculated using logistic regression models, controlling for sex, race/ethnicity, and grade.

RESULTS

Compared to students attending low-poverty schools, high-poverty school students were significantly more likely to be currently sexually active (adjusted prevalence ratio = 1.4 [95% confidence interval = 1.1-1.8]) and have four or more lifetime sexual partners (1.6 [1.0-2.5]), but were significantly less likely to have drank alcohol or used drugs before the last sexual intercourse (.7 [.5-.9]) and have used hormonal birth control during the last sexual intercourse (.7 [.6-1.0]). Compared to students attending rural schools, urban school students were significantly less likely to be currently sexually active (.8 [.7-.9]) and have four or more lifetime sexual partners (.7 [.5-.9]).

CONCLUSIONS

School-level socioeconomic status and metropolitan status were associated with differential risk in sexual behaviors.

Implicit Bias and Caring for Diverse Populations: Pediatric Trainee Attitudes and Gaps in Training

The objective of this study was to determine the attitudes, skill level, and preferred educational interventions of pediatric residents related to implicit bias and caring for diverse patient populations. A cross-sectional survey of pediatric residents at a single, large urban residency program was utilized. Surveys were completed by 88 (55%) residents who were 69% female and 35% non-White or mixed race. Almost all residents felt that it was very or extremely important to receive training on health disparities, diverse patient populations, and implicit bias. Self-assessment of skill level revealed that residents felt confident in areas often covered by cultural competency curricula, such as interpreter use, but were less confident in other areas. The top 3 areas identified for further training included implicit bias, working with transgender and gender nonconforming patients, and weight bias. For the majority of diversity and bias-related skills, prior training was significantly correlated with higher skill level (P < .05).

Concussion Knowledge, Attitudes, and Self-Reporting Intentions in Youth Athletes

CONTEXT

Although it has been suggested that developmental and sociological factors play a role in concussion reporting, the empirical evidence related to this is limited.

OBJECTIVE

To examine the influences of sex, school level, school location, concussion-reporting history, and socioeconomic status on concussion-related knowledge, attitudes, and reporting intentions among middle school and high school athletes.

DESIGN

Cross-sectional study.

SETTING

Master students and High School athletes attending pre-participation examinations (PPEs) were asked to complete paper-based surveys.

PATIENTS OR OTHER PARTICIPANTS

Overall, 541 athletes representing 18 sports returned fully completed surveys.

MAIN OUTCOME MEASURE(S)

Outcomes were concussion-related knowledge, perceived seriousness, positive feelings about reporting, and self-reporting intentions. We examined group differences in these outcomes across levels of the explanatory variables of sex, school level (middle school versus high school), school location (urban versus rural), concussion self-reporting history (yes or no), and socioeconomic status (free or reduced-price lunch versus no free or reduced-price lunch) using Wilcoxon rank sum tests. Then we used multivariable ordinal logistic regression models to identify predictors of higher score levels for each outcome. Odds ratio (OR) estimates with 95% confidence intervals (CIs) excluding 1.00 were deemed significant.

RESULTS

Odds of higher levels of knowledge were higher in urban versus rural school student-athletes (ORAdjusted = 1.81; 95% CI = 1.03, 3.17), and lower in student-athletes on free or reduced-price lunch versus those not on free or reduced-price lunch (ORAdjusted = 0.52; 95% CI = 0.36, 0.77). Similarly, odds of higher levels of seriousness were lower in male versus female student-athletes (ORAdjusted = 0.48; 95% CI = 0.32, 0.72). Further, odds of higher levels of self-reporting intentions were lower among male versus female student-athletes (ORAdjusted = 0.53; 95% CI = 0.37, 0.75).

CONCLUSIONS

Developmental and sociological factors were differentially associated with concussion-related knowledge, attitudes, and self-reporting intentions. These results can inform medical providers, parents, and coaches with regard to context-specific clinical assessments of concussion symptoms.

Racial and ethnic comparison of ecological risk factors and youth outcomes: A test of the desensitization hypothesis

Minority youth, because of structural, ecological, and societal inequalities, are at heightened risk of reporting depression and experiencing negative sanctions associated with delinquency. Sociological theories suggest that greater exposure to ecological risk factors at the peer, family, school and community levels are associated with elevated rates of youth depression and delinquency. Desensitization theory posits that repeated exposures to ongoing stressors result in a numbing of psychological and behavioral responses. Thus, it remains unclear whether racial/ethnic differences exist with regards to how contextual stressors correlate with depression and delinquency. Using a sample of 616 Black, 687 Latinx, and 1,318 White youth, this study explores racial/ethnic differences across four ecological risk factors of risky peers, low family warmth, poor school engagement, and community violence as they relate to youth delinquency and depression. Data were collected through in-school survey of youth from 16 public schools surrounding a major city in the Midwest. Significant racial/ethnic differences provided partial support for the desensitization theory. Among Black youth, the magnitude of relationships between ecological risk factors and delinquency was significantly weaker for three of the four predictors and for all four predictors of depression in comparison to White youth. Among Latinx youth, the magnitude of relationships between ecological risk factors was significantly weaker for depression, but not delinquency, in comparison to White youth. Results indicate that ecological risk factors may have differential associations to youth depression and delinquency, which may call for culturally tailored intervention approaches.

Disparity in child welfare referrals from public schools: An example of Simpson's Paradox?

BACKGROUND

Black children continue to be found in child welfare outcome measures at rates nearly double those of White children in the United States. Researchers have turned from bias theory to risk theory, arguing that disparity disappears when considering only the subgroup of children in poverty. In this study, we consider whether this phenomenon is an example of Simpson's Paradox, where aggregate findings are confounded by a third factor.

PARTICIPANTS

We created a dataset by matching child welfare data to schools in a metropolitan California county.

METHODS

We consider measures of poverty and racial-ethnic student composition as possible confounders, utilizing compositional data analysis for the latter. Traditional linear and ridge regression models were used to calculate the unadjusted and adjusted effects of each independent variable.

RESULTS

We find only partial evidence of Simpson's Paradox, in that Black to White disparity only disappears in the highest quartile of poverty. Holding poverty constant, only increasing student population non-White composition was significantly associated with reducing Black to White disparity ratios.

CONCLUSION

In a small, exploratory study, we find that while poverty may serve as an equalizer, diversity racial/ethnic student body composition may serve as a neutralizer. We find that underlying causes of disparity are complex and caution against endorsement of single theories to explain the disproportionate representation of Black children in child welfare. We find utility in analyzing child welfare data with concepts and techniques common in other disciplines and highlight several weaknesses of current child welfare informatics which impact both program evaluation and research.

The effects of student, school and neighborhood poverty on the association between fitness and absenteeism in New York City middle school youth

Recent research demonstrates that youth fitness improvements are associated with lower absenteeism. This study assessed whether the effects of poverty on the longitudinal fitness-absenteeism relationship are consistent across poverty measures at the student, school, and neighborhood levels and across sex in New York City (NYC) public school youth individually followed over 4 years. Negative binomial longitudinal mixed models with random-intercepts were developed stratified by five dichotomized student, school and neighborhood poverty measures and sex to test the change in fitness-lagged absenteeism relationship in six cohorts of NYC middle school students (2006/7-2012/13). Models were adjusted for individual-level race/ethnicity, place of birth, change in obesity status, grade, time, and school size. The sample included 360,743 students (51% male, 39% Hispanic, 28% non-Hispanic black, 69% qualifying for free/reduced price school meals). Adjusted estimates showed an inverse dose-response fitness-absenteeism relationship in high poverty youth across all poverty measures, including the student, school and neighborhood levels. For example, in girls exposed to high poverty based on school neighborhood, absenteeism decreased by 11.3% (IRR = -0.12, 95% CI: -0.20, -0.04), 10.4% (IRR = -0.11, 95% CI: -0.21, -0.02), 6.8% (IRR = -0.07, 95% CI: -0.14, 0.00) and 4.9% (IRR = -0.05, 95% CI: -0.15, 0.04) for students who had a >20% increase, 10-20% increase, <10% change, and 10-20% decrease in fitness from the prior year, respectively, relative to the reference group (>20% decrease in fitness). Future research should explore the impact of tailored interventions for youth that aim to promote youth physical activity at each of the individual, school and neighborhood levels, and particularly among high poverty subgroups.

Trust and Discipline: Adolescents' Institutional and Teacher Trust Predict Classroom Behavioral Engagement following Teacher Discipline

This daily diary study examined how adolescents' institutional and teacher-specific trust predicted classroom behavioral engagement the day after being disciplined by that teacher. Within mathematics classrooms, adolescents (N = 190; M_age  = 14 years) reported institutional and teacher-specific trust and then completed a 15-day diary assessing teacher discipline and behavioral engagement. The results indicated that, among adolescents with low teacher trust, discipline was unrelated to next-day behavior. Contrastingly, adolescents with high teacher but low institutional trust became less engaged following discipline, whereas those with high teacher and institutional trust became more engaged. These findings suggest that adolescents interpret discipline within the social context of trust, and adolescents' trust in the institution and teacher are important for discipline to improve behavior.

Effect of Cardiorespiratory Fitness on Academic Achievement is Stronger in High-SES Elementary Schools Compared to Low

BACKGROUND

Academic achievement is influenced by factors at the student, school, and community levels. We estimated the effect of cardiorespiratory fitness performance on academic performance at the school level in Georgia elementary schools and examined effect modification by sociodemographic factors.

METHODS

This study is a repeat cross-sectional analysis of Georgia elementary schools between 2011 and 2014 (approximately 1138 schools per year). Multivariable beta regression estimated the effect of the proportion of 4th and 5th graders meeting cardiorespiratory fitness standards on the proportion of 5th graders passing standardized tests for Reading, English and Language Arts, Mathematics, Science, and Social Studies and considered potential interaction by school-level socioeconomic status (SES), racial composition, and urbanity.

RESULTS

There was a 0.15 higher estimated odds (OR: 1.15 (1.09, 1.22)) of passing the mathematics standardized test for every 10-percentage-point increase in school-level cardiorespiratory fitness among high-SES schools and 0.04 higher odds (OR: 1.04 (1.02, 1.05)) for low-SES schools. This pattern was similar for other academic subjects. No effect modification by racial composition or urbanity was observed for any academic subject.

CONCLUSIONS

Promoting physical fitness may be effective in improving academic performance among high-SES schools, but additional strategies may be needed among lower-SES schools.