Content comparison of campus medical amnesty policies

Objective: To describe common components of medical amnesty (MA) policies and examine how MA policies differ across institutions. Participants: 50 U.S. colleges and universities with current MA policies. Methods: A checklist was developed to compare and assess the campus MA policies of 50 institutions. Descriptive statistics, chi-square, and regression analyses were used to examine common policy components and differences across types of institutions. Results: 40% of policies did not include a purpose statement. 42% of policies had no mention about how to use the policy. 48% did not mention restrictions on amnesty. 32% did not mention follow-up actions. 24% of policies mentioned extending amnesty for additional person(s) present. There were no significant differences in policy components across school characteristics. Conclusions: Many policies lacked detail, highlighting the need for guidelines and best practices to develop MA policies. Future research could examine the effects of these policy components on help seeking intentions.

Associations of formal childcare use with health and human capital development for adolescent mothers and their children in South Africa: A cross-sectional study

AIM

This study aims to investigate associations of formal childcare with maternal and child outcomes in a large sample of adolescent mothers.

BACKGROUND

Forty percent of adolescent girls in Africa are mothers. Increasing evidence shows positive impacts of formal childcare use for adult women, but no known studies in the Global South examine associations for adolescent mothers and their children.

METHODS

We interviewed 1046 adolescent mothers and completed developmental assessments with their children (n = 1139) in South Africa's Eastern Cape between 2017 and 2019. Questionnaires measured childcare use, maternal and child outcomes and socio-demographic background variables. Using cross-sectional data, associations between formal childcare use and outcomes were estimated in multivariate multi-level analyses that accounted for individual-level and family-level clustering.

RESULTS

Childcare use was associated with higher odds of being in education or employment (AOR: 4.01, 95% CIs: 2.59-6.21, p < .001), grade promotion (AOR: 2.08, 95% CIs: 1.42-3.05, p < .001) and positive future ideation (AOR: 1.58, 95% CIs: 1.01-2.49, p = .047) but no differences in mental health. Childcare use was also associated with better parenting on all measures: positive parenting (AOR: 1.66, 95% CIs: 1.16-2.38, p = .006), better parental limit-setting (AOR: 2.00, 95% CIs: 1.37-2.93, p < .001) and better positive discipline (AOR: 1.77, 95% CIs: 1.21-2.59, p = .003). For the children, there were no differences in temperament or illness, but a significant interaction showed stronger associations between childcare use and better cognitive, language and motor scores with increasing child age (AOR: 5.04, 95% CIs: 1.59-15.96, p = .006).

CONCLUSIONS

Adolescent mothers might benefit substantially from formal childcare, but causal links need to be explored further. Childcare use was also associated with improved parenting and better child development over time, suggesting positive pathways for children. At an average of $9 per month, childcare provisions for adolescent mothers may offer low-cost opportunities to achieve high returns on health and human capital outcomes in Sub-Saharan African contexts.

Improving educational and reproductive outcomes for adolescent mothers in South Africa: A cross-sectional analysis towards realising policy goals

Adolescent mothers face numerous challenges. This study aimed to address the operationalisation of the new South African national policy for young mothers by testing the associations of potential protective provisions with three policy goals: School return, grade promotion, and pregnancy/HIV prevention. Adolescent mothers aged 12-24 from rural and urban communities of South Africa's Eastern Cape completed study questionnaires between 2017-2019. Using multivariate multi-level analysis, we simultaneously estimated associations between hypothesized provisions and protective variables and all policy-aligned goals. School return was associated with using formal childcare services, higher confidence and self-efficacy scores, and remaining in school throughout pregnancy. Grade promotion was associated with greater exposure to friendly and respectful health staff, using formal childcare services, higher confidence and self-efficacy scores, and remaining in school throughout pregnancy. Pregnancy/HIV prevention (condom use) was moderately associated with greater exposure to friendly and respectful health staff. There was evidence of synergies of provisions whereby a combination of protective characteristics showed larger positive effects than receipt of any single factor alone. This study provides essential evidence for operationalising South Africa's new policy on the Prevention and Management of Learner Pregnancy in Schools, and points to implementation strategies that provide low-cost opportunities to promote educational and health outcomes for adolescent mothers.

"It's Not the Stereotypical 80s Movie Bullying": A Qualitative Study on the High School Environment, Body Image, and Weight Stigma

BACKGROUND

Schools are crucial for preventing negative health outcomes in youth and are an ideal setting to address weight stigma and poor body image. The current study sought to examine and describe the nature of weight stigma and body image in adolescents, ascertain aspects of the school environment that affect body image, and identify recommendations for schools.

METHODS

We conducted 24 semi-structured interviews with students at 2 high schools in 2020. Qualitative data were analyzed using inductive coding and an immersion/crystallization approach.

RESULTS

Students did not report weight discrimination or harmful body image messaging from teachers or administrators. Physical education (PE) class and dress codes were 2 instances where covert weight stigma appeared. The most common forms of peer weight stigma reported were weight-based teasing and self-directed appearance critiques. Students recommended that schools eliminate dress codes, diversify PE activities, address body image issues in school, and be cognizant of teasing within friend groups.

CONCLUSIONS

Weight stigma presents itself in unique ways in high school settings. Schools can play a role in reducing experiences of weight stigma and negative body image. Weight-related teasing within friend groups was common and may not be captured in traditional assessments of bullying. More nuanced survey instruments may be needed.

Teachers' dissatisfaction during the COVID-19 pandemic: Factors contributing to a desire to leave the profession

Introduction

The COVID-19 pandemic required more responsibilities from teachers, including implementing prevention strategies, changes in school policies, and managing their own mental health, which yielded higher dissatisfaction in the field.

Methods

A cross-sectional web survey was conducted among educators to collect information on their experiences teaching during the COVID-19 pandemic throughout the 2020-2021 academic year. Qualtrics, an online survey platform, fielded the survey from May 6 to June 8, 2021 to a national, convenience sample of 1,807 respondents.

Results

Findings revealed that overall, 43% of K-12 teachers reported a greater intention to leave the profession than previously recalled prior to the COVID-19 pandemic. Intention to leave was multi-level, and associated with socio-demographic factors (e.g., age: AOR = 1.87, p < 0.05), individual factors (e.g., perceived COVID risks: AOR = 1.44, p < 0.05), and teachers' agency (e.g., dissatisfaction with school/district communications and decisions: AOR = 1.34, p < 0.05). We also found demographic disparities with respect to race and gender (e.g., female teachers: AOR: 1.78, p < 0.05) around teachers' ability to provide feedback to schools on opening/closing and overall dissatisfaction with school/district COVID-19 prevention strategies implementation and policies.

Conclusion

These findings are consistent with the Job-Demand and Resources Model (JD-R), which posits that lack of organizational support can exacerbate job stressors, leading to burnout. Specifically, dissatisfaction with the way school policies were implemented took a toll on teachers' mental health, leading to a desire to leave the profession. These findings are also consistent with research conducted once in-person teaching resumed in 2020-2021, specifically that the COVID-19 pandemic exacerbated preexisting teacher shortages that led to self-reported issues of stress, burnout, and retention.

Implications

Further research is necessary to understand the resources that may be most useful to reduce the demands of teaching in the context of the COVID-19 pandemic. Some teachers are more likely to leave the field, and educational agencies may wish to target their teacher-retention efforts with emphasis on strong employee wellness programs that help educators to manage and reduce their stress. Education agency staff may wish to review policies and practices to provide meaningful opportunities to give input to school/district decisions and enable proactive communication channels.

Student awareness of campus medical amnesty policies

ObjectiveExamine students' awareness of medical amnesty policies and the influence of policy awareness on the expected consequences of bystander help seeking in alcohol-related emergencies among student-athletes and non-athletes. Participants: 1,012 college students. Methods: Spearman's correlation and chi-square tests were used to examine accuracy in awareness of amnesty policies. Nominal logistic regression was used to test the relationship between amnesty policy awareness and expected consequences of bystander help seeking. Results: About 25% of students were unsure if their school had an amnesty policy; of these students, 67% attended schools with such a policy. Students who were unsure about the presence of amnesty policies were more likely to expect serious negative consequences of calling for help for both non-athlete peers (B = 1.152 p < 0.001) and student-athlete peers (B = 0.887 p = 0.001). Conclusions: Greater attention is needed to how amnesty policies are implemented on college campuses, including how they are communicated to and interpreted by student-athletes.

Prevalence of Concussion-Related Policies and Practices Among Public School Districts in the United States, 2012 and 2016

BACKGROUND

Beginning in 2009, there was an increase in the number of states with laws addressing 3 different components of youth sports-related concussion prevention and management: concussion education, removal from play, and medical clearance requirements before allowing an athlete to return to play. Schools are an important setting to implement policies and practices related to concussions, as many youth participate in organized sports through school venues.

OBJECTIVE

To examine whether the prevalence of concussion-related policies and practices adopted by school districts changed from 2012 to 2016.

METHODS

This study used nationally representative data from the 2012 and 2016 School Health Policies and Practices Study to examine whether the prevalence of 4 concussion-related policies and practices changed during 2012 and 2016 and whether comprehensive policies changed during the same time frame. Comprehensive policies were defined as those that address removal from play after injury, medical clearance before returning to play, and concussion-related educational materials and sessions for parents and student athletes.

RESULTS

Among school districts nationwide, the prevalence of each of the 4 concussion-related policies and practices significantly increased during 2012 and 2016. The prevalence of comprehensive policies significantly increased from 51.6% in 2012 to 66.7% in 2016. While these findings are promising, it is important to note that one-third of districts still lacked comprehensive policies in 2016 and only 71% of districts provided educational sessions in 2016.

CONCLUSIONS

The findings in this study highlight improvements in school districts nationwide in adopting concussion-related policies and practices. Policies such as requiring educational sessions allow parents and student athletes to learn about concussions and understand the importance of reporting a concussion or concussion symptoms.

Smart Indigenous Youth: The Smart Platform Policy Solution for Systems Integration to Address Indigenous Youth Mental Health

Indigenous youth mental health is an urgent public health issue, which cannot be addressed with a one-size-fits-all approach. The success of health policies in Indigenous communities is dependent on bottom-up, culturally appropriate, and strengths-based prevention strategies. In order to maximize the effectiveness of these strategies, they need to be embedded in replicable and contextually relevant mechanisms such as school curricula across multiple communities. Moreover, to engage youth in the twenty-first century, especially in rural and remote areas, it is imperative to leverage ubiquitous mobile tools that empower Indigenous youth and facilitate novel Two-Eyed Seeing solutions. Smart Indigenous Youth is a 5-year community trial, which aims to improve Indigenous youth mental health by embedding a culturally appropriate digital health initiative into school curricula in rural and remote Indigenous communities in Canada. This policy analysis explores the benefits of such upstream initiatives. More importantly, this article describes evidence-based strategies to overcome barriers to implementation through the integration of citizen science and community-based participatory research action.

School Health Promotion Policies and Adolescent Risk Behaviors in Israel: A Multilevel Analysis

BACKGROUND

Health promotion policies targeting risk-taking behaviors are being implemented across schools in Israel. This study identified the most effective components of these policies influencing cigarette smoking and alcohol consumption among adolescents.

METHODS

Logistic hierarchical linear model (HLM) analysis of data for 5279 students in 95 Jewish public schools from the Health Behavior in School-Aged Children (HBSC) 2010-2011 survey in Israel enabled simultaneous estimation of the relationship between student- and school-level variables (health promotion policy) to alcohol consumption and smoking behavior. Principals of participating schools also were interviewed to ascertain their degree of adoption and implementation of a health promotion policy.

RESULTS

Most of the variance in adolescent risk behaviors is explained by student-level variables: negative perceptions of school, lack of parental support for school issues, and more time spent with friends. Among the school-level policy measures, parental participation in health promotion intervention programs was repeatedly associated with lower rates of risk behaviors, over and above student characteristics.

CONCLUSIONS

School health promotion policies should focus on parents' involvement in intervention programs and should seek to improve students' perceptions of school and their sense of well-being to promote resilience. Further research is needed to identify additional factors that may increase the effectiveness of school health promotion policies.

Allowing and Using Foods of Low Nutritional Value in Elementary School Classrooms: The Implications of Teachers' Beliefs

OBJECTIVE

To investigate elementary teachers' behavior toward allowing and using foods with low nutritional value in the classroom.

DESIGN/SETTING

A survey guided by the Theory of Planned Behavior was administered in fall, 2012 in 10 schools.

PARTICIPANTS

Elementary public school teachers in grades pre-kindergarten through 6.

MAIN OUTCOME MEASURES

Teachers' behavior and beliefs regarding allowing and using foods with low nutritional value in the classroom and Theory of Planned Behavior determinants.

ANALYSIS

Pairwise correlation coefficients and multivariate linear regression to assess relationships between theory determinants and descriptive statistics.

RESULTS

All 3 determinants, Attitude Toward the Behavior (t = 4.04; P < .01), Subjective Norms (t = 3.78; P < .01), and Perceived Behavioral Control (t = 5.19; p < .01), were statistically significant predictors of behavior. The majority of teachers (94%) allowed foods of low nutritional value for celebrations at least some of the time, and 75% stated that they had control over what foods they allow.

CONCLUSIONS AND IMPLICATIONS

Discussions among teachers and school health professionals should ensue to improve nutritional content of foods allowed in classrooms. School policies can be developed and evaluated for effectiveness to have a positive impact on childhood obesity and school nutrition environments.

Association Between School Policies and Built Environment, and Youth's Participation in Various Types of Physical Activities

BACKGROUND

School environmental characteristics may be associated with youth's participation in different types of physical activities (PAs). This study aimed to identify which school policies and built environmental characteristics were associated with participation in organized, nonorganized, individual, and group-based activities.

METHODS

This cross-sectional analysis included 776 students in grade 5 or 6 from 16 schools. The school environment was assessed through school-based questionnaires completed by school representatives. Types of PA and attainment of PA recommendations were obtained using self-administered student questionnaires. Associations between environment and student PA were examined using multilevel logistic regressions.

RESULTS

Schools with favorable active commuting environments were positively associated with girls' participation in organized (odds ratio [OR] = 1.34, confidence interval [CI] = 1.04-1.74) and group-based PA (OR = 1.54, CI = 1.19-1.99) and with boys' odds of participating in individual activities (OR = 1.45, CI = 1.04-2.04). There was also a positive relationship between having a school environment favorable to active commuting and boys' odds of meeting PA recommendations (OR = 2.19, CI = 1.43-3.37). School policies supporting PA were positively associated with girls' odds of participating in nonorganized activities (OR = 1.18, CI = 1.00-1.40).

CONCLUSIONS

School environments that favor active commuting may encourage participation in different types of PA. School policies promoting PA also may encourage girls to participate in organized activities.

Association between school district policies that address chronic health conditions of students and professional development for school nurses on such policies

Supportive school policies and well-prepared school nurses can best address the needs of students with chronic health conditions. We analyzed nationally representative data from the 2012 School Health Policies and Practices Study to examine whether districts with policies requiring that schools provide health services to students with chronic health conditions were more likely to provide funding for professional development (PD) or offer PD to school nurses on those health services than districts without such policies. Compared to districts without certain requirements for health services related to chronic health conditions, districts with those requirements were more likely to provide PD on related topics (for all comparisons, p ≤ .001). For some topics, however, regardless of district requirements, PD was fairly low and suggests the need for increases in the rates at which districts provide PD to support school nurses who deliver services to students with chronic health conditions.

From policy to practice: implementation of physical activity and food policies in schools

PURPOSE

Public policies targeting the school setting are increasingly being used to address childhood obesity; however, their effectiveness depends on their implementation. This study explores the factors which impeded or facilitated the implementation of publicly mandated school-based physical activity and nutrition guidelines in the province of British Columbia (BC), Canada.

METHODS

Semi-structured interviews were conducted with 50 school informants (17 principals - 33 teacher/school informants) to examine the factors associated with the implementation of the mandated Daily Physical Activity (DPA) and Food and Beverage Sales in Schools (FBSS) guidelines. Coding used a constructivist grounded theory approach. The first five transcripts and every fifth transcript thereafter were coded by two independent coders with discrepancies reconciled by a third coder. Data was coded and analysed in the NVivo 9 software. Concept maps were developed and current theoretical perspectives were integrated in the later stages of analysis.

RESULTS

The Diffusion of Innovations Model provided an organizing framework to present emergent themes. With the exception of triability (not relevant in the context of mandated guidelines/policies), the key attributes of the Diffusion of Innovations Model (relative advantage, compatibility, complexity, and observability) provided a robust framework for understanding themes associated with implementation of mandated guidelines. Specifically, implementation of the DPA and FBSS guidelines was facilitated by perceptions that they: were relatively advantageous compared to status quo; were compatible with school mandates and teaching philosophies; had observable positive impacts and impeded when perceived as complex to understand and implement. In addition, a number of contextual factors including availability of resources facilitated implementation.

CONCLUSIONS

The enactment of mandated policies/guidelines for schools is considered an essential step in improving physical activity and healthy eating. However, policy makers need to: monitor whether schools are able to implement the guidelines, support schools struggling with implementation, and document the impact of the guidelines on students' behaviors. To facilitate the implementation of mandated guidelines/policies, the Diffusion of Innovations Model provides an organizational framework for planning interventions. Changing the school environment is a process which cannot be undertaken solely by passive means as we know that such approaches have not resulted in adequate implementation.