Childhood nutrition education in health promotion and disease prevention.

In the last 10 to 15 years, nutrition has become a major component of health promotion and chronic disease prevention. Two widely recommended strategies for incorporating nutrition education directed toward children and youth into health promotion and disease prevention efforts are school-based nutrition education and the integration of nutritional care into health care. School-based nutrition education programs targeted toward very specific eating behaviors are showing very promising results in regard to behavior and attitude change of children and adolescents. Substantial changes in health care providers'' attitudes and practices and in the funding and financing of health care will be needed if nutrition education delivered in the context of routine health care is to be a major force in health promotion and disease prevention for youth.     

Preventing Youth Suicide: Potential “Crossover Effects” of Existing School-Based Programs

Notable increases in youth mental health problems combined with strains on the already stretched mental health workforce raise concerns that there will be an ensuing increase in youth suicide thoughts, behaviors, and even deaths. Schools are recognized as crucial settings for youth mental health support and suicide prevention activities, yet schools also face staff shortages and ever-increasing responsibilities for student well-being. Evidence is emerging that prevention programs originally designed to improve problem-solving skills and social-emotional functioning in youth have demonstrated downstream, “crossover effects,” that is, unanticipated benefits, on youth suicidal behavior. Relatively little research on crossover effects has been conducted within school settings, despite the strong potential for commonly administered programs to have an impact on later suicide risk. We review key suicide risk factors and their proposed mechanisms of action; we also discuss factors that may protect against suicide risk. We then identify upstream prevention programs targeting the same factors and mechanisms; these programs may hold promise for downstream, crossover effects on youth suicide risk. This paper is intended to provide a framework to help researchers, practitioners, and policymakers as they consider how to prevent youth suicide using existing school-based resources. Rigorous investigation of upstream prevention programs is urgently needed to determine ideal approaches schools and communities can deploy to prevent youth suicide.

     

Adolescents and access to health care.

The developmental characteristics and health behaviors of adolescents make the availability of certain services--including reproductive health services, diagnosis and treatment of sexually transmitted disease, mental health and substance abuse counseling and treatment--critically important. Furthermore, to serve adolescents appropriately, services must be available in a wide range of health care settings, including community-based adolescent health, family planning and public health clinics, school-based and school-linked health clinics, physicians'' offices, HMOs, and hospitals. National, authoritative content standards (for example, the American Medical Association''s Guidelines for Adolescent Preventive Services (GAPS), a multispecialty, interdisciplinary guideline for a package of clinical preventive services for adolescents may increase the possibility that insurers will cover adolescent preventive services, and that these services will become part of health professionals'' curricula and thus part of routine practice. However, additional and specific guidelines mandating specific services that must be available to adolescents in clinical settings (whether in schools or in communities) are also needed. Although local government, parents, providers, and schools must assume responsibility for ensuring that health services are available and accessible to adolescents, federal and state financing mandates are also needed to assist communities and providers in achieving these goals. The limitations in what even comprehensive programs currently are able to provide, and the dismally low rates of preventive service delivery to adolescents, suggests that adolescents require multiple points of access to comprehensive, coordinated services, and that preventive health interventions must be actively and increasingly integrated across health care, school, and community settings. Unless access issues are dealt with in a rational, coordinated fashion, America''s adolescents will not have access to appropriate health services. Current efforts to minimize current health care expenditures through managed care programs inevitably conflict with efforts to deliver comprehensive preventive services to all adolescents. Use of multiple sites may not represent inadequate access to care. However, as managed care reimbursement continues to expand, school-based clinics and free-standing adolescent health programs increasingly report decreases in reimbursement without a change in demand for services. The Office of Technology Assessment study called for explicit funding and expansion of services for America''s youth; since then, a federal Office of Adolescent Health has been authorized, and, by the time this reaches print, should have received appropriations and been staffed. Dryfoos has called for expansion to nearly 5000 comprehensive programs in the coming years.(ABSTRACT TRUNCATED AT 400 WORDS)     

Making the Case for Cancer Prevention in the Schools

Advances in scientific research indicate school-based cancer prevention programs could substantially reduce the risk that children and youth will develop cancer in later life. Nevertheless, scientific evidence alone cannot make a winning case for cancer prevention in schools. This programmatic emphasis must be justified in relation to the school's role in achieving national health objectives and concepts of comprehensive health education. Problems in implementing school health education also must be addressed, but this will require confronting fundamental value conflicts concerning the mission of schools in American society. After examining these issues, the author concludes that the case for school-based cancer prevention can best be advanced through collaboration with others who share a commitment to children and youth, but who differ in their specific concerns and agendas.     

The Politics of School-Based Clinics: A Community-Level Analysis

ABSTRACT: School-based primary health care, supported as an effective means for addressing the health needs of youth, also tends to be perceived as controversial partly due to opposition by national and state level organizations. This investigation used case studies of four selected school-based clinic (SBC) sites, and of one community in which an SBC was disputed, to investigate the existence of organized opposition, how proponents contended with opposition, and effects of organized opposition on SBC approval and implementation. Four sites experienced opposition affiliated with larger conservative organizations. Opponents' strategies and proponents counterstrategies were identified. Effects ranged from limiting SBC services to preventing an SBC's establishment. Proponents, consisting largely of medical and school administrative professionals, overcame opposition through strategies to increase public awareness about youth health issues and to demonstrate public support in the face of expressed opposition. Implications for planning and implementing potentially controversial programs are offered.     

Promoting Physical Activity Among Youth Through Community-Based Prevention Marketing

BACKGROUND: Community-based prevention marketing (CBPM) is a program planning framework that blends community-organizing principles with a social marketing mind-set to design, implement, and evaluate public health interventions. A community coalition used CBPM to create a physical activity promotion program for tweens (youth 9–13 years of age) called VERB™ Summer Scorecard. Based on the national VERB™ media campaign, the program offered opportunities for tweens to try new types of physical activity during the summer months. METHODS: The VERB™ Summer Scorecard was implemented and monitored between 2004 and 2007 using the 9-step CBPM framework. Program performance was assessed through in-depth interviews and a school-based survey of youth. RESULTS: The CBPM process and principles used by school and community personnel to promote physical activity among tweens are presented. Observed declines may become less steep if school officials adopt a marketing mind-set to encourage youth physical activity: deemphasizing health benefits but promoting activity as something fun that fosters spending time with friends while trying and mastering new skills. CONCLUSIONS: Community-based programs can augment and provide continuity to school-based prevention programs to increase physical activity among tweens.     

Translating evidence based violence and drug use prevention to obesity prevention: development and construction of the pathways program

Effective school-based obesity prevention programs are needed to prevent and reduce the growing obesity risk among youth. Utilizing the evidence-rich areas of violence and substance use prevention, translation science may provide an efficient means for developing curricula across multiple health behaviors. This paper introduces Pathways to Health, a school-based obesity prevention program that was developed by translating from evidence-based violence and drug use prevention programs, Promoting Alternative THinking Strategies and the Midwestern Prevention Project STAR (STAR). We illustrate how a hypothesized underlying behavior change mechanism in two domains of risk behavior, violence and substance use, can be applied to obesity prevention. A 4-step translational process is provided and may be relevant for use in developing other curricula to address multiple health risk behaviors. Practical application and decision points are also provided.     

Wraparound Team Composition,Youth Self-determination,and Youth Satisfaction in Transition Services

Wraparound, a team-based planning process for youth and families, has been widely adopted in school-based services for older adolescents and emerging adults with serious mental health conditions transitioning to adulthood. Reservations have been voiced, however, regarding possible drawbacks of teams for these youth, including concerns about difficulties with involving supportive adults, and whether youth might perceive team-based planning as a threat to their developing autonomy. To date, however, no studies have examined the feasibility of involving supports in teams and relationships between team composition and youth’s service experiences. The present study examined the relationships between team composition and youth’s perceptions of self-determination and service satisfaction among 36 youths in seven school-based programs using a specialized form of wraparound for transition services. Findings showed that meeting participation by caregivers and professionals from both inside and outside of schools was common and that regular participation by combinations of these types of adults was related to youth self-determination and satisfaction.     

Recommendations from Overweight Youth Regarding School-Based Weight Control Programs

ABSTRACT: This study aimed to obtain recommendations from overweight youth on the development of school-based weight control programs; to determine their level of interest in participation; and to learn about the outcomes they desired from such a program. Because obesity is prevalent among youth of certain minority groups and low socioeconomic backgrounds, and since few programs address the needs of these youth, the study population was selected from inner city public schools with high percentages of youth from minority groups and low socioeconomic backgrounds. Sixty-one overweight adolescents participated in semi-structured, in-depth individual interviews, which were audiotaped, transcribed, coded, and analyzed. Findings indicated that many overweight adolescents were interested in participating in school-based weight control programs, provided they are conducted in a supportive manner; offer enjoyable activities; are informative; are sensitive to the needs of overweight youth; and do not conflict with other activities. Adolescents stressed the importance of a program leader who understands the difficulties that overweight youth face, and many expressed their preference for a leader who is currently overweight or had been overweight in the past.     

Interventions on Sexuality for Adolescents with Autism Spectrum Disorder: A Systematic Review

Sexuality and intimate relationships are topics of interest to adolescents and young adults with Autism Spectrum Disorder (ASD). Given their relative difficulties to the social dimension, several intervention programs have been developed to meet this demand, but the complexity of the reality experienced by these young people limits the effectiveness of these intervention programs. To find the effects of different intervention programs to influence the development of sexuality and sexual health of adolescents with ASD and determine the impact of these interventions on the parents, through a systematic review. Literature review conducted on November 27, 2019 in the psycINFO, Pubmed, web of science and CINAHL databases. Intervention programs consisting solely of teaching sessions improve the knowledge of the youth. However, when they also included a direct approach or homework, behavioral effects were also observable. Parent-focused intervention programs resulted in a slight increase in parents’ comfort level and ability to interact well with their youth. Intervention programs targeting school-based workers appear to have a limited effect, having good concrete results with youth for some workers and no results for others, while intervention programs targeting health professionals have no conclusive results. The results of the literature review are not very transferable to practice because of the low level of evidence in the articles included, however, they offer an interesting starting point. Further research is needed to equip health professionals to intervene in sexuality after youth with ASD.

     

Differences in Mental Health Service Sector Utilization among African American and Caucasian Youth Entering Systems of Care Programs

Differences in unmet need and access to services between African American and Caucasian youth have been established; less is known about differences in specific mental health service sectors. This study examined differences in past year outpatient, school-based, day treatment and residential/inpatient service utilization among African American and Caucasian youth (n = 3,649) entering a federally funded system of care program. Random effect logistic regression models were implemented to examine the relationship between race and past year service utilization. Analyses revealed that African American youth were less likely than Caucasian youth to have utilized school-based and residential/inpatient mental health services in the past year. Findings suggest that racial disparities exist in service use for certain types of service sectors and highlight the importance of understanding and identifying individual, family, and community factors that contribute to disparities in service utilization.     

Primary prevention: educational approaches to enhance social and emotional learning

The 1995 publication of Goleman's Emotional Intelligence triggered a revolution in mental health promotion. Goleman's examination of Gardner's work on multiple intelligences and current brain research, and review of successful programs that promoted emotional health, revealed a common objective among those working to prevent specific problem behaviors: producing knowledgeable, responsible, nonviolent, and caring individuals. Advances in research and field experiences confirm that school-based programs that promote social and emotional learning (SEL) in children can be powerful in accomplishing these goals. This article reviews the work of the Collaborative to Advance Social and Emotional Learning (CASEL), its guidelines for promoting mental health in children and youth based on SEL, key principles, and examples of exemplary programs.     

Impacts of a Medicaid Wraparound Model Demonstration Program on Youth Specialty Mental Health Services Use

Effective coordination of mental health care is critical in Medicaid wraparound model programs for youth. This study examined participation over time in mental health services for youth diverted or transitioned from residential care to a Medicaid wraparound demonstration program. Youth in wraparound had more sustained use of mental health outpatient clinic services than did propensity score matched youth who were not in wraparound. However, the rate of outpatient clinic follow-up after inpatient discharge was no greater in wraparound. Routine assessment of wraparound programs’ impacts on receipt of mental health care may inform the development of Medicaid wraparound program performance standards.     

Achieving health outcomes through professional dental care: comparing the cost of dental treatment for children in three practice modes.

The search for effective strategies to deal with prevention and treatment of oral disease focuses on children as a natural target population. This article reports data on the comparative costs of delivering dental care to children via (1) a school-based practice using Expanded Function Dental Auxiliaries, (2) a school-based practice without EFDAs, and (3) a group of unrelated private dental practices operating independent of the school system. Utilization of a dentist's services varied significantly between the children assigned to private care and those assigned to the school-based programs, but it cost less per patient to provide dental treatment through the private practitioners. If school-based practices are clearly more effective in reducing dental disease, in the long run the need for manpower and resources in these programs might be lowered to a point where they will become more cost-effective than private practices. If the two delivery modes are equally effective in reducing dental disease, however, results from the study indicate that private practices are more cost-effective and will probably maintain their cost-effective advantage over school-based programs.     

Health access and status of adolescents and young adults using youth employment and training programs in an urban environment.

PURPOSE: To describe the health status and access to healthcare of adolescents and young adults disconnected from traditional education and work settings. The health status of these disconnected youth is largely unknown, although it is suspected to be quite poor. Most information about the health of youth in the United States relies on school-based samples. METHOD: In-person interviews with 1037 adolescents and young adults (aged 16-24 years) enrolled in an employment and training program in Baltimore were used to measure access to health services and health status in four domains: violent behavior, mental health, substance use, and reproductive health. Differences in healthcare access and health status by age and gender were examined. In addition, youth in the employment and training sample are compared with Baltimore youth in school and of comparable ages, as measured by the Youth Risk Behavior Surveillance System. RESULTS: Nearly 50% of young adults in the employment and training program were found to lack health insurance, and about 20% reported a time when they needed medical care but did not receive it. Youth in the program exhibited notable health status concerns, often exceeding the risk prevalence of students in school. In particular, adolescents and young adults disconnected from traditional employment and work settings were more likely to be in physical fights, to smoke cigarettes, and to use marijuana than their in-school counterparts. In-school youth were more likely to have considered harming themselves and to have made a suicide plan in the last year. CONCLUSIONS: Given high levels of health risk among youth disconnected from traditional education and work settings, adolescent health providers must increasingly pay attention to integrating health promotion and disease prevention strategies into youth employment and training programs, where sizable numbers of these youth can be reached.     

Illness experiences of homeless youth

The purpose of this study was to document the illness experiences of homeless youth. The research was a focused ethnography with 45 clinic- and street-based homeless youth aged 15 to 23 years. The authors noted gender differences for health-seeking behaviors, with most male youth reporting embarrassment about needing to seek care, and female youth reporting fears over safety issues while ill and homeless. Most youth under age 18 stated that they were often denied health care at hospitals because of their underage status, and youth over age 18 stated that health care bills contributed to their inability to obtain stable housing. Street-based youth reported more illnesses related to substance use and greater reliance on emergency departments for health care than clinic-based youth did. Policies and programs focused on improving the health of homeless youth need to address the differences in illness experiences by age, gender, and sampling site.     

An evaluation of selected federal categorical health programs for the poor.

We examine evidence regarding the impact of several categorical federal health service programs--neighborhood health centers, maternal and infant care projects, and children and youth projects--on access to and quality of health care for the poor. We conclude that, although conclusive evidence of improved access and quality are lacking, suggestive evidence of improved quality exists. It is difficult to utilize legislative objectives as guidelines for evaluating the success of a federal program; it is also difficult to obtain solid data supporting the effectiveness or ineffectiveness of health care in general, and of other government programs. These difficulties are discussed.     

Ethnic and gender disparities in needed adolescent mental health care

Psychological problems are overlooked and undertreated in adolescents, especially in low-income and ethnically-diverse youth. School-based health centers are one way to increase health care utilization, and may be particularly important for accessing hard-to-reach populations. The present study examines adolescents' psychological health and their experiences with receiving needed mental health care. Participants included 1,695 African-American (31%), Hispanic (38%), and White (31%) high-school students in southeast Texas. All students were from the same high school and all had access to a school-based mental health clinic. Twenty six percent of the sample had symptoms indicative of major depression, and 18% had scores consistent with subthreshold depression. Across all ethnicities, the prevalence of depressive symptoms was highest among females. Depressed White students were more likely than depressed minority youth to report having received a prior diagnosis of depression and to have been treated for depression. Thus, ethnic disparities in obtaining needed mental health care may persist even in settings where access to equivalent care is readily available.     

Expanded school mental health programs: advancing reform and closing the gap between research and practice

Expanded school mental health (ESMH) programs provide a range of mental health services to youth in special and regular education including prevention, assessment, treatment, and case management. Despite the rapid growth of ESMH programs in the United States and elsewhere, many communities still do not have ESMH programs and those that do exist often fail to implement empirically validated intervention and treatment strategies. Systematic prevention efforts remain a lauded, yet illusive goal. For ESMH programs to fulfill their promise of improved access, increased productivity and improved behavioral outcomes, researchers, school-based mental health service providers, and educators must work together to move child mental health programs beyond limiting constructs and approaches. These issues are reviewed and an example of an "ideal" approach to implement best practices in schools and close the gap between research and practice is offered.     

Joys and tribulations of faith-based youth tobacco use prevention: a case study in Mississippi

Faith-based health promotion initiatives are resurging in popularity among health promoters and providers, but few programs are systematic, large-scale, and funded at the state level. One exception is an initiative by the Partnership for a Healthy Mississippi (PHM), a nonprofit organization funded by tobacco settlement monies. PHM funded churches and other faith-based organizations to implement a grassroots youth tobacco use prevention program to coincide with other community- and school-based efforts. In the 2-year evolution of this faith-community health partnership, PHM experienced both successes and challenges. This article outlines the history of tobacco use prevention and control programs within Mississippi's faith community, provides a brief case study of two churches, and makes 10 recommendations based on lessons learned.