School Wellness Committees Are Associated With Lower Body Mass Index Z‐Scores and Improved Dietary Intakes in US Children: The Healthy Communities Study

BACKGROUND

Our objective was to examine the association between school wellness committees and implementation of nutrition wellness policies and children's weight status and obesity‐related dietary outcomes.

METHODS

A cross‐sectional study was conducted of 4790 children aged 4‐15 years recruited from 130 communities in the Healthy Communities Study. Multilevel statistical models assessed associations between school wellness policies and anthropometric (body mass index z‐score [BMIz]) and nutrition measures, adjusting for child and community‐level covariates.

RESULTS

Children had lower BMI z‐scores (?0.11, 95% confidence interval [CI]: ?0.19, ?0.03) and ate breakfast more frequently (0.14 days/week, 95% CI: 0.02‐0.25) if attending a school with a wellness committee that met once or more in the past year compared to attending a school with a wellness committee that did not meet/did not exist. Children had lower added sugar (p < .0001), lower energy‐dense foods (p = .0004), lower sugar intake from sugar‐sweetened beverages (p = .0002), and lower dairy consumption (p = .001) if attending a school with similar or stronger implementation of the nutrition components of the school wellness policies compared to other schools in the district.

CONCLUSIONS

A more active wellness committee was associated with lower BMI z‐scores in US schoolchildren. Active school engagement in wellness policy implementation appears to play a positive role in efforts to reduce childhood obesity.

     

Academic‐Related Factors and Emotional Eating in Adolescents

BACKGROUND

Existing literature indicates a relationship between stress and emotional eating in adults, yet limited research has examined the impact of school‐related stress on emotional eating in adolescents. This study investigated the influence of academic factors on emotional eating among minority adolescents.

METHODS

A survey was implemented among a sample of minority adolescents (N = 666) to investigate the relationship between emotional eating and 3 academic factors: academic self‐esteem, grade point average (GPA), and academic worries. Forced‐entry multiple linear regressions were used to test for relationships.

RESULTS

Findings indicate that GPA, academic self‐esteem, and academic worries were related to emotional eating scores in adolescents. There were no significant differences in academic factors between emotional eaters and nonemotional eaters.

CONCLUSIONS

Additional research is needed to further elucidate the complex interaction between emotional eating behavior and academics.

     

The Link Between Nutrition and Physical Activity in Increasing Academic Achievement

BACKGROUND

Research demonstrates a link between decreased cognitive function in overweight school‐aged children and improved cognitive function among students with high fitness levels and children engaging in regular physical activity (PA). The purpose of this study was to examine whether regular PA and proper nutrition together had a significant effect on academic achievement.

METHODS

Using the seventh wave of the Early Childhood Longitudinal Study, Kindergarten Class 1998–99 (ECLS‐K) dataset, linear regression analysis with a Jackknife resampling correction was conducted to analyze the relationship among nutrition, PA, and academic achievement, while controlling for socioeconomic status, age, and sex. A nonactive, unhealthy nutrition group and a physically active, healthy nutrition group were compared on standardized tests of academic achievement.

RESULTS

Findings indicated that PA levels and proper nutrition significantly predicted achievement scores. Thus, the active, healthy nutrition group scored higher on reading, math, and science standardized achievement tests scores.

CONCLUSIONS

There is a strong connection between healthy nutrition and adequate PA, and the average performance within the population. Thus, results from this study suggest a supporting relationship between students' health and academic achievement. Findings also provide implications for school and district policy changes.

     

Effects of a Collaborative Board Game on Bullying Intervention: A Group‐Randomized Controlled Trial

BACKGROUND

We examined the effects of the Galaxy Rescuers game, a collaborative board game on schoolchildren's bullying intervention.

METHODS

We conducted a group‐randomized controlled trial. We recruited 328 fifth graders at an elementary school in northern Taiwan. The study took place in fall 2015 over a 7‐week period. We used the generalized estimation equation (GEE) to evaluate the intervention effects on students' scores on the outcome measures.

RESULTS

At posttest, the change in bullying knowledge was statistically significant for the game‐only group and the game‐with‐debriefing group. Students in the game‐with‐debriefing group also showed an increase in empathy and a decrease in bullying attitude. At the follow‐up test, knowledge increase remained significant for both the game‐only group and the game‐with‐debriefing group. Game satisfaction survey indicated that 66.8% of the players said that the game was enjoyable.

CONCLUSIONS

The Galaxy Rescuers game is effective in changing players' bullying knowledge, attitude, and empathy. This game is an entertaining tool for promoting awareness of bullying and encouraging defending atmosphere among children.

     

The Influence of Organizational Culture on School‐Based Obesity Prevention Interventions: A Systematic Review of the Literature

BACKGROUND

Although the influence of organizational culture has been examined on a variety of student outcomes, few studies consider the influence that culture may have on school‐based obesity prevention interventions. We present a systematic review of the literature to examine how elements of organizational culture may affect the adoption, implementation, and sustainability of school‐based obesity prevention interventions.

METHODS

Fourteen studies examining the impact of organizational‐level characteristics on school‐based obesity prevention interventions were identified through the online databases EBSCO (CINAHL, ERIC, Agricola), Web of Science, Medline (PubMed), and Scopus.

RESULTS

Five themes were identified as elements of organizational culture that influence the adoption, implementation, and sustainability of school‐based obesity prevention interventions: organizational response to limited resources, value placed on staff training and professional development, internal support, organizational values, and school climate.

CONCLUSIONS

Organizational culture can greatly influence the success of school‐based obesity interventions. The collection of data related to organizational‐level factors may be used to identify strategies for creating and sustaining a supportive environment for obesity prevention interventions in the school setting.

     

Body Dissatisfaction,Perceptions of Competence,and Lesson Content in Physical Education

BACKGROUND

Significant proportions of young people experience body dissatisfaction, which has implications for psychological and physical well‐being. Lesson content and perceived competence may be important variables for the experience of body dissatisfaction, yet these have been underexplored in physical education. The aim of this cross‐sectional study is to identify the relationships between body dissatisfaction and perceptions of competence, and to explore whether body dissatisfaction depends on lesson content.

METHODS

A paper‐and‐pencil questionnaire was completed by 446 (210 boys, 236 girls) 13‐ to 14‐year‐old pupils from 37 physical education classes. The questionnaire assessed body dissatisfaction and perceived competence in physical education. Lesson content was also recorded. Twenty‐nine of the classes were engaged in team activities, eg, ball games. Eight classes were engaged in individual activities, eg, fitness.

RESULTS

Multilevel analysis identified a significant negative association between body dissatisfaction and perceptions of competence in physical education. Lesson content did not significantly predict variations in body dissatisfaction scores.

CONCLUSIONS

Teachers should focus on enhancing pupils' perceptions of competence in physical education to support the development of body satisfaction.

     

The Impact of State Legislation and Model Policies on Bullying in Schools

BACKGROUND

The purpose of this study was to determine the impact of the coverage of state legislation and the expansiveness ratings of state model policies on the state‐level prevalence of bullying in schools.

METHODS

The state‐level prevalence of bullying in schools was based on cross‐sectional data from the 2013 High School Youth Risk Behavior Survey. Multiple regression was conducted to determine whether the coverage of state legislation and the expansiveness rating of a state model policy affected the state‐level prevalence of bullying in schools.

RESULTS

The purpose and definition category of components in state legislation and the expansiveness rating of a state model policy were statistically significant predictors of the state‐level prevalence of bullying in schools. The other 3 categories of components in state legislation—District Policy Development and Review, District Policy Components, and Additional Components—were not statistically significant predictors in the model.

CONCLUSIONS

Extensive coverage in the purpose and definition category of components in state legislation and a high expansiveness rating of a state model policy may be important in efforts to reduce bullying in schools. Improving these areas may reduce the state‐level prevalence of bullying in schools.

     

The School Contextual Effect of Sexual Debut on Sexual Risk‐Taking: A Joint Parameter Approach

BACKGROUND

Previous research has identified individual and school‐level characteristics that are associated with sexual risk‐taking, but the impact of school‐level mechanisms on sexual risk‐taking is not well understood. We examine the aggregated effects that early sex at the school level have on risky sexual behaviors.

METHODS

We use 3 waves of data from the National Longitudinal Study of Adolescent Health. An individual's first sexual intercourse before age 15 was recorded along with various risky sexual behaviors at debut. Two variables at respondent's later stage of life were also included: having sex in exchange for drugs or money, and contraction of sexually transmitted disease (STD). Longitudinal analysis was conducted using a joint parameter model that tested unobserved school effects on individual behaviors simultaneously.

RESULTS

An increase in early sexual initiation at the school level was associated with higher probability of sexual debut, along with increased involvement in sexual risk‐taking controlling for student family background.

CONCLUSIONS

School behavioral mechanisms are directly related to sexual health behaviors among youth. Our findings have implications for school‐based interventions, education programs, and the role of parents.

     

Addressing Gaps in Cardiopulmonary Resuscitation Education: Training Middle School Students in Hands‐Only Cardiopulmonary Resuscitation

BACKGROUND

Training middle school students to perform hands‐only cardiopulmonary resuscitation (HOCPR) is a potential method to increase overall rates of bystander cardiopulmonary resuscitation (CPR). We aimed to examine the feasibility of teaching this population CPR using teacher‐implemented education sessions guided by American Heart Association (AHA) training kits and resources.

METHODS

We conducted a national HOCPR training campaign in middle schools during the 2014‐2015 school year. Participating schools utilized AHA CPR training kits to train seventh and eighth grade students. We assessed pretest/posttest knowledge and comfort in performing HOCPR.

RESULTS

We recruited 1131 schools and trained approximately 334,610 students in HOCPR. The average pretest score on knowledge questions was 50% and the average posttest score was 84%. Most students (76%) felt comfortable performing HOCPR after the education session. Overall, 98% of teachers said they would continue to implement CPR training in the future.

CONCLUSIONS

Large‐scale, teacher‐implemented CPR education sessions in the middle school setting are a successful approach to increase middle school student's knowledge and comfort in performing HOCPR and to increase overall bystander CPR rates.

     

School‐Level Practices and Perceptions Associated With Salad Bars in Schools

BACKGROUND

Salad bars are placed in schools to promote fruit and vegetable consumption among students. This study assessed differences in school nutrition practices and perceptions in schools with and without salad bars.

METHODS

Cross‐sectional surveys were completed by school nutrition managers (N = 648) in Arizona schools participating in the National School Lunch Program during 2013–2014. Mixed general estimating equation binomial regressions assessed factors related to having a salad bar after mutually adjusting for clustering within districts, school level, free/reduced rate, and respondents' time in current position.

RESULTS

On average, 61% of schools reported having a salad bar. After adjustment, school nutrition managers were significantly more likely to report having a salad bar if they served lunch by grade level (vs mixed grades), had a full‐service kitchen, and their personal perception of salad bars was positive; schools were less likely to have a salad bar if menu and food service decisions were made at the school level.

CONCLUSIONS

Several school‐level nutrition practices and perceptions were associated with having a salad bar in schools. Enhancement of these factors may facilitate having salad bars in schools.

     

Enhancing Educator Engagement in School Mental Health Care Through Digital Simulation Professional Development

BACKGROUND

Despite the critical role of educators as gatekeepers for school mental health services, they receive limited training to support student mental health. We report findings from a trial of an online mental health role‐play simulation for elementary school teachers on changes in attitudes and self‐reported helping behaviors for students experiencing psychological distress.

METHODS

We randomly assigned 18,896 elementary school teachers to wait‐list control or intervention conditions in which they received the 45‐ to 90‐minute online role‐play simulation. We administered a version of the validated Gatekeeper Behavior Scale at baseline and postintervention, which measures attitudinal dimensions shown to predict teacher helping behavior change. Self‐reported helping behaviors were collected at baseline and 3‐month follow‐up. Outcomes were compared between the intervention follow‐up and control group baseline measures.

RESULTS

The intervention group posttraining scores were significantly higher (p < .001) than the control group for all the preparedness, likelihood, and self‐efficacy Gatekeeper Behavior subscales. All 5 helping behaviors were significantly higher among the intervention group at follow‐up compared to the control group at baseline.

CONCLUSIONS

We found that a brief online role‐play simulation was an effective strategy for improving teacher attitudes and behaviors needed to perform a positive mental health gatekeeper role in schools.

     

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.

     

The Influence of Active Gaming on Cardiorespiratory Fitness in Black and Hispanic Youth

BACKGROUND

Youth in the United States have low levels of cardiorespiratory fitness, a risk factor for childhood obesity. Lower levels of physical fitness for black and Hispanic youth contribute to health disparities. In this feasibility study, we examined active video games (AVGs) as a tool to improve fitness and attitudes toward physical activity during early adolescence.

METHOD

A 6‐week AVG program took place in a youth development program in a high‐poverty neighborhood in New York City. Youth aged 10 to 15 years (50% overweight or obese) participated in 2 fitness tests and completed surveys that captured barriers to physical activity pre‐ and postintervention. Each week, participants played Wii Fit games for 30 minutes.

RESULTS

Participants improved the number of sit‐ups and step‐ups they completed from pre‐ to postintervention (p < .05). Participants also increased their self‐efficacy, intention to exercise and perceived social support to exercise (p < .05). Youth reported a high level of enjoyment and perceived Wii Fit as ways to increase physical fitness and increase their physical activity.

CONCLUSION

AVGs may be a viable alternative exercise program to increase physical activity for black and Hispanic youth living in poverty‐impacted neighborhoods.

     

Active Commuting to School,Physical Activity,and Behavior Problems Among Third‐Grade Children

BACKGROUND

We examined factors associated with active commuting to school and the relationships of active commuting and physical activity to child‐ and teacher‐reported internalizing and externalizing behavior problems in a sample of third graders.

METHODS

The study sample consisted of 13,166 third graders enrolled in the Early Childhood Longitudinal Study Kindergarten Class of 1998‐1999. “Active” commuters were children who walked to school and “passive” commuters were those who took the bus or were driven. Linear analyses evaluated differences in behavior problems by school commute, physical activity, and sports team participation after adjusting for sociodemographic, regional, and neighborhood factors.

RESULTS

Overall, 11% of children actively commuted. Type of commute differed by sociodemographics, region, urbanicity, school type, and neighborhood safety. Active commuters had less general physical activity participation and sports team participation. Commuting type and general physical activity were not associated with behavior problems, but sports team participation was associated with fewer child‐reported internalizing and externalizing behaviors as well as fewer teacher‐reported internalizing behaviors.

CONCLUSIONS

Our findings demonstrate the ongoing need for creating and maintaining physical activity programs (such as sports teams) among school‐aged children to optimize children's overall health and well‐being.

     

Impacts of a School‐Wide,Peer‐Led Approach to Sexuality Education: A Matched Comparison Group Design

BACKGROUND

Teen Prevention Education Program (PEP) is a school‐wide, peer‐led comprehensive sexuality education program currently implemented in more than 50 schools across 2 states. Many teen pregnancy prevention researchers and practitioners view peer‐led programs as a promising approach for reducing teen pregnancy and associated sexual risk behaviors. However, prior research on the effectiveness of these programs indicates mixed results.

METHODS

We randomly assigned schools to implement Teen PEP immediately (intervention group) or on a delayed schedule (comparison group) and used propensity score matching to improve the comparability of the study groups. We surveyed students at baseline and about 6 months after the program ended.

RESULTS

Teen PEP did not significantly impact rates of sexual activity or unprotected sex; however, the program led to improvements in exposure to information about sexual health topics and knowledge of preventing pregnancy and transmission of sexually transmitted infections.

CONCLUSIONS

Teen PEP succeeded in accomplishing some of its most proximal goals, increasing students' access to information and knowledge. However, we found little evidence that the program affects sexual risk‐taking within 6 months of its conclusion. Future research will examine the program's longer‐term impacts on sexual risk behaviors.

     

The Utility of Measuring Intentions to Use Best Practices: A Longitudinal Study Among Teachers Supporting Students With Autism

BACKGROUND

School‐based interventions can result in profound social, behavioral, and academic improvement for students with autism, but teachers rarely implement them. It is important to understand why this occurs and use this information to increase the use of evidence‐based practices. Toward this goal, 2 proof‐of‐construct studies demonstrate the theoretical and methodological advantages of measuring behavioral intentions to use specific practices.

METHODS

Two observational studies enrolled public school teachers who work with students with autism. The studies measure the strength of teachers' intentions to use each of 4 different evidence‐based practices, assess variability in intentions, and test whether intentions predict future teacher behavior.

RESULTS

In adjusted analyses, intentions to use a specific evidence‐based practice were strongly associated with subsequent use (adjusted odds ratio = 5.2). The proportion of teachers who reported strong intentions varied from a low of 33% to a high of 66%, depending on the practice.

CONCLUSIONS

The findings illustrate that the strength of intentions, which varies depending on the specific practice, can predict implementation. More generally, the studies demonstrate how measures of intention can aid efforts to identify implementation barriers. The approach taken can be applied to study implementation of any practices designed to improve student health.

     

National Analysis of State Health Policies on Students' Right to Self‐Carry and Self‐Administer Asthma Inhalers at School

BACKGROUND

Asthma has no known cure, and though manageable, it disrupts the everyday lives of over 6 million US children. Because children spend more than half of their waking hours in school, students must be able to carry and administer their inhaler at school to manage their asthma.

METHODS

This policy paper is a comprehensive review of all 50 states and the District of Columbia's laws and policies for the self‐carry and administration of quick‐relief asthma inhalers among children in prekindergarten through 12th grade.

RESULTS

All states permit students to carry and administer their inhalers at school, although each state differs in their development and implementation of policies for asthma self‐management at school. This review examines how states regulate self‐carry policies by looking at policy development, regulated school systems, relevant stakeholders, required medical records, and school liability.

CONCLUSIONS

Each state's laws have nuances that create gray areas, increasing the potential of misinterpreted or incorrectly implemented policies for asthma self‐management at school. As a result, children may not have immediate access to their inhaler for symptom management or in an emergency. State policymakers should reform current laws to remove barriers for students to carry and use inhalers at school.

     

Sexting Rates and Predictors From an Urban Midwest High School

BACKGROUND

Risks associated with teen sexting draw increasing concern from teachers and communities as developments in communication software and devices make sharing private content faster and simpler each year. We examined rates, recipients, and predictors of teen sexting to better plan education and preventative policies and strategies. A comprehensive literature review was conducted to determine the most likely predictors of teen sexting using prior survey studies and theoretical conceptions.

METHODS

We surveyed 314 high school students in an urban area of a large Midwestern city.

RESULTS

Males were found to more frequently report sexting. Impulsivity, frequency of electronic communication, peer pressure, peer sexting, and social learning significantly predicted sexting beyond age, race, and sex. Self‐esteem did not moderate the effect of peer pressure to sext. Structural predictive models attained good fit to the data, and neither were moderated by sex.

CONCLUSIONS

Sexting was highly associated with reported peer pressure, perceived norms, and impulsive decision making. Adolescents in relationships may be at particular risk of sexting. These findings will help parents, teens, and educators take appropriate measures to inform about and encourage the safe use of technology.

     

Changes in School Competitive Food Environments after a Health Promotion Campaign

BACKGROUND

Schools can reduce student access to competitive foods and influence healthy food choices by improving the school nutrition environment. This study describes changes in competitive nutrition environments in 100 K‐8 schools participating in the Philadelphia Campaign for Healthier Schools.

METHODS

Interviews with school staff were used to elicit information about policies, practices, and guidelines to restrict/limit competitive foods in schools, before and 1 year into the campaign. To increase the validity of responses, respondents provided documentation for reported policies and guidelines. Baseline interviews were conducted between April and June 2011 and follow‐up interviews were conducted between April and June 2012.

RESULTS

At follow‐up, significantly more schools reported having policies and/or guidelines in place to regulate food as a reward in the classroom, food served at parties and celebrations, outside foods allowed in school, and the availability of sodas and sugar‐sweetened beverages. There were no measurable effects on food available in school stores, fundraisers, or afterschool programs. Availability of concrete documentation of policies was limited, but when provided, it corroborated the interview responses.

CONCLUSIONS

In the context of a comprehensive school wellness policy, school wellness councils were associated with increases in school‐level policies and practices that improved the competitive nutrition environment.

     

The Effects of Asthma and Bullying on Suicidal Behaviors Among US Adolescents

BACKGROUND

Positive associations between suicidal behaviors and asthma have been established in previous adolescent studies. Few studies consider social risk factors, such as bullying. This study involved an analysis of suicidal behaviors and asthma, but also includes an assessment of whether these relationships were modified by the co‐occurrence of bullying.

METHODS

Data included 13,154 participants from the 2013 Youth Risk Behavior Survey (YRBS), collected by the US Centers for Disease Control and Prevention. Logistic regression models were constructed and summarized using odds ratios (ORs) and 95% confidence intervals (95% CIs).

RESULTS

When comparing adolescents with asthma who were bullied at school to those who were not bullied at school, the odds of contemplating suicide were increased by nearly 2‐fold (OR = 1.8, 95% CI = 1.5‐2.3), and the odds of creating a suicide plan were 2.3 times higher (OR = 2.3, 95% CI = 1.7‐3.1). The odds of a suicide attempt and incurring an injury from a suicide attempt were also substantially increased. Similarly, increased odds of suicidal behaviors were observed for adolescents with asthma who were bullied electronically.

CONCLUSION

Having asthma and being bullied are both associated with increased odds of suicidal behaviors.