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.

     

State Agency Support of Weight‐Related School Policy Implementation

BACKGROUND

In this study, we describe state agency strategies to support weight‐related policy implementation in schools, and examine the association among state support, obesity prevalence, and strength of state policies governing school nutrition and physical education.

METHODS

The 2012 School Health Policies and Practices Study describes prevalence of implementation support state agencies provided to schools/districts. Implementation support items were analyzed by weight‐related policy area (eg, advertising, wellness policy) and by type of support (eg, technical assistance). Results were summed to create a total weight‐related policy support score. Linear regression was used to examine associations between policy support and state youth obesity prevalence (2011‐2012 National Survey for Children's Health), overall and stratified by state policy strength (2012 Classification of Laws Associated with School Students).

RESULTS

States provided support most commonly for school meals and wellness policies (89% and 81%, respectively) and least often for after‐school PE (26%). Most states (80%) provided technical assistance. The total weight‐related policy support score had a significant positive association with state‐level youth overweight/obesity prevalence (p = .03).

CONCLUSION

State agencies appear to be responding to their youth obesity prevalence with technical support. Schools and state agencies should work in collaboration to provide a healthy school environment for all students.

     

Motor Competence Levels and Prevalence of Developmental Coordination Disorder in Spanish Children: The MOVI‐KIDS Study

BACKGROUND

Motor competence (MC) affects numerous aspects of children's daily life. The aims of this study were to: evaluate MC, provide population‐based percentile values for MC; and determine the prevalence of developmental coordination disorder (DCD) in Spanish schoolchildren.

METHODS

This cross‐sectional study included 1562 children aged 4 to 6 years from Castilla‐La Mancha, Spain. MC was assessed using the Movement Assessment Battery for Children‐Second Edition. Values were analyzed according to age, sex, socioeconomic status (SES), environment (rural/urban), and type of school.

RESULTS

Boys scored higher than girls in aiming and catching, whereas girls aged 6 scored higher than boys in balance. Children living in rural areas and those attending to public schools obtained better scores in aiming and catching than those from urban areas and private schools. The prevalence of DCD was 9.9%, and 7.5% of children were at risk of having movement problems.

CONCLUSION

Motor test scores can represent a valuable reference to evaluate and compare the MC in schoolchildren. Schools should identify motor problems at early ages and design initiatives which prevent or mitigate them.

     

Gender Expression,Violence, and Bullying Victimization: Findings From Probability Samples of High School Students in 4 US School Districts

BACKGROUND

Young people may experience school‐based violence and bullying victimization related to their gender expression, independent of sexual orientation identity. However, the associations between gender expression and bullying and violence have not been examined in racially and ethnically diverse population‐based samples of high school students.

METHODS

This study includes 5469 students (13–18 years) from the 2013 Youth Risk Behavior Surveys conducted in 4 urban school districts. Respondents were 51% Hispanic/Latino, 21% black/African American, 14% white. Generalized additive models were used to examine the functional form of relationships between self‐reported gender expression (range: 1 = Most gender conforming, 7 = Most gender nonconforming) and 5 indicators of violence and bullying victimization. We estimated predicted probabilities across gender expression by sex, adjusting for sexual orientation identity and potential confounders.

RESULTS

Statistically significant quadratic associations indicated that girls and boys at the most gender conforming and nonconforming ends of the scale had elevated probabilities of fighting and fighting‐related injury, compared to those in the middle of the scale (p < .05). There was a significant linear relationship between gender expression and bullying victimization; every unit increase in gender nonconformity was associated with 15% greater odds of experiencing bullying (p < .0001).

CONCLUSIONS

School‐based victimization is associated with conformity and nonconformity to gender norms. School violence prevention programs should include gender diversity education.

     

Barriers to the Administration of Epinephrine in Schools

BACKGROUND

Anaphylaxis is a serious and growing concern in the school setting as the prevalence of food allergies and food‐induced severe allergic reactions continues to increase.

METHODS

A cross‐sectional, web‐based survey was conducted regarding anaphylactic events that occurred during the 2014‐2015 school year. Eligible schools were enrolled in the EPIPEN4SCHOOLS^® program (Mylan Specialty L.P., Canonsburg, PA), which provides free epinephrine auto‐injectors to qualifying US schools. Participating schools completed a 29‐item survey on anaphylactic event occurrence and treatment, epinephrine stock, school policies regarding anaphylaxis, school staff training, and school nursing coverage.

RESULTS

Responses were provided by 12,275 schools. Epinephrine was administered on school property for 63.7% of reported anaphylactic events (1272/1998). In 38.5% (235/610) of events for which epinephrine was not used, antihistamines were cited as the reason. Only 59.4% of schools cited epinephrine as their standard first‐line therapy for anaphylaxis. School nurses were most likely to be trained in anaphylaxis recognition and permitted to administer epinephrine; however, just 53.6% of schools had a full‐time nurse on staff.

CONCLUSIONS

Process‐related barriers to the appropriate use of epinephrine go beyond access to medication. Widespread staff training and review of school policies are needed to ensure that anaphylaxis is appropriately managed in schools.

     

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.

     

Correlates of Private Secondary Schools Meeting Physical Education Guidelines

BACKGROUND

Although there are over 26,000 private schools in the United States, little is known about the relationship of their characteristics to mandated and recommended time allocations for physical education (PE).

METHODS

Private secondary schools (N = 450; grades 6‐12) in California completed a 15‐item questionnaire related to school characteristics and PE policies and practices. Using correlational analysis and predictive modeling, we assessed the associations and influences of various factors relative to the schools meeting state (California) and national professional time targets for PE.

RESULTS

Whereas most schools fell short of meeting PE weekly time recommendations, 5 of 10 tested variables were significantly associated with schools meeting PE minutes/week targets: school enrollment, school level, having a fitness testing policy, PE class size, and not permitting exemptions for PE. Large schools and those serving high school students provided more PE and were more likely to meet PE time allocation standards. Having policies for PE minutes/week and no exemptions for PE were significantly associated with a school having all its PE classes taught by a specialist.

CONCLUSIONS

Private secondary schools should consider the adoption of professional guidelines related to PE time allocations, class size, conducting physical fitness testing, employing PE specialists, and not permitting exemptions for PE.

     

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.

     

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.

     

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.

     

School Factors Associated With the Implementation of Integrated Pest Management‐Related Policies and Practices

BACKGROUND

Schools are particularly vulnerable to pests, but integrated pest management (IPM) can address pest problems. This study describes IPM policies and practices and the extent to which they are associated with school characteristics.

METHODS

We analyzed data from the 2014 School Health Policies and Practices Study, a nationally representative survey of schools in the United States (N = 568, response rate = 69%). Pairwise comparisons assessed differences in pest prevention strategies by school characteristics.

RESULTS

Nationwide, 55.3% of schools conducted campus‐wide inspections for pests at least monthly; 35.6% of schools notified staff, students, and families prior to each application of pesticides; and 56.1% of schools required custodial or maintenance staff to receive training on pest management practices that limit the use of pesticides. During the 12 months before the study, 46.5% of schools almost always or always used spot treatments and baiting rather than widespread applications of pesticides, and 36.8% of schools almost always or always marked indoor and outdoor areas that had been treated with pesticides. No clear pattern emerged for school characteristics associated with IPM policies and practices.

CONCLUSIONS

The variation in implementation of IPM‐related policies and practices suggest opportunities for targeted education among school staff about IPM principles.

     

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.

     

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.

     

Composition of School Meals in Sweden,Finland, and Iceland: Official Guidelines and Comparison With Practice and Availability

BACKGROUND

Nutritious and attractive school meals can improve health equality and public health. Current official guidelines and recommendations on food and nutrient composition of school meals in 3 Nordic countries; Sweden, Finland, and Iceland, are described and compared with actual practice, ie, availability of foods and nutrients in served reference meals in 3 selected areas in each country.

METHODS

A country comparison was made between official guidelines, and actual practice was studied in participating schools. Reference portions of school meals (N = 170) provided in 24 compulsory schools were photographed and weighed. Food and nutrient availability were compared with official guidelines in each country.

RESULTS

Emphasis of recommendations on whole‐grain bread in Sweden, whole grains in Finland, and fish in Iceland were reflected in food availability. The energy content of the meals provided was lower than guidelines and there was a large variation in energy content between days.

CONCLUSIONS

The guidelines regarding food availability were quite well followed, but the large variation in energy and nutrient content of provided school meals between days indicates a need for standardization.

     

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.

     

Crime Prevention Through Environmental Design (CPTED) Characteristics Associated With Violence and Safety in Middle Schools

BACKGROUND

This study used a new Crime Prevention Through Environmental Design (CPTED) assessment tool to test the associations between physical attributes of schools and violence‐related behaviors and perceptions of students.

METHODS

Data were collected from 4717 students from 50 middle schools. Student perceptions of risk and safety, and violence were assessed. Evaluators used the CPTED School Assessment (CSA) to quantify how well the physical elements of each school correspond to ideal CPTED principles. Generalized linear mixed models were used to adjust for school‐ and student‐level characteristics.

RESULTS

Higher CSA scores were generally associated with higher perceptions of safety and lower levels of violence perpetration and perceived risk in unadjusted models. Higher CSA scores were also associated with lower odds of missing school because of safety concerns in most adjusted models, with significant adjusted odds ratios (AORs) ranging from 0.32 to 0.63. CSA scores for parking and bus loading areas also remained associated with higher perceived safety (AORs = 1.28 and 1.32, respectively) and lower perceived risk (AORs = 0.73 and 0.66, respectively) in adjusted models.

CONCLUSIONS

The CSA is useful for assessing school environments that are associated with violence‐related behaviors and perceptions. The CSA might help guide school environmental modifications to reduce violence.

     

Use of a Model Wellness Policy May Not Increase the Strength and Comprehensiveness of Written School Wellness Policies

BACKGROUND

Many state agencies have developed model wellness policies (MWPs) to serve as examples for schools when writing their own school wellness policy (SWP). The purpose of this study was to evaluate if a MWP aids schools in writing stronger, more comprehensive SWPs.

METHODS

For this cross‐sectional study, 91 school districts submitted their current SWP and completed a survey that classified districts into either districts that utilized the state MWP (N = 56; 61.5%) or those that did not (NMWP, N =35; 38.5%). The Wellness School Assessment Tool (WellSAT) was used to assess the strength, comprehensiveness, total overall score, and subsection scores of each policy. Dependent variables were compared between groups using t tests. Statistical significance was set at p ≤ .05. Data are presented as mean ±SD.

RESULTS

No significant differences were found between groups in total overall (MWP 76.8 ± 37.9; NMWP 62.1 ± 34.3), strength (MWP 25.3 ± 17.6; NMWP 19.1 ± 12.8), or comprehensiveness scores (MWP 51.5 ± 21.2; NMWP 43.0 ± 22.1). The only subsection score difference identified between groups was the Nutrition Standards comprehension score (p = .02).

CONCLUSIONS

These data suggest MWPs may not improve the quality of written SWPs. Further research is needed to better understand the needs of school districts in SWP development.

     

Negative Substance Use Consequences Associated With Noncondom Use Among Male,but Not Female,Alternative High School Students

BACKGROUND

Alternative (or continuation) high schools are institutions designed for students at risk for not graduating due to behavioral, educational, or medical problems. The present study explored the relationship between negative substance use consequences (eg, having trouble at school or work) and noncondom use in this at‐risk population and whether these associations varied by sex.

METHODS

Participants (N = 1101; 62.9% Hispanic; M_age = 16.85) were sampled from 24 alternative high schools in California, and data were analyzed using cross‐sectional multivariate logistic regression models.

RESULTS

We observed a relationship between the number of negative substance use consequences and probability of noncondom use at the last sexual encounter for boys (p < .001) but not girls (p > .05). There were significant associations between specific social consequences (missing school/work) and dependence symptoms (selling personal items to get alcohol or drugs) with noncondom use for boys only. There was a similar association between substance use frequency and noncondom use for boys.

CONCLUSIONS

These findings suggest that substance use consequences may be a useful and advantageous indicator of risky sexual behaviors such as noncondom use for boys, but not girls, in alternative high school settings. Future research and intervention programming recommendations are discussed.

     

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.

     

Later Start,Longer Sleep: Implications of Middle School Start Times

BACKGROUND

Although adolescents generally get less than the recommended 9 hours of sleep per night, research and effort to delay school start times have generally focused on high schools. This study assesses the relation between school start times and sleep in middle school students while accounting for potentially confounding demographic variables.

METHODS

Seventh and eighth grade students attending 8 late starting schools (～8:00 am , n = 630) and 3 early starting schools (～7:23 am , n = 343) from a diverse suburban school district completed online surveys about their sleep behaviors. Doubly robust inverse probability of treatment weighted regression estimates of the effects of later school start time on student bedtimes, sleep duration, and daytime sleepiness were generated.

RESULTS

Attending a school starting 37 minutes later was associated with an average of 17 additional minutes of sleep per weeknight, despite an average bedtime 15 minutes later. Students attending late starting schools were less sleepy than their counterparts in early starting schools, and more likely to be wide awake.

CONCLUSIONS

Later school start times were significantly associated with improved sleep outcomes for early adolescents, providing support for the movement to delay school start times for middle schools.