Adolescent Health: Priorities for the Next Millennium

There have been dramatic changes in adolescent health status over the past decade that have resulted from successful interventions. Overall mortality rates are down 14%, and many morbidities have declined. Today we know many of the elements that reduce risk: parental caring and connectedness, parental expectations for school and parent availability all outweigh family structure, ethnicity, and income. Likewise, schools can be extremely protective when young people feel connectedness. Factors associated with successful interventions include: strengthening families; strengthening educational involvement; expanding economic opportunities; and supporting youth development, not just problem reduction. Priorities for the next decade include: establishing resiliency-building interventions; developing positive correlates of negative behaviors; establishing broader multisectorial interdisciplinary teams; and formulating a new, more inclusive framework for adolescent health and development.     

The relationship between media use and psychological and physical assets among third- to fifth-grade girls

BACKGROUND: Media use is associated with an increased risk of chronic disease and reduced quality of life among children. This study examined the relationship between media use during discretionary hours after school and psychological and physical assets among preadolescent girls. METHODS: A cross‐sectional analysis was conducted using data from a larger quasi‐experimental evaluation of a positive youth development program through sport for third‐ to fifth‐grade girls. Indicators of media use were the number of hours per school day spent watching television and videos and using computers. Psychological assets included global self‐esteem, body size satisfaction, and commitment to physical activity; physical assets included physical activity. Nested random effects analysis of variance (ANOVA) models were used to examine the relationship between media use and psychological and physical assets controlling for relevant confounding factors. RESULTS: The analytic sample included 1027 participants; most were ≥10 years old, non‐White; 27% self‐reported ≥4 hours of media use on school days. In adjusted results, media use was inversely associated with self‐esteem (p = .008) and commitment to physical activity (p < .001). Time spent using media was not associated with body size satisfaction or physical activity in this age group. CONCLUSIONS: Media use was negatively associated with self‐esteem and commitment to physical activity. It may be useful for school professionals to encourage after‐school programs that offer opportunities for girls to reduce sedentary pursuits and improve important psychological and physical assets.     

Researchers Supporting Schools to Improve Health: Influential Factors and Outcomes of Knowledge Brokering in the COMPASS Study

BACKGROUND

Although schools are considered opportune settings for youth health interventions, a gap between school health research and practice exists. COMPASS, a longitudinal study of Ontario and Alberta secondary students and schools (2012–2021), used integrated knowledge translation to enhance schools' uptake of research findings. Schools received annual summaries of their students' health behaviors and suggestions for action, and were linked with COMPASS knowledge brokers to support them in making changes to improve student health. This research examines the factors that influenced schools' participation in knowledge brokering and associated outcomes.

METHODS

School‐ and student‐level data from the first 3 years of the COMPASS study (2012–2013; 2013–2014; 2014–2015) were used to examine factors that influenced knowledge brokering participation, school‐level changes, and school‐aggregated student health behaviors.

RESULTS

Both school characteristics and study‐related factors influenced schools' participation in knowledge brokering. Knowledge brokering participation was significantly associated with school‐level changes related to healthy eating, physical activity, and tobacco programming, but the impact of those changes was not evident at the aggregate student level.

CONCLUSIONS

Knowledge brokering provided a platform for collaboration between researchers and school practitioners, and led to school‐level changes. These findings can inform future researcher‐school practitioner partnerships to ultimately enhance student health.     

Use of SPARK to Promote After-School Physical Activity

BACKGROUND: The after-school period is potentially an important venue for increasing physical activity for youth. We sought to assess the effectiveness of the Sports, Play, and Recreation for Youth (SPARK) program to increase physical activity and improve cardiorespiratory fitness and weight status among elementary students after school. METHODS: This quasi-experimental controlled study compared change in moderate to vigorous physical activity (MVPA), body mass index (BMI) z-score, and cardiorespiratory fitness (VO(2) ) over 5 months between students in after-school programs exposed to SPARK versus controls. Participants were fifth grade students at 3 intervention schools (N = 48) and 3 control schools (N = 52). RESULTS: There was no difference between groups in mean change in MVPA, BMI z-score, or cardiorespiratory fitness. After-school time dedicated to physical activity did not increase with the implementation of SPARK. Intervention students' self-assessment of their activity levels relative to their peers significantly increased compared to control students (p = .011). CONCLUSIONS: In this 5-month study, the SPARK program did not increase MVPA in the after-school setting. Increasing the amount of time dedicated to physical activity may be as important as the curriculum used to effectively increase physical activity after school.     

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.     

Effect of a low-cost, teacher-directed classroom intervention on elementary students' physical activity

BACKGROUND: Effective physical activity (PA) interventions are warranted for youth, and schools have been identified as logical locations for such involvement. Experts and professionals in the field promote comprehensive school PA programs, including classroom PA. The purpose of this study was to determine the effect of a low‐cost, teacher‐directed classroom‐based intervention on the school PA of elementary children. METHODS: Nine classroom teachers were provided inexpensive curricula and trained to implement and instruct PA breaks (2 × 30 minute training sessions). The teachers were encouraged to lead 1 activity break per day after the training. One hundred and six elementary students wore pedometers up to 12 days over 3 monitoring periods during the school year (baseline, follow‐up, post follow‐up) to assess the effectiveness and the sustainability of the intervention. The teachers self‐reported the frequency of activity breaks instructed. RESULTS: The teachers (n = 5) who complied with the recommended 1 activity break per day had students who accrued ～33% more mean school steps/day at follow‐up (～1100) and post follow‐up (～1350) compared to controls. Teachers (n = 4) in the intervention who did not comply with the 1 activity break per day recommendation had students accrue similar mean school steps/day as controls. CONCLUSION: Inexpensive, teacher‐directed classroom‐based PA interventions can be effective in improving children's PA levels if teachers implement 1 activity break per school day. We recommend promoting the notion of 1 activity break per day in the classroom as part of a comprehensive school PA program that includes quality physical education, recess, and before/after school programs.     

HEALTHY Study School Food Service Revenue and Expense Report

BACKGROUND: Food service directors have a concern that federal reimbursement is not meeting the demands of increasing costs of healthier meals. The purpose of this article is to report the food option changes and the annual revenues and expenses of the school food service environment. METHODS: The HEALTHY study was a 3-year (2006 to 2009) randomized, cluster-designed trial conducted in 42 middle schools at 7 field centers. The schools selected had at least 50% of students who were eligible for free or reduced-price lunch or who belonged to a minority group. A randomly assigned half of the HEALTHY schools received a school health intervention program consisting of 4 integrated components: nutrition, physical activity, behavioral knowledge and skills, and social marketing. The nutrition component consisted of changing the meal plans to meet 5 nutrition goals. Revenue and expense data were collected from income statements, federal meal records, à la carte sale sheets, school store sale sheets, donated money/food records, and vending machines. RESULTS: Although more intervention schools reached the nutritional goals than control schools, revenues and expenses were not significantly different between groups. CONCLUSION: The HEALTHY study showed no adverse effect of school food policies on food service finances.     

The Association Between Socio-Ecological Factors and Having an After-School Physical Activity Program

BACKGROUND: After-school physical activity (PA) programs promote PA among youth. Few studies have used socio-ecological health models to identify barriers and facilitators of after-school PA programs. This study examined which socio-ecological factors are associated with having an after-school PA program. METHODS: A questionnaire was administered to key representatives of 114 elementary and 129 secondary schools. The association between socio-ecological factors and having an after-school PA program was analyzed at school level. RESULTS: In both types of schools more knowledge about community schools was positively associated with having an after-school PA program (odds ratio [OR] = 1.96; 95% confidence interval [CI] = 1.18-3.27; OR = 1.88; 95% CI = 1.27-2.80, respectively). In elementary schools, environmental factors associated with having an after-school PA program included PA facilities (OR = 4.98; 95% CI = 1.08-23.05), a PA working group (OR = 3.37; 95% CI = 1.02-11.10), agreements with the community (OR = 1.60; 95% CI = 1.05-2.43), shortage of human resources (OR = 0.57; 95% CI = 0.37-0.89) and lack of support from teachers (OR = 0.51; 95% CI = 0.33-0.80). In secondary schools, environmental factors included the presence of a remunerated coordinator (OR = 5.12; 95% CI = 1.38-19.10) and partnerships with "sport and PA leaders" (OR = 3.54; 95% CI = 1.01-12.41). CONCLUSION: Having an after-school PA program was associated with personal and environmental factors, which supports the use of socio-ecological frameworks for explorative and intervention studies aiming to increase after-school PA programs.     

School Disconnectedness: Identifying Adolescents at Risk in Ontario, Canada

Background:  There is strong theoretical and empirical support for school connectedness as an important element of healthy youth development. The primary objective of this study was to replicate previous research identifying factors differentiating youth who do not feel connected to their schools in a sample of adolescents in Ontario, Canada. A secondary objective was to extend this work by assessing whether physical activity was an additional health behavior that differentiated youth who feel connected to their schools from those who do not.
Methods:  Data for this study were based on questionnaires from 2243 grade 7 to grade 12 students derived from the 2001 cycle of the Ontario Student Drug Use Survey. Logistic regression analysis was used to examine associations between physical activity, other health risk factors, and school disconnectedness.
Results:  The odds of feeling disconnected from their schools were substantially greater for female students who perceived their health or academic performance to be poor, engaged in no vigorous physical activity, reported 3 or more physician visits during the past year, and had low extracurricular involvement. None of the sociodemographic factors or substance use measures was significantly associated with school disconnectedness for any students.
Conclusions:  Our results highlight sex differences in how school disconnectedness is related to health-compromising behaviors such as physical inactivity. Further research is required to examine how boys and girls perceive, interpret, and internalize the school climate. Increasing school connectedness should be a consideration for academic administrators and health-promotion advocates.     

Dietary and physical activity behaviors of middle school youth: the youth physical activity and nutrition survey

BACKGROUND: Obesity has become a national epidemic among youth. Declining physical activity and poor nutrition contribute to this epidemic. The purpose of this study was to obtain data on middle school students' physical activity and nutrition knowledge and practices. METHODS: The Youth Physical Activity and Nutrition Survey was developed and distributed to a probability sample of Florida public middle schools (n = 73) in spring 2003, producing data from 4,452 students in grades 6-8. RESULTS: Results showed that less than one fourth of youth met expert recommendations for daily fruit and vegetable intake and less than one fifth identified the daily fruit and vegetable serving recommendation. Less than half of students reported eating breakfast daily. More non-Hispanic black youth reported not engaging in vigorous or moderate physical activity during the previous 7 days, and more girls and Hispanic youth reported not attending any physical education classes during the average school week. CONCLUSION: These findings demonstrate that dietary and physical activity behaviors and knowledge among these middle school youth are setting the stage for the obesity epidemic to continue.     

Relation of School Environment and Policy to Adolescent Physical Activity*

Background: Physical activity (PA) declines as children and adolescents age. The purpose of this study was to examine how specific school factors relate to youth PA, TV viewing, and body mass index (BMI). Methods: A sample of 12‐ to 18‐year‐old adolescents in 3 cities (N = 165, 53% females, mean age 14.6 ± 1.7 years, 44% nonwhite) completed surveys assessing days of physical education (PE) class per week, school equipment accessibility, after‐school supervised PA, and after‐school field access. Regression analyses were conducted to examine relationships between these school factors and PA at school facilities open to the public (never active vs active), overall PA level (days per week physically active for 60 minutes), BMI z score, and TV watching (hours per week). Results: Adjusting for demographics, days of PE per week and access to school fields after school were correlated with overall PA (β= 0.286, p = .002, semipartial correlation .236 and β= 0.801, p = .016, semipartial correlation .186, respectively). The association between after‐school field access and overall PA was mediated by use of publicly accessible school facilities for PA. After‐school supervised PA and school PA equipment were not associated with overall PA. In adjusted regression analyses including all school factors, days of PE remained correlated to overall PA independent of other school factors (β= 0.264, p = .007, semipartial correlation = .136). There were no associations between school factors and BMI or TV watching. Conclusions: Based on these study findings, PE is a promising intervention to address improving overall adolescent PA within the school setting.     

School sports opportunities influence physical activity in secondary school and beyond

BACKGROUND: The purpose of the present study was to examine whether the availability of intramural or extramural sports in secondary schools is associated with physical activity levels in youth throughout secondary school and at age 20. METHODS: Eight hundred and eight adolescents from 10 secondary schools in Montreal, Canada, provided physical activity data every 3 months during the school year from ages 13 to 17, and again at age 20. School administrators completed questionnaires on the availability of intramural and extramural sports. Three‐level general linear models were used to examine associations among the number of intramural and extramural sports, moderate and vigorous physical activity controlling for age, sex, body mass index, mother's education, and school‐level socioeconomic status. RESULTS: Regardless of whether or not they reported participating in intramural sports, adolescents in schools with more intramural sports engaged in 3.6 (p = .03) more total, and 1.3 (p = 0.03) more vigorous activities per week than those attending schools with fewer intramural sports. Number of extramural sports was not statistically significantly associated with physical activity, regardless of whether or not individual students participated. CONCLUSION: Providing more opportunities for intramural sports in secondary schools may be an effective strategy to help adolescents attain physical activity recommendations.     

Environmental justice at school: understanding research, policy, and practice to improve our children's health

BACKGROUND: No overarching federal agencies or policies are responsible for ensuring environmental health at schools in the United States, potentially allowing many inequities for low‐income and minority communities to persist. This article examines emergent research, policy, and practice‐based efforts that may be used to identify and address environmental justice at school. METHODS: A brief literature review was conducted to understand (1) major mental, behavioral, and physical outcomes associated with environmental risk for school‐aged children and (2) current research methods for assessing these relationships. Documents prepared by government agencies, school districts, and advocacy groups were also collected and synthesized to improve understanding of the state of planning and policies for maintaining or improving school environments. RESULTS: Environmental risk can manifest in diverse ways such as mold, poor air quality, poor community design, or contaminated playgrounds. Deeply rooted in national and state structures of school funding and planning, such risks can lead to outcomes including respiratory illness, poor performance in school, and reduced levels of physical activity. With growing attention to these concerns, methods for measuring environmental risks and underlying disparities have advanced tremendously in the last few decades, yet development of innovative research approaches may be necessary to further advance and evaluate appropriate interventions. CONCLUSIONS: Environmental injustice is generally unacknowledged during decision‐making in US school districts. Continued dialogue reflective of translatable science is necessary to support school districts with limited funding in ensuring safe, healthy environments for learning.     

Protective connections and educational attainment among young adults with childhood-onset chronic illness

BACKGROUND: Youth with childhood‐onset chronic illness (COCI) are at risk of poor educational attainment. Specific protective factors that promote college graduation in this population have not been studied previously. In this study, we examine the role protective factors during adolescence play in promoting college graduation among young adults with COCI. METHODS: Data were collected from 10,925 participants in the National Longitudinal Study of Adolescent Health (Add Health). Protective factors present before 18 years of age included mentoring, parent relationship quality, school connectedness, and religious attendance. College graduation was the outcome of interest assessed when participants had a mean age of 28 years. Analysis was stratified by presence of COCI. RESULTS: About 2% of participants (N = 230) had 1 of 4 COCIs (cancer, diabetes, epilepsy, or heart disease). All 4 protective factors were associated with college graduation for youth without COCI. In the final multivariate model, only school connectedness was associated with college graduation for youth with COCI. CONCLUSION: School connectedness is of particular importance in promoting educational attainment for youth with COCI.     

Protective Factors for Sexual Violence: Understanding How Trajectories Relate to Perpetration in High School

Adolescent sexual violence (SV) perpetration is a significant public health problem. Many risk factors for perpetration are known, but less is known about what protects youth from perpetration, or how protective factors change over time. This longitudinal study reports trajectories of four potential protective factors for SV perpetration (empathy, parental monitoring, social support, and school belonging) across middle and high school and examines their relationship to SV perpetration in high school. Findings reveal that youth who identified as SV perpetrators had significantly lower mean empathy scores (d?=????0.18,?95?%?CI [?0.26,??0.10]) and social support scores (d?=????0.05,?95?%?CI [?0.14,??0.03]) at the beginning of middle school than non-perpetrators. We also found that youth who identified as SV perpetrators had a quicker deceleration in parental monitoring (slopes) and empathy from middle to high school, compared to non-perpetrators. Within-sex differences emerged; significant differences in slopes were detected for school belonging between male perpetrators and male non-perpetrators (Wald test?=?3.76 (1), p?=?.05) and between female perpetrators and female non-perpetrators (Wald test?=?3.95(1), p?=?.04). Significant differences in slopes for empathy between female perpetrators and female non-perpetrators (Wald test?=?4.76(1), p?=?.03) were also detected. No differences were found between male and female SV perpetrators for either empathy or school belonging. These findings have implications for the content and timing of adolescent SV prevention efforts. Intervention in adolescence, involving parents and schools in a comprehensive, multi-level approach, may be effective in preventing SV perpetration.     

Promoting physical activity among children and adolescents: the strengths and limitations of school‐based approaches

Paediatric overweight and obesity is recognised as one of Australia's most significant health problems and effective approaches to increasing physical activity and reducing energy consumption are being sought urgently. Every potential approach and setting should be subjected to critical review in an attempt to maximise the impact of policy and program initiatives. This paper identifies the strengths and limitations of schools as a setting for promoting physical activity. The strengths are: most children and adolescents attend school; most young people are likely to see teachers as credible sources of information; schools provide access to the facilities, infrastructure and support required for physical activity; and schools are the workplace of skilled educators. Potential limitations are: those students who like school the least are the most likely to engage in health‐compromising behaviours and the least likely to be influenced by school‐based programs; there are about 20 more hours per week available for physical activity outside schools hours than during school hours; enormous demands are already being made on schools; many primary school teachers have low levels of perceived competence in teaching physical education and fundamental movement skills; and opportunities for being active at school may not be consistent with how and when students prefer to be active.     

A Multilevel Examination of School and Student Characteristics Associated With Physical Education Class Enrollment Among High School Students

BACKGROUND: Schools can be an efficient venue for promoting physical activity (PA) among adolescents. Physical education (PE) requires investigation because it is a variable associated with adolescent PA levels and its existence in schools represents a significant opportunity for strategies to combat declining PA levels among this population. This article examines the between-school variability in student rates of PE enrollment among a large sample of high schools in Ontario, Canada, and identifies the school- and student-level characteristics associated with PE enrollment. METHODS: This cross-sectional study utilized self-reported school- and student-level data from administrators and students at 73 high schools. Students' enrollment in PE, demographic, behavioral, and psychosocial variables was linked to school environment data comprising of school demographics and administrator assessed quality of policies, facilities, and programs related to PA. Analysis involved multilevel modeling. RESULTS: The mean rate of PE enrollment among the 73 high schools was 62.4%, with rates by school ranging from 28.9% to 81.1%. When student demographics, behavioral, and psychosocial factors were controlled for, there was still a school effect for student PE enrollment. The school effect was explained by the provision of daily PE and school median household income. CONCLUSIONS: This is the first study to examine the extent to which PE enrollment varies between schools and to identify school factors associated with school variability in rates of PE enrollment. Although most variation in PE enrollment lies between students within schools, there is sufficient between-school variation to be of interest to practitioners and policy makers.     

Effectiveness of a universal drug abuse prevention approach for youth at high risk for substance use initiation

BACKGROUND: Universal school-based prevention programs for alcohol, tobacco, and other drug use are typically designed for all students within a particular school setting. However, it is unclear whether such broad-based programs are effective for youth at high risk for substance use initiation. METHOD: The effectiveness of a universal drug abuse preventive intervention was examined among youth from 29 inner-city middle schools participating in a randomized, controlled prevention trial. A subsample of youth (21% of full sample) was identified as being at high risk for substance use initiation based on exposure to substance-using peers and poor academic performance in school. The prevention program taught drug refusal skills, antidrug norms, personal self-management skills, and general social skills. RESULTS: Findings indicated that youth at high risk who received the program (n = 426) reported less smoking, drinking, inhalant use, and polydrug use at the one-year follow-up assessment compared to youth at high risk in the control condition that did not receive the intervention (n = 332). Results indicate that a universal drug abuse prevention program is effective for minority, economically disadvantaged, inner-city youth who are at higher than average risk for substance use initiation. CONCLUSIONS: Findings suggest that universal prevention programs can be effective for a range of youth along a continuum of risk.     

Correlates of physical and emotional health among Native American adolescents

Purpose: To examine the risk and protective factors among Native American youth that are correlated with both physical and emotional health.Methods: The study was based upon the National American Indian Adolescent Health Survey (n = 13,454), conducted using students self-categorized into a ranked variable of physical health (“poor,” “fair,” “good,” or “excellent”) and a continuous variable of emotional health based upon a nine-item unidimensional scale (overall Cronbach’s alpha of .74). Twenty-nine variables derived from resilience theory encompassing both risk and protective factors were selected. Associations with physical and emotional health were examined using linear regression analysis.Results: Identified protective factors explained approximately 30% of variance for emotional health, with family caring explaining nearly 15% of variance for both genders. The most significant associations for emotional health for females were family caring, body pride, feelings about school, and worries or concerns particularly about violence. For males, most significant protective factors included family caring, body pride, parental expectations, and type of sexual attraction. For physical health, the identified variables explained only 16% of variance for both genders. Body pride was the most significant association, explaining 10% of variance.Conclusions: Connection to family remains a consistently powerful factor in the lives of these youth. Other associations including body pride and parental expectations may help in the exploration and buffering of emotional health among American Indian youth.