Flavored Tobacco Sales Restrictions and Youth E-cigarette Behavior: Impact by Tobacco Retailer Density in Diverse Communities in California.

INTRODUCTION: Factors that impact flavored tobacco sales restriction (flavor restrictions) effectiveness on youth e-cigarette behavior are unclear. Tobacco retailer density (retailer density) is a health equity issue with greater retailer density in high-minority, low-income areas. We examined the association between flavor restrictions and youth e-cigarette behavior by retailer density across diverse communities in the California Bay Area. AIMS AND METHODS: We analyzed data from the California Healthy Kids Survey using a difference-in-differences (DID) strategy. We compared pre- and post-policy changes in e-cigarette access and use one-year post-implementation among high school students in the Bay Area with a flavor restriction (n = 20 832) versus without (n = 66 126). Separate analyses were conducted for students in cities with low and high retailer density, with a median cutoff of 3.3 tobacco retailers/square mile. RESULTS: Students with high retailer density were more likely to identify as a minority and have parents with lower education. Among students with low retailer density, flavor restrictions were associated with 24% lower odds in the pre- to post-policy increase in ease of access relative to unexposed students (DID = 0.76, 95% CI: 0.58, 0.99). Among students with high retailer density, flavor restrictions were associated with 26% higher odds in ease of access (DID: 1.26, 95% CI: 1.02, 1.56) and 57% higher odds of current use (DID = 1.57, 95% CI: 1.31, 1.87). CONCLUSIONS: Flavor restrictions had positive impacts on youth e-cigarette access in low, but not high retailer density cities. From a health equity perspective, our results underscore how flavor restrictions may have uneven effects among vulnerable groups. IMPLICATIONS: In diverse communities in the California Bay Area, our results suggest a protective association between flavored tobacco sales restrictions and youth access to e-cigarettes in low, but not high tobacco retailer density cities one-year post-implementation. These results underscore how flavor restrictions may have uneven effects, and when implemented in high retailer density areas, may disproportionately place already vulnerable groups at heightened exposure to e-cigarette use and access. In high retailer density areas, additional tobacco control efforts may need to be included with flavor restriction implementation, such as increased education, youth prevention and cessation programs, policies to reduce tobacco retailer density, or stronger tobacco retailer enforcement or compliance monitoring.

Hate Speech Against Asian American Youth: Pre-Pandemic Trends and The Role of School Factors.

Although hate speech against Asian American youth has intensified in recent years-fueled, in part, by anti-Asian rhetoric associated with the COVID-19 pandemic-the phenomenon remains largely understudied at scale and in relation to the role of schools prior to the pandemic. This study describes the prevalence of hate speech against Asian American adolescents in the US between 2015 and 2019 and investigates how school-related factors are associated with whether Asian American youth are victims of hate speech at school. Analyses are based on a sample of 938 Asian American adolescents (Mage = 14.8; 48% female) from the three most recently available waves (2015, 2017, and 2019) of the School Crime Supplement to the National Crime Victimization Survey. On average, approximately 7% of Asian Americans were targets of hate speech at school between 2015 and 2019, with rates remaining stable over time. Findings also indicate that students had lower odds of experiencing hate speech if they attended schools with a stronger authoritative school climate, which is characterized by strict, yet fair disciplinary rules coupled with high levels of support from adults. On the other hand, Asian American youth faced higher odds of experiencing hate speech if they were involved in school fights. Authoritative school climate and exposure to fights are malleable and can be shaped directly by broader school climate related policies, programs and interventions. Accordingly, efforts to promote stronger authoritative climates and reduce exposure to physical fights hold considerable potential in protecting Asian American youth from hate speech at school.

Co-Use of Tobacco Products and Cannabis Is Associated with Absenteeism and Lower Grades in California High School Students.

OBJECTIVE: To examine the association between co-use of commercial tobacco product (hereafter referred to as tobacco) and cannabis with educational outcomes among high school students. STUDY DESIGN: We analyzed high school student data from the 2021-2022 California Healthy Kids Survey (n = 287 653). Current (past-month) or ever tobacco and cannabis use was categorized as co-use, only tobacco or cannabis, or neither. Two self-reported educational outcomes were examined: absenteeism and grades. Adjusted logistic and linear regression models were used to examine the association between tobacco/cannabis use and absenteeism or grades, respectively. Estimates were adjusted for individual, peer, and school covariates, and clustering within schools. RESULTS: Current co-use of tobacco and cannabis was more than double the use of only tobacco (3.7% vs 1.7%) and similar to only cannabis (3.7%). Almost 18% of students reported absenteeism. Compared with students who used neither substance, students with current co-use had greater odds of absenteeism (aOR 1.41, 95% CI 1.33-1.49) and lower grades (ß = -0.87, 95% CI -0.92 to -0.82). Compared with students using tobacco alone, students with co-use also had a significant elevated odds of absenteeism (aOR 1.19, 95% CI 1.10-1.29) and lower grades (ß = -0.39, 95% CI -0.46 to -0.32). Similar results were found for students who ever used tobacco and cannabis. CONCLUSIONS: California youth who co-use tobacco and cannabis were most likely to have absenteeism and lower grades. Comprehensive efforts to prevent or reduce youth substance use may improve educational outcomes.

Educational impacts of the COVID-19 pandemic in the United States: Inequities by race, ethnicity, and socioeconomic status.

The COVID-19 pandemic caused reverberations throughout the educational system that disproportionately impacted students of color and those from lower socioeconomic backgrounds. In this review, we examine recent research documenting the disparate educational impacts of the pandemic across racial, ethnic, and socioeconomic status groups that deepened existing educational inequities in the United States. Numerous systemic barriers underlie these disparities, including disproportionate access to in-person learning and technology alongside the intensification of racial discrimination. Amidst these disparities, we also highlight emerging evidence of similarities in the educational impacts. Finally, recent evidence reveals a more multifaceted view of how some students of color leveraged supplemental educational supports and their academic confidence to confront educational challenges during the pandemic despite experiencing more pandemic-related stressors.

BMI Reporting and Accuracy of Child's Weight Perception.

OBJECTIVES: To estimate whether school-based body mass index (BMI) reports impacted the accuracy of children's self-reported weight category, for children overall and within subgroups. METHODS: We analyzed existing data from the Fit Study, a randomized controlled trial of a BMI screening and reporting intervention conducted in California from 2014 to 2017. The sample included 4690 children in 27 schools randomized to receive BMI reports and 4975 children in 27 controls schools that received BMI screening only. To estimate how BMI reporting affected accuracy, we fit multinomial logistic regression models to our data. We calculated average marginal effects, which capture the change in probability that children more accurately reported their weight category because of BMI reporting. RESULTS: We detected no impact of BMI reporting on children's self-reported weight accuracy. Exploratory subgroup analyses show that for Black children, exposure to 1 round of BMI reporting was associated with a 10.0 percentage point increase in the probability of accurately reporting their weight category (95% confidence interval [CI]: 2.6 to 17.4). Two rounds of reporting were associated with an increase in the probability of accuracy for Asian children (6.6 percentage points; 95% CI: 0.4 to 12.8), 5th graders (11.1 percentage points; 95% CI: 1.6 to 20.5), and those with BMI <5th percentile (17.1 percentage points; 95% CI: 2.7 to 31.6). CONCLUSIONS: BMI reporting has limited efficacy in increasing children's weight perception accuracy. Although exploratory analyses show that specific subpopulations became more accurate, future prospective studies should be designed to confirm these results.

In the Aftermath of School Victimization: Links Between Authoritative School Climate and Adolescents' Perceptions of the Negative Effects of Bullying Victimization.

Although authoritative school climate-strict, yet fair enforcement of rules alongside strong adult support-is associated with lower rates of bullying victimization, less is known about whether it influences how negatively adolescents feel after being victimized at school. Further, it is unclear whether boys and girls respond differently to an authoritative climate. Identifying ways that schools can reduce negative feelings after being bullied is important given the long term psychological ramifications of bullying that, if left unaddressed, can extend into adulthood. To address these gaps, this study examined whether authoritative school climate related to how negatively adolescents felt about their schoolwork, relationships, physical health and self-perception after being bullied. Differences between boys and girls were also investigated. Analyses were conducting using national data from the 2017 School Crime Supplement on a sample of 1,331 adolescents aged 12 to 18 years (Mage = 14.3 years; 59% girls). Findings from a set of ordinal regression models with a robust set of student, parent and school controls demonstrated that adolescents in more supportive schools were less likely to report that bullying victimization negatively impacted their schoolwork and feelings about themselves. Similar results were found for girls but not boys. By investing in supportive school climates, schools can be potentially transformative places where adolescents, especially girls, can feel more positively about themselves despite being bullied.

Promoting college and career readiness among underserved adolescents: A mixed methods pilot study.

INTRODUCTION: Many underserved adolescents, defined as those with inequitable access to educational resources, face limited access to interventions that develop their college and career know-how. In our study, we implemented and evaluated a pilot college and career readiness curriculum intervention called Paths to the Future for All (P2F4A). P2F4A takes a developmental approach to college and career development, weaving together the procedural know-how of college and career planning with a broader focus on building social-emotional skills that support positive trajectories towards the future. We evaluated pre-post changes in adolescents' career-related and social-emotional outcomes alongside views of their personal growth. METHODS: We used a purposeful sample of five schools in the Western region of the United States and recruited a sample of adolescents (N = 61; Mage = 16.3 years; 57.4% female) who experienced challenging academic and life circumstances to participate in P2F4A. We conducted pre-post surveys as well as focus groups and interviews with adolescents. RESULTS: We detected significant (p < .05) pre-post gains in adolescents' knowledge of P2F4A curricular content and selected coping skills, such as relaxing and solving family problems. Our focus groups and interviews revealed that P2F4A helped adolescents build stronger interpersonal relationships with peers and the content was directly applicable to real life. CONCLUSION: Our new findings suggest that college and career readiness curriculum interventions-if appropriately developed for and targeted to underserved adolescents-have strong potential to build underserved adolescents' foundational skills that they can apply towards realizing their future college and career aspirations.

School-Based Telemedicine Interventions for Asthma: A Systematic Review.

BACKGROUND: School health systems are increasingly investing in telemedicine platforms to address acute and chronic illnesses. Asthma, the most common chronic illness in childhood, is of particular interest given its high burden on school absenteeism. OBJECTIVE: Conduct a systematic review evaluating impact of school-based telemedicine programs on improving asthma-related outcomes. DATA SOURCES: PubMed, Cochrane CENTRAL, CINAHL, ERIC, PsycINFO, Embase, and Google Scholar. STUDY ELIGIBILITY CRITERIA: Original research, including quasi-experimental studies, without restriction on the type of telemedicine. PARTICIPANTS: School-aged pediatric patients with asthma and their families. INTERVENTIONS: School-based telemedicine. STUDY APPRAISAL AND SYNTHESIS METHODS: Two authors independently screened each abstract, conducted full-text review, assessed study quality, and extracted information. A third author resolved disagreements. RESULTS: Of 371 articles identified, 7 were included for the review. Outcomes of interest were asthma symptom-free days, asthma symptom frequency, quality of life, health care utilization, school absences, and spirometry. Four of 7 studies reported significant increases in symptom-free days and/or decrease in symptom frequency. Five of 6 reported increases in at least one quality-of-life metric, 2 of 7 reported a decrease in at least 1 health care utilization metric, 1 of 3 showed reductions in school absences, and 1 of 2 reported improvements in spirometry measures. LIMITATIONS: Variability in intervention designs and outcome measures make comparisons and quantitative analyses across studies difficult. Only 2 of 7 studies were randomized controlled trials. CONCLUSIONS AND IMPLICATIONS OF KEY FINDINGS: High-quality evidence supporting the use of school-based telemedicine programs to improve patient outcomes is limited. While available evidence suggests benefit, only 2 comparative trials were identified, and the contribution of telemedicine to these studies' results is unclear.

Excessive Absenteeism Due to Asthma in California Elementary Schoolchildren.

OBJECTIVE: Previous studies of asthma-related school absenteeism have reported absenteeism dichotomously (ie, any school days missed vs none). However, schools use higher thresholds to identify and intervene for students at risk of chronic absenteeism (18 days or ≥10% schoolyear missed), which is associated with negative health and educational outcomes. We sought to identify factors associated with excessive absenteeism (EA) due to asthma (≥9 days missed), a threshold based on a convention defined by Attendance Works for absenteeism risk, and is linked to decreased academic performance and increased risk of chronic absenteeism. METHODS: We examined responses for asthma-related absenteeism from the 2011 to 2014 California Health Interview Survey for children ages 5-11. Multivariate logistic regression modeled odds ratios of EA for demographic, healthcare utilization, and asthma-related factors. Sensitivity analysis was performed modeling a ≥1 threshold (any absenteeism). RESULTS: 715 respondents represent an estimated 314,200 California schoolchildren with asthma. 50.3% of students missed ≥1 day, and 11.7% missed ≥9 days of school due to asthma. Odds of EA were significantly higher for younger children, lower-income families, and rural students, but not significant for any absenteeism. Indicators of greater asthma severity and poorer control were significantly associated with both EA and any absenteeism. CONCLUSIONS: This study identified factors significantly associated with EA that were not significant for lower absence thresholds. This may help direct school-based asthma interventions for which limited resources must target students at higher risk of chronic absenteeism.

Leveraging the Public School System to Combat Adolescent Obesity: The Limits of Arkansas's Statewide Policy Initiative.

PURPOSE: This study assessed the effectiveness of one of the earliest statewide policy initiatives to address obesity via schools-Arkansas's Act 1220 of 2003-on adolescent obesity. The Act required public schools in Arkansas to conduct body mass index (BMI) screening and reporting, restrict access to vending machines, and establish physical education and nutrition standards. METHODS: To determine the effect of Act 1220 as a whole, this study analyzed data representative of adolescents in grades 9-12 from the Youth Risk Behavior Survey using the quasi-experimental method of difference-in-differences. Changes in adolescents' weight outcomes in Arkansas before (1999 and 2001) and after (2005, 2007, and 2009) the implementation of Act 1220 were compared to changes in weight outcomes for adolescents from the neighboring state of Missouri across the same time period. RESULTS: Arkansas's Act 1220 did not significantly influence adolescents' BMI-for-age z-scores (-.017; 95% confidence interval [CI] [-.097, .063]; p = .68). Further, the Act did not lead to significant reductions in BMI-for-age z-scores among adolescents who were either overweight (-.003; 95% CI [-.043, .036]; p = .86) or obese (-.010; 95% CI [-.070, .051]; p = .75). Results remain robust to adjustments for self-report bias in height and weight as well as a set of alternative comparison states. CONCLUSIONS: Preventing adolescent overweight and obesity is unlikely to occur through such large-scale policy initiatives alone.

School-Based Body Mass Index Screening and Parental Notification in Late Adolescence: Evidence From Arkansas's Act 1220.

PURPOSE: In 2003, Arkansas enacted Act 1220, one of the first comprehensive legislative initiatives aimed at addressing childhood obesity. One important provision of Act 1220 mandated that all children attending public schools be screened for their body mass index (BMI) and the information sent home to their parents. Since then, eight other states have adopted similar school-based BMI screening and notification policies. Despite their widespread adoption and implementation, there is a dearth of empirical studies evaluating such policies, particularly for adolescents. The aim of this study was to evaluate whether adolescents, who had been previously screened in early adolescence, experienced changes in their health outcomes if they continued to receive screening and reporting throughout late adolescence (11th and 12th grades). METHODS: Secondary data from the Centers for Disease Control's Youth Risk Behavior Survey were analyzed using the method of difference-in-differences. Changes in outcomes between 10th and 12th grade were compared between a group of students who received screenings throughout 11th and 12th grades versus a later comparison group who were exempt from screening and reporting requirements in 11th and 12th grades. RESULTS: BMI screening and parental notification during late adolescence, given prior screening and notification in early adolescence, was not significantly related to BMI-for-age z-scores, the probability of being in a lower weight classification or exercise and dietary intake behaviors. CONCLUSIONS: Exposing 11th and 12th graders to BMI screening and reporting, given that they had been exposed in prior grades, was not associated with adolescents' health outcomes.

The effects of single-sex versus coeducational schools on adolescent peer victimization and perpetration.

Bullying is a growing public health concern for South Korean adolescents. In our quantitative investigation, we analyze the frequency with which Korean adolescents in single-sex versus coeducational schools are targets of or engage in three peer aggressive behaviors (verbal, relational (social exclusion), and physical (including theft)). We use two nationally representative datasets, the 2011 Trends in International Mathematics and Science Study (TIMSS) and the 2005 Korea Education Longitudinal Study (KELS), and rely on propensity score matching (PSM). For adolescent girls, we find that being in all-girls schools mitigates both their exposure to and engagement in peer victimization. For adolescent boys, we find that boys in all-boys schools have significantly higher odds of experiencing more frequent verbal and physical attacks versus their counterparts in coeducational schools. Our findings strongly suggest that interventions to mitigate peer victimization and aggression in Korea should consider the gendered schooling contexts in which they are implemented.

Sensitivity analyses for clustered data: an illustration from a large-scale clustered randomized controlled trial in education.

In this paper, we demonstrate the importance of conducting well-thought-out sensitivity analyses for handling clustered data (data in which individuals are grouped into higher order units, such as students in schools) that arise from cluster randomized controlled trials (RCTs). This is particularly relevant given the rise in rigorous impact evaluations that use cluster randomized designs across various fields including education, public health and social welfare. Using data from a recently completed cluster RCT of a school-based teacher professional development program, we demonstrate our use of four commonly applied methods for analyzing clustered data. These methods include: (1) hierarchical linear modeling (HLM); (2) feasible generalized least squares (FGLS); (3) generalized estimating equations (GEE); and (4) ordinary least squares (OLS) regression with cluster-robust (Huber-White) standard errors. We compare our findings across each method, showing how inconsistent results - in terms of both effect sizes and statistical significance - emerged across each method and our analytic approach to resolving such inconsistencies.

National trends in school victimization among Asian American adolescents.

The "model minority" perception of Asian American students often ignores the academic and social challenges that many face in schools. One area that has received less attention is the school victimization experiences of Asian American adolescents. While some qualitative researchers have explored factors contributing to school victimization in recent years, missing in the literature is the scope of these incidents among Asian Americans. This paper contributes to this literature by (1) examining national trends in the victimization of Asian American adolescents in schools over the last decade and (2) investigating how victimization varies according to their gender, socioeconomic status, and achievement levels. The results show that although Asian American adolescents are consistently less likely to be bullied relative to other students, they are more likely to report experiences of racial discrimination. Victimization incidents for Asian Americans also differ by gender and academic achievement levels.