Pediatric Residents' Outpatient Firearm Screening and Safety Counseling Practices (Or Lack Thereof): A Retrospective Chart Review.

The American Academy of Pediatrics recommends that children and adolescents be universally screened for access to firearms and exposure to violence. The purpose of this study was to characterize how often pediatric residents at one institution document screening for firearm access and violence risk factors and provide risk reduction counseling in the primary care setting. A retrospective chart review was conducted at two primary care clinics in Baltimore, Maryland, for patient ages 10 to 25 years who were seen by resident physicians for well care between October 2019 and December 2020. We reviewed 169 patients' charts meeting the inclusion criteria. Forty (24%) patients had a documented history of exposure to violence or history of suicidal ideation. Based on resident documentation, one (<1%) patient was screened for firearm access or exposure to firearm violence and 10 (6%) were provided risk reduction counseling or any type of firearm safety counseling. Pediatric resident physicians at our institution rarely screen for firearm access or provide violence prevention counseling in the primary care setting. Targeted interventions and quality improvement projects are needed to address screening barriers and design novel interventions to overcome these barriers.

My Best Alaskan Life: Addressing Adolescent Mental and Reproductive Health in Alaska.

INTRODUCTION: Since 2020, a multisector research team has coordinated a youth-driven, community-based participatory research project to adapt a reproductive life plan for application in a statewide initiative called My Best Alaskan Life (MBAL). The RLP is adapted for Alaskan youth and is intended to support teens in decision-making processes reflecting cultural priorities, personal goals, and sexual and reproductive health. Background. With 46% of youth in Alaska reporting not having used a condom during their last sexual intercourse and 15% not having used contraception, unintended pregnancy and transmission of STIs will continue. Furthermore, Alaskan youth also cite high rates of hopelessness and suicidality, and research shows that poor mental health among adolescents is correlated with developing and maintaining high-risk sexual behaviors. An intervention focusing on supporting mental wellness and developing personal goals in the context of sexual health decision-making may encourage adolescents to adopt safer sexual health behaviors. METHODS: The MBAL research team completed a statewide pilot assessing the design and implementation of the tool, gathering feedback from over 700 survey responses (youth, ages 14-20); conducted 10 in-depth interviews (adult partners at community organizations and clinics); and hosted two youth-led design review sessions. FINDINGS: Questionnaire respondents were overwhelmingly positive about the tool (91% "liked or loved" the tool) and its potential applicability in their community (86% cited "very applicable"). Project next steps include incorporating design recommendations, a statewide randomized control trial and ultimately, open source access for all interested parties.

Move and Thrive: Development of an Adolescent Friendly and Inclusive Online Fitness Resource.

While physical activity (PA) is a strong protective factor for adolescents, many youth experience discrimination and intimidation in traditional fitness spaces. This is especially true for youth of color, youth in larger bodies, and transgender youth. This manuscript describes the development of Move and Thrive, an online resource for PA promotion designed specifically for adolescents prioritizing inclusivity and diversity. Working with Community and Youth Advisory Boards, we developed guiding principles of Move and Thrive: to create resources that are 1) youth and community driven; 2) inclusive of diverse representation; 3) body and weight neutral; 4) trauma informed; and 5) accessible. We developed a guide for PA instructors to use trauma informed approaches; avoid mention of weight talk or physical appearance; use gender inclusive language; and offer multiple options to improve accessibility. Specific care was taken to hire instructors diverse in body size, race, ethnicity, and gender identity. The first iteration of Move and Thrive was launched in March 2021, and the current resource contains 72 PA videos. Over the course of 12 months, the site had more than the site had over 9,000 views in over 40 countries, including six continents. Users have reported high levels of satisfaction with Move and Thrive, and physicians have responded enthusiastically to sharing Move and Thrive as a free resource for adolescents. University of Minnesota Move and Thrive Project is currently available on an ad-free YouTube Channel. We believe that Move and Thrive has the potential to reach populations historically excluded from PA resources.

My Way to School Through a Camera Lens: Involving Children to Inform a Policy Recommendation on Active School Travel.

Active school travel (AST) is an effective approach for increasing children's physical activity and independent mobility, but policy supporting AST is lacking. This study aims to explore children's experiences of AST to inform a policy recommendation. Photovoice methodology with a qualitative approach was applied, with children taking pictures on their way to school. This was followed by focus groups where the children explored their experiences of AST based on their photos. The data were analyzed using qualitative content analysis. The results show that the children valued independent mobility and wanted to be involved in decisions about their travels; they also expressed feelings of increased responsibility and personal growth as a consequence. Although the children recognized areas of improvement regarding infrastructure, especially regarding heavy traffic that jeopardized travel safety, they continued using AST. Finally, the children talked about the value of the health and environmental benefits of AST. Opportunities for friendship, play, and making decisions about their own time were highlighted as important incentives. The benefits from AST are many for children, as well as for society. The result has informed policy recommendations for AST, and the children's input will be used to communicate the recommendations. Listening to the voices of children could be a steppingstone toward forming future healthy mobility initiatives. In that process, it is key to include children's perspectives when formulating the AST policy for successful adoption and implementation.

The Forgotten Youth: Responding to Mental Health Needs Among Confined Youth in the Time of COVID-19.

As COVID-19 sweeps across the country, individuals within the carceral system face an increased risk of contracting the virus, and as a result, heightened risk for mental health symptoms. We discuss how COVID-19 appears to be exacerbating mental health inequities for children within the carceral system and the need to respond accordingly. Children within the carceral system represent a particularly vulnerable population, and the majority of detained or confined youth identify as Black, Indigenous, and People of Color (BIPOC). As juvenile detention centers in multiple states report cases of COVID-19, children who are confined are experiencing higher rates of illness and fear of illness. It is crucial to consider how the mental health of children who are confined will be disproportionately affected compared with the general population. We provide recommendations to revise practices to improve and reduce mental health outcomes among confined children.

"Young Women My Age Really Need Boosts Like This": Exploring Improv as a Facilitator of Wellness Among Young Women of Color.

This project qualitatively examined the potential of scenic improvisation ("improv") for engaging young women of color as a possible means of promoting and enhancing health and wellness outcomes in this often-overlooked population. Seven young women of color (ages 15-18), accessing virtual after-school programming, participated in a three-session professionally facilitated improv workshop series. Participants provided insights through in-depth pre- and postproject qualitative interviews about their experiences. Participants indicated that improv boosted their self-esteem and strengthened their social connections. Participants were enthusiastic about accessing further improv opportunities, noting that improv should be embedded into other youth-serving programs and health-promotion efforts, as such approaches were deemed as particularly needed among young women of color. Inclusion of improv activities in intervention and prevention efforts would benefit from additional exploration as ways by which health and wellness programs and supports might be innovated and tailored to the specific needs and preferences of young women of color.

Creating a Virtual Network to Support LGBTQIA+ Youth in Rural Settings: Development of Colorado's Queer Youth Network.

LGBTQIA+ (lesbian, gay, bisexual, transgender, queer or questioning, intersex, asexual, and more) youth in rural communities have little to no access to gender or sexuality-affirming support, compared with their peers in the metro areas of Colorado. Without access to support and exposure to bullying or discrimination, many rural LGBTQIA+ youth struggle to find belonging. Staff from One Colorado and the Hub for Justice-centered Youth Engagement partnered to develop Colorado's Queer Youth Network (CQYN) to foster a virtual community to support rural LGBTQIA+ youth, enhance belonging and acceptance, and feel empowered to make a change in their community. CQYN is offered virtually, every other week during the academic year, to create a consistent safe space for rural LGBTQIA+ youth and to offer opportunities to grow their unique leadership skills and connect with affirming LGBTQIA+ adults. This article highlights the development of the partnership, design of the virtual network, and challenges in recruiting youth who have been pushed to the margins.

Addressing Gendered Racism Against Black Girls Using a Strengths-Based Empowerment-Intersectional Framework for Sexual Health and Substance Use Prevention Programming.

Although Black girls use substances at lower rates than boys and girls from various other racial groups, they tend to have worse health outcomes associated with substance use that can also impact their sexual health. The association between substance use and sexual risk behaviors is usually attributed to lack of access to quality health care and lack of culturally specific prevention programming and treatment options tailored to this group. Accordingly, the theoretical frameworks for health promotion for Black girls often focus on addressing deficits, ignoring the powerful and intersecting social forces that can impact identity, agency, and behavioral options. Key among these forces is gendered racism. We propose a strengths-based conceptual framework to address and challenge gendered racism as a critical foundation for promoting health and wellbeing for Black girls. Our approach integrates Intersectionality Theory and Empowerment Theory, with psychological and intrapersonal empowerment identified as critical mediators of behavior and health outcomes, supported by protective factors of positive racial identity and gendered racial socialization. This framework has been developed with and for Black girls but can be adapted for health promotion efforts with other minoritized groups.

Impact of an Elementary School-Based Wellness Initiative on Child Obesity Prevalence: LiveWell Kids.

Despite major public health investments over the past several decades, little progress has been made in reducing the prevalence of obesity among school-aged children in the United States. In 2007, the Redondo Beach Unified School District (RBUSD) and the Beach Cities Health District launched a wellness initiative, LiveWell Kids, that included multi-level interventions to improve nutrition and increase physical activity. The initiative also included annual measurements of height and weight among all kindergartners and first, third, and fifth graders in the eight elementary schools in the RBUSD. To assess trends in obesity prevalence, we analyzed height and weight data collected during the 2008 to 2009 to 2018 to 2019 school years. To more fully assess the impact of the initiative, we conducted a least-squares regression difference-in-differences analysis of data from the California Physical Fitness Testing Program on measured height and weight among fifth graders from the RBUSD, three neighboring school districts, and Los Angeles County overall. Among elementary school students in the RBUSD, obesity prevalence decreased from 13.9% in 2008 to 2009 to 6.4% in 2018 to 2019. Significant declines in prevalence were observed in all eight elementary schools, and across all grade levels and demographic groups. Among fifth graders, a similar decline in obesity prevalence was not observed in the other school districts or the county overall. The findings suggest that interventions that adhere to the socio-ecologic model and engage students, parents, and school personnel at all levels while also addressing school and community environments may reduce obesity prevalence among elementary school-aged children.

COVID-19 Testing in Schools: Perspectives of School Administrators, Teachers, Parents, and Students in Southern California.

BACKGROUND: School-based COVID-19 testing is a potential strategy to facilitate the safe reopening of schools that have been closed due to the pandemic. This qualitative study assessed attitudes toward this strategy among four groups of stakeholders: school administrators, teachers, parents, and high school students. METHODS: Focus groups and interviews were conducted in Los Angeles from December 2020 to January 2021 when schools were closed due to the high level of COVID transmission in the community. RESULTS: Findings indicated similarities and differences in attitudes toward in-school COVID-19 testing. All groups agreed that frequent in-school COVID-19 testing could increase the actual safety and perceived safety of the school environment. School administrators expressed pessimism about the financial cost and logistics of implementing a testing program. Parents supported frequent testing but expressed concerns about physical discomfort and stigma for students who test positive. Teachers and parents noted that testing would prevent parents from sending sick children to school. Students were in favor of testing because it would allow them to return to in-person school after a difficult year of online learning. CONCLUSION: In-school COVID-19 testing could be a useful component of school reopening plans and will be accepted by stakeholders if logistical and financial barriers can be surmounted and stigma from positive results can be minimized.

A Pandemic Adaptation and Its Aftermath: Using AI and In-Person Facilitation for Community Health Education in Liberia and the United States.

Health promotion commonly focuses on supporting youth wellness, as health behaviors acquired in childhood and adolescence tend to have a significant impact on an individual's future. Adolescent health education is associated with positive health and educational outcomes, yet young people experience barriers to fully engaging in learning about health issues that are often unique to their social location. Barriers for successful engagement in health education for African diaspora youth in North American and European contexts may include school initiatives built around engagement models that do not center Black youth; for Black youth in majority-Black societies, barriers may include access to resources or exclusionary practices based on other social characteristics. Global health promotion has used a variety of multimodal educational tools from radio to more recently online engagement, especially in African contexts, to reach young people. This essay shares experiences using AI and in-person facilitation to engage in community health education with youth in Liberia and the United States. In our practice, we found that there are far more underlying systemic and structural similarities to the inequities experienced between African and Black American youth and that utilizing AI tools alongside of in-person discussion may contribute to better outcomes for youth health education.

Vaping-Know the Truth: Evaluation of an Online Vaping Prevention Curriculum.

BACKGROUND: Unacceptably high levels of e-cigarette use among youth paired with growing research about the dangers of vaping demonstrate a critical need to develop interventions that educate young people to reject e-cigarette use and promote cessation for current users. Vaping: Know the Truth (VKT) is a free digital learning experience prioritizing middle and high school students that aims to improve students' knowledge about the dangers of using e-cigarettes and provide quitting resources for those who already vape. The current study was designed to evaluate whether students receiving the curriculum increased knowledge of the dangers of vaping. METHODS: The outcome measures were calculated as the change in the number of correct responses from the pre- to post-module assessments among middle and high school students who completed four modules of the VKT curriculum (N = 103,522). Linear regression was performed to determine the association between the student's pre-module assessment score and the knowledge change score after completion of the four modules. RESULTS: Students' e-cigarette knowledge significantly improved by an average of 3.24 points (SD: 3.54), following implementation of the VKT curriculum. This indicates that participants answered more than 3 additional questions correctly, on average, after the intervention. CONCLUSION: Findings demonstrate that the Vaping: Know the Truth curriculum is an effective resource for increasing knowledge among youth about the harms associated with e-cigarette use. Further research is needed to evaluate whether the intervention is associated with behavioral outcomes over time.

Evaluation of a Mandatory Professional Development on Supporting Transgender, Nonbinary, and Gender-Nonconforming Students in Chicago Public Schools.

To address the reality that LGBTQ+ (lesbian, gay, bisexual, transgender, queer, intersex, asexual, and others) students remain more likely to experience harm, harassment, and violence at school as well as miss school due to feeling unsafe and the fact that students identifying as transgender, nonbinary, and gender-nonconforming (TNBGNC) are at even greater risk of bullying, harassment, and significant mental health concerns, Chicago Public Schools' (CPS) Office of Student Health and Wellness (OSHW) created a novel professional development (PD) requirement in 2019, entitled "Supporting Transgender, Nonbinary, and Gender Nonconforming Students." The PD, a recorded webinar encouraging independent time for reflection and planning, takes an intersectional approach and is required of all CPS staff members across the entire district. A pre- and postevaluation of the PD, guided by the Kirkpatrick model, was completed by 19,503 staff members. The findings from this evaluation show that staff members significantly increased their knowledge, showed statistically significant gain in self-reported skills, and articulated key actions they could take toward sustaining an environment that fosters skill implementation and culture change more broadly. Findings reveal that a culture that supports staff members in learning from their mistakes can help to encourage staff members to employ gender-inclusive behaviors such as asking individuals for their pronouns and using gender-neutral pronouns. This districtwide mandatory PD approach shows value in influencing staff members' thinking and behaviors known to be supportive of TNBGNC students and may serve as a model for other school districts looking to build capacity to support TNBGNC students.

What Kinds of Support are Alaska Native Youth and Young Adults Reporting? An Examination of Types, Quantities, Sources, and Frequencies of Support.

American Indian and Alaska Native (AI/AN) youth, particularly males, experience disproportionately high rates of suicide compared to other young people in the United States. Therefore, enacting suicide prevention efforts for AI/AN youth is especially important. Since research shows that strengthening social, cultural, and emotional support can reduce suicide risk, many recent prevention efforts focus on these strategies. Yet, to reinforce and to extend the positive impact of these strategies for suicide risk reduction, we argue it is useful to identify baseline levels and other features of already-existing support. Toward this end, we describe the types (i.e., category), quantities (i.e., distribution and average number), sources (i.e., from whom), and frequencies (i.e., how often) of social support that AN young people report receiving, and we examine if these "support profiles" differ by age and sex. We use survey data from 165 ANs under age 30, collected as part of a participatory intervention study focused on Promoting Community Conversations About Research to End Suicide (PC CARES). We find that: 1) most ANs reported receiving nearly all supports, 2) compared with females, males reported receiving fewer supports on average, 3) family was the most selected support source, followed by close friends and service providers, and 4) family (e.g., parents, siblings, and grandparents) provided support regularly (i.e., monthly or more). Though our findings may suggest fruitful avenues for interventions targeted toward AN males, we discuss these findings in relation to the gendered nature of suicide prevention and assessment.

Perspectives of Pediatric Community Health Workers: Roles, Successes, and Challenges.

This multicenter qualitative study described the roles of 10 pediatric community health workers (CHWs) in their own words through exploration of the role features, successes, and challenges in pediatric health care settings across three urban U.S. cities (Philadelphia, New York City, and Cincinnati). Individual, semi-structured telephone interviews were conducted. Interviews described prominent features of the pediatric CHW role, which included taking a family-centered approach to goal setting and determining support needed, ensuring family goals stayed at the center of the work, and acting as a trusted figure for families to talk openly with. CHWs described their role as rewarding, believing in the work, and feeling a sense of fulfillment, and felt successful when families had positive outcomes, including when barriers were eliminated, resources were obtained, or independence was demonstrated by families. Challenges CHWs faced in their roles included establishing trust with families, managing the ever-changing family circumstances many families experience due to socioeconomic barriers, and managing limitations of protocol and restrictions within their roles. This study demonstrated numerous considerations for CHW practice in pediatric health care settings, in addition to considerations for pediatric-specific CHW program development and management. The primary policy implication of this study included a basis for increased funding for CHW programs in pediatric health care settings. This study also demonstrated a need for further research on the change CHWs effect within child and family systems outside of health care, such as schools and child welfare agencies.

Impact of Engaging Students in Health Survey Data Analysis and as Full Partners in School Change: Results From a Mixed Methods Study.

Young people demand and deserve participation in shaping the health and well-being of their community. Getting to Y: Youth Bring Meaning to the Youth Risk Behavior Survey (GTY) is a positive youth development initiative, whereby students analyze local youth health data and create change. This article adds definitive evidence to support the theoretical foundations of GTY expounded by Garnett et al. (2019). A mixed methods convergent study design, collecting quantitative data from pre- and postintervention surveys and qualitative data from focus groups, was enacted during the 2018-2019 school year. Survey participants were 256 students attending 20 Vermont middle/high schools. Surveys measured self-efficacy, health literacy, civic engagement, resiliency, and knowledge. Focus groups with 50 students solicited open-ended feedback. Wilcoxon signed-rank tests determined student-level change over time. Focus group transcripts were coded using grounded theory and a priori codes from the survey. Statistically significant improvements were seen in average scores from pre- to postintervention surveys in all five domains and differences in effect by gender. Results from the focus group complement the quantitative findings. Participation in GTY positively affected youth participant's understanding of their own health and well-being and increased agency to take action on behalf of themselves and their community. As the Youth Risk Behavior Survey is available nationwide, GTY is poised for replication to critically engage youth with relevant data to inform social change.

Implementation of CDC Guidelines for Recess: A Formative Research Study.

The American Academy of Pediatrics recognizes recess as an essential part of overall child development in schools, impacting children's cognitive, socioemotional and physical health and development. However, recess is often removed from the school curriculum in exchange for more classroom activities. The Centers for Disease Control and Prevention (CDC) and SHAPE America developed Strategies for Recess in Schools to promote high-quality recess through specific actions, yet is not known how these are successfully implemented, particularly, in underserved settings. This formative research study examined the implementation of the CDC strategy in an urban, inner-city charter elementary school to identify barriers and facilitators to successful recess implementation from the perspective of various stakeholders. Thirteen in-depth interviews and focus group discussions were conducted with parents, teachers, recess monitors, and school administrators. Interviews were recorded, transcribed, and coded for thematic analysis, supported by group discussion and analytic memos. Results suggested that although stakeholders recognized the importance of recess, the implementation of the CDC strategy was neither uniformly understood nor implemented, suggesting that additional frameworks may be helpful in implementing the CDC strategy in schools in underserved communities.

Identifying Implementation Drivers for Teen Sexual Health Education Curricula.

This article focuses on examining the implementation of evidence-based teen pregnancy prevention programming in a select school district. Results are presented based on the following implementation drivers: (1) actions taken by leadership to make decisions, provide guidance, and support how the school site and community-based organizations are functioning in support of implementation; (2) actions taken to ensure competent staff delivery of the curricula; and (3) actions taken to create and sustain a hospitable context in order to implement the interventions at the school site. The need for adolescent sexual health education is evident in this geographic location where Hispanic or Latino teens consistently have higher birth rates among race and ethnicities that are routinely reported. For 2018, when this project started, those rates were 40 births per 1,000 females aged 15 to 19 years. For 2018, the birth rates for African Americans was 31 and for Whites was 17 per 1,000 females aged 15 to 19 years. The project goals were to reduce teen birth rates by (1) providing evidence-based teen pregnancy prevention curricula to youth aged 11 to 19 years over the course of the 5-year project period, (2) training school staff and community members in the curricula, and (3) generating community support of youth access to reproductive health care and education. Despite a funding interruption to implementation of the project and the impact of COVD-19, educational programming was provided to 9,616 youth. The article details the key implementation strategies and solutions so that other practitioners can consider application of these implementation drivers in their own adolescent health education programming.

Real-Time Video Scan Method for Community Partner Use to Inform Play Streets Implementation.

System for Observing Play and Recreation in Communities (SOPARC) can provide accurate assessment of physical activity; however, the skills, time, and human resources necessary to collect/interpret SOPARC data can be challenging for community organizations. This article describes a more accessible adaptation of SOPARC using video recordings for community organizations to obtain physical activity feedback at Play Streets. Narrated panoramic video scans occurred every 30 minutes at each Play Street using an iPad. Videographers narrated: (1) sex, (2) age group (child, teen, adult, senior), and (3) activity level (sedentary, walking, vigorous) for everyone recorded. SOPARC video scans, in-person iSOPARC observations, and interviews were conducted with Play Streets implementors to determine validity and feasibility. Validity was examined using Lin's concordance correlation coefficient (CCC). In-person and video scans showed near perfect agreement for sedentary individuals (CCC = .95) and substantial agreement for active individuals (CCC = .72). Overall, community partners felt that they "could see how [the scans] could be useful" and "help[ed] see a bit more clearly what's happening." The method described here is a more accessible systematic observation approach to measure physical activity for communities implementing Play Streets. Further, this method can be used without research training while still providing valuable activity feedback.

Development and Interrater Reliability of an Observational School Environment Checklist: A Practical, Comprehensive Tool to Assess Healthy Eating and Physical Activity Opportunities in Schools.

INTRODUCTION: Comprehensive, objective assessment of schools' eating and physical activity environments is critical to developing and evaluating policies and interventions to reduce pediatric obesity inequities; however, few tools exist that describe the entire school comprehensively and are feasible with restricted resources. This study describes development and reliability of the observational school environment checklist (OSEC), a comprehensive observational audit tool. METHOD: We developed the OSEC through iterative adaptations of existing instruments and pilot testing. The tool assesses four focus areas: cafeteria, lobby/hallway, gym, and outdoor areas. For reliability testing, two trained auditors independently completed the OSEC and met to resolve disagreements. For items with poor agreement, a third independent coder coded photographs taken during auditing. Percent agreement and Cohen's kappa were calculated for all items and across four evidence-based constructs: atmosphere, accessibility, attractiveness, and advertising. RESULTS: After iterative development, the 88-item OSEC was tested for reliability in 18 schools. Items with poor (<80%) agreement or redundancy were discarded or reworded (n = 16 items). All four constructs had acceptable agreement, ranging by focus area: 72.3% (attractiveness), 86.3% to 97.1% (atmosphere), 82.9% to 100% (accessibility), and 92.9% (advertising). Cohen's kappa ranges were acceptable: 0.66-0.91 (atmosphere), 0.60-1.00 (accessibility), 0.46 (attractiveness), and 0.77 (advertising). After adding similar items across domains (n = 49) to improve comprehensiveness, the final tool contained 121 binary items. IMPLICATIONS: The OSEC reliably and comprehensively captures the school environment. It requires few resources or expertise to administer, has acceptable reliability, and can assess atmosphere, accessibility, attractiveness, and advertising in school areas where students engage in eating and physical activity.