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.

Participatory Survey Data Analysis as Catalyst for Empowering Youth as School Health Change Agents.

Addressing and preventing the major health issues affecting American adolescents requires collaborative and authentic youth participation. Our current time reflects a pendulum shift toward authentic youth voice and democratic participation in school wellness and reform. In this application article, we outline and describe a youth-adult partnership curriculum to engage youth as change agents in their school community through youth-led research activities with publicly available and locally derived data from the Youth Risk Behavior Surveillance Survey. Getting to "Y": Youth Bring Meaning to the Youth Risk Behavior Survey (GTY) is a positive youth development/youth participatory action research initiative, whereby students analyze their school health data and use those data as a starting point to create change in their school community. Focus groups were conducted with GTY youth and adult alumni in spring 2018. Results from the focus group data reinforce the GTY core assumptions and speak to the importance of structured opportunities for youth agency. GTY is a scalable, developmentally appropriate, resource-efficient, and empirically based curriculum that provides structured opportunities for youth-led research utilizing local Youth Risk Behavior Surveillance Survey data as a youth-adult partnership model to increase youth agency and engagement with school/community health needs.

Social norms theory and concussion education.

Secondary prevention of harm from sport-related concussion is contingent on immediate removal from play post-injury. To-date, educational efforts to reduce the prevalent risk behavior of continued play while symptomatic have been largely ineffective. Social norms theory may hold promise as a foundation for more effective concussion education aimed at increasing concussion reporting. The primary objective of this study was to assess whether perceived team concussion reporting norms would be less supportive of an individual's safe concussion symptom reporting behavior than objective team norms. Participants were 328 male and female US collegiate athletes. Written surveys were completed in person during the spring of 2014. Among both male and female athletes, team concussion reporting norms were significantly misperceived, with athletes tending to think that they themselves have safer attitudes about concussion reporting than their teammates. Perceived norms were associated with symptom reporting intention, independent of the team's objective reporting norm. A social norms approach to concussion education, in which misperceived group norms are corrected and shifted in the direction of safety, is an important avenue for program development and evaluation research aimed at the secondary prevention of harm from concussion. Implications for the design of this type of educational programming are discussed.

The importance of campaign saliency as a predictor of attitude and behavior change: A pilot evaluation of social marketing campaign Fat Talk Free Week.

Fat Talk Free Week (FTFW), a social marketing campaign designed to decrease self-disparaging talk about body and weight, has not yet been evaluated. We conducted a theory-informed pilot evaluation of FTFW with two college samples using a pre- and posttest design. Aligned with the central tenets of the Elaboration Likelihood Model (ELM), we investigated the importance of FTFW saliency as a predictor of fat talk behavior change. Our analytic sample consisted of 118 female participants (83% of original sample). Approximately 76% of the sample was non-Hispanic White, 14% Asian, and 8% Hispanic. At baseline, more than 50% of respondents reported engaging in frequent self fat talk; at posttest, this number dropped to 34% of respondents. Multivariable regression models supported campaign saliency as the single strongest predictor of a decrease in self fat talk. Our results support the social diffusion of campaign messages among shared communities, as we found significant decreases in fat talk among campaign attenders and nonattenders. FTFW may be a promising short-term health communication campaign to reduce fat talk, as campaign messages are salient among university women and may encourage interpersonal communication.

The intersectionality of discrimination attributes and bullying among youth: an applied latent class analysis.

Discrimination is commonly experienced among adolescents. However, little is known about the intersection of multiple attributes of discrimination and bullying. We used a latent class analysis (LCA) to illustrate the intersections of discrimination attributes and bullying, and to assess the associations of LCA membership to depressive symptoms, deliberate self harm and suicidal ideation among a sample of ethnically diverse adolescents. The data come from the 2006 Boston Youth Survey where students were asked whether they had experienced discrimination based on four attributes: race/ethnicity, immigration status, perceived sexual orientation and weight. They were also asked whether they had been bullied or assaulted for these attributes. A total of 965 (78%) students contributed to the LCA analytic sample (45% Non-Hispanic Black, 29% Hispanic, 58% Female). The LCA revealed that a 4-class solution had adequate relative and absolute fit. The 4-classes were characterized as: low discrimination (51%); racial discrimination (33%); sexual orientation discrimination (7%); racial and weight discrimination with high bullying (intersectional class) (7%). In multivariate models, compared to the low discrimination class, individuals in the sexual orientation discrimination class and the intersectional class had higher odds of engaging in deliberate self-harm. Students in the intersectional class also had higher odds of suicidal ideation. All three discrimination latent classes had significantly higher depressive symptoms compared to the low discrimination class. Multiple attributes of discrimination and bullying co-occur among adolescents. Research should consider the co-occurrence of bullying and discrimination.

Support for a Weight-Inclusive Curriculum? Exploring Partner Perspectives and Influences on Nutrition Education in Vermont High Schools.

BACKGROUND: The weight-normative approach to nutrition education dominates health education programming across the United States, despite evidence that this paradigm contributes to negative outcomes including weight cycling, bias and stigma, the development of disordered eating behaviors, and weight-based bullying. METHODS: This study investigates perspectives of 10 potential partners with interest in and potential to influence nutrition education. Through qualitative interviews and document analysis, researchers explored support for a weight-inclusive curriculum and factors that influence high school nutrition curricular content and implementation. RESULTS: Findings indicate that partners hold both weight-inclusive and weight-normative values, guidance around nutrition curricular content is lacking, and state-level policy is crucial to the valuing and implementation of consistent curricula. IMPLICATIONS FOR SCHOOL HEALTH POLICY, PRACTICE, AND EQUITY: Lack of guidance or mandated curricular content contributes to inequities across the state. Weight-inclusive curricular materials are needed. Administration must take an active role in providing access to professional development and state policy support for curricular implementation is essential. CONCLUSIONS: Weight-inclusive curriculum could serve to improve health outcomes for adolescents. However, successful implementation of, or changes to, health and nutrition curricula will require support and engagement from partners at all ecological levels.

Consumption of soda and other sugar-sweetened beverages by 2-year-olds: findings from a population-based survey.

OBJECTIVE: To determine risk factors for consumption of soda and other sugar-sweetened beverages (SSB) among 2-year-old children. DESIGN: The analysis was performed using three linked data sets: the 2004-2005 Oregon Pregnancy Risk Assessment Monitoring Survey (PRAMS); its longitudinal follow-up, 2006-2007 Oregon PRAMS-2; and 2004-2005 Oregon birth certificates. SETTING: PRAMS is a surveillance programme supported by the federal Centers for Disease Control and Prevention and implemented by participating state health departments. Using mixed methods, PRAMS surveys women 2-6 months after a live birth. Oregon PRAMS-2 re-interviews respondents shortly after the index child's second birthday. Oregon PRAMS oversamples minority women. SUBJECTS: Using monthly cohorts, we randomly selected 5851 women from the 2004-2005 birth certificates. In total 1911 women completed both PRAMS and PRAMS-2. The weighted response rate of PRAMS-2 was 43.5%. RESULTS: Almost half of mothers (49.9%) reported that their child drank SSB on at least 1 d/week. Mothers whose children drank SSB at least once weekly were more likely to have low income (adjusted OR=2.83, 95% CI 2.09, 3.83) and to eat out on ≥2 d/week (OR=2.11 %, 95% CI 1.66, 2.70). Hispanic and non-Hispanic black women were most likely to report that their child drank SSB at least once weekly. CONCLUSIONS: Half of mothers reported that their 2-year-old children drank SSB at least once weekly. Public health interventions and policies should address childhood SSB consumption including educating health-care providers and parents.

Inspired to Garden: A Qualitative Study of Participants' Experiences in an Academic Medical Center Garden.

Introduction Gardening is a healthy activity that promotes nutrition and satisfaction, with positive impacts on patients with chronic diseases, including patients with obesity, diabetes, and cardiovascular disease. Hospital-based gardening programs may provide opportunities to introduce patients to gardening. However, few studies have included participant experience as a metric of evaluation. The objective of this study was to explore participant experience in a hospital-based gardening intervention designed for individuals with metabolic syndrome. Methods This study was a qualitative evaluation of free text responses from four questions included in post-participation questionnaires from 59 community-dwelling adults who participated in a hospital-based garden program located at the University of Vermont Medical Center in 2020 and 2021. Eligible participants included a convenience sample of novice gardeners with self-reported hypertension, diabetes, pre-diabetes, or overweight/obesity. We used an interpretative phenomenological approach to analyze the questionnaire data. The phenomenological cycle for each of the questions included: 1) reading and re-reading participant responses, 2) exploratory noting, 3) constructing experimental statements, 4) searching for connections across statements, and 5) naming the themes. This process also involved working with individual question-level themes to develop group themes across questions. Results This dataset was one of positivity about gardening, new information gleaned, and the quality of instruction. Several themes and codes emerged: program implementation (new knowledge, new skills, new connections, instructor ability, climate), self-efficacy (confidence, vicarious experience, mastery experience, verbal persuasion), and future change (behavior change, future issues/problem-solving, passing it on). Conclusion This study supports analyzing participant experience as part of hospital-based gardening interventions. We found positivity around program implementation, increased self-efficacy, and intentions to change behavior in ways that support healthy lifestyles.

Exploring the Utility of Theory-Informed Methodological Approaches in Youth Harassment Research.

In comparison to research on youth bullying, less research has been dedicated to youth harassment experiences in school. This study seeks to illustrate youth harassment experiences in school through three theoretically informed methodological approaches to modeling youth victimization: binary, cumulative risk, and attributional approaches. Data come from the 2015 Vermont School Climate Pilot Survey (N = 2,589 students). Students with complete harassment information (N = 2,481) were included. Using theoretically informed methodological approaches, regression models examined the associations between experiencing harassment (binary, attributions, and cumulative) and school connection, safety, and equity. About 16% of the sample experienced some form of harassment during the current school year (2014-2015). The most prominent attributions of harassment include weight (40%), sex (27%), and race (22%). After controlling for sociodemographics, ever experiencing harassment was associated with lower school safety, -0.73 (ß), p < .001, lower connection with school, -0.52 (ß), p < .001, and lower perceived equity, -0.77 (ß), p < .001. Experiencing harassment is negatively related to school climate. The results from these analyses underscore the negative relationship among harassment victimization and several important indicators of school climate including student connection, perceived safety at and to/from school, and perceived equity of school. Theoretically informed methodological approaches in youth harassment research should be advanced to comprehensively assess the relationship between harassment victimization and harassment attributes on the social, academic, and behavioral development of youth.

Intra-and Interpersonal Factors Buffer the Relationship Between Food Insecurity and Mental Well-Being Among Middle Schoolers.

BACKGROUND: Food insecurity (FI) is a significant predictor of feelings of isolation in children, as well as suicide ideation and depression. Using a census of public middle school-aged children, we seek to determine whether FI is associated with suicide ideation and feelings of hopelessness and how individual and school community factors can alleviate or exacerbate this relationship. METHODS: We analyzed data from the 2015 Youth Risk Behavior Surveillance Survey, conducted statewide by the Vermont Department of Health and administered to all public middle schoolers (N = 13,648). Questions were asked about FI, suicidal thoughts, feelings of hopelessness, perceptions of teaching and community care, physical activity, breakfast consumption, and demographics. Bivariate and cross-tabular analyses were conducted in SPSS, and regressions and Sobel tests were conducted in STATA. RESULTS: Results show that FI is associated with decreases in psychological well-being as measured by suicide ideation and feelings of hopelessness in students. However, students who reported eating breakfast regularly, feeling connected to their community or having a positive relationship with a teacher had significantly lower instances of suicide ideation and hopelessness. CONCLUSION: Suicide prevention programs should focus on enhancing community connection and student-teacher relationships and increasing funding for breakfast programs in schools.

Lessons Learned Through the Implementation of an eHealth Physical Activity Gaming Intervention with High School Youth.

OBJECTIVE: To encourage high school students to meet physical activity goals using a newly developed game, and to document the feasibility, benefits, and challenges of using an electronic gaming application to promote physical activity in high school students. MATERIALS AND METHODS: Working with youth and game designers an electronic game, Camp Conquer, was developed to motivate high school students to meet physical activity goals. One-hundred-five high school students were recruited to participate in a 12-week pilot test of the game and randomly assigned to a Game Condition or Control Condition. Students in both conditions received a FitBit to track their activity, and participants in the Game Condition received access to Camp Conquer. Number of steps and active minutes each day were tracked for all participants. FitBit use, game logins, and qualitative feedback from researchers, school personnel, and participants were used to determine intervention engagement. RESULTS: The majority of study participants did not consistently wear their FitBit or engage with the gaming intervention. Numerous design challenges and barriers to successful implementation such as the randomized design, absence of a true school-based champion, ease of use, and game glitches were identified. CONCLUSION: Developing games is an exciting technique for motivating the completion of a variety of health behaviors. Although the present intervention was not successful in increasing physical activity in high school students, important lessons were learned regarding how to best structure a gaming intervention for the high school population.

Engaging Adolescents to Inform the Development of a Mobile Gaming App to Incentivize Physical Activity.

BACKGROUND: Involving youth in the development of a mobile game designed to increase physical activity may increase relevancy and adoption. OBJECTIVE: To share the development process used to create a gaming app aimed at incentivizing physical activity in high school students. METHODS: Five focus groups were conducted with high school students (N=50) to understand gaming behaviors. A subset of students from the focus groups chose to complete a Web-based survey (N=10). Four different versions of gaming artwork and concept design based on student input were pilot tested (N=35), and group consensus building determined the direction of the game. The 4 game versions differed in their artwork style and gaming concept with some requiring competition versus cooperation, or being more individual versus team based. Group consensus building meant that all artwork and game concept options were displayed at the front of a classroom. Students could then vote for their top artwork and concept choices by putting stickers on the top 1 or 2 artwork and concept options that they liked best. Once all votes were cast, investigators discussed the voting results with students, and brainstormed ways to incorporate popular aspects of the 3 "losing" artwork and game concepts into the winning ideas. RESULTS: Focus group transcripts were analyzed for common themes. Artwork and gaming concept-voting data was tallied at the time of voting to share with students in real time. Focus groups and survey results revealed important themes for a successful gaming app: (1) competition, (2) balanced in-game rewards, (3) accessibility, and (4) aesthetic features. Consensus voting indicated the popularity of a collaborative competitive content design (35/66, 53%) and playful art (27/71, 38%). CONCLUSIONS: To ensure saliency and effectiveness of game-based physical activity interventions, youth need to be included in design and implementation. Furthermore, the unique preferences and social constructs of high school students need to be considered during intervention development.

Engaging Teammates in the Promotion of Concussion Help Seeking.

Concussion underreporting contributes to the substantial public health burden of concussions from sport. Teammates may be able to play an important role in encouraging injury identification and help seeking. This study assessed whether there was an association between beliefs about the consequences of continued play with a concussion and intentions to engage as a proactive bystander in facilitating or encouraging teammate help seeking for a possible concussion. Participants were 328 (male and female) members of 19 U.S. collegiate contact or collision sports teams. Athletes who believed that there were negative health or performance consequences of continued play with a concussion were significantly more likely than their peers to intend to encourage teammate help seeking, but not more likely to alert a coach or medical personnel. Additionally, athletes who believed that their teammates were more supportive of concussion safety were more likely to intend to engage as proactive bystanders in encouraging teammate help seeking. Exploring how to encourage bystander promotion of concussion safety is an important direction for future programming and evaluation research and may provide an opportunity to improve the effectiveness of concussion education.

Coping styles of adolescents experiencing multiple forms of discrimination and bullying: evidence from a sample of ethnically diverse urban youth.

BACKGROUND: We used a latent class analysis (LCA) to characterize coping styles of urban youth and examined if coping styles moderated the association between experiencing discrimination and bullying and depressive symptoms. METHODS: The data come from the 2006 Boston Youth Survey, where students were asked to select 2 behaviors they do most often when they are upset, from a list of 15 options. A total of 927 (75%) students contributed to the LCA analytic sample (44% non-Hispanic Blacks, 29% Hispanics, and 58% girls). Relative and absolute fit indices determined the number of classes. An interaction term between types of discrimination and bullying experienced and coping style tested for moderation. RESULTS: The LCA revealed that a 3-class solution had the best fit (Lo-Mendell-Rubin likelihood ratio test, 4-class vs 3-class, p-value .12). The largest coping style class was characterized by high endorsement of distractive coping strategies (59%), the second class was characterized by using supportive coping strategies (27%), and the third class was characterized by using avoidance coping strategies (12%). We found a significant interaction between discrimination and coping style for depressive symptoms. CONCLUSIONS: The relationship between experiencing discrimination and depression varied based on coping style and the type of discrimination and bullying experienced.

Concussion under-reporting and pressure from coaches, teammates, fans, and parents.

Concussions from sport present a substantial public health burden given the number of youth, adolescent and emerging adult athletes that participate in contact or collision sports. Athletes who fail to report symptoms of a suspected concussion and continue play are at risk of worsened symptomatology and potentially catastrophic neurologic consequences if another impact is sustained during this vulnerable period. Understanding why athletes do or do not report their symptoms is critical for developing efficacious strategies for risk reduction. Psychosocial theories and frameworks that explicitly incorporate context, as a source of expectations about the outcomes of reporting and as a source of behavioral reinforcement, are useful in framing this problem. The present study quantifies the pressure that athletes experience to continue playing after a head impact--from coaches, teammates, parents, and fans--and assesses how this pressure, both independently and as a system, is related to future concussion reporting intention. Participants in the study were 328 male and female athletes from 19 teams competing in one of seven sports (soccer, lacrosse, basketball, softball, baseball, volleyball, field hockey) at four colleges in the northeast region of the United States. Results found that more than one-quarter of the sample had experienced pressure from at least one source to continue playing after a head impact during the previous year. Results of a latent profile mixture model indicated that athletes who experienced pressure from all four of the measured sources were significantly more likely to intend to continue playing in the future than were athletes who had not experienced pressure from all sources, or only pressure from coaches and teammates. These findings underscore the importance of designing interventions that address the system in which athletes make decisions about concussion reporting, including athletes' parents, rather than focusing solely on modifying the individual's reporting cognitions.

Challenges of Data Dissemination Efforts Within a Community-Based Participatory Project About Persistent Racial Disparities in Excess Weight.

BACKGROUND: Despite universal environmental and policy-focused initiatives that resulted in declines in obesity among children in Cambridge, Massachusetts, disparities persist among racial/ethnic groups. In response, a community coalition formed the Healthy Eating and Living Project (HELP), to investigate and disseminate findings regarding disparities in excess weight among Cambridge Black youth (ages 6-14), with the aim of facilitating reciprocal learning and community mobilization to ultimately increase community engagement and inform prevention efforts. OBJECTIVES: This paper details the theoretical framework, methods, and results of disseminating HELP findings to various sectors of the Cambridge Black/African American (Black) community. METHODS: First, using a community-based participatory research (CBPR) approach, the HELP coalition analyzed existing data and conducted qualitative studies with Cambridge Black families to better understand the sociocultural and familial determinants of excess weight. We then developed presentation and print materials and used different dissemination approaches. We solicited feedback to inform the dissemination process and mobilization of obesity prevention efforts. RESULTS: We disseminated information through six community groups (parents, students, pastors, men's health group, community leaders, and a health coalition), email lists, and websites. Reciprocal learning among and between HELP and community members yielded data presentation challenges, as well as prevention effort ideas and barriers. CONCLUSION: Dissemination of local health data should be considered both as a strategy to increase community engagement and as an intervention to promote collective efficacy and community change. Careful attention should be dedicated to the language used when communicating racial disparities in excess weight to various community groups.