A Cost-Benefit Analysis of School Nursing in One Large Urban School District.

This study is a cost-benefit analysis examining an urban district's partial school nurse coverage conversion to full-time coverage. Through a partnership with a health care system, the district received funding, resulting in the hiring of full-time nurses to cover all K-8 elementary schools. Researchers compared the cost of nursing services to the savings in teacher, secretary, principal, and parent productivity, reduced medical procedure costs, and grants nurses managed. The year before implementing additional nurses, the return on investment (ROI) to the community for nursing services was calculated to be $1.59 for every dollar invested in schools with full-time coverage and $1.29 for schools with partial coverage. After implementing full-time nurses in each school, there was an ROI of $1.50 during the 2015-2016 school year, $1.64 for 2016-2017, and $1.67 for 2017-2018. The analysis provides evidence that full-time coverage could result in a positive ROI for schools and the community.

Parent Perceptions regarding High School Drug Testing.

BACKGROUND: Adolescent drug use remains a critical public health issue. Almost 38 percent of school districts currently implement student drug testing, and more schools may be considering implementation due to emerging recreational drug use laws. Parents are an essential key stakeholder and decision-maker in school policies. Purpose: The purpose of this study was to examine Colorado parents' perceptions regarding high school drug testing. Methods: A cross-sectional research design was used to assess parental support for implementing drug testing in public high schools. A total of 205 participants completed a survey evaluating support, attitude, and beliefs regarding this policy. Descriptive statistics, chi-square, and logistic regression analyses were conducted to examine the data. Results: The majority of parents perceived that alcohol (68.3%), cannabis (77.6%), and illicit drugs (51.2%) were a problem amongst students at their child's high school. Parents overall were supportive of drug testing students (61.9%), except for parents who were current cannabis users (p = .002). The majority of parents are supportive of drug testing because they believe it could help students resist peer pressure (65.9%), facilitate early intervention (e.g. counseling; 71.2%), while not violating student privacy rights (57.6%) or creating a negative school climate (50.7%). Conclusions/Importance: Parents recognize there may be an adolescent drug use problem. Parental support of drug testing is an important consideration for superintendents/school districts who are contemplating implementation of a drug testing policy for high schools.

The Health Education Teacher Instructional Competency Framework: A Conceptual Guide for Quality Instruction in School Health.

BACKGROUND: Teacher instructional competency, the set of essential knowledge and skills needed to guide teaching practice, is critical to the successful implementation of school health education. The purpose of this paper is to introduce the Health Education Teacher Instructional Competency (HETIC) framework, a new conceptualization describing teacher characteristics, essential knowledge, and essential skills, which can influence instructional practice and improve student learning outcomes in health education. METHODS: Data from 17 publicly available guidance documents, professional standards, published reports, and empirical studies relevant to the fields of public education, school health education, and sexual health education were abstracted and analyzed using qualitative thematic content analysis. RESULTS: The framework describes 3 domains: personal characteristics, essential knowledge, and essential skills, which are believed to contribute to teachers' instructional competencies in delivering health education. The knowledge domain asserts 5 key categories, while the essential skills domain includes 3 categories (learning environments, content and delivery, and collaboration and learning) and contains 11 unique skills. Collectively, these domains are influenced by the learner, school/community, and policy-level factors that shape health education curriculum and instruction. CONCLUSIONS: The HETIC framework presents a conceptual roadmap to guide quality health education preparation, job-embedded training, and delivery. Improving teachers' instructional competencies strengthens learning and prosocial environments that are inclusive, responsive, and affirming of students' health and learning needs. Teacher who demonstrate instructional competency can help students to achieve desired education and health outcomes, specifically acquiring the knowledge and skills needed to adapt, practice, and maintain healthy behaviors throughout their lifetime.

Clinical psychologists' firearm risk management perceptions and practices.

The purpose of this study was to investigate the current perceptions and practices of discussing firearm risk management with patients diagnosed with selected mental health problems. A three-wave survey was mailed to a national random sample of clinical psychologists and 339 responded (62%). The majority (78.5%) believed firearm safety issues were greater among those with mental health problems. However, the majority of clinical psychologists did not have a routine system for identifying patients with access to firearms (78.2%). Additionally, the majority (78.8%) reported they did not routinely chart or keep a record of whether patients owned or had access to firearms. About one-half (51.6%) of the clinical psychologists reported they would initiate firearm safety counseling if the patients were assessed as at risk for self-harm or harm to others. Almost half (46%) of clinical psychologists reported not receiving any information on firearm safety issues. Thus, the findings of this study suggest that a more formal role regarding anticipatory guidance on firearms is needed in the professional training of clinical psychologists.

African American parents'/guardians' health literacy and self-efficacy and their child's level of asthma control.

Nearly 1 of 10 American children has asthma. Asthma is addressed in Healthy People 2010 as a public health problem. This study examined the relationship between parents'/guardians' health literacy levels and their perceived self-efficacy to manage their child's asthma. A four-page asthma questionnaire was developed to assess the self-efficacy of parents/guardians of African American children with asthma. There was a statistically significant relationship among the parents'/guardians health literacy levels and their perceived efficacy expectations to manage their child's asthma. There is evidence that high parental/guardian self-efficacy and successful asthma management contribute to a child with well-controlled asthma. It is necessary for patient educators to capitalize on physician/nurse visits and use the time for asthma education, particularly to increase the efficacy expectations of parents/guardians with limited health literacy skills.

Health education: results from the School Health Policies and Programs Study 2006.

BACKGROUND: School health education can effectively help reduce the prevalence of health-risk behaviors among students and have a positive influence on students' academic performance. This article describes the characteristics of school health education policies and programs in the United States at the state, district, school, and classroom levels. METHODS: The Centers for Disease Control and Prevention conducts the School Health Policies and Programs Study every 6 years. In 2006, computer-assisted telephone interviews or self-administered mail questionnaires were completed by state education agency personnel in all 50 states plus the District of Columbia and among a nationally representative sample of districts (n=459). Computer-assisted personal interviews were conducted with personnel in a nationally representative sample of elementary, middle, and high schools (n=920) and with a nationally representative sample of teachers of classes covering required health instruction in elementary schools and required health education courses in middle and high schools (n=912). RESULTS: Most states and districts had adopted a policy stating that schools will teach at least 1 of the 14 health topics, and nearly all schools required students to receive instruction on at least 1 of these topics. However, only 6.4% of elementary schools, 20.6% of middle schools, and 35.8% of high schools required instruction on all 14 topics. In support of schools, most states and districts offered staff development for those who teach health education, although the percentage of teachers of required health instruction receiving staff development was low. CONCLUSIONS: Health education has the potential to help students maintain and improve their health, prevent disease, and reduce health-related risk behaviors. However, despite signs of progress, this potential is not being fully realized, particularly at the school level.

Primary grade teachers' perceptions and practices regarding pedestrian safety education.

BACKGROUND: Pedestrian injury is the third leading cause of unintentional injury and death among children 1-14 years old. The purpose of this study was to examine primary grade teachers' perceived role in pedestrian safety education. METHODS: A total of 630 surveys were sent to a national random sample of primary school teachers and 54% responded. RESULTS: The results of the study found that 85% of primary grade teachers believed it was extremely important or important to teach pedestrian safety. Forty percent of the teachers identified that they had been teaching pedestrian safety for more than 1 year (maintenance stage), whereas 1 in 3 teachers had never thought about (precontemplation stage) teaching pedestrian safety to their students. Eighty-eight percent of primary grade teachers were very confident about teaching students how to safely cross the street, where to safely cross the street (87%), when to safely cross the street (86%), and how to safely walk along streets with sidewalks (83%). An examination of how pedestrian safety information was presented found that a plurality (39%) of the teachers who taught pedestrian safety presented information through classroom discussion. Also, 46% of the teachers who taught pedestrian safety identified the following as the most common curriculum content: when to safely cross the street (46%), how to safely cross the street (45%), and where to safely cross the street (43%). CONCLUSIONS: Only 16% of primary school teachers reported pedestrian safety education was required for their grade levels. Yet, pedestrian safety education decreases pedestrian-related deaths. Therefore, it is important for schools and primary grade teachers to expose their students to this essential topic.

Elementary school parents'/guardians' perceptions of school health service personnel and the services they provide.

BACKGROUND: The school nurse, the school social worker, and the school counselor play an important role in promoting the health of children. Health services in the school setting provide opportunities to appraise, protect, and promote student health. The purpose of this study was to identify parents' or caregivers' perceptions and beliefs regarding the importance of schools providing various health services to their elementary school-aged children. In addition, the study examined the levels of parental support for, perceptions of, and contact with school health service personnel. METHODS: In 2005, a nationally representative random sample of 369 (51% return rate) parents of elementary school-aged children completed the questionnaire developed for this study. RESULTS: A majority of parents/caregivers reported that their child's school had a school nurse (78.8%) and counselor (60.5%), but only 22.6% reported their school had a social worker. A majority of parents/caregivers perceived full-time school nurses (86.3%), school counselors (78.6%), and school social workers (56.3%) as important or extremely important and that schools should be held responsible for having each in their child's elementary school. A majority of parents/caregivers were willing to pay an increase in yearly tax dollars to have full-time school health personnel. CONCLUSIONS: This study established a level of parental support for, perceptions of, and contact with school health service personnel. Parents were most supportive of school nurses and should be perceived as allies in ensuring job security.

Parents' perceptions of curricular issues affecting children's weight in elementary schools.

The purpose of this study was to examine Ohio parents' perceptions of the role of elementary schools in preventing childhood overweight. In the United States, overweight is the most widespread health threat facing children and adolescents. Schools may be a useful point of intervention in addressing the escalating prevalence of childhood overweight because children spend over half their day at school. A questionnaire was developed based primarily on the School Health Index, a tool developed by the Centers for Disease Control and Prevention to help schools assess and improve their physical activity, healthy eating, tobacco use prevention, and safety policies and programs. Seven hundred surveys were sent to a random sample of Ohio parents of elementary school-aged children. This study (53% response rate) found that the majority (51-73%) of parents identified 14 items as very important in preventing childhood overweight, which is indicative of their support for these curricular topics within the elementary school. All items from the physical education component had less than 50% of the parents identifying these items as very important. The item that was least supported (16%) by the parents was measuring a child's body mass index. The majority (51%) of parents indicated their preference for elementary students' access to vending machines only if they contained nutritious foods and beverages, while 42% of parents preferred that elementary students should not be allowed access to vending machines at all. The findings from this study suggest that Ohio parents would be supportive of school-based interventions focusing on healthy eating, physical activity, and the school environment to help reduce the prevalence of overweight in elementary children.

Availability of services for emergency contraceptive pills at high school-based health centers.

CONTEXT: School-based health centers have the potential to increase adolescents' awareness of, access to and use of emergency contraceptive pills, which can prevent unintended pregnancy following unprotected sex. METHODS: In 2001, 250 high school-based health centers responded to a nationwide mail survey that assessed the provision of education, referral and prescription services for emergency contraceptive pills, as well as the perceived benefits and barriers related to offering these services. Frequencies, cross-tabulations and logistic regression models were used to analyze the data. RESULTS: Fifty-nine percent of the centers provided education and referrals for emergency contraceptive pills, while 30% provided prescriptions. Staff generally identified the same benefits of and barriers to services, although centers that provided services were more likely than nonproviders to report benefits and less likely to report barriers. Predictors of offering education were providing reproductive health services (odds ratio, 4.6) and citing the increased likelihood that students would use the method (3.5) and have the opportunity to discuss contraception (2.6). Reporting the benefit of pregnancy prevention was a predictor of offering referrals (2.9), while providing reproductive health services (30.4) and citing pregnancy prevention (6.3) were predictors of offering prescriptions. Predictors of the decreased likelihood of offering services were also identified. CONCLUSIONS: School centers that provide all three services have the greatest potential to ensure the successful use of emergency contraceptive pills by adolescents. While the number of centers offering services appears to be increasing, greater efforts are needed to improve students' awareness of and access to the method so they can make informed decisions regarding their reproductive health.

Elementary school teachers' involvement in firearm safety education.

This national study assessed elementary school teachers' (n = 352) firearm safety education activities and perceptions using a 3-wave mailing survey. One percent of the teachers reported receiving undergraduate training regarding firearm safety. Yet, 12% claimed to be well prepared or very well prepared to teach firearm safety. Most teachers had high perceived self-efficacy regarding teaching firearm safety and perceived firearm safety education as important. Ten percent were currently teaching firearm safety. Teachers perceived 3 main barriers to teaching firearm safety: not enough expertise (66%), not sure what topics should be taught (58%), and not enough time to include firearm safety in the curriculum (54%). About one third (35%) desired further information regarding teaching firearm safety.

A whole school approach: collaborative development of school health policies, processes, and practices.

BACKGROUND: The Whole School, Whole Community, Whole Child (WSCC) model shows the interrelationship between health and learning and the potential for improving educational outcomes by improving health outcomes. However, current descriptions do not explain how to implement the model. METHODS: The existing literature, including scientific articles, programmatic guidance, and publications by national agencies and organizations, was reviewed and synthesized to describe an overview of interrelatedness of learning and health and the 10 components of the WSCC model. RESULTS: The literature suggests potential benefits of applying the WSCC model at the district and school level. But, the model lacks specific guidance as to how this might be made actionable. A collaborative approach to health and learning is suggested, including a 10-step systematic process to help schools and districts develop an action plan for improving health and education outcomes. Essential preliminary actions are suggested to minimize the impact of the challenges that commonly derail systematic planning processes and program implementation, such as lack of readiness, personnel shortages, insufficient resources, and competing priorities. CONCLUSIONS: All new models require testing and evidence to confirm their value. District and schools will need to test this model and put plans into action to show that significant, substantial, and sustainable health and academic outcomes can be achieved.

A national assessment of colleges and university school health education methods courses.

BACKGROUND: Across the United States, school health education programs provide a wide variety of knowledge and skills to their students. There are currently no guidelines for school health methods courses. METHODS: Using a 2-wave mailing followed by a third wave e-mail reminder, a final population of 226 university school health methods instructors at school health preparation programs were surveyed. RESULTS: A total of 138 completed surveys (61%) were returned. The topics taught in school health education methods courses emphasized the most included aligning objectives, instruction, and assessment (79%); development of lesson plans (73%); teaching methods that engage learners (72%); and application of the National Health Education Standards and performance indicators (69%). The content taught and how the instructors assessed their students differed statistically by 1 or more of the following: whether they had a health education degree, had experience teaching in the public schools, and if their program was accredited. CONCLUSIONS: This study provides information regarding what school health methods instructors across the United States are teaching in their classes. Using this information as a baseline can serve as a guide for preservice faculty teaching a school health methods course.

Pediatricians' perceptions and practices regarding prevention and treatment of type 2 diabetes mellitus in children and adolescents.

OBJECTIVE: To assess pediatricians' perceptions and practices regarding the prevention and treatment of type 2 diabetes mellitus in children and adolescents in a cross-sectional study. DESIGN: A 3-wave mailing of a questionnaire to 550 pediatricians. Descriptive statistics, analysis of variance, and logistic regression were used for data analyses. SETTING: A national random sample of pediatricians who work in private practice, hospital settings, and/or clinics. RESULTS: Every 1 in 9 respondents referred their patients with type 2 diabetes mellitus for exercise, while most pediatricians referred their patients for dietary interventions (62.3%) and educational services (62.6%). Pediatricians who were confident during counseling and follow-up were significantly (P =.02) more likely than pediatricians who were less confident to refer their patients for exercise, dietary interventions, and educational services. Of the respondents, 15.3% perceived they were well prepared to counsel and provide follow-up to patients with type 2 diabetes mellitus. The leading perceived barriers to counseling and follow-up were inadequate time for counseling, poor adherence of patients, lack of family support, lack of familiarity of clinical practice recommendations, and lack of health care insurance coverage. CONCLUSIONS: Pediatricians who had a higher perceived confidence level and who perceived they were better prepared for the counseling and follow-up of patients with type 2 diabetes mellitus had a greater potential to positively affect their diabetic patients. Improving continuing medical education and residency-based programs is imperative to adequately address the emerging epidemic of type 2 diabetes mellitus in children and adolescents.

Adolescent smoking cessation services of school-based health centers.

A national sample of 390 junior and senior high school-based centers were mailed an 18-item survey to assess their institutional stages of change regarding smoking cessation education, referral, and prescription nicotine replacement therapy (NRT) services and their perceived barriers and benefits regarding the provision of these services. Nearly half were in the maintenance stage for cessation education programs, one-third were in maintenance stage for referral services, and 12% were in the maintenance stage for NRT. The most frequently cited perceived benefits included an increased awareness of short- and long-term effects of smoking (education programs and referral services) and increasing student access to cessation methods (NRT). The greatest barriers cited were a lack of financial resources (education programs), problems with student transportation (referral services), and staff not having the authority to provide prescription services (NRT). School-based centers can do more to help stop adolescents from using tobacco.

Principals' perceptions and practices of school bullying prevention activities.

The purpose of this study was to examine principals' perceptions and practices regarding bullying prevention. A survey instrument was developed to assess principals' stages of change and perceived barriers regarding selected bullying prevention activities as well as the effectiveness of bullying prevention activities. Of a national random sample of 700 principals to which the survey was mailed, 55% responded. None of the school-based bullying prevention activities were being done by more than one in five schools even though principals perceived there to be no barriers regarding these activities. Characteristics that affected the offering of these activities included number of perceived barriers to implementing the activity, whether the principal had received violence/bullying prevention training, perceptions regarding the extent of bullying, and the number of bullying problems reported to them. The findings suggest that preprofessional training and continuing education are needed to educate principals regarding this area.

Elementary school teachers' techniques of responding to student questions regarding sexuality issues.

Fifth- and sixth-grade elementary school teachers' (n = 277) techniques of responding to students' human sexuality-related questions were assessed. Few teachers (34%) reported receiving formal training in sexuality education. The most commonly asked student questions dealt with STDs, puberty, homosexuality, pregnancy, and abortion. Teachers' willingness to answer sexually-related questions in front of the class varied (73% to 14%) by content of the question. There were no questions on the questionnaire in which more than one in five teachers would choose not to answer. The most common questions the teachers identified they would not respond to dealt with topics such as abortion, masturbation, homosexuality, and issues about the male genitals. Finally, none of the questions was perceived by more than one in eight of the teachers as questions they would not be allowed to answer.

The nature and extent of bullying at school.

In elementary schools, the prevalence of bullying ranges from 11.3% in Finland to 49.8% in Ireland. The only United States study of elementary students found that 19% were bullied. Bullying behavior declines as students progress through the grades. School bullying is associated with numerous physical, mental, and social detriments. A relationship also exists between student bullying behavior and school issues such as academic achievement, school bonding, and absenteeism. Prevention of school bullying should become a priority issue for schools. The most effective methods of bullying reduction involve a whole school approach. This method includes assessing the problem, planning school conference days, providing better supervision at recess, forming a bullying prevention coordinating group, encouraging parent-teacher meetings, establishing classroom rules against bullying, holding classroom meetings about bullying, requiring talks with the bullies and victims, and scheduling talks with the parents of involved students. Finally, this review suggests further studies needed to help ameliorate the bullying problem in US schools.

Elementary school secretaries' experiences and perceptions of administering prescription medication.

This study assessed elementary school secretaries' (n = 385) experiences and perceptions with student prescription medication. Sixty-nine percent (n = 246) reported dispensing student medication, and this group represents the focus of this study. One in four secretaries reported not receiving any training regarding administration of student medication. Of those who were trained, 28% received training of less than one hour, and 24% received training of one to two hours duration. Secretaries generally disliked the responsibility of dispensing medication to students, but felt prepared to do so. Most (63%) administered student medication five days per week. The most commonly administered categories included attention deficit/hyperactivity medication (92%), asthma medication (87%), and antibiotics (68%). Most (85%) reported they had made no medication errors during the past year.

Teacher perceptions and practices regarding school bullying prevention.

This study examined a national random sample of teachers regarding their perceptions and practices concerning school bullying prevention activities. A total of 359 of 700 (52.4%) teachers responded. Most (86.3%) teachers had serious talks with both the bully and victim. Less than one-third set aside classroom time to discuss bullying (31.7%) or involved students in creating classroom rules against bullying (31.2%). Most perceived no barriers to implementing these activities. Teachers perceived post-bullying activities as the most effective means of reducing bullying problems, followed by improved student supervision, and by environmental bullying prevention activities. The findings suggest that preprofessional and continuing education are needed to improve teacher knowledge about effective classroom-based bullying prevention activities.