Model-based evaluation of alternative reactive class closure strategies against COVID-19.

There are contrasting results concerning the effect of reactive school closure on SARS-CoV-2 transmission. To shed light on this controversy, we developed a data-driven computational model of SARS-CoV-2 transmission. We found that by reactively closing classes based on syndromic surveillance, SARS-CoV-2 infections are reduced by no more than 17.3% (95%CI: 8.0-26.8%), due to the low probability of timely identification of infections in the young population. We thus investigated an alternative triggering mechanism based on repeated screening of students using antigen tests. Depending on the contribution of schools to transmission, this strategy can greatly reduce COVID-19 burden even when school contribution to transmission and immunity in the population is low. Moving forward, the adoption of antigen-based screenings in schools could be instrumental to limit COVID-19 burden while vaccines continue to be rolled out.

Food commercialization in schools: analysis of the regulatory process in Brazil / Comercialização de alimentos em escolas: análise do processo de regulamentação no Brasil

ABSTRACT Objective To identify and to describe the legal provisions that regulate the sale of food in Brazilian schools. Method Documentary analysis carried out in 2019, on the websites of the State, capital and Federal District Legislative Assemblies, via e-mail and/or telephone contact and publications on the subject review. The data were grouped by geographic region and a descriptive analysis was carried out. Results Data were obtained from 96% of the federative units (25 States and the Federal District). 62 legal provisions were found: 60% current, 11% revoked and 29% draft bills. Current legislation was found in 67% of States: 100% of the States in the South, Southeast and Center-West regions, 56% in the Northeast and 43% in the North. Most of the legal provisions prohibit the sale of ultra-processed foods and encourage the sale of fruits and fresh foods in the public and private school network. Conclusion Progress is observed in the school food regulatory process in this country, considering its coverage in the States and in the public and private school network, but still restricted to the South, Southeast and Midwest regions.

RESUMO Objetivo Identificar e descrever os dispositivos legais que regulamentam a comercialização de alimentos em escolas brasileiras. Método Análise documental realizada em 2019, nos sites das Assembleias Legislativas dos Estados, Capitais e Distrito Federal, via e-mail e/ou contato telefônico e publicações sobre o tema. Os dados foram agrupados por região geográfica e procedeu-se análise descritiva. Resultados Obteve-se dados de 96% das unidades federativas (25 Estados/Capitais e Distrito Federal). Foram encontrados 62 dispositivos legais: 60% vigentes, 11% revogados e 29% projetos de lei. Regulamentação vigente foi encontrada em 67% dos Estados brasileiros: 100% dos Estados das Regiões Sul, Sudeste e Centro-Oeste, 56% no Nordeste e 43% no Norte. A maioria dos dispositivos legais proíbe a comercialização de alimentos ultraprocessados e incentiva a venda de frutas e alimentos in natura, na rede pública e privada. Conclusão Constata-se avanço no processo de regulamentação no país, considerando abrangência nos estados/capitais e na rede pública e privada, porém ainda restrito às Regiões Sul, Sudeste e Centro-Oeste.

Compliance with the school smoking ban: A cross-sectional study from Italy.

BACKGROUND: In 2015, 37% of Italian adolescents reported to have smoked in the past month. The study aimed to evaluate smoking beha-viour on the school premises and to study the influence of the school environment on student smoking. METHODS: Around 900 junior high-school students, aged 11-13 years old completed an online survey in November 2016 and May 2017. Descriptive statistics, univariate analyses and binary logistic regression were performed to analyse data. RESULTS: Between 40 - 50% of students indicated that students and staff smoke on the school premises. Students who witnessed students (OR: 3.48 (2.20 - 5.50)) and school employees (OR: 3.17 (1.97 - 5.10)) smoking were more likely to be a smoker. CONCLUSION: Although laws making it illegal to smoke on the school ground are in place, in Italy, its enforcement is sloppy. To tackle adolescent smoking effectively, policymakers are advised to enforce smoking restrictions and to verify these are respected.

The evidence for the impact of policy on physical activity outcomes within the school setting: A systematic review.

BACKGROUND: Despite the well-established health benefits of physical activity (PA) for young people (aged 4-19 years), most do not meet PA guidelines. Policies that support PA in schools may be promising, but their impact on PA behavior is poorly understood. The aim of this systematic review was to ascertain the level and type of evidence reported in the international scientific literature for policies within the school setting that contribute directly or indirectly to increasing PA. METHODS: This systematic review is compliant with Preferred Reporting Items for Systematic Review and Meta-Analysis guidelines. Six databases were searched using key concepts of policy, school, evaluation, and PA. Following title and abstract screening of 2323 studies, 25 progressed to data synthesis. Methodological quality was assessed using standardized tools, and the strength of the evidence of policy impact was described based on pre-determined codes: positive, negative, inconclusive, or untested statistically. RESULTS: Evidence emerged for 9 policy areas that had a direct or indirect effect on PA within the school setting. These were whole school PA policy, physical education, sport/extracurricular PA, classroom-based PA, active breaks/recess, physical environment, shared use agreements, active school transport, and surveillance. The bulk of the evidence was significantly positive (54%), 27% was inconclusive, 9% was significantly negative, and 11% was untested (due to rounding, some numbers add to 99% or 101%). Frequency of evidence was highest in the primary setting (41%), 34% in the secondary setting, and 24% in primary/secondary combined school settings. By policy area, frequency of evidence was highest for sport/extracurricular PA (35%), 17% for physical education, and 12% for whole school PA policy, with evidence for shared use agreements between schools and local communities rarely reported (2%). Comparing relative strength of evidence, the evidence for shared use agreements, though sparse, was 100% positive, while 60% of the evidence for whole school PA policy, 59% of the evidence for sport/extracurricular PA, 57% of the evidence for physical education, 50% of the evidence for PA in classroom, and 50% of the evidence for active breaks/recess were positive. CONCLUSION: The current evidence base supports the effectiveness of PA policy actions within the school setting but cautions against a "one-size-fits-all" approach and emphasizes the need to examine policy implementation to maximize translation into practice. Greater clarity regarding terminology, measurement, and methods for evaluation of policy interventions is needed.

Characteristics of Students Identified With Dyslexia Within the Context of State Legislation.

All but seven U.S. states have laws that govern some aspects of dyslexia screening, intervention, or teacher training in public schools. However, in the three states that mandate child-level reporting, data indicate lower than expected rates of dyslexia identification when compared with commonly accepted dyslexia prevalence rates. To better understand this apparent mismatch, this study explores factors that might predict the school-assigned identification of individuals with dyslexia. Deidentified data on 7,947 second-grade students in 126 schools from one U.S. state included a universal screening measure of literacy skills indicative of dyslexia (i.e., reading and spelling), school-assigned dyslexia classification, and demographic characteristics. As expected, behavioral characteristics of dyslexia from universal screening were associated with school-assigned dyslexia classification. However, dyslexia classification was less likely for minority students and individuals attending schools with a higher percentage of minority students. Students who showed behavioral characteristics of dyslexia and attended schools with a higher proportion of other students with similar poor literacy skills were more likely not to receive a school-assigned dyslexia classification. The findings suggest systematic demographic differences in whether a student is identified with dyslexia by schools even when using universal screening.

Falling short: When testing is mandated and follow-up is not.

In 1999, the Texas Legislature mandated acanthosis nigricans (AN) screening in primary schools in designated regions of the state through the passage of House Bill 1860 to identify children at risk for diabetes by identifying the skin condition AN. AN is related to insulin resistance, and, thus, is associated with type 2 diabetes (diabetes mellitus type 2 [DMT2]), a growing concern among school-aged children. Since 1999, millions of children have been screened and hundreds of thousands have been screened positive. No data are available about the effectiveness of the program in identifying DMT2 among the school-aged population because no follow-up is mandated. The current practice is to send a letter to the parents of the child who screens positive, advising the parents to take the child to a health care provider for further assessment. Hence, children within the state may have diabetes or are developing diabetes but have yet to be diagnosed. In light of the presence of a law mandating AN screening, mandating a follow-up to identify those who have diabetes or are developing the condition of diabetes can provide early intervention and decrease costs of care. It is not known why the follow-up of those who screen positive was not included in the initial legislation. It may have been due to the cost of the necessary blood tests that are used to assess an individual for diabetes. Related to this is the reality that blood tests are invasive procedures, whereas screening for a skin disorder is not, thereby possibly explaining the omission of mandated follow-up from the legislation .

Are laws restricting soft drinks sales in Brazilian schools able to lower their availability?

ABSTRACT OBJECTIVE To describe students protected by laws and exposed to soft drinks sales and assess whether forbidding laws are associated with lower availability of these beverages. METHODS We identified laws forbidding non-government administered cafeterias or sales of soft drinks in schools in the 27 Brazilian state capitals. Data on soft drinks sales were obtained from Pesquisa Nacional de Saúde do Escolar 2015 (PeNSE - National Survey of School Health 2015), for a representative sample of 9th graders from public and private schools. Students were attributed with the status of their school regarding the law and sale of soft drinks. Co-variables were school status (public or private), school size, geographic regions, mother's educational level, score of goods and services. We performed multivariate analyses using Poisson regression. RESULTS The total of 23 laws forbidding sales of soft drinks covered 63.0% of capitals, comprising 56.9% of students. Law coverage was higher among students from more developed regions (67.6%) and in public schools (60.6%), compared with those from less developed regions (38.0%) and private schools (45.8%). Soft drinks were available for 33.9% of students. Students attending public schools in less developed regions had the lowest availability of soft drinks, regardless of law coverage (14.8%; 12.0%); while students attending private schools in these regions had a high availability, regardless of law coverage (82.1%; 73.4%). Restrictive laws were associated with lower sales of soft drinks in more developed regions, and restrictions had a greater association with the availability of soft drinks in public schools (PR = 0.25; 95%CI = 0.15-0.41), compared with private schools (PR = 0.48; 95%CI = 0.35-0.66). CONCLUSION Laws restricting soft drinks in schools were associated with fewer sales in more developed regions. Private schools were less compliant with the law than public schools. A broadly enforced national law could reduce the availability of soft drinks in schools.

Anti-Smoking Measures Implemented by Educational Institutions and the Prohibition of Smoking and Protection of Non-Smokers Health Ordinance, 2002.

Various legislative measures have been taken in Pakistan to restrict smoking. The law prohibits smoking in public places, which include educational institutions, and provides the procedure and the punishments regarding its violations. Educational institutions, instead of observing the law, have devised their own anti-smoking measures. Consequently, educational institutions themselves determine guilt and impose and collect fines whenever students smoke on their premises. Thus, by implementing their own disciplinary processes and by themselves awarding punishments, educational institutions are acting contrary to what the law has ordained. In order to demonstrate the same, websites and other publically available documents of various educational institutions were consulted to obtain information regarding their anti-smoking policies and rules. The information confirmed that educational institutions are not acting in conformity with the law. It is recommended that awareness-raising campaigns must be launched for educational institutions and students in order for the law to take its course and achieve its objective.

The Association Between School Tobacco Control Policies and Youth Smoking Behavior.

BACKGROUND: While U.S. tobacco control policy has focused mainly on tobacco excise taxes, product advertising bans, and state tobacco control policies such as indoor/outdoor smoking bans, little attention has been paid to school tobacco control policies and their impact on youth smoking behavior. Thus, the objective of this study is to examine the impact of school tobacco control policies on smoking behavior among teenagers and young adults in the USA. METHODS: Using logistic regression approach, this study examines the effect of school tobacco control policies on individuals ever trying smoking and ever being a regular smoker using data from waves I, II, and III of the National Longitudinal Study of Adolescent Health. RESULTS: Findings indicate that school tobacco control policies targeting both students and employees of the school are associated with a reduced odds of smoking initiation among youth, but do not have much effect on youth becoming regular smokers. CONCLUSIONS: If implemented properly, school tobacco control policies could play a vital role in preventing youth smoking and help reduce youth smoking rates in the country, addressing a key public health issue.

Why Secondary Schools Do Not Implement Far-Reaching Smoke-Free Policies: Exploring Deep Core, Policy Core, and Secondary Beliefs of School Staff in the Netherlands.

BACKGROUND: Secondary schools that implement smoke-free policies are confronted with students who start smoking outside their premises. One solution is to complement smoke-free policies with prohibitions for all students to leave the school area during school hours, technically making school hours a smoke-free period. However, there are strikingly few Dutch secondary schools that implement this approach. This study explores why staff members in the Netherlands decide not to implement smoke-free school hours for all students. METHOD: We interviewed 13 staff members, with different functions, from four secondary schools. The analysis was informed by the Advocacy Coalition Framework (ACF) to delve into the values, rationales, and assumptions of staff with the aim to identify deep core, policy core, and secondary beliefs. RESULTS: We identified six beliefs. Two deep core beliefs are that schools should provide adolescents the freedom to learn how to responsibly use their personal autonomy and that schools should only interfere if adolescents endanger or bother others. Three policy core beliefs identified included the following: that smoking is not a pressing issue for schools to deal with; that schools should demarcate their jurisdiction to intervene in adolescents' lives in time, space, and precise risk behavior; and that implementing smoke-free school hours would interfere with maintaining positive student-staff relationships. One secondary belief identified was that smoke-free school hours would be impossible to enforce consistently. CONCLUSION: This paper was the first to demonstrate the many beliefs explaining why schools refrain from voluntary implementing far-reaching smoke-free policies.

Cluster Randomized Trial of Teens Against Tobacco Use: Youth Empowerment for Tobacco Control in El Paso, Texas.

INTRODUCTION: This study examines smoke-free youth partnerships implementing the Teens Against Tobacco Use model developed by the American Lung Association. This innovative tobacco prevention strategy has not been evaluated rigorously. Students used peer teaching to educate youth about tobacco use and engaged in tobacco control advocacy activities. Participating high school and middle school youth were trained to develop and deliver tobacco prevention presentations to 4th-8th grade students in schools. STUDY DESIGN: To evaluate the efficacy of the presentations, matched pairs of classrooms willing to have 1 presentation were randomly assigned to receive either the presentation first (intervention condition) or later in the school year (control condition). SETTING/PARTICIPANTS: The study took place in a predominantly low-income Hispanic community. A total of 9 schools, 107 classes, and 2,257 students participated in the evaluation. MAIN OUTCOME MEASURES: Tobacco susceptibility was assessed with a brief survey administered to students in both intervention and control classrooms in 2014 and 2015 after the completion of presentations in intervention classrooms. Analyses completed in 2019 compared intervention and control classrooms on tobacco susceptibility. RESULTS: Intent-to-treat analyses indicated that classrooms receiving a tobacco prevention presentation had significantly lower tobacco susceptibility scores than classrooms that did not receive a presentation (12% vs 17%, p<0.01), representing a 37% reduction in the odds of tobacco susceptibility. Teens Against Tobacco Use presenters also completed tobacco retailer compliance checks and gained media coverage in advocating to regulate e-cigarettes in the same manner as other tobacco products. CONCLUSIONS: Findings suggest Teens Against Tobacco Use is an effective means of reducing tobacco susceptibility among 4th-8th graders in the immediate term. Longer-term outcome evaluations are needed to determine whether Teens Against Tobacco Use presentations can have a lasting impact on tobacco use. TRIAL REGISTRATION: This study is registered at www.clinicaltrials.gov NCT02443025.

High School Physical Activity and Nutrition Policy: Summarizing Changes Over Time Using Latent Class Analysis.

INTRODUCTION: High school physical activity and nutrition policies can substantially affect student behavior and outcomes. Although public health officials and legislators have advocated for policy improvements, the extent to which policies have changed at local levels is not well understood. This study identifies latent classes of physical activity and nutrition policy environments and explores changes in prevalence of these classes from 2000 to 2016. METHODS: Data from the School Health Policies and Practices Study, a repeated cross-sectional survey from the Centers for Disease Control and Prevention administered at the school district level in 2000, 2006, 2012, and 2016, were analyzed in 2018. Using latent class analysis, policy environment subgroups were identified, described, and then dichotomized based on satisfaction in meeting recommendations. Associations of latent classes with year and urbanicity were evaluated using logistic regression. RESULTS: Five latent classes were identified each for physical activity and nutrition policy environments, all with distinct characteristics. Physical activity policies improved from 2000 to 2006 (p<0.001) and then plateaued until 2016, whereas nutrition policies improved consistently from 2000 to 2016 (p<0.001, p=0.011, p<0.001). Though significant disparities between urban and rural school districts were found, these disparities narrowed during the studied years, particularly for physical activity policies. CONCLUSIONS: The estimated proportion of school districts with satisfactory physical activity and nutrition policy environments increased from 2000 to 2016, possibly because of legislative and policy advocacy efforts. However, many areas for improvement remain. Unsatisfactory latent classes that remained prevalent though 2016 may highlight policy domains that should be targeted by future interventions or subject to further research.

Assessment of perceptions, knowledge, and attitudes of parents regarding children's schoolbags and related musculoskeletal health.

BACKGROUND: Heavy schoolbags and their adverse musculoskeletal effects are a cause of great concern. Parents' awareness and knowledge about this are crucial to prevent such health problems. Thus, this study aimed to assess parents' perceptions, knowledge, and attitudes regarding children's schoolbags and related musculoskeletal health. METHODS: A cross-sectional study was conducted targeting parents with children of school age. In January 2015, a self-administered, validated questionnaire was distributed to all participants, consisting of questions about their awareness, knowledge, and attitude regarding the negative effects of carrying inappropriate schoolbags on children's musculoskeletal health. RESULT: A total of 616 parents (284 fathers and 332 mothers) completed the questionnaire (response rate of 100%). A total of 247 (87.3%) fathers and 301 (90.9%) mothers knew that carrying heavy schoolbags produces back problems. However, only 105 (36.9%) fathers and 107 (37.6%) mothers knew that incorrect schoolbag weight and inadequate way to carry it may impede the normal alignment and growth of the spine. Only 107 (37.6%) fathers and 96 (28.9%) mothers knew the ideal weight of the schoolbag, while 49.6% of fathers and 42.8% of mothers did not check their children's schoolbags for unnecessary contents. CONCLUSION: Awareness of parents about the consequences of heavy schoolbags and correct use is still limited and suboptimal. Educational sessions for parents and awareness campaigns may help to reduce the prevalence of musculoskeletal health problems among children.

Regulating the local availability of tobacco retailing in Madrid, Spain: a GIS study to evaluate compliance.

BACKGROUND: In Spain, tobacco sales are limited to tobacco-exclusive stores and associated vending machines. A minimum of 150 m between stores is required, unless they exceed a legal sales threshold. Minimum distances to schools are recommended but not defined. We evaluated compliance with these regulations in Madrid, Spain. METHODS: Information about tobacco-exclusive stores and their sales volume was obtained in 2014. We used geographic information system to identify stores closer than 150 m between them and examine whether they exceeded the sales threshold. We estimated distances between stores and schools, considering different distance intervals (<150 m, 150-300 m and >300 m) and calculations (crow flies and street network). We assessed the association of area-level demographic and socioeconomic characteristics with the distribution of tobacco stores. RESULTS: 5.3% (34/638) of tobacco stores were within 150 m of each other. Among those, 76% (26/34) did not meet the regulation sales threshold. These stores were in areas with lower proportion of young population (<15 years) and higher proportion of people with university-level education. 75% (476/638) of stores were situated closer than 300 m to schools. No differences were identified in sociodemographic and economic characteristics by the store distance to schools. CONCLUSION: Most tobacco stores are compliant with the regulations in Spain. However, these regulations are insufficient to reduce tobacco availability. More restrictive regulations are needed to limit the geographic distribution of tobacco retailers, and health criteria should also be considered in the current legislation. The evaluation of the Spanish regulatory model may provide useful insights for other jurisdictions looking to decrease the tobacco retail availability.

Radon in Schools: A Brief Review of State Laws and Regulations in the United States.

Exposure to Radon, a colorless, naturally occurring radioactive gas, is one of leading causes of lung cancer, and may pose a significant long-term risk for school age children. We examined the regulations and statutes in each US state related to radon in schools to delineate key features of policies and discrepancies among states that may have public health implications. Search terms such as "radon", "school", "mitigation", "certification", "licensing", and "radon resistant new construction" were used to scan current statutes from each state legislature's website and regulations from official state government websites for relevant regulatory and statutory requirements concerning radon in schools. State regulations related to the testing, mitigation, and public dissemination of radon levels in schools are inconsistent and the lack of nationwide indoor radon policy for schools may result in unacceptably high radon exposure levels in some US schools. We highlight the features and discrepancies of state laws and regulations concerning radon in schools, and offer several constructive means to reduce risks associated with radon exposure in school children.

Inequities in coverage of smokefree outdoor space policies within the United States: school grounds and playgrounds.

BACKGROUND: Previous studies have found extensive geographic and demographic differences in tobacco use. These differences have been found to be reduced by effective public policies, including banning smoking in public spaces. Smokefree outdoor spaces reduce secondhand smoke exposure and de-normalize smoking. METHODS: After previously publishing a study of smokefree indoor and outdoor space policies, it was brought to the authors' attention that the dataset used in analyses was incomplete (Lowrie et al., BMC Public Health 17:456, 2017). The current manuscript is a corrected version. Here, we include analyses for outdoor space policies. We evaluated regional and demographic differences in the proportion of the population (both adult and child) covered by smokefree outdoor space policies for school grounds and playgrounds enacted in the United States prior to 2014. RESULTS: Children had a low level of protection in playgrounds and schools (8% covered nationwide in both settings). Significant differences in coverage were found by ethnicity, region, income, and education (p < 0.001). The odds of having a smokefree playgrounds policy was lower for jurisdictions with higher proportions of poor households, households with no high school diploma, whites and the Alaska/Hawaii region. Increased ethnic heterogeneity was found to be a significant predictor of increased odds of having a smokefree playgrounds policy, meaning that diversity is protective, with differential effect by region (p < 0.001) - which may relate to urbanicity. CONCLUSIONS: Disparities in smokefree outdoor space policies have potential to exacerbate existing health inequities. A national increase in smokefree outdoor space policies to protect children in playgrounds and schools is a crucial intervention to reduce such inequities.

Impact of an Outdoor Smoking Ban at Secondary Schools on Cigarettes, E-Cigarettes and Water Pipe Use among Adolescents: An 18-Month Follow-Up.

Abstract: The effectiveness of outdoor smoking bans on smoking behavior among adolescents remains inconclusive. This study evaluates the long-term impact of outdoor school ground smoking bans among adolescents at secondary schools on the use of conventional cigarettes, e-cigarettes (with/without nicotine) and water pipes. Outdoor smoking bans at 19 Dutch secondary schools were evaluated using a quasi-experimental design. Data on 7733 adolescents were obtained at baseline, and at 6 and 18-month follow-up. The impact of outdoor smoking bans on 'ever use of conventional cigarettes', 'smoking onset', 'ever use of e-cigarette with nicotine', 'e-cigarette without nicotine', and 'water pipe' was measured. Multilevel logistic regression analysis was used. At schools with a ban, implementation fidelity was checked. At schools where a ban was implemented, at 18-month follow-up more adolescents had started smoking compared to the control condition. No effect of implementation of the ban was found for smoking prevalence, e-cigarettes with/without nicotine, and water pipe use. Implementation fidelity was sufficient. No long-term effects were found of an outdoor smoking ban, except for smoking onset. The ban might cause a reversal effect when schools encounter difficulties with its enforcement or when adolescents still see others smoking. Additional research is required with a longer follow-up than 18 months.