Management of Childhood Obesity-Time to Shift from Generalized to Personalized Intervention Strategies.

As a major public health concern, childhood obesity is a multifaceted and multilevel metabolic disorder influenced by genetic and behavioral aspects. While genetic risk factors contribute to and interact with the onset and development of excess body weight, available evidence indicates that several modifiable obesogenic behaviors play a crucial role in the etiology of childhood obesity. Although a variety of systematic reviews and meta-analyses have reported the effectiveness of several interventions in community-based, school-based, and home-based programs regarding childhood obesity, the prevalence of children with excess body weight remains high. Additionally, researchers and pediatric clinicians are often encountering several challenges and the characteristics of an optimal weight management strategy remain controversial. Strategies involving a combination of physical activity, nutritional, and educational interventions are likely to yield better outcomes compared to single-component strategies but various prohibitory limitations have been reported in practice. This review seeks to (i) provide a brief overview of the current preventative and therapeutic approaches towards childhood obesity, (ii) discuss the complexity and limitations of research in the childhood obesity area, and (iii) suggest an Etiology-Based Personalized Intervention Strategy Targeting Childhood Obesity (EPISTCO). This purposeful approach includes prioritized nutritional, educational, behavioral, and physical activity intervention strategies directly based on the etiology of obesity and interpretation of individual characteristics.

Self-Reported Changes in Risk Behaviours of Cardiovascular Diseases among School Adolescents in Nepal: Application of an Integrated Experiential Learning Approach.

Cardiovascular diseases (CVDs) account for the largest proportion of all deaths in Nepal (30%). Studies report that CVDs often begin with modifiable lifestyle risk behaviours established during adolescence which manifest later. This study aimed to measure changes in the five mortality-associated CVD risk behaviours (i.e., consumption of tobacco, alcohol, and junk food, physical inactivity, and stress among school adolescents) using an integrative intervention with the experiential learning approach. The study was carried out for 24 weeks (25 credit hours) among 4,225 students from grades 8 to 10 in community schools in seven provinces in Nepal. Pre- and post-intervention in-class self-reported surveys were conducted for assessing change in the students' aggregate risk behaviours. These percent changes were assessed through bivariate analysis. Key-informant interviews of teachers were conducted to assess their perceptions of the effectiveness of the intervention. At 24 weeks, the percentages of students reporting consumption of cigarettes and smokeless tobacco declined by 25% and 28% respectively, consumption of alcohol declined by 29%, consumption of instant noodles by 11%, and consumption of coke by 43%. The proportion of students reporting 'going to school by foot every day' increased by 11%, and those 'exercising until they sweat' increased by 29%. The percentage of students who reported feeling that their 'life has been running as desired' increased by 16%. Key-informant interviews of the teachers revealed that the intervention had contributed to improved motivation, knowledge, and attitude among students towards mitigating the risk behaviours. These interviews also recommended continuation of the intervention. The sample in this study has shown positive changes in school adolescents' self-reported aggregate CVD risk behaviours using the experiential learning approach. However, further research should be conducted to explore the sustainability and scaling of these learning modules through the existing non-communicable disease (NCD) school curriculum activities in Nepal.

Involving the headteacher in the development of school-based health interventions: A mixed-methods outcome and process evaluation using the RE-AIM framework.

Although interventions delivered in school settings have the potential to improve children's health and well-being, the implementation of effective interventions in schools presents challenges. Previous research suggests facilitating greater autonomy for schools to select interventions aligned to their needs could improve implementation and maintenance. The aim of this mixed-methods outcome and process evaluation was to explore whether involving headteachers in the developmental stages of health interventions influenced adoption, effectiveness (e.g. pupil fitness and physical activity, assessed quantitatively), implementation and maintenance (assessed quantitatively and qualitatively). Three UK primary schools were provided with a choice of five evidence-based physical activity interventions: Playground scrapstore, daily classroom refreshers, alternative afterschool clubs, parent and child afterschool activities and an 'In the Zone' playground intervention. To evaluate the impact of this autonomous approach, semi-structured interviews with headteachers (n = 3), teachers (n = 3), and a private coach, and focus groups with pupils aged 9-11 (n = 6, 31 pupils, 15 boys), were undertaken. This was alongside an outcome and process evaluation, guided by the RE-AIM framework. This study assessed the impacts on adoption, implementation and maintenance of the autonomous approach and the effect on physical activity (seven day accelerometry-GENEActiv) and aerobic fitness (20m shuttle run). All three schools adopted different intervention components; alternative afterschool clubs, parent and child afterschool activities and daily classroom refreshers. Headteachers welcomed greater autonomy in developing school-based interventions and appreciated the more collaborative approach. Mixed results were reported for the effectiveness, implementation and maintenance of the interventions adopted. Allowing pupils choice and promoting a positive school environment were key factors for enhancing engagement. Moreover, promoting inclusive physical activity projects with a consideration of existing curriculum pressures aided implementation. This mixed-methods study provides valuable insights about autonomous approaches to inform further development, implementation and maintenance for future interventions.

Factors affecting the implementation of a whole school mindfulness program: a qualitative study using the consolidated framework for implementation research.

BACKGROUND: Preventing the onset of poor mental health in adolescence is an international public health priority. Universal, whole school preventative approaches are valued for their reach, and anti-stigmatising and resilience building principles. Mindfulness approaches to well-being have the potential to be effective when delivered as a whole school approach for both young people and staff. However, despite growing demand, there is little understanding of possible and optimal ways to implement a mindfulness, whole school approach (M-WSA) to well-being. This study aimed to identify the determinants of early implementation success of a M-WSA. We tested the capacity of the Consolidated Framework for Implementation Research (CFIR), to capture the determinants of the implementation of a mental health intervention in a school setting. METHODS: Key members of school staff (n = 15) from five UK secondary schools attempting to implement a M-WSA were interviewed at two-time points, 6 months apart, generating a total of 30 interviews. Interviews explored participants' attitudes, beliefs and experiences around implementing a M-WSA. Interview data were coded as CFIR constructs or other (non CFIR) factors affecting implementation. We also mapped school-reported implementation activity and perceived success over 30 months. RESULTS: The CFIR captured the implementation activities and challenges well, with 74% of CFIR constructs identifiable in the dataset. Of the 38 CFIR constructs, 11 appeared to distinguish between high and low implementation schools. The most essential construct was school leadership. It strongly distinguished between high and low implementation schools and appeared inter-related with many other distinguishing constructs. Other strongly distinguishing constructs included relative priority, networks and communications, formally appointed implementation leaders, knowledge and beliefs about the intervention, and executing. CONCLUSIONS: Our findings suggest key implementation constructs that schools, commissioners and policy makers should focus on to promote successful early implementation of mental health programs. School leadership is a key construct to target at the outset. The CFIR appears useful for assessing the implementation of mental health programs in UK secondary schools.

A randomized controlled trial of a trauma-informed school prevention program for urban youth: Rationale, design, and methods.

INTRODUCTION: Youth in disadvantaged urban areas are frequently exposed to chronic stress and trauma, including housing instability, neighborhood violence, and other poverty-related adversities. These exposures increase risk for emotional, behavioral, and academic problems and ultimately, school dropout. Schools are a promising setting in which to address these issues; however, there are few universal, trauma-informed school-based interventions for urban youth. METHODS/DESIGN: Project POWER (Promoting Options for Wellness and Emotion Regulation) is a randomized controlled trial testing the impact of RAP Club, a trauma-informed intervention for eighth graders that includes mindfulness as a core component. Students in 32 urban public schools (n = 800) are randomly assigned to either RAP Club or a health education active control group. We assess student emotional, behavioral, and academic outcomes using self-report surveys and teacher ratings at baseline, post-intervention, and 4-month follow up. Focus groups and interviews with students, teachers, and principals address program feasibility, acceptability, and fidelity, as well as perceived program impacts. Students complete an additional self-report survey in ninth grade. Schools provide students' academic and disciplinary data for their seventh, eighth, and ninth grade years. In addition, data on program costs are collected to conduct an economic analysis of the intervention and active control programs. DISCUSSION: Notable study features include program co-leadership by young adults from the community and building capacity of school personnel for continued program delivery. In addition to testing program impact, we will identify factors related to successful program implementation to inform future program use and dissemination.

Danish 'add-in' school-based health promotion: integrating health in curriculum time.

Schools provide an important setting for health promotion and health education. In countries where health education is not a specific subject, it is typically undertaken by teachers in health-integrating subjects such as biology, home economics or physical education. More ambitious and holistic frameworks and whole school approaches such as health promoting schools have been considered best practice for the past three decades. Recently, more attention has been given to policy initiatives integrating health activities into school curriculum time. This paper discusses potentials and challenges of school-based health promotion applying an 'add-in' approach, that integrates health activities into teachers' curricular obligations without taking time away from them, based on a presentation of three Danish cases. This may serve as a supplement to health promotion activities that have been initiated over and above the day-to-day teaching (add-on). We contend that an 'add-in' approach to school health promotion provides a potential win-win situation where both health and core education stand to gain; makes it possible to reach a wider range of schools; mobilizes additional resources for health promotion; and leads to more sustainable activities. However, potential limitations including not addressing structural aspects of health promotion and reliance on a relatively limited evidence base should also be considered.

Doctors in secondary schools program: the first year of program implementation in a rural Victorian school.

INTRODUCTION: Lifelong health behaviour habits are often consolidated in adolescence, with primary health care an important element of current and future health and wellbeing. Barriers to adolescent primary healthcare access are complex and include social, behavioural and geographical issues as well as organisational and systemic barriers. METHOD: This article describes the first year of implementation of a Doctors in Secondary School program in a rural setting in Victoria, Australia. RESULTS: The program provided 332 primary healthcare appointments over 10 months, equating to 102.33 hours of general practitioner contact with students. The program offered scheduled and unscheduled (drop-in) appointments with above-average consultation times. Cancellations and 'no-shows' were low, at 9% overall. Health promotion resources, material and information, were sourced and provided by the clinic practice nurse. CONCLUSION: The role of the practice nurse has been instrumental in providing a needs-based service for students, connecting to local and regional health and community services. Adolescents in rural areas require holistic primary care including provision of resources, basic wellbeing needs and advocacy. Programs to support rural adolescents should be integrated across the strengths and opportunities that exist in each unique context.

A National Survey of Speech-Language Pathologists' Engagement in Interprofessional Collaborative Practice in Schools: Identifying Predictive Factors and Barriers to Implementation.

Purpose This study examined the models of collaboration used by school-based speech-language pathologists (SLPs) during the provision of special education services including factors predicting use of the interprofessional collaborative practice (IPP) model and barriers to collaboration. Method School-based SLPs responded to a survey on models of collaboration within their work setting. Anchored vignettes were created to determine their engagement in 3 different models (i.e., multidisciplinary, interdisciplinary, and interprofessional) used in the provision of special education services during evaluation and intervention. Predictive factors supporting and/or hindering the use of IPP were identified. Results Results demonstrated low percentages of school-based SLPs engaging in IPP during initial evaluations (8%), eligibility meetings (43%), and intervention sessions (14%). Three factors predicted use of IPP in schools: prior training in collaboration, years of experience, and educational setting. The most frequently cited barriers to SLPs' engagement in collaboration included time constraints/scheduling (48%), resistance from other professionals (23%), and lack of support from employers/administration (11%). Conclusions The results of the current study indicated that systemic change is needed at both the university and public school levels. At the university level, preprofessional students need collaborative learning opportunities that are integrated across programs and colleges. School-based SLPs and other education professionals could benefit from job-embedded learning focused on IPP to increase their knowledge and engagement in IPP and improve student outcomes. Supplemental Material https://doi.org/10.23641/asha.9340760.

Kids Out; evaluation of a brief multimodal cluster randomized intervention integrated in health education lessons to increase physical activity and reduce sedentary behavior among eighth graders.

BACKGROUND: Most Finnish adolescents are not sufficiently physically active. Health education (HE) provides beneficial starting point for physical activity (PA) promotion in schools. This study evaluates an intervention integrated into three HE lessons to increase PA and reduce sedentary behavior (SB) among eighth graders. METHODS: All public secondary schools in Tampere, Finland participated and were randomized to intervention (INT, n = 7) and comparison group (COM, n = 7). In INT (690 students, 36 classes) the teachers (n = 14) implemented behavioral theory-driven content during three HE lessons. In COM (860 students, 41 classes) the teachers (n = 14) carried out standard lessons. The evaluation was based on RE-AIM: Effectiveness was assessed from baseline to 4 weeks (Follow-up 1) and Maintenance from 4 weeks to 7 months (Follow-up 2) with change in students' PA and SB and related psychosocial and parental factors. Methods included questionnaire, accelerometer and activity diary. Linear mixed models with baseline adjustments and random effect correction were used to compare the difference in change between INT and COM. Data on Reach, Adoption and Implementation were collected during the process. RESULTS: Intervention effects were only seen in the self-reported data favoring INT in the weekly number of days with at least 1 h of brisk leisure PA (0.3 [95%CI 0.1 to 0.6]), proportion of students meeting PA recommendations (4.1 [95%CI 2.5 to 5.7]), proportion of students reporting that their family sets limitations for screen time (5.4 [95%CI 3.3 to 7.4]) and in the number of days on which the students intended to do leisure PA in the following week (0.3 [95%CI 0.1 to 0.6]). The effects on PA were still beneficial for INT at Follow-up 2. The intervention reached 96% of the students, was adopted in all 7 schools and was implemented by 13/14 teachers in 35/36 classes. CONCLUSIONS: The intervention was feasible and had small favorable effects on students' self-reported PA, intention to do PA and family norm in screen time. The effects on PA persisted until Follow-up 2. It is likely that for greater impacts the HE lessons should have been supported with other actions without compromising feasibility. TRIAL REGISTRATION: NCT01633918 (June 27th, 2012).

An Innovative Approach to Care: Integrating Mental Health Services Through Telemedicine in Rural School-Based Health Centers.

In rural communities, primary care providers continue to provide mental health services, and about 70% of children and adolescents identified to have a psychiatric disorder never receive treatment. A telehealth model for providing integrated mental health services in a school-based health clinic has the potential to increase access to specialized care for the most vulnerable youths. This column provides an overview of the strategies used to implement and integrate such a model in West Virginia. Operationalization, barriers, challenges, and judicious resource use are discussed. Appropriate reimbursement for services and state-specific legislation to ensure consistent revenue to sustain the program are considered.

Implementing School-Based Policies to Prevent Obesity: Cluster Randomized Trial.

INTRODUCTION: Healthier school environments can benefit students, and school wellness policies may result in meaningful enhancements. Schools participating in federal child nutrition programs must implement wellness policies as mandated by law. The primary study objective is to assess effectiveness of implementing school-based nutrition and physical activity policies on student BMI trajectories. STUDY DESIGN: Cluster randomized trial using 2 × 2 factorial design. SETTING/PARTICIPANTS: Twelve randomly selected schools in an urban district. Students were followed for 3 years through middle school, fifth to eighth grades (2011-2015, n=595 students, 92.3% participation, 85.2% retention). INTERVENTION: Specific to randomized condition, support was provided for implementation of nutrition policies (e.g., alternatives to food-based rewards/celebrations) and physical activity policies (e.g., opportunities for physical activity during/after school). MAIN OUTCOME MEASURES: Sex-/age-adjusted BMI percentile and BMI z-score; behavioral indicators. Data collected via standardized protocols. RESULTS: Analyses followed intention-to-treat principles, with planned secondary analyses (conducted 2016-2018). Students at schools randomized to receive support for nutrition policy implementation had healthier BMI trajectories over time (F=3.20, p=0.02), with a greater magnitude over time and cumulatively significant effects 3 years post-intervention (ß=-2.40, p=0.04). Overall, students at schools randomized to receive the nutrition intervention had an increase in BMI percentile of <1%, compared with students in other conditions, whereas BMI percentile increased 3%-4%. There was no difference in student BMI between those in schools with and without physical activity policy implementation. Examining behavioral correlates in eighth grade, students at schools randomized to the nutrition condition consumed fewer unhealthy foods and sugar-sweetened beverages, and ate less frequently at fast-food restaurants (all p<0.03). CONCLUSIONS: This cluster randomized trial demonstrated effectiveness of providing support for implementation of school-based nutrition policies, but not physical activity policies, to limit BMI increases among middle school students. Results can guide future school interventions. TRIAL REGISTRATION: This study is registered at www.clinicaltrials.gov NCT02043626.

The Legalization of Medical/Recreational Marijuana: Implications for School Health Drug Education Programs.

BACKGROUND: More than half of US states have legalized medical marijuana. Several states have also legalized it for recreational use. In spite of states' actions, marijuana remains illegal under federal law. It remains to be seen, however, if the Trump administration will enforce federal law in states that have legalized marijuana. For now, it appears the move toward state legalization of marijuana will increase. Because of its legal status, research concerning the medical benefits of marijuana has been limited. METHODS: We reviewed the literature pertaining to medical use and legalization of marijuana. RESULTS: Available research shows that marijuana can benefit some conditions. There are also concerns about harmful effects on both individual and public health and whether legalization will lead to increased marijuana use among youth. Each of these elements has implications for school-based drug education programs. Researchers have shown that the 10 states with the highest rate of past month marijuana use by youth all have legalized recreational and/or medical use of marijuana, whereas none of the 10 states with the lowest rate of past month marijuana use by youth, has legalized marijuana. In the debate over legalization schools can potentially serve as a community resource, providing accurate information concerning marijuana. CONCLUSIONS: Teachers and parents should continue to discourage young people from using marijuana (as well as alcohol, tobacco, and other drugs).

Mejora del comportamiento preventivo diarreico a través del juego sociodramático terapéutico en niños en edad escolar / Improving diarrheal preventive behavior through therapeutic sociodramatic play in school-aged children

Los comportamientos de vida sanos y limpios entre los niños en edad escolar todavía son relativamente bajos, exponiéndolos al riesgo de experimentar problemas de salud en el futuro, como la diarrea. Sin embargo, el período de los niños en edad escolar es el punto de partida para desarrollar comportamientos saludables y se convierte en un objetivo estratégico para mejorar la salud. Los niños en edad escolar están en un período de desarrollo operativo concreto para requerir métodos de educación sanitaria que puedan reflejar experiencias reales e interactivas. El estudio tuvo como objetivo determinar el efecto del sociodrama terapéutico sobre los cambios de comportamiento preventivo de la diarrea en niños en edad escolar (6-12 años). El método de estudio utilizado cuasi experimento pre-post con grupo control que consistió en dos grupos; 38 sujetos fueron como grupos de intervención y 38 sujetos fueron como grupos de control. Muestreo aleatorio multietapa utilizado para determinar el área de investigación y la escuela, mientras que la muestra del sujeto de la investigación utilizó un muestreo aleatorio simple. Los resultados mostraron que el sociodrama terapéutico se realizó significativamente en el conocimiento (valor de p = 0,000), actitud (valor de p = 0,000) y habilidades de prevención de la diarrea (valor de p = 0,001). El sociodrama terapéutico podría aplicarse como un esfuerzo para mejorar el comportamiento preventivo de la diarrea de los niños en edad escolar que podría integrarse en el servicio de enfermería escolar

Healthy and clean living behaviors among school-aged children are still relatively low, exposing them to the risk of experiencing health problems in the future, such as diarrhea. This school-age period is actually the earliest phase in which children can develop healthy behaviors, hence making this phase a strategic target for health improvements. School-aged children are in a period of concrete operational development and they require specific health education methods that can reflect real and interactive experiences. The aim of the study was to determine the effect of therapeutic sociodramatic play on diarrheal preventive behaviors among school-aged children (6-12 years). The study design was a quasi-experimental with pre-and post-tests design, involving 76 school-age children who were divided into intervention group and control group. Multistage random sampling was used to determine the research area and school where the research was conducted, while the research subject was selected using simple random sampling. The results showed that therapeutic sociodramatic play significantly affects knowledge (p value = 0.000), attitudes (p value = 0.000), and diarrheal prevention skills (p value = 0.001). The study recommends that therapeutic sociodramatic play could be applied in an effort to enhance healthy and clean living behaviors and to prevent diarrhea among school-aged children, and it could be integrated into school nursing services

Implementation of Brain Breaks® in the Classroom and Effects on Attitudes toward Physical Activity in a Macedonian School Setting.

The purpose of this study was to explore the effects of Brain Break® activities on interest and motivation for physical activity among schoolchildren and the contribution of such activities on learning for health and holistic development. The study sample was comprised of 283 participants, primary school students from 3rd to 5th grades from two public schools in the Republic of Macedonia. Six experimental and six control groups were included in the study. Interventions in classroom settings-based Brain Break® video exercises were introduced in the experimental group during a period of three months. Students' attitudes toward physical activity were tested using a self-report survey instrument entitled "Attitudes toward Physical Activity Scale (APAS)" before and after intervention. Applied factor analyses were completed and the results of these analysis support APAS validity and the successful use of this application in the measurement of the learning experience, self-awareness, self-efficacy, and self-confidence in developing physical fitness. Learning was enhanced by using video exercises. Information presented in this paper is meaningful for the promotion of better exercise habits and the holistic approach to better health by using personal motivation and motivation provided by others. The results from repeated ANCOVA suggest positive effects of the applied Brain Break® video exercises as an interventional program. The study confirms the effect of application of Brain Break® video exercises on children's attitudes for physical activity, motivation for PA, internalization of movement habits as personal good.

Promoting Water Consumption on a Caribbean Island: An Intervention Using Children's Social Networks at Schools.

Sugar-sweetened beverage (SSB) consumption and the associated childhood obesity are major concerns in the Caribbean, creating a need for interventions promoting water consumption as a healthy alternative. A social network-based intervention (SNI) was tested among Aruban children to increase their water consumption and behavioral intention to do so and, consequently, to decrease SSB consumption and the associated behavioral intention. In this study, the moderating effects of descriptive and injunctive norms were tested. A cluster randomized controlled trial was completed in schools (mean age = 11 years ± SD = 0.98; 54% girls). Children were assigned to the intervention group (IG; n = 192) or control group (CG; n = 185). IG children were exposed to peer influencers promoting water consumption and CG children were not. Regression analyses showed that water consumption increased for IG children with a high injunctive norm score (p = 0.05); however, their intention to consume more water remained unchanged (p = 0.42). Moreover, IG children showed a decrease in SSB consumption (p = 0.04) and an increase in their intention to consume less SSB (p = 0.00). These findings indicate that SNIs are a promising instrument for health behavioral changes for Aruba and other islands in the Caribbean region.

An exploratory trial of a health education programme to promote healthy lifestyles through social and emotional competence in young children: Study protocol.

AIM: To implement and evaluate a health education programme based on the development of social and emotional competence in young children. BACKGROUND: Children's social and emotional skills play a key role in the adoption and maintenance of their lifestyles. Currently, a more comprehensive perspective dealing with these aspects is needed to promote healthy habits in children and develop effective health education programmes. DESIGN: An exploratory randomized controlled trial. METHODS: A convenience sample of 30 children (5 and 6 years old) will be recruited from a public school in Spain, with 15 participants in the experimental group and 15 in the control group. Participants in the experimental group will receive the first unit of the programme, consisting of developing emotional knowledge skills around daily health habits (eating, hygiene, sleep and physical exercise) using different game-based dynamics and an emotional diary, while those in the control group will continue with their usual school routine. Outcome measures include emotional knowledge ability, basic social skills and children's health profile. The perceived impact of the intervention by parents, acceptability (by parents and children) and feasibility of the programme will be also assessed. Data will be collected at baseline, postintervention and at 7-month follow-up. DISCUSSION: This study offers an innovative intervention aimed at improving children's healthy lifestyles from a holistic perspective by addressing social and emotional competence as one of the most influential aspects of children's development. This exploratory trial is an essential step to explore crucial aspects of the full-scale clinical trial.

A creche como promotora da amamentação e da alimentação adequada e saudável: livreto para os gestores / The day care center as a promoter of breastfeeding and adequate and healthy food: a booklet for managers

É nesse sentido que o Ministério da Saúde, em parceria com a Universidade do Estado do Rio de Janeiro (UERJ) e com apoio da Organização Pan-Americana da Saúde (Opas), elaborou uma série de materiais para apoiar gestores e profissionais da Saúde e de Educação no planejamento, na organização e na implementação das ações de promoção da segurança alimentar e nutricional e da alimentação adequada e saudável nas creches e nas escolas. Neste livreto, você encontra orientações de ações a serem desenvolvidas ou aprimoradas pela creche, com destaque para o apoio ao aleitamento materno e para a introdução da alimentação complementar adequada e saudável.

Massage and Storytelling Reduce Aggression and Improve Academic Performance in Children Attending Elementary School.

BACKGROUND: Aggressive behaviors must be addressed in elementary schools. Massage and storytelling can be strategies to deal with aggression because both involve experience exchange and social interaction. Both can decrease stress and anxiety and increase self-esteem. OBJECTIVE: To evaluate the effect of two interventions (massage and storytelling) on aggressive behaviors and academic performance of elementary school children. METHOD: Three groups (n = 35 children in each group) of the second grade participated (aged 6.5-8.1 years). One group received ten extra classes of massage (MG), another group received extra classes of storytelling (SG), and the control group received extra classes of random subjects (CG). Extra classes lasted for 50 minutes, once a week. Aggressive behaviors were recorded on diaries, by the teachers and the coordinator. The frequency of aggressive behaviors and the academic performance of MG, SG, and CG were observed for six months and the groups were compared. FINDINGS: ANOVAs evidenced that MG and SG, but not CG, showed a reduction in aggressive behaviors registered by the teachers and coordinator, after the intervention. Academic performance of MG and SC improved after the intervention (p < 0.05).

Australian primary school communities' understandings of SunSmart: a qualitative study.

OBJECTIVES: Skin cancer represents a major health issue for Australia. Childhood sun exposure is an important risk factor and evidence suggests the use of sun protection measures by Australian school children could be improved. This study examines how the SunSmart Program, a school-based skin cancer prevention resource, can be supported to further increase sun protection behaviours to assist in lowering skin cancer incidence. METHODS: The Health Promoting Schools (HPS) framework was adopted to select key stakeholders from a convenience sample of five school communities. Students, teaching staff and parents participated in semi-structured focus group and individual interviews. A thematic analysis was used to extract key themes from the data. RESULTS: Although these school communities were aware of sun protection practices and the risks associated with sun exposure, their understandings of the SunSmart Program were limited. Sun protection policy implementation was inconsistent and students were unlikely to engage in sun protection practices beyond the school setting. CONCLUSION AND IMPLICATIONS: School communities require additional support and engagement to holistically enforce the principles of the SunSmart Program.

Development of School-Based Asthma Management Programs in Rochester, New York: Presented in Honor of Dr Robert Haggerty.

In the spirit of Dr. Haggerty's teachings, we present an overview of our work to improve care for children with asthma in the context of 3 lessons learned: 1) the importance of providing integrated services across disciplinary boundaries for children with chronic illness, 2) the need to move from a care model focused only on the individual child to a model focused on the child, family, and community, and 3) the need to expand beyond the local community and take a broad perspective on improving health on a national level. The goal of our program is to develop sustainable models to overcome the multiple obstacles to effective preventive care for urban children with asthma. The primary intervention for our original School-Based Asthma Therapy program was directly observed administration of preventive asthma medications in school (with dose adjustments on the basis of National Heart, Lung, and Blood Institute guidelines). We found that children who received preventive medications in school through directly observed therapy had improved outcomes across multiple outcome measures. Our subsequent asthma programs have focused on dissemination and sustainability, with the incorporation of communication technology to enhance the system of care. We are currently testing the 'School-Based Telemedicine Enhanced Asthma Management' program, including 400 children with persistent asthma from the Rochester City School District. This program includes directly observed administration of preventive asthma medication at school, and school-based telemedicine to assure appropriate evaluation, preventive medication prescription, and follow-up care. It is designed to implement and sustain guideline-based asthma care through existing community infrastructure, and could serve as a model for the integration of services in rural as well as urban communities.