The Healthy, Immunized Communities Study: A pilot intervention to increase parents' intentions to get vaccines for their middle school children.

Pennsylvania shortened the provisional period for student vaccine compliance in 2018. We pilot tested a school-based health education intervention, The Healthy, Immunized Communities Study, to improve parents' intentions to get school-required (tetanus, diphtheria, acellular pertussis [Tdap]; and meningococcal conjugate [MCV]) and recommended (human papillomavirus [HPV]) vaccines for their children. In Phase 1, we partnered with the School District of Lancaster (SDL) to conduct four focus groups with stakeholders (local clinicians, school staff, school nurses, and parents) to inform the development of the intervention. In Phase 2, we randomized four middle schools in SDL to either the intervention (six email communications and school-community educational event) or control group. Seventy-eight parents took part in the intervention and 70 joined the control group. Vaccine intentions were compared within and between groups from baseline to 6-month follow-up with generalized estimating equations (GEE) models. Compared to the control, the intervention did not increase parents' vaccine intentions for Tdap (RR = 1.18; 95 % CI:0.98-1.41), MCV (RR = 1.10; 95 % CI:0.89-1.35), or HPV (RR = 0.96; 95 % CI:0.86-1.07). Among intervention participants, only 37 % opened ≥ 3 email communications and 23 % attended the event. Intervention participants reported high satisfaction with email communications (e.g., informative = 71 %) and felt that the school-community event met their educational objectives on key topics (e.g., immune system = 89 %). In conclusion, although we observed no intervention effect, our data suggest that this could be a result of the low uptake of intervention components. Further research is needed to understand how school-based vaccination-focused interventions can be successfully implemented with high fidelity among parents.

The Role of Technical Assistance in School Wellness Policy Enhancement.

BACKGROUND: School settings offer an opportunity to impact student health and wellness. Quality wellness policies are important in establishing strong wellness environments, but current resources to support policy development, maintenance, and dissemination are lacking. The Building Healthy Schools Program aimed to develop capacity of school districts to improve the strength and comprehensiveness of wellness policies and sustain these activities. METHODS: Fifteen school districts in Pennsylvania participated in a program to facilitate the improvement of district wellness policies and practices. Program staff provided technical assistance to evaluate wellness policies before and after program implementation. Professional development and tailored training was provided for school personnel to create sustainability. Statistical analysis was performed to evaluate policy improvement. RESULTS: Thirteen of the 15 participating districts completed a policy revision. Median strength (p = .001) and comprehensiveness (p = .002) scores improved from baseline to post-program and there were significant improvements in most assessment sub-sections. Some districts were hesitant to make strong language improvements due to their limited capacity (ie, staff) for implementation. Champions (n = 13; 87%) reported confidence to revise wellness policy language independently in the future. CONCLUSIONS: Technical assistance provided to districts facilitated significant improvements to wellness policy language, especially in the implementation, evaluation, and communication; critical components for policy impact on school wellness environments. In addition, participant feedback suggested an ability to sustain activities in the future. Both external (ie, technical assistance) and internal resources are needed to facilitate school districts' ongoing wellness policy improvement and implementation, including improved model wellness policy language and enforcement within schools, respectively.

"I wouldn't even know what to do," Adolescent and Parent Perspectives on Identifying, Understanding, and Seeking Help for Adolescent Depression.

Within the context of a randomized clinical trial (RCT) of school-based depression screening, the study objective was to understand parent and adolescent perspectives on school-based depression screening and barriers to help-seeking for adolescent depression. From May-Nov. 2019, separate focus groups were held with adolescents (8 groups, n = 52) and parents (6 groups, n = 36). Two coders individually coded 20% of transcripts to establish interrater reliability (adolescent k = 0.76 and parent k = 0.80). Remaining transcripts were then separately coded and reviewed to develop three themes: (1) Both recognized depression as a serious issue that needed to be addressed in schools, but had confidentiality and communication concerns; (2) Both parents and adolescents believed the majority of adolescents would seek help with depression from friends more than any other source; and (3) Neither adolescents nor parents could clearly describe steps to take if their peers (adolescents) or adolescents (parents) were depressed. We intend to address identified barriers and concerns in the context of the larger RCT.

In Their Own Words: Resources Needed by School Nurses to Facilitate Student Immunization Compliance.

BACKGROUND: All 50 states have school-entry immunization requirements, and many also allow exemptions based on medical and non-medical reasons. School nurses are responsible for managing student immunization compliance based on state policies, but lack standardized resources and guidance. METHODS: Pennsylvania school nurses (N = 21) participated in semi-structured interviews regarding their strategies for communication and management of student immunization information, along with resources needed for practice improvement. Data were analyzed using descriptive content analysis. RESULTS: Nurses reported similarities in timelines used for communication of immunization requirements, but differences in mechanisms used to secure and manage immunization records. Nurses reported a need for clarity regarding exclusions and exemption policy implementation and requested standardized resources and guidance for navigating immunization compliance. CONCLUSIONS: A need exists for standardized processes that support immunization compliance. Furthermore, nurses highlighted a need for additional training and enhanced networks to develop creative strategies for promoting immunization uptake among families.

Investigating the effectiveness of webinars in the adoption of proven school wellness strategies.

OBJECTIVE: Recent federal legislation in the USA highlights the role schools play in student health by requiring the utilisation of wellness councils for policy development and oversight. One barrier to developing good-quality wellness policies and wellness culture is limited knowledge of resources among school professionals. This article describes an approach to webinar delivery to improve school wellness efforts. DESIGN: Eight webinars, 30-60 minutes in length, were delivered on topics designed to enhance school wellness environments. SETTING: Webinars were delivered using an online meeting software platform to school professionals, who participated from their respective school buildings remotely. METHOD: Webinars featured content experts for the selected topics and were promoted to school professionals and wellness organisations. Attendees were invited to participate in a post-webinar questionnaire regarding satisfaction with the session and intent to act on knowledge gained from participation. RESULTS: Webinars reached 280 school and wellness professionals (teachers, administrators, nurses, etc.). Participants who completed post-webinar surveys (n = 78) rated the webinar's ability to enhance their knowledge in the respective topic area with an average score of 4.3 out of 5.0 (1 = poor, 5 = excellent). Most respondents (n = 69) intended to share the information gained with a colleague. CONCLUSION: Webinars provide a viable method of instruction and education for school personnel interested in strategies for improving a school's wellness environment. Further investigation is necessary to determine the best strategies for promoting webinar engagement. Future research should also explore the link between webinar participation and positive changes in school wellness environments.