Maryland School Health partners' Perspectives on the Impact of COVID-19 on School Health Services for Grades K-12.

BACKGROUND: The COVID-19 pandemic disrupted routine school operations, including school health programs. This study aims to describe the pandemic's impact on school health service delivery from the perspective of Maryland school health partners. METHODS: We conducted semi-structured interviews with health service representatives from public schools (K-12) between July and December 2021. Interviews were recorded, transcribed, and coded through an iterative process to develop analytic themes. RESULTS: Twenty school health partners from 15 Maryland school districts participated. Participants identified key impacts of COVID-19 on school health: (1) COVID-19 disrupted delivery of services such as dental, mental health, and preventative care, (2) COVID-19 necessitated changes in service delivery platforms, (3) COVID-19 affected school health staff through increased responsibilities and staffing shortages, and (4) COVID-19 prompted schools to become hubs for community outreach and health education. IMPLICATIONS FOR SCHOOL HEALTH POLICY, PRACTICE, AND EQUITY: Consideration of school health service disruptions and the increased demands on service providers may inform future priorities for school administrators, health departments, and policymakers. CONCLUSIONS: COVID-19 impacted the timing and method of service delivery as well as the roles of school health staff and schools themselves in public health and education.

School Health Services' Use of Information and Communication Technologies in Interorganizational Collaboration Regarding Students With Mental Illness: A Scoping Review.

School health services (SHSs) and school nurses play a crucial role in identifying and supporting students with mental illness. The integration of information and communication technology (ICT) can facilitate interorganizational collaboration in this context. Due to the limited research in this area, a scoping review was conducted to explore SHSs' use of ICT in interorganization collaboration regarding students with mental illness. Six articles were reviewed, revealing three key themes: "types of ICT employed by SHSs in interorganizational collaboration," "constellation of SHSs in interorganizational collaboration," and "opportunities and challenges for SHSs using ICT in interorganizational collaboration." Notably, two of the six articles highlighted the absence of school nurses in interorganizational collaboration. Even though ICT plays a crucial role in interorganizational collaboration, no comprehensive solution was found. This scoping review confirms that there are challenges with operability and regulations that govern the exchange of private information between organizations.

Period Product Resources and Needs in Missouri Schools: Focus Group Discussions with School Nurses.

This study explored period product resources and needs in Missouri schools from the perspective of school nurses. We conducted eight focus groups with school nurses (n = 51) across Missouri using purposive sampling. Focus group data were analyzed in Dedoose via multiple coders and achieved strong inter-rater reliability (Cohen's Kappa = 0.92). Several interconnected themes with associated sub-themes were identified. First, school nurses do not have sufficient resources to help students manage menstruation and minimize menstruation-related absenteeism. Second, schools' heavy reliance on donations can lead to inconsistencies in supply and a mismatch between what is donated and what is most needed. Third, school nurses desire additional educational resources around menstruation management for students and caregivers. Nurse-identified themes can help inform recommendations for improving schools' response to students' menstrual hygiene needs by highlighting priorities for educational content, resources, and product acquisition with a goal of ensuring the suitability and sustainability of MHM in schools.

Health Promoting Behaviors among Adolescents at Selected Schools of Chitwan.

BACKGROUND: Health Promotion and maintenance are fundamental prerequisites to achieve optimum health in an individual and limit the illness. The objective of the study was to assess the health promoting behaviors among adolescents at selected schools. METHODS: A descriptive cross-sectional study was conducted among 238 adolescents age 14-18 years of age studying in three different government schools of Bharatpur-10 Chitwan. Probability simple random method was used for selecting the required respondent. Data were collected using Adolescents Health Promoting Scale questionnaire through self-administered technique. Obtained data were analyzed using descriptive and inferential statistics. RESULTS: The study revealed that 47.5% had high level of health promoting behaviors whereas 52.5% had low level of health promoting behavior. Regarding, the subscale, the highest score was obtained in the area of exercise (median percentage=72.5%) and lowest score was obtained in the area of stress management (median percentage=48%). Moreover, statistically significant variables for health promoting behavior were respondents age, availability of school health nurse, educational status of both the parents and and occupation of father (p<0.05). CONCLUSIONS: More than half of the adolescents in schools have low health promoting behavior, particularly in the area of stress management and nutrition. Adolescence is the period when most of the healthy and unhealthy habits are developed. Hence, it is necessary to focus on developing efficient health promotion and disease prevention strategies in collaboration with school teachers and school health nurse.

School health promotion and fruit and vegetable consumption in secondary schools: a repeated cross-sectional multilevel study.

BACKGROUND: Worldwide, recommendations for fruit and vegetable consumption are not met, which can cause chronic diseases. Especially adolescence is an important phase for the development of health behaviours. Therefore, in the Netherlands, the Healthy School program was established to aid schools in promoting healthy lifestyles among their students. We examined to what extent the variation between secondary schools regarding students' fruit and vegetable consumption could be explained by differences between schools regarding Healthy School certification, general school characteristics, and the school population. Additionally, we examined whether Healthy School certification was related to the outcomes, and whether the association differed for subgroups. METHODS: We performed a repeated cross-sectional multilevel study. We used data from multiple school years from the national Youth Health Monitor on secondary schools (grades 2 and 4, age ranged from approximately 12 to 18 years) of seven Public Health Services, and added data with regard to Healthy School certification, general school characteristics and school population characteristics. We included two outcomes: the number of days a student consumed fruit and vegetables per week. In total, we analysed data on 168,127 students from 256 secondary schools in the Netherlands. RESULTS: Results indicated that 2.87% of the variation in fruit consumption and 5.57% of the variation in vegetable consumption could be attributed to differences at the school-level. Characteristics related to high parental educational attainment, household income, and educational track of the students explained most of the variance between schools. Additionally, we found a small favourable association between Healthy School certification and the number of days secondary school students consumed fruit and vegetables. CONCLUSIONS: School population characteristics explained more variation between schools than Healthy School certification and general school characteristics, especially indicators of parental socioeconomic status. Nevertheless, Healthy School certification seemed to be slightly related to fruit and vegetable consumption, and might contribute to healthier dietary intake. We found small differences for some subgroups, but future research should focus on the impact in different school contexts, since we were restricted in the characteristics that could be included in this study.

RISKY BEHAVIORS AMONG SCHOOL-AGED ADOLESCENTS AND SOCIAL DETERMINANTS OF HEALTH / CONDUCTAS DE RIESGO ENTRE ADOLESCENTES EN EDAD ESCOLAR Y DETERMINANTES SOCIALES DE LA SALUD / COMPORTAMENTOS DE RISCO ENTRE ADOLESCENTES ESCOLARES E DETERMINANTES SOCIAIS DA SAÚDE

This study aimed to identify the association between the occurrence of risk behaviors among school adolescents and the Social Determinants of Health of both the students and their families. This is a descriptive, correlational, cross-sectional study, with a quantitative approach, carried out with adolescents enrolled in elementary school (final years) and high school, in public schools in the metropolitan region and the agrestic region of Pernambuco, between June and August 2023. Two instruments were used: a sociodemographic questionnaire prepared by the researchers and the Risk Behavior Index. The data was analyzed using Epi info and SPSS software. The results revealed that aspects such as age, gender, religion, marital status, physical activity and family structure were related to the behaviors assessed and could act as risk or protective factors. When considering ways of conducting actions to protect, prevent and mitigate risk behaviors among school adolescents, it is imperative to include the involvement of health and education professionals in the development of strategies that facilitate the development of dialogical spaces. It is also important to encourage responsible protagonism and active participation by adolescents in making decisions about their lives and health.

Este estudio tuvo como objetivo identificar la asociación entre la ocurrencia de comportamientos de riesgo entre adolescentes escolares y los Determinantes Sociales de la Salud tanto de los alumnos como de sus familias. Se trata de un estudio descriptivo, correlacional, transversal, con abordaje cuantitativo, realizado entre adolescentes matriculados en la enseñanza fundamental (años finales) y secundaria en escuelas públicas de las regiones metropolitana y agreste de Pernambuco, entre junio y agosto de 2023. Se utilizaron dos instrumentos: un cuestionario sociodemográfico elaborado por los investigadores y el Índice de Comportamiento de Riesgo. Los datos fueron analizados utilizando los softwares Epi info y SPSS. Los resultados mostraron que aspectos como la edad, el sexo, la religión, el estado civil, la actividad física y la estructura familiar estaban relacionados con los comportamientos evaluados y podían actuar como factores de riesgo o de protección. Al pensar en formas de conducir acciones para proteger, prevenir y mitigar las conductas de riesgo entre los adolescentes escolarizados, es fundamental considerar la participación de los profesionales de la salud y de la educación en el desarrollo de estrategias que faciliten la construcción de espacios dialógicos. También es importante fomentar el protagonismo responsable y la participación activa de los adolescentes en la toma de decisiones sobre sus vidas y su salud.

Este estudo objetivou identificar a associação entre a ocorrência de comportamentos de risco entre adolescentes escolares e os Determinantes Sociais de Saúde tanto dos estudantes quanto de suas famílias. Trata-se de um uma pesquisa descritiva, correlacional, de delineamento transversal, com abordagem quantitativa, realizada ao público de adolescentes matriculados no Ensino Fundamental II e Médio, em escolas públicas da região metropolitana e do agreste de Pernambuco, durante o período de junho a agosto de 2023. Foram aplicados 2 instrumentos: um questionário sociodemográfico elaborado pelos pesquisadores e o Índice de Comportamentos de Risco. Os dados foram analisados com suporte dos softwares Epi info e SPSS. Os resultados evidenciaram que aspectos como idade, gênero, religião, estado civil dos adolescentes, prática de atividades físicas e estrutura familiar obtiveram relações com os comportamentos avaliados, podendo agir como fatores de risco ou protetivos. Ao pensar formas de conduzir ações de proteção, prevenção e mitigação de comportamentos de risco entre adolescentes escolares, é crucial considerar o envolvimento de profissionais da saúde e da educação no desenvolvimento de estratégias que facilitem a criação de espaços dialógicos. Ademais, o estímulo ao protagonismo responsável e participação ativa dos adolescentes na tomada de decisões relacionadas às suas vidas e saúde.

Staff perspectives on poor mental health in secondary school students: an increasing problem handled with insufficient resources.

Introduction: An increasing number of schools are recognizing the importance of addressing students' mental health based on the association with educational outcomes and long-term health. The school organization and the members of the school staff play important but, in several ways, challenging roles in this work. The purpose of this study was to explore views of staff from schools and school health services on mental ill health among students and their own role in detecting and managing it. Methods: A qualitative study was conducted in a sparsely populated municipality in northern Sweden. In total, 40 participants from three secondary schools and the school health services participated either in focus groups or individual interviews. Participants were teachers, assistants, school nurses, school counselors and psychologists. Data were analyzed using thematic analysis. Results: The analysis revealed the main theme Student mental ill health: an increasing problem handled with insufficient resources and two subthemes, i.e., Uncertainty in interpreting students' signs of mental ill health and the need to clarify roles and establish a supportive organization. Conclusions: It was concluded that school staff were uncertain regarding how to interpret signs of mental ill health among students and required better knowledge and more resources to help students with mental ill health. A clearer organization and consensus regarding support for students with mental ill health were also necessary in light of the division of responsibilities between school staff and the school health services.

"And I still remember it to this day": A qualitative exploration of retrospective memories of school-based recess.

Objectives: Previous research has shown the most common memory of physical education (PE) was embarrassment, and that childhood memories of PE relate to physical activity (PA) attitude, intention, and sedentary behavior in adulthood [13]. Recess memories may have a similar effect on adult attitudes towards PA, given that recess is a physically active part of the school day, yet is more autonomous and less supervised than PE. Recent literature has supported this, as Massey and colleagues (2021b) reported memories of recess enjoyment were associated with PA enjoyment in adulthood, whereas negative recess memories were associated with social isolation. In an effort to better understand recess memories, and how they may be related to adult behaviors, the purpose of this study was to examine qualitative descriptions of adults' worst recess memories as it related to physical and social health. Study design: Mixed methods design; inductive content analysis and analysis of covariance. Methods: As part of a larger project, 433 participants between the ages of 19 and 77 (M = 44.91; SD = 15.35) were asked to recall their worst recess memories and the grades in which those memories occurred. Participants identified as predominantly female (52%), White (72%), and college educated (46%). Data analysis was conducted via an inductive content analysis by three research team members. Results: The most common negative memories included isolating experiences, physical injuries, victimization, and contextual factors (e.g., weather). Through a series of analysis of covariance, self-reported isolation and self-efficacy of exercise were significantly related to participants with social isolation and physical injury memories respectively. Conclusions: This study adds to a growing line of research documenting the importance of recess as a developmentally impactful environment with implications for physical and emotional health.

Vacillating between "strange" and "familiar" - representations of children in migrant families and their health in Swedish school health services.

Representations of migrants influence how they are perceived by others. Hence, how children who have migrated or whose parents have migrated (Children in Migrant Families: CMFs) are represented in clinical practice guidelines (CPGs) for Swedish school health services (SHS) may influence how they are perceived by school nurses. Thus, this study aimed to explore representations of CMFs in school nurses' CPGs. Data consisted of 130 CPGs from municipalities in Sweden. Documents were analyzed using the "What is the Problem Represented to be" (WPR) approach - an analytic strategy for investigating embedded assumptions of "problems". In the analysis, Sarah Ahmed's work on "strangers" and "strangeness" was applied. In the CPGs, the CMFs and their health were repeatedly mentioned in conjunction with the need for particular or additional actions, efforts, or routines when assessing or discussing their health, to a degree beyond what is "usually" provided. This need was motivated by representing the CMFs and their health as being the same, yet different in relation to "Swedish" children in general. Thus, the children were not only represented as different, but they were "foreignized". These representations of difference and foreignness placed the children on a continuum in relation to what is recognized as "familiar" in their health, and constructed elastic boundaries between the strange and the familiar. By illustrating how these boundaries were used for difference-making between "familiar" and "strange", this study showed how CMFs are alternately represented as similar and different, and foreignized while provided with SHS aiming to make them "familiar".

School children's perceptions about being offered the HPV vaccination - A focus group study.

AIM: There is limited knowledge about the perceptions of HPV vaccination in middle-school children. This qualitative study aimed to explore their views. METHODS: We conducted focus group interviews with children, 10-11 years of age, who had been offered HPV vaccination through the school health services in mid-north Sweden in spring of 2023. Data were analysed with qualitative content analysis. RESULTS: This study included six focus group interviews with 49 children (boys n = 29; girls n = 20), mean of 11 years of age. Participating children expressed the need to feel safe to be of utmost importance and the means to do so was to be prepared and informed by someone the child trusted. The school nurse was perceived as the expert, best suited to provide factual information, support and motivation, both to children and their parents. CONCLUSION: We confirm that healthcare providers' recommendations are crucial for HPV vaccine acceptance also from the child's perspective. Improved information about HPV vaccination to children is necessary. Children's right to participate on their own terms is not fulfilled today. Vaccine promotion, both to children and parents, should be actively managed by the school nurse.

Multi-country case study on school health policy and its implementation in relation to COVID-19 control in Micronesia Small Islands Developing States.

INTRODUCTION: The COVID-19 pandemic caused school closures and rises in mental illness and non-communicable disease among school children worldwide. The Pacific Small Islands Developing States (SIDS) were also affected, but school health activities, which can effectively reduce negative effects of COVID-19, were not widely implemented compared to other Asia-Pacific countries. This study examined current school health implementation and related policies at national, local, and school levels in the Micronesia SIDS according to phases of COVID-19 control. METHODS: Multi-country case study targeted the Federated States of Micronesia (FSM), Republic of the Marshall Islands (RMI), and Republic of Palau (ROP). These studies focused on school health implementation periods according to the PPR (Prevention, Preparedness, and Response) concept: Phase #1: prevention/preparedness, #2: early phase response, and #3: chronic phase response/recovery phase. Data were collected through policy document reviews that identified school health policies related to COVID-19 controls in the three phases and key informant interviews (KIIs) with 44 key informants (FSM, n = 14; RMI, n = 18; ROP, n = 12) whose work related to school health. The collected data were analyzed using content analysis methods according to the conceptual framework in this study. RESULTS: This study identified three factors of school health implementation related to COVID-19 controls: promotion of decentralized education (FSM), implementation of COVID-19 controls in the school community (RMI), and disaster management for the protection of students including response to infectious disease (ROP). In Phase #1, no country had established a school health policy. In Phase #2, three enablers were identified in FSM and ROP, as reflected in COVID-19 controls by the education and health sectors. In Phase #3, RMI implemented COVID-19 controls in the school community. Documents on youth policy and disaster management in ROP were updated to reflect the chronic phase response and response to future public health crises. CONCLUSIONS: A decentralized education was instrumental in immediately implementing COVID-19 control measures in schools at national and local levels for coordination between education and health sectors. Despite each county's multi-sectoral approach to engage COVID-19 controls in schools, local government organization requires strengthening and implementation of the formulated school health policy. In preparation for the next public health crisis, school health should be promoted that is integrated into both infection control and disaster management.

The impact of COVID-19 on school nursing: A qualitative survey of stressors faced by school nurses.

BACKGROUND: As students returned to school, school nurses were responsible for infection control, communication, and the preparation of supplies and facilities. School nurses in the Pacific Northwest US demonstrated a higher prevalence of mental health symptoms in the years since the pandemic began, suggesting that their experience may have been unique. OBJECTIVE: This study aimed to explore the stressors of school nurses in the Pacific Northwest at two time points. DESIGN: This study is a qualitative, descriptive analysis of anonymous survey responses collected in June of 2021 (n = 333) and between October and December 2021 (n = 284). SAMPLE: Self-identifying school nurses working in K-12 schools in Washington State were invited to participate. MEASUREMENTS: Participants completed open-ended survey questions designed to elicit their experiences during the pandemic. RESULTS: Four themes emerged from the data: (1) isolation from administration and the school community, (2) COVID-19-related workload, (3) disorganized and inconsistent communication, and (4) concern for students, themselves, and others. CONCLUSIONS: School nurses played a vital public health role during the pandemic. However, their effectiveness may not have been fully utilized and sometimes undermined. Lastly, our findings highlight the difficulties encountered in implementing the changing scientific and public health guidance during the pandemic.

Awareness and attitudes towards infectious diseases among teachers and administrators: Evaluation of health-related school program and practices.

BACKGROUND: Schools play a crucial role in promoting health education and awareness about infectious diseases. This study aims to examine teachers' and administrators' awareness and attitudes towards infectious diseases and their specific health-related applications. METHODS: This study used a new scale to collect survey data from 435 teachers and administrators. The validity and reliability of the scale were assessed by factor analysis. Pearson correlation and regression analysis were conducted to explore the relationships between variables. T-tests and one-way ANOVA were employed for group comparisons. RESULTS: The findings revealed a concerning skepticism among a significant portion of participants towards the effectiveness of vaccines in ending epidemics and a lack of health education activities in schools. Significant differences were observed in the scores for physical measures, educational activities, awareness, observation, and attitudes based on school type and ownership of certificates (p ≤ 0.05). CONCLUSIONS: This study highlights the need for continuous education and awareness-raising efforts to develop sustainable school health practices. Integrating diverse health professionals into school health management teams can enhance health services in educational settings. The present study also emphasizes the importance of comprehensive health education in understanding infectious diseases, preventive measures, and proper hygiene practices.

Health literacy in the context of child health promotion: a scoping review of conceptualizations and descriptions.

BACKGROUND: Increasing health literacy (HL) in children could be an opportunity for a more health literate future generation. The aim of this scoping review is to provide an overview of how HL is conceptualized and described in the context of health promotion in 9-12-year-old children. METHODS: A systematic and comprehensive search for 'health literacy' and 'children' and 'measure' was performed in accordance with PRISMA ScR in PubMed, Embase.com and via Ebsco in CINAHL, APA PsycInfo and ERIC. Two reviewers independently screened titles and abstracts and evaluated full-text publications regarding eligibility. Data was extracted systematically, and the extracted descriptions of HL were analyzed qualitatively using deductive analysis based on previously published HL definitions. RESULTS: The search provided 5,401 original titles, of which 26 eligible publications were included. We found a wide variation of descriptions of learning outcomes as well as competencies for HL. Most HL descriptions could be linked to commonly used definitions of HL in the literature, and some combined several HL dimensions. The descriptions varied between HL dimensions and were not always relevant to health promotion. The educational setting plays a prominent role in HL regarding health promotion. CONCLUSION: The description of HL is truly diverse and complex encompassing a wide range of topics. We recommend adopting a comprehensive and integrated approach to describe HL dimensions, particularly in the context of health promotion for children. By considering the diverse dimensions of HL and its integration within educational programs, children can learn HL skills and competencies from an early age.

Reduction in intake of discretionary foods and drinks among Danish schoolchildren: dietary results from the real-life cluster-randomised controlled trial 'Are You Too Sweet?'

OBJECTIVE: To evaluate the effectiveness of the multicomponent intervention trial 'Are You Too Sweet?' in reducing discretionary foods and drinks intake among young schoolchildren. DESIGN: The study was a 3·5-month two-arm cluster-randomised controlled trial among primary schoolchildren and their families. School health nurses provided guidance to families regarding discretionary foods and drinks for the children. Moreover, families were given a variety of knowledge- and capability-building materials to utilise at home. Dietary intake was assessed using a web-based 7-d dietary record. Linear mixed regression models were used to estimate intervention effects as changes in child intake of discretionary foods and drinks and sugar between groups. SETTING: Six schools from a Danish municipality were randomised to the intervention group (n 4) or the control group (n 2). PARTICIPANTS: A total of 153 children aged 5-7 years. RESULTS: No significant reduction in the children's intake of total discretionary foods and drinks or discretionary foods alone was observed between the intervention and control group, while a decreased intake of discretionary drinks of 40·9 % (P = 0·045) was observed compared with control. Secondary subgroup analysis showed that children of parents with shorter educational level significantly reduced their intake of added sugar by 2·9 E% (P = 0·002). CONCLUSION: The results of this study indicate that multicomponent interventions involving school health nurses may have some effects in reducing, especially, discretionary drinks.

Data Submission: HOW the Power of One Creates the Power of Many.

This article is the third and final article in a series exploring the WHAT, WHY, and HOW of data collection and data utilization. The final step, the HOW of data submission, provides discussion and guidance in contributing your data to the collective voice, including submitting data from the school, district, state, and national levels. Submitting individual school nursing data enriches the bigger story and increases the awareness and meaningfulness of school health data, the role of the school nurse as an integral member of the school community, and the connections of student health and academic outcomes. This article will also explore how to submit your school health data and the opportunities to submit it to district, state, or national levels, including to the National School Health Data Set: Every Student Counts! (ESC!).

Development and Testing of the School Healthcare Partnership Scale for Parents.

BACKGROUND: Cooperation between parents and school nurses is essential for the successful completion of school courses and a healthy school life for children with long-term conditions. Therefore, this study aimed to develop and test a scale to measure parental perceptions of partnerships between school nurses and parents in the school health care (SHC) system for children with type 1 diabetes (T1D). METHODS: The content validity, factorial structure validity, convergent validity, discriminant validity, known-group validity, internal consistency reliability, and test-retest reliability of the School Healthcare Partnership Scale for Parents (SHCPS-P) were evaluated. Data were analyzed by performing exploratory factor analysis (EFA), Pearson's correlation, Cronbach's α, and independent t-tests. The total sample included 155 parents for the EFA and 49 parents for the stability test. Seventeen items, grouped into 3 dimensions, were extracted through principal axis factoring. RESULTS: The total variance explained by these factors was 53.57%. The scale demonstrated a high correlation with parental satisfaction regarding school nursing and a moderate correlation with diabetes-related safety, thereby showing convergent validity. A low correlation with empathy demonstrated discriminant validity. A significant difference existed in the partnership scores in known-group comparisons. Cronbach's α was 0.95, and the test-retest correlation coefficient was 0.95, which showed reliability. CONCLUSIONS: This study suggests that the SHCPS-P is a reliable and valid tool for measuring the perception of SHC partnership among parents of children with T1D and can be used as an indicator to measure parents' perspectives about SHC.

Reopening schools safely and educating youth (ROSSEY) study: Protocol for a community-based, cluster randomized controlled trial.

INTRODUCTION: ROSSEY is a community-academic partnership aiming to develop and test a COVID-19 risk communication intervention for elementary school students and families in Yakima County, Washington. We describe the ROSSEY study protocol that will be implemented in the Yakima School District. METHODS: Aim 1 is to identify the community's social, ethical, and behavioral needs and resources for students to return to school and maintain onsite learning. We will conduct semi-structured interviews with students and school employees and focus groups with parents. Aim 2 is to evaluate the effectiveness of risk communication on students' school attendance. We will conduct a cluster randomized control trial. We will enroll 14 Yakima School District elementary schools with 900 student participants and randomize the schools into the COVID-19 risk communication intervention or control group. Aim 3 will assess implementation of the risk communication intervention and schools' COVID-19 mitigation strategies. We will use the RE-AIM framework to guide this work, which will entail conducting semi-structured interviews with students and school employees and focus groups with parents. DISCUSSION: Implementation of science-based risk communication can educate the community on the benefits and safety of COVID-19 testing and vaccination. Risk communication may also inform families about the role of COVID-19 testing and vaccines as part of mitigation strategies to allow for safe in-person learning. Schools have extraordinary influence to promote children's health through policy and practice change. Study findings will provide evidence to facilitate policy decisions and best practices at schools that facilitate adoption of COVID-19 risk communication. TRIAL REGISTRATION: ClinicalTrials.govNCT04859699. Registered on April 26, 2021.

Predisposing factors of health promotion behaviors and health literacy in adolescents: A cross-sectional design.

OBJECTIVE: This study was designed to measure health promotion behaviors, health literacy (HL) levels, and their predisposing factors among adolescents. DESIGN: A cross-sectional design was used. SAMPLE: The study was completed by 1046 students aged 11-14 years. MEASUREMENTS: Data were collected via the HL for School-Aged Children Scale and the Adolescent Health Promotion Scale. RESULTS: HL was significantly associated with gender, participation in sport activities, and health promotion behaviors. There was no confounding factor for HL. Adolescent health promotion behaviors were significantly associated with academic level, weight perception, participation in sport activities, and HL. CONCLUSIONS: Nurses could improve communication and decision-making skills related to health behaviors and learn how to obtain health-related knowledge to promote the health of adolescents.

The State School Mental Health Profile: Findings from 25 States.

BACKGROUND: State-level leadership and conditions are instrumental to local and regional comprehensive school mental health system (CSMHS) quality, sustainability, and growth. However, systematic documentation of state-level school mental health (SMH) policy, infrastructure, funding, and practice is limited. METHODS: Using a multi-phase, multi-method process, we developed the State School Mental Health Profile (State Profile) to offer a comprehensive landscape of state SMH efforts. State leaders in 25 states completed the State Profile once over a 3-year data collection period. Mixed methods results are reported in 8 domains. RESULTS: State education agencies were reportedly most involved in SMH technical assistance, advocacy, leadership, funding, and service provision, with mental health agencies reported as second most involved. Nearly half of state respondents reported having a state-level SMH director or coordinator. Policies with the greatest perceived impact require implementation of and funding for SMH services and supports. Despite leveraging multiple sources of funding, most states emphasized lack of funding as a primary barrier to establishing CSMHSs. All states reported staffing shortages. CONCLUSION: The State Profile can assist multi-agency state leadership teams to self-assess policy, infrastructure, and resources to support CSMHSs statewide. Findings point to areas of opportunity to advance equity across resource allocation, service provision, and policy development.