School nutrition laws in the US: do they influence obesity among youth in a racially/ethnically diverse state?

BACKGROUND/OBJECTIVES: Little is known about the separate or combined effects of state and national nutrition policies regulating food and beverages in schools on child overweight/obesity (OV/OB) and related racial/ethnic disparities. We investigated the influence of school nutrition policies enacted in California, independently and in combination with the United States' national policy "Healthy Hunger Free Kids Act" (HHFKA) on childhood OV/OB and racial/ethnic disparities. SUBJECTS/METHODS: An interrupted time series design was used with data from 12,363,089 child-level records on 5th- and 7th-graders in California public schools to estimate sex- and racial/ethnic-specific time trends in OV/OB prevalence during three periods: before the California nutrition policies (2002-2004); when only California policies were in effect (2005-2012); and when they were in effect simultaneously with HHFKA (2013-2016). RESULTS: Before the state's policies, OV/OB prevalence increased annually among children in most subgroups. Improvements in OV/OB trends were observed for almost all groups after the California policies were in effect, with further improvements after the addition of HFFKA. The total change in annual log-odds of OV/OB, comparing the periods with both state and federal policies versus no policies, ranged from -0.08 to -0.01 and varied by grade, sex, and race/ethnicity. Within each sex and grade, the greatest changes were among African-American (-0.08 to -0.02, all p < 0.05) followed by Latino children (-0.06 to -0.01, all p < 0.05). Although disparities narrowed among these groups versus White children after the dual policy period, disparities remained large. CONCLUSIONS: State and national nutrition policies for schools may have contributed to containing the upward trend in childhood OV/OB and racial/ethnic OV/OB disparities within California. However, sizable OV/OB prevalence and disparities persist. To end the epidemic, promote healthy weight and increase health equity, future efforts should strengthen state and national policies to improve food quality in schools, particularly those serving populations with the highest OV/OB prevalence.

A realist evaluation of the implementation of a large-scale school eye health programme in India: a qualitative study.

PURPOSE: This study investigates how and in what circumstances a school-based eye health programme, the Refractive Errors Among CHildren (REACH) programme, achieved its desired outcomes: accessibility, standards of refractive care, fidelity and availability of comprehensive services, for over 2 million school children in six districts across India. METHODS: We conducted a realist evaluation to identify programme aspects and their causal relationships with outcomes. Deductive and inductive thematic analysis of qualitative data included three phases: 1. theory gleaning, 2. eliciting programme theory, 3. revisiting programme theory. The Initial Programme Theories (IPTs) were developed and revised through review of the literature, programme documents and field notes. We reviewed informal and formal discussions from the participatory advisory workshops and conducted semi-structured interviews with key stakeholders for the development and refinement of the IPTs. We based our analysis on the programme designers' perspective; used contexts, mechanisms and outcomes configuration for the analysis and presentation of the findings and reported the revised IPTs for the REACH programme. RESULTS: We identified four major programme aspects of the REACH programme for evaluation: programme governing unit, human resource, innovation and technology and funding. Based on the intended outcomes of the programme, themes and contexts were sorted and IPTs were defined. We revised the IPTs based on the analysis of the interviews (n = 19). The contexts and mechanisms that were reported to have potential influence on the attainment of favourable programme outcomes were identified. The revisions to the IPTs included: co-designing a collaborative model and involving local government officials to reinforce trust, community partnerships; local well-trained staff to encourage participation; use of the web-based data capturing system with built-in quality control measures and continued technical support; pre-determined costs and targets for the outputs promoted transparency and adherence with costs. CONCLUSION: This process provided a comprehensive understanding of the opportunities and possibilities for a large-scale school eye health programme in diverse local contexts in India. This illustrated the importance of embracing principles of system thinking and considering contextual factors for School Eye Health programmes in low and middle-income countries.

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.

The Future of Telehealth in School-Based Health Centers: Lessons from COVID-19.

INTRODUCTION: In response to COVID-19, schools rapidly transitioned to virtual learning. School-based health centers (SBHCs) required immediate shifts from in-person to telehealth services to continue supporting students. METHOD: A qualitative analysis of nationally-led "Listening and Learning" sessions by the School-Based Health Alliance revealed substantial innovation and expansion of telehealth services. RESULTS: Providers and sponsoring organizations shared challenges and mechanisms for troubleshooting barriers during online webinars to provide support, education, and resources to SBHCs. DISCUSSION: Lessons learned during the COVID-19 pandemic demonstrate the value of SBHCs, which continue to target barriers to health care access, protect the most vulnerable, and decrease the spread of disease. Telehealth implementation by SBHCs can support schools and communities, mitigate future strain on the health care system by continuing to keep youth from over-burdened emergency departments and provide needed mental health care. State and federal policy changes can ensure the continued provision of telehealth by SBHCs for disadvantaged youth.

Instrumentos de avaliação de ensino-aprendizagem de materiais didáticos utilizados na atenção básica- scoping review / Methods of evaluating the effectiveness of teaching materials used in primary health care- scoping review

Identificar, junto à literatura, quais os métodos mais eficientes para avaliar a aplicação dos materiais didáticos na Atenção Básica, enfatizando o público infanto-juvenil,Scoping Review, por meio da pergunta de pesquisa: "Quais os métodos de avaliação de ensino-aprendizagem da educação em saúde nas escolas, no contexto da Atenção Primária, para crianças e adolescentes?". A busca foi realizada nas bases de dados National Library of Medicine (PubMed), Cumulative Index to Nursing and Allied Health Literature (CINAHL), Search for an Author Profile (SCOPUS) e Scientific Electronic Library Online (Scielo). Entre os 285 estudos encontrados, 13 fizeram parte da amostra por responderem à pergunta de pesquisa. Entre os 13 estudos analisados, 9 (69,24%) foram publicados nos últimos nove anos e 4 (30,76%) entre 1991 e 1999. Todos são de língua inglesa e a maior parte deles aborda hábitos alimentares e físicos (30,7%). Sobre o ensino-aprendizagem, as estratégias mais efetivas foram aquelas que incluíam a família e a comunidade e/ou desenvolviam a autonomia do aluno no processo. A maioria utilizou questionários autorais para avaliar a educação em saúde, exceto na temática alimentação e atividades físicas, em que dados antropométricos foram mais frequentemente utilizados. O assunto é recente, publicado, na maior parte, no exterior. A maioria dos instrumentos de avaliação foram criados pelos próprios autores e os aspectos clínicos majoritariamente investigados nos estudos tratavam sobre as questões alimentares. As estratégias de ensino-aprendizagem mostraram-se mais efetivas quando adolescentes eram o público-alvo.

To identify the most efficient methods for evaluating the effectiveness of teaching materials in Primary Health Care, aimed at school-age youngsters, Scoping Review. Our leading question was: Which are the evaluation methodologies of the teaching-learning process in health education in schools in Primary Health Care used with kids and teenagers (schooling age youngsters)? The search occurred on the National Library of Medicine (PubMed), Cumulative Index to Nursing and Allied Health Literature (CINAHL), Search for an Author Profile (SCOPUS), and Scientific Electronic Library Online (Scielo). Among the 285 studies found, 13 (100%) constituted our sample for answering our leading question. Among the 13 studies analyzed, 9 (69,24%) were published in the past 9 years and 4 (30,76%) between 1991 and 1999. All were in English, and most were on eating and physical habits (30,7%). Concerning the learning-teaching process, the most effective strategies included family and community and/or aimed to develop students' autonomy. Most were based on self-made questionnaires to evaluate health education activities, except for the studies on feeding/nutrition and physical activities, which frequently used anthropometric data. Due to its newness, most of the work on the subject was from abroad. The authors created most of the evaluation methodologies, and nutrition and feeding were the main topics investigat-ed. Teaching-learning strategies were more effective among teenagers.

Educação física escolar e o celular: mover o corpo todo ou somente mexer os dedos? / School physical education and cell phone: moving the entire body or only the fingers?

Este estudo tem como finalidade uma discussão acerca das implicações para a Educação Física (EF) escolar do uso exagerado do aparelho celular na contemporaneidade. O aparelho celular tornou-se uma ferramenta "quase" indispensável na vida das pessoas. Essa dependência do aparelho modifica modos de convivência das pessoas de todas as idades. Como procedimento metodológico desenvolvemos uma pesquisa bibliográfica eminentemente qualitativa tecendo um diálogo com as observações empíricas. Consideramos que o celular se manifesta como algo que pode tencionar com as aulas de EF, que se propõem a valorização à um estilo de vida saudável. Esse tema trata-se de um problema recente para a Educação e para a EF, sendo necessário um enfrentamento de comportamentos relacionados com a vida moderna que atrapalham o ambiente escolar.

This work aims to propose reflections on the implications of habits related to technology, especially the use of cell phones, in Physical Education (PE) classes. The cell phone has become an "almost" indispensable tool in our lives. Depending on the device, it has modified the coexistence and interactions of people of all ages. As our methodological procedure, we developed a mainly qualitative bibliographic research, aiming at a discussion with empirical observations. We considered that the cell phone is an obstacle for PE classes, which are aimed at promoting a healthy lifestyle. This topic is a recent issue for Education and PE, and it is necessary to address behaviors related to the modern life that hinder the school environment.

Fit to Study: Reflections on designing and implementing a large-scale randomized controlled trial in secondary schools.

BACKGROUND: The randomised controlled trial (RCT) design is increasingly common among studies seeking good-quality evidence to advance educational neuroscience, but conducting RCTs in schools is challenging. Fit to Study, one of six such trials funded by the Education Endowment Foundation and Wellcome Trust, tested an intervention to increase vigorous physical activity during PE lessons on maths attainment among pupils aged 12-13. This review of designing and conducting an RCT in 104 schools is intended as a resource on which researchers might draw for future studies. METHOD: We consider intervention design and delivery; recruitment, retention, trial management, data collection and analysis including ethical considerations and working with evaluators. RESULTS: Teacher training, intervention delivery and data collection during large-scale RCTs require a flexible approach appropriate to educational settings, which in turn entails planning and resources. CONCLUSION: Simple interventions, with few outcome measures and minimal missing data, are preferable to more complex designs.

Sensory processing sensitivity and culturally modified resilience education: Differential susceptibility in Japanese adolescents.

This study investigated the efficacy of a culturally modified resilience education program on Japanese adolescents' well-being from a differential susceptibility perspective. First, a culturally modified resilience education intervention was developed by employing the SPARK resilience program and implemented with 407 Japanese high school students in Tokyo (age = 15-16, M = 192, F = 215). To test intervention efficacy, students' level of resilience, self-esteem, self-efficacy, and depression were measured pre-, post-, and three months after intervention. Additionally, sensory processing sensitivity, using the Japanese version of the Highly Sensitive Child Scale for Adolescence, was measured as an index of individual sensitivity. Analysis of variance was used to examine the baseline differences and interaction effects of students' gender and level of sensory processing sensitivity. Latent growth curve models were used to assess the overall effects of the intervention and change over time. Results indicated that the intervention was effective in enhancing students' overall self-efficacy; and that highly sensitive students, who scored significantly lower in well-being than their counterparts at baseline, responded more positively to the intervention, and had a greater reduction in depression and promotion of self-esteem. These findings provided unique evidence in line with the differential susceptibility perspective and useful implications to develop personalized treatment interventions for adolescents in different cultural contexts.

Disparities in the Healthfulness of School Food Environments and the Nutritional Quality of School Lunches.

The Healthy, Hunger-Free Kids Act (HHFKA), a public law in the United States passed in 2010, sought to improve the healthfulness of the school food environment by requiring updated nutrition standards for school meals and competitive foods. Studies conducted since the passage of the HHFKA indicate improvements in the food environment overall, but few studies have examined whether these improvements varied by the socioeconomic and racial/ethnic composition of students in schools. To better understand the extent of disparities in the school food environment after HHFKA, this paper examined differences in the healthfulness of school food environments and the nutritional quality of school lunches by the school poverty level and racial/ethnic composition of students using data from the School Nutrition and Meal Cost Study. Results from chi-square analyses showed lower proportions of high poverty, majority black, and majority Hispanic schools had access to competitive foods, while higher proportions of these schools had a school wellness policy in addition to a district wellness policy. The overall nutritional quality of school lunches, as measured by total Healthy Eating Index (HEI)-2010 scores, did not vary significantly across school types, although some HEI component scores did. From these findings, we concluded that there were disparities in the school food environment based on the socioeconomic and racial/ethnic composition of students in schools, but no significant disparities in the overall nutritional quality of school lunches were found.

Modern diabetes devices in the school setting: Perspectives from school nurses.

OBJECTIVE: To explore the experiences, practices, and attitudes of school nurses related to modern diabetes devices (insulin pumps, continuous glucose monitors, and hybrid-closed loop systems). RESEARCH DESIGN AND METHODS: Semistructured interviews were conducted with 40 public school nurses caring for children in elementary and middle schools. Developed with stakeholder input, the interview questions explored experiences working with devices and communicating with the health care system. Deidentified transcripts were analyzed through an iterative process of coding to identify major themes. RESULTS: School nurses reported a range of educational backgrounds (58% undergraduate, 42% graduate), geographic settings (20% urban, 55% suburban, 25% rural), and years of experience (20% <5 years, 38%, 5-15 years, 42% >15 years). Four major themes emerged: (a) As devices become more common, school nurses must quickly develop new knowledge and skills yet have inconsistent training opportunities; (b) Enthusiasm for devices is tempered by concerns about implementation due to poor planning prior to the school year and potential disruptions by remote monitors; (c) Barriers exist to integrating devices into schools, including school/classroom policies, liability/privacy concerns, and variable staff engagement; and (d) Collaboration between school nurses and providers is limited; better communication may benefit children with diabetes. CONCLUSIONS: Devices are increasingly used by school-aged children. School nurses appreciate device potential but share structural and individual-level challenges. Guiding policy is needed as the technology progressively becomes standard of care. Enhanced training and collaboration with diabetes providers may help to optimize school-based management for children in the modern era.

National Trends in Mental Health Care for US Adolescents.

Importance: The prevalence of adolescent depression and other internalizing mental health problems has increased in recent years, whereas the prevalence of externalizing behaviors has decreased. The association of these changes with the use of mental health services has not been previously examined. Objective: To examine national trends in the care of different mental health problems and in different treatment settings among adolescents. Design, Setting, and Participants: Data for this survey study were drawn from the National Survey on Drug Use and Health, an annual cross-sectional survey of the US general population. This study focused on adolescent participants aged 12 to 17 years interviewed from January 1, 2005, to December 31, 2018. Data were reported as weighted percentages and adjusted odds ratios (aORs) and analyzed from July 20 to December 1, 2019. Main Outcomes and Measures: Time trends in 12-month prevalence of any mental health treatment or counseling in a wide range of settings were examined overall and for different sociodemographic groups, types of mental health problems (internalizing, externalizing, relationship, and school related), and treatment settings (inpatient mental health, outpatient mental health, general medical, and school counseling). Trends in the number of visits and nights in inpatient settings were also examined. Results: A total of 47 090 of the 230 070 adolescents across survey years (19.7%) received mental health care. Of these, 57.5% were female; 31.3%, aged 12 to 13 years; 35.8%, aged 14 to 15 years; and 32.9%, aged 16 to 17 years. The overall prevalence of mental health care did not change appreciably over time. However, mental health care increased among girls (from 22.8% in 2005-2006 to 25.4% in 2017-2018; aOR, 1.11; 95% CI, 1.04-1.19; P = .001), non-Hispanic white adolescents (from 20.4% in 2005-2006 to 22.7% in 2017-2018; aOR, 1.08; 95% CI, 1.03-1.14; P = .004), and those with private insurance (from 19.4% in 2005-2006 to 21.2% in 2017-2018; aOR, 1.11; 95% CI, 1.04-1.18; P = .002). Internalizing problems, including suicidal ideation and depressive symptoms, accounted for an increasing proportion of care (from 48.3% in 2005-2006 to 57.8% in 2017-2018; aOR, 1.52; 95% CI, 1.39-1.66; P < .001), whereas externalizing problems (from 31.9% in 2005-2006 to 23.7% in 2017-2018; aOR, 0.67; 95% CI, 0.62-0.73; P < .001) and relationship problems (from 30.4% in 2005-2006 to 26.9% in 2017-2018; aOR, 0.75; 95% CI, 0.69-0.82; P < .001) accounted for decreasing proportions. During this period, use of outpatient mental health services increased from 58.1% in 2005-2006 to 67.3% in 2017-2018 (aOR, 1.47; 95% CI, 1.35-1.59; P < .001), although use of school counseling decreased from 49.1% in 2005-2006 to 45.4% in 2017-2018 (aOR, 0.86; 95% CI, 0.79-0.93; P < .001). Outpatient mental health visits (eg, private mental health clinicians, from 7.2 in 2005-2006 to 9.0 in 2017-2018; incidence rate ratio, 1.30; 95% CI, 1.23-1.37; P < .001) and overnight stays in inpatient mental health settings (from 4.0 nights in 2005-2006 to 5.4 nights in 2017-2018; incidence rate ratio, 1.18; 95% CI, 1.02-1.37; P = .03) increased. Conclusions and Relevance: This study's findings suggest that the growing number of adolescents who receive care for internalizing mental health problems and the increasing share who receive care in specialty outpatient settings are placing new demands on specialty adolescent mental health treatment resources.

Using Data and Research to Heal the Future.

This invited testimony was given during a Robert Wood Johnson Foundation and Campaign for Action meeting held in New Orleans, LA. The meeting was held in conjunction with the Future of Nursing Town Hall in Chicago that focused on social determinants of health. The focus of the meeting was school health and social determinants of health. The author, serving as Director of Research for NASN, was asked to specifically focus on NASN's efforts related to data and research, as well as social determinants of health.

Does Every Student Count! in Your State? Update on the National School Nurse Dataset.

The NASN launched a new data initiative in 2018 called: The National School Health Data Set: Every Student Counts! The initiative includes three distinct foci or prongs. This article reports on the progress of states participating in Every Student Counts! For more information on NASN's initiative and to learn how school nurses can join the data revolution, go to http://nasn.org/everystudentcounts .

Bring School Nursing Out of the Shadows: Advocacy for the Future of Nursing 2030.

School nursing is part of America's hidden healthcare system. Recently, the Institute of Medicine commissioned the Robert Wood Johnson Foundation and the AARP (formerly the American Association of Retired Persons) to review progress on its Future of Nursing 2010 study. Additionally, the AARP and the Future of Nursing Campaign for Action held town halls that focused on school nursing. This article is a summary of the testimony offered to the Future of Nursing and Campaign for Action leaders about the value that school nursing brings to the health of our nation and the recommendations for action.

Future of Nursing 2020-2030 Philadelphia Town Hall: Lessons Shared From a Relentless School Nurse.

The Robert Wood Johnson Foundation in partnership with the National Academy of Medicine held Town Meeting discussions the summer of 2019 at three sites across the country on the Future of Nursing 2030. Included in the testimony were both invited presentation and public testimony. This article is the transcript of the invited testimony of Robin Cogan, a school nurse who has established a voice for advocacy and the creator of the blog titled The Relentless School Nurse and is one of four presentations featured in this issue of the NASN School Nurse. In her January 2020 letter, NASN's President Laurie Combe discussed the Future of Nursing 2030 and the importance of school nurse advocacy.

Using Youth Risk Behavior Survey Data to Create Change: A Guide for 21st-Century School Nurses.

To meet the diverse and complex needs of school-age children, school nurses must practice student-centered, evidence-based, and quality care. As school nurses look to increase the use of data within their practice, the Youth Risk Behavior Survey (YRBS) is an essential source of information about adolescent behaviors that contribute to leading causes of morbidity and mortality. Results from the YRBS are available at the national, state and, in some cases, school district and county level. In addition to providing an overview of the YRBS survey, this article will guide readers on how to implement the survey, access results, and apply the findings within their student population. The use of these data aids nurses who act as leaders within the school community.

School-based delivery of routinely recommended vaccines and opportunities to check vaccination status at school, a global summary, 2008-2017.

School-based vaccination (SBV) and checking students' vaccination records at school have the potential to optimize vaccination coverage among school-aged children. The primary aim of this paper is to describe adoption of SBV by countries from 2008 to 2017, including target age groups and vaccines delivered in 2017, as reported annually through the World Health Organization (WHO)-United Nations Children's fund (UNICEF) Joint Reporting Form (JRF). Expanding upon previous analyses, country-specific rates of primary school enrollment and home-based record (HBR) ownership were linked to the WHO-UNICEF JRF data, to identify countries with high potential to implement vaccination record checks at school. The proportion of countries reporting delivery of at least one routinely recommended vaccine dose in school settings increased from 95 (of 163 reporting; 58%) in 2008 to 108 (of 181 reporting; 60%) in 2017. The 13 additional countries that reported using SBV in 2017 were among 31 countries for which SBV data from the JRF were unavailable in 2017. The most common antigens delivered through SBV in 2017 were tetanus (94 countries), diphtheria (89 countries), and human papillomavirus (52 countries). Among 93 countries with data available for net primary school enrollment and HBR ownership, 52 (56%) countries had both ≥80% net primary school enrollment and ≥80% of children aged 12-23 months ever owning an HBR; 33 (63%) of these used SBV. If not already doing so, these 33 countries represent an opportunity to introduce routine checking of vaccination status at entry to, or during primary school. With the growing number of new vaccines and booster doses of childhood vaccines targeting school-age children, implementation of SBV and checking of student vaccination records at school may help improve vaccination coverage; however, additional data are needed to assess global prevalence of checking vaccination status at school and to identify factors facilitating optimal implementation of this strategy.

Health and Academic Equity in Schools: Is Nursing Far Enough Up Stream?

When the Robert Wood Johnson Foundation in partnership with the National Academy of Medicine announced the Town Meeting discussions of the Future of Nursing 2030, the president of the National Association of State School Nurse Consultants felt that the voice of School Nursing was crucial to informing the national discussion on health equity and health promotion. Sharonlee Trefry, State School Nurse Consultant, wanted to be sure that the leadership team of the Future of Nursing 2030 heard about the needs of the nation's 56.6 million elementary and secondary public and independent school students. Serving in an even greater role today with regard to promoting equity in healthcare and educational access, school nurses recognize and address social determinants of health every day all day working to grow the next generation of healthy citizens.

Creación del distintivo Soludable / Creation of the "Soludable" Sun Protection Accreditation Program

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