School-based Wellness Research Articles

Nutrition and physical activity in schools in Pacific Island Countries

The increasing rates of obesity among children and adolescents are significant issues worldwide and in the Pacific Island Nations(1). An energy imbalance between calorie intake and expenditure is linked to overweight and obesity for children and adolescents. Epidemiological, nutritional, and technological changes are linked to altered eating habits, including an increase in energy consumption. Conversely, technological advancements and market globalization are responsible for declines in physical activity (PA)(2). During COVID-19 outbreak a more sedentary lifestyle than before the outbreak has been adopted by children and adolescents as a result of lockdown measures, which include shutting of schools, restrictive travel outside the home, and limiting social interactions has made the issue worse(3). Studies have shown that 40% to 70 % of obese children become obese adults(4). Since children spend a large portion of their day in school and eat their main meals there, school settings are suitable for interventions aimed at preventing childhood obesity. Additionally, school environments will reduce the number of dropouts brought on by problems with accessibility or transit(5). The selection of primary school children is important for interventions as the dietary and physical activity habits acquired at this age are ingrained in children and continue into adulthood. So, it is important to have a robust nutrition and physical activity curriculum in all the primary schools. There are many challenges faced by the governments in implementing such curriculum which includes lack of trained in country staff, limited infrastructures in schools for physical activity, culturally relevant information which can be easily understood by local populations, proper monitoring, and evaluation of the existing guidelines. Community engagement and partnership with local health ministries and departments are crucial for the success of these curriculum (6). To fill this gap robust evidence on effectiveness and implementation of school-based wellness intervention programs in primary schools are in dire needs in Pacific Island nations. Given this, the project titled “Healthy Child Promising Future-Promoting health in primary school settings was conducted in all schools in Wallis & Futuna and piloted in one urban school in Fiji. A knowledge, attitude, practice (KAP) questionnaire was used to evaluate the effectiveness of the intervention which was conducted for all the children (7-9 years) and their care takers. Intervention was conducted on 15 pre identified themes by face-to-face sessions every week and 30 minutes physical activity session was conducted every day in all the schools for children. For caretakers intervention was conducted around 5 themes. In both the countries the intervention had shown significant improvement in KAP scores both for caretakers and children related to the healthy diet consumption and promotion of physical activity. The results indicate that the developed intervention package had a positive impact on KAP.

The Commit to Be Fit framework: a community case study of a multi-level, holistic school-based wellness initiative in rural Virginia.

Public health interventions that target children's physical, mental, and emotional health will enhance their ability to learn and grow. Although more complex, school initiatives that address multiple ecological levels and take a holistic view may be more effective and likely to lead to lasting change. This article presents the framework of Commit to Be Fit (C2BF) as an example of how schools can integrate multi-level and holistic approaches for health. This innovative school-based intervention includes activities addressing individual, home, school, and community to create a culture of wellness. We describe the implementation of C2BF and its basis in ecological models and give examples of activities across three components: cafeteria, classroom, and community. We discuss challenges and note that leadership engagement and alignment were critical elements for C2BF's success thus far. C2BF uses a school-based multi-level approach to creating a culture of wellness and holistic health for students, teachers, and community members. C2BF is unique compared to other school-based programming and includes activities that address all eight domains posited for program sustainability within public health. Built to be flexible and adaptive, C2BF was able to successfully pivot during the COVID pandemic and also follow new science. C2BF and other multi-level holistic approaches are more likely to achieve long-term change by utilizing strategies across the multiple levels of the ecological model to improve health and wellbeing.

Editorial introductions.

Editorial introductions.

Participation in a School-Based Wellness Initiative Associated With Improved K-12 Student Body Mass Index Trends.

Associations between school participation in an academic medical center-supported school-based wellness initiative and programmatic components implemented with change in average student body mass index (BMI) over time were examined. This was an observational study of 103 K-12 South Carolina schools over school years 2014-2018, classified as participating (n=87 schools, 27,855 students) or non-participating (n=16 schools; 3608 students). Associations between students' BMI z-score (BMIz) and school participation were evaluated by linear multilevel mixed-effects modeling using data from FitnessGram and the School Wellness Checklist© (SWC), respectively. One-third of the students had a BMI percentile ≥85. Average student BMIz decreased in participating schools (p=.026) and increased in non-participating schools (p=.004) over time. For schools that participated two or more years, there was an inverse relationship between SWC score and student BMIz (p=.002) that did not differ by school type, rural/urban location, Title 1 status, or student sex. Physical activity and stress management interventions for students, as well as employee wellness and establishing a wellness committee at the school level were significantly associated with decreased average student BMIz (all p < .05). Implementation of similar comprehensive school-based wellness programs focused on improving physical activity, stress management, and employee engagement may help prevent and reduce pediatric obesity in diverse communities.

Walking in two worlds with type 2 diabetes: a scoping review of prevention and management practices incorporating traditional indigenous approaches

ABSTRACT Type 2 diabetes is a complex chronic disease rapidly increasing among young people and disproportionately impacting Indigenous youth. Treatment programs are often inadequate for this population as they lack cultural relevance. A scoping review was conducted to explore traditional Indigenous approaches for diabetes prevention and management, to inform a program aimed at supporting Indigenous youth and families with type 2 diabetes. We seek to answer the following question: “Which traditional medicines and practices have been incorporated into intervention or prevention strategies for Indigenous people living with diabetes?” Search was done June 2021 using Ovid Medline, ESBCO and ProQuest databases. Terms included wellbeing, intervention, diabetes, and traditional approaches. Of the 2138 titles screened, 34 met inclusion criteria. Three studies integrated traditional Indigenous approaches into Western-based intervention programming. Content included traditional food and nutrition programs, gardening programs, Elder knowledge sharing, story telling, talking circles, feasting, prayer, traditional dancing, hunting, and school-based wellness curricula. Many were wholistic, co-created with community, Indigenous-led and held in accessible community spaces. The heterogeneity in approaches reflects the diversity of Indigenous nations and communities. This review identifies important elements to include in culturally relevant programs to address diabetes-related wellness.

Addressing Adolescent Stress in School: Perceptions of a High School Wellness Center.

Adolescents are often burdened with academic, home, and peer stressors. With adolescent mental health issues and suicide on the rise, administrators have worked with nonprofit organizations and the community to address stress and internalized behavior problems. School-based wellness centers are tranquil rooms with various sensory activities, calming nature scenes, and sounds for relaxation purposes. School-based wellness centers may have behavioral effects by reducing exposure to aversive events and increasing access to positive and negative reinforcers. There has not yet been a formal study of school-based wellness centers published in the literature. In the present study, we used questionnaires to examine the perceptions of 752 students, 124 parents, and 69 school staff of their high school wellness center. Results indicated that stakeholders had positive perceptions of the wellness center. In particular, results implied that stakeholders believed the wellness center contributed to students’ academic success, elevation of mood, confidence, and coping skills. Results also suggested that attendance at the wellness center was associated with a decrease in student stress and anxiety, though recommendations for improvements were noted. Implications and limitations of this study are discussed.Supplementary InformationThe online version contains supplementary material available at 10.1007/s43494-022-00079-1.

From Self-Doubt to Pride: Understanding the Empowering Effects of Delivering School-Based Wellness Programmes for Emerging Adult Facilitators-A Qualitative Study.

Ample literature exists on the impact of prevention programmes on their target audience, while much less is known about how delivering such programmes influences their facilitators. Even less literature exists on the emotional and social processes that form this potential impact on facilitators. The current study analysed qualitative in-depth, non-structured interviews, as well as written essays provided by 33 student-facilitators who delivered the “Favoring Myself” programme in Israel during 2019–2021. This school-based wellness programme comprised 10 weekly, 90 min sessions on self-care behaviours, media literacy, self-esteem, and positive body image, which are well-known protective factors against risky behaviours. A thematic analysis was applied to explore the main themes in the collected data. An interesting affective transformation from self-doubt to pride in themselves emerged as a shared experience of these young facilitators. Facilitators related their ability to facilitate the programme, as well as to undergo an individual maturation and empowerment experience, to certain components of the programme itself, such as the preparatory course, individual supervision, and the peer-group experience. This shift from doubt to pride is discussed using two frameworks—a theoretical discourse of emerging adulthood as a developmental stage, and the self-determination theory.

Environmental Constructs Associated with School Readiness to Implement Wellness Initiatives

Objective: In this study, we examined school and environmental factors associated with readiness to implement school-based wellness initiatives. Methods: We used an exploratory mixed methods design to assess facilitators and barriers to school wellness policy implementation. We conducted school site visits in 8 K-12 schools in one midwestern school district. We collected quantitative and qualitative data to measure school wellness environments and readiness for change. We used a one-way ANOVA to examine associations between readiness for change and school wellness environments. We analyzed qualitative data inductively; school- and district-level themes emerged. Results: One-way ANOVA results revealed schools in the high readiness (HR) group reported more active school wellness teams than those in the low readiness (LR) group (F(1,6) = 8.442, p = .03). Qualitative data indicated that establishing local school wellness committees was an area of growth needed for all schools. Areas of need in HR schools included enhancing school wellness policy communication, leadership, and staff wellness initiatives. Areas of need in LR schools focused on providing more physical activity and wellness opportunities for students. Conclusion: Readiness for change is a promising metric that could associate with more physical activity opportunities, better wellness team function, and perhaps, wellness policy implementation.

Non-Cooperation within a School-Based Wellness Program during the COVID-19 Pandemic-A Qualitative Research.

This paper presents a qualitative analysis of COVID-19′s impact on the development, delivery, and uptake of “Favoring Myself”, a school-based interactive wellness program conducted via Zoom during 2020–2021. “Favoring Myself” targets resilience, self-esteem, body-esteem, self-care behaviors, and media literacy among 5th-grade preadolescents. Data were obtained from meetings, 23 semi-structured interviews with parents, teachers, and principals, and other modes of correspondence. All data were transcribed and thematically analyzed. The analysis highlighted the barriers faced when delivering external programs during COVID-19. Parents’ difficulties in cooperating with the program, distrustful relationships between parents and the education system, as well as teachers’ overload and stress, were identified as barriers to the external program’s sustainability. These challenges are discussed in light of previous studies of school-based programs, the psychological and social contexts of an ongoing crisis and the impact of neoliberalism on education. This study concludes that school-based prevention programs and accompanying research should be more flexible and focus on understanding and relating to parents’ and schools’ fears, uncertainties, and resistance. It is the hope of the authors that knowledge created through this exploration will be helpful in future coping vis-à-vis prevention program teams and recipients in times of unpredictable, unmanageable, and overpowering crises.

Health Promotion and Wellness for All Students: School-Based Occupational Therapy as a Preventive Approach.

The coronavirus disease 2019 pandemic accelerated the impending youth mental health crisis in the United States, necessitating a comprehensive approach to providing mental health education and interventions. School-based occupational therapy practitioners' scope of practice includes wellness promotion, early detection, and evidence-based interventions for mental health challenges. Given the rise of school-based wellness programs, the growing legislation supporting the formation of such programs, and the burgeoning burden of pediatric mental health concerns, occupational therapy practitioners are uniquely positioned to create and implement interventions to support student access to the general education curriculum and can do so by using both prepandemic funding sources and pandemic response funds. This Health Policy Perspectives column is a call to action to refocus the occupational therapy practitioner's role in school settings to include providing high-quality, evidence-based preventive mental health education and interventions. In this column, we examine prevention-based occupational therapy services in Mason City Schools, Mason, Ohio, as a model of success in the execution of this vision for school-based practice. In addition, we outline the importance of expanding the role of occupational therapy practitioners in schools, which will in turn increase the visibility and relevancy of the profession and broaden its impact on mitigating the youth mental health crisis.

Feasibility and effect of adding a concurrent parental component to a school-based wellness program using two modes of mobile-based technology \u2013 mixed methods evaluation of RCT

BackgroundThis study assessed the feasibility and effect of two mobile modes (WhatsApp vs. a specially designed app) in their delivery of updates and assignments to parents.MethodsTwo three-armed, randomized, controlled feasibility studies were conducted. In each trial, four schools with a total of 418 students in grade 5th, mean age 10.1 years, were randomly allocated to the control arm, youth-only arm, or youth & parental component arm. Only the data of those that completed all three assessments (pre, post and 3 months post program) were analyzed: 133 in the first trial and 137 in the second.In the youth-only arm, students participated in an interactive age-tailored prevention program delivered in 10 weekly, 90-min sessions on self-care behaviors, media literacy, self-esteem, and positive body image. The control groups in both studies received three health- and nutrition-related sessions.In the parental arm, in addition to the ‘Favoring-Myself–Young’s ten sessions program, parents received updates and were requested to complete shared assignments with their children. In the first year, the assignments were sent via WhatsApp, and in the following year via “Favoring Myself” smartphone application.Facilitators were third year undergraduate students. They used a detailed semi-structured guide and received 4-weekly hours of didactic and group dynamic supervision. Mixed-methods assessments were performed using semi-structured interviews with ten parents and five school staff members each year, as well as a computerized self-report questionnaire.ResultsFeasibility of parent-adolescent shared assignments in both digital modes was lower than expected. The use of WhatsApp had higher feasibility and uptake than the use of the special application.The addition of the concurrent parental component via WhatsApp was associated with superior improvement in self-esteem and identification of advertisement strategies, compared with the youth-only program. However, adolescents in the youth-only program delivered via the smartphone application demonstrated superior improvement compared to those in the youth and parental component arm.ConclusionsAlthough the addition of the concurrent parenting component was praised by the actively participating parents, overall, under the chosen structure and population, it did not prove to add statistically significant value to the youth-only arm.Trial registrationsNCT03216018 (12.7.2017) and NCT03540277 (26.4.2018).

Assessing the Effects of a Statewide Training Initiative on Local School Wellness Policies.

Local district wellness policies are designed to ensure that schools support student health by providing a healthy nutrition environment and opportunities for physical activity. The Kansas State Department of Education (KSDE) developed a 5-year initiative to strengthen wellness policies across their state by offering regional wellness workshops and providing coaches to work with individual districts. KSDE also developed the Wellness Impact Tool (WIT), a self-report measure districts use to document their practices at each school level related to Nutrition, Nutrition Promotion, Physical Activity, and Integrated School-Based Wellness. Kansas districts (N = 286) completed the WIT annually over a 5-year period. The current study evaluates the KSDE wellness initiative by examining the changes in WIT scores over time and by school level, and testing whether greater engagement with wellness supports (i.e., workshops attended and coaching sessions received) predicts higher WIT scores. The findings indicate that district WIT scores increased over the 5-year initiative. Overall, high schools scored higher than elementary or middle schools on Nutrition items, and elementary schools scored higher than other school levels in the domains of Nutrition Promotion, Physical Activity, and Integrated School-Based Wellness. The number of wellness supports utilized by districts each year were significant predictors of subsequent WIT scores. The KSDE's initiative to support Kansas school districts was associated with significant improvements in the quality of wellness practices across the state and provides a model for consideration by other states.

Impact of an Elementary School-Based Wellness Initiative on Child Obesity Prevalence: LiveWell Kids.

Despite major public health investments over the past several decades, little progress has been made in reducing the prevalence of obesity among school-aged children in the United States. In 2007, the Redondo Beach Unified School District (RBUSD) and the Beach Cities Health District launched a wellness initiative, LiveWell Kids, that included multi-level interventions to improve nutrition and increase physical activity. The initiative also included annual measurements of height and weight among all kindergartners and first, third, and fifth graders in the eight elementary schools in the RBUSD. To assess trends in obesity prevalence, we analyzed height and weight data collected during the 2008 to 2009 to 2018 to 2019 school years. To more fully assess the impact of the initiative, we conducted a least-squares regression difference-in-differences analysis of data from the California Physical Fitness Testing Program on measured height and weight among fifth graders from the RBUSD, three neighboring school districts, and Los Angeles County overall. Among elementary school students in the RBUSD, obesity prevalence decreased from 13.9% in 2008 to 2009 to 6.4% in 2018 to 2019. Significant declines in prevalence were observed in all eight elementary schools, and across all grade levels and demographic groups. Among fifth graders, a similar decline in obesity prevalence was not observed in the other school districts or the county overall. The findings suggest that interventions that adhere to the socio-ecologic model and engage students, parents, and school personnel at all levels while also addressing school and community environments may reduce obesity prevalence among elementary school-aged children.

High Technology Use at Bedtime Doubles Risk for Sleep Insufficiency

Source: Stine F, Collier DN, Fang X, et al. Impact of body mass index, socioeconomic status, and bedtime technology use on sleep duration in adolescents [published online ahead of print September 25, 2021). Clin Pediatr (Phila). doi:10.1177/00099228211047791Investigators from East Carolina University, Greenville, NC, conducted a cross-sectional study to evaluate the association of use of technology prior to going to bed and insufficient sleep. Study participants were children enrolled in the seventh grade in the fall of 2017 at 1 of 47 schools in 10 counties in North Carolina who were participating a school-based wellness program. Data were analyzed on those children in the program who had height and weight measured for BMI determination and who completed a questionnaire on sleep and technology use. Participant sex and race data also were collected. Socioeconomic status was approximated for each participant by school-level participation in the National School Lunch Program (NSLP), with higher percentages of participation indicative of lower SES. The primary study outcome was insufficient sleep, defined as a self-report of sleeping <8 hours/night. The main exposure of interest was high technology use (TU), which was based on a student reporting use of a form of technology within 1 hour of trying to go to sleep either “a few nights each week,” or “every night or almost every night.” The bivariate association between insufficient sleep and self-report of having a TV in the bedroom, being overweight (BMI ≥85th and <95th percentile for age) or obese (BMI >95th percentile for age), sex, race, and SES also were evaluated using chi-square tests. Logistic regression was used to determine the independent association of these variables and insufficient sleep.Data were analyzed on 3,956 seventh graders, of whom 38.7% reported getting insufficient sleep (<8 hours/night), 83.1% reported high TU, and 72.9% reported having a TV in their bedroom. There were no significant differences in reporting insufficient sleep by sex (P = 0.116), or race (P = 0.160), and these characteristics were not included in the multivariate model. In the multivariate logistic model, high TU was an independent predictor of insufficient sleep (OR, 0.53; 95% CI, 0.46, 0.61), indicating that the risk of sleep <8 hours/night was almost twice as high in those with high TU. Having a TV in the bedroom (OR, 0.82; 95% CI, 0.70, 0.95) and being obese (OR, 0.82; 95% CI, 0.70, 0.95) also were significantly associated with sleeping <8 hours/night. There was no significant association between being overweight and insufficient sleep (OR, 0.85; 95% CI, 0.71, 1.01), but children in schools with higher participation in the NSLP were at significantly increased risk for reporting <8 hour/night of sleep.The authors conclude that seventh graders reporting high bedtime TU were at increased risk for insufficient sleep.Dr Candee has disclosed no financial relationship relevant to this commentary. This commentary does not contain a discussion of an unapproved/investigative use of a commercial product/device.Adolescent sleep deprivation is a growing health problem with profound consequences, including depressed mood, cognitive impairment, behavioral dysregulation, and poor school performance.1 This problem is in large part related to the availability and use of electronic devices at bedtime.2The investigators of the current study found that more than a third of nearly 4,000 seventh graders in rural North Carolina were not getting sufficient sleep. Those with high TU within 1 hour of trying to go to sleep were nearly twice as likely (as those with lower TU) to be getting <8 hours of sleep per night. Having a TV in the bedroom, obesity, and lower SES also were associated with a higher likelihood of sleep insufficiency. The study results fortify those of previous studies showing that portable devices have more deleterious effects on sleep than those that are not (eg, a TV).3The investigators’ findings are strengthened by the large sample size. Potential weaknesses include the use of the national school lunch program as a surrogate for the SES level of the entire school (rather than tracking by individual participants), the use of self-reported health data, and the use of a single question to capture sleep duration despite adolescent propensity for weekend catch-up sleep. The results of another recently published study showed that greater electronic device use at bedtime was not only associated with delayed sleep onset and decreased sleep duration but also with overall sleep disturbance symptom severity.4If seventh graders in rural North Carolina aren’t getting enough sleep, it stands to argue that older adolescents attending high school in more urban settings with increased access to phones/technology are likely not getting enough sleep either. More counseling on the importance of sleep hygiene and the impact of electronic device use upon sleep is needed in order to help adolescents and their families prioritize and protect sleep duration.High bedtime technology use in adolescents is a significant risk factor for insufficient sleep and is a modifiable behavior.

Impact of Body Mass Index, Socioeconomic Status, and Bedtime Technology Use on Sleep Duration in Adolescents.

Factors related to adolescents and sleep are understudied. We evaluate the relationship between bedtime technology use (TU), TV in bedroom, weight, and socioeconomic status in seventh graders (N = 3956) enrolled in a school-based wellness intervention. Sleep quantity was dichotomized to insufficient (<8 hours) or sufficient (≥8 hours); high TU before sleep was defined by use “a few nights each week” or “every, or almost every night.” Insufficient sleep (38.7%), having TV in bedroom (72.9%), and high TU (83.1%) were commonly reported. The likelihood of sufficient sleep was lower for those with high TU (odds ratio [OR] = 0.529 [0.463-0.605]), obese students (OR = 0.815 [0.700-0.949]), and those with a TV in the bedroom (OR = 0.817 [0.703-0.950]). Also, attending a school with higher percent low socioeconomic status students was also associated with insufficient sleep (P = .026). Interventions to reduce TU may be important for improving sleep quantity, especially for some vulnerable populations.

Analysis of Concordance Between Parent Proxy and Child Self-report of KIDSCREEN-10 Health-related Quality of Life Questionnaire in an Elementary School-based Wellness Program: A Pilot Focus Group Study

Background: Researchers have previously commenced examining the degree of concordance between parent proxy and child self-reports on health-related quality of life (HRQOL) of many disease and impairment populations. Objects: To explore the differences between parent proxy and child self-reports on the HRQOL using Korean version of KIDSCREEN-10 questionnaires for applying to elementary school children and their parents who participated for a school-based wellness program. Methods: The focus groups were recruited for a school-based wellness program by implementing the following wellness services: 1) referring to a screening session for detecting potential posture-related musculoskeletal problems and 2) recommending home exercise programs. Before a primary field testing for the program, two focus groups were formed with a group of 9 parents and their 9 elementary school children aged 8-10 years of age. The parent proxy and child self-report versions of KIDSCREEN-10 questionnaires were administered to both groups after completion of the wellness program. Item level Rasch rating scale analysis was applied to compute logit scales of KIDSCREEN-10 questionnaire. Intraclass correlation coefficients (ICCs) and scatterplot of item difficulty between two reports were analyzed. Results: For fit statistics of parent proxy report, all items except 4 items (i.e., psychological well-being, mood/emotions, self-perception, parent relation) were found to be acceptable. For fit statistics of child self-report, all items except 3 items (i.e., psychological well-being, autonomy and home life) were acceptable. The relationship between two reports using ICCs were ranging from weak to very strong at p = 0.05 (i.e, ICCs = 0.011 to 0.905). Scatterplot analysis between two reports showed a major disparity on self-perception item at 95% confidence intervals. Conclusion: Both item level analyses and ICC comparisons provided a disparity between parent proxy and child self-reports of the HRQOL on self-perception item after competing a school-based wellness program. Therapist should consider the item as part of the HRQOL assessment.

Physiological and Lifestyle Factors Associated With Abnormal Blood Pressure in Adolescents Before and After a School-Based Wellness Program in Michigan: A Report From Project Healthy Schools

PurposeHypertension (HTN) is associated with increased cardiovascular risk and unhealthy lifestyles in adults. However, data on both physiological and lifestyle factors associated with abnormal blood pressure (BP) in adolescents, as well as the effectiveness of interventions in improving these factors among adolescents with abnormal BP, is scarce. MethodsStudents enrolled in a middle-school-based wellness program, Project Healthy Schools (PHS), between 2005–2016 were eligible. Three systolic (SBP) and diastolic (DBP) BP measurements were taken pre-PHS and post-PHS; averages of the final two were analyzed. Students were grouped by baseline BP: abnormal BP (≥90th percentile for SBP and/or DBP, or ≥120/80 mmHg) or normal BP (<90th percentile for SBP and/or DBP, or <120/80 mmHg). Demographics, physiologic measures, and health behaviors were compared between groups pre- and post-PHS. ResultsOf 2,865 students, 812 (28.3%) had abnormal BP. Median SBP was 119 mmHg in abnormal BP students and 103 mmHg in normal BP students (p < .001). Females were less likely to have abnormal BP than males (48.4% vs. 51.6%, p < .01). Pre-PHS, abnormal BP students were more likely to be overweight (62.3% vs. 28.2%, p < .001) or obese (38.9% vs. 11.3%, p < .001) than normal BP students. Their total cholesterol, triglycerides, random glucose, resting, and recovery heart rates were also higher, and they had worse dietary and sedentary habits. Post-PHS, abnormal BP students demonstrated greater reduction in SBP (−4.0 vs. 2.8 mmHg, p < .001) and DBP (–3.3 vs. .8 mmHg, p < .001) than normal BP students. ConclusionsAbnormal BP was prevalent and associated with worse cardiometabolic health parameters and behaviors at baseline. Abnormal BP students demonstrated significant improvements in BP post-PHS, suggesting school-based programs may be effective as nonpharmacological lifestyle interventions in this population.

Abstract 228: Comparison of the Effect of Local and Long-Distance Delivery Models for a School-Based Wellness Intervention on Health Behaviors of Middle School Students

Background: Michigan’s upper peninsula (UP) is a remote area with only 3% of the state’s population, making it difficult to reach with health interventions. Nearly half of the UP counties have higher adult obesity rates than the state average. The Project Healthy Schools (PHS) middle school-based wellness program uses local and long-distance delivery models in Michigan’s lower peninsula (LP) and UP, respectively. Schools utilizing the local model (LP schools) have routine staff visits to assist in program implementation; conversely, long-distance model schools (UP) rely on telecommunication with PHS staff to implement the program. This study sought to determine if differences exist in health behaviors of LP and UP students at baseline, as well as post-PHS intervention to determine the effectiveness of the local and long-distance PHS delivery models. Methods: Data from 6 th grade students enrolled in PHS between 2014-2017 were analyzed. Students were divided into two groups, UP and LP students. Demographics and health behaviors at baseline and post-intervention were compared between groups. Results: Of 21,459 students, 695 (3.2%) were from the UP. Compared to LP students, UP students were more likely to be White and from lower and middle socioeconomic status communities. Pre-PHS intervention, UP students ate more fruits, vegetables, and chocolate candy, engaged in more moderate exercise, and spent less time on TV, computers, video games, and mobile devices than LP students. No significant differences in post-intervention impact on health behaviors were seen between UP and LP students. Conclusions: At baseline, UP students reported better health behaviors than LP students. However, the lack of differences in post-intervention impact suggest the local and long-distance delivery models were equally effective in influencing health behaviors. Future investigation of the effect of school-based interventions in remote communities, like the UP, are warranted.

Abstract 261: Gender-Specific Differences in Behavioral and Physiological Risk Factors Associated with Childhood Obesity

Background: Prior research has shown differences in physiologic and behavioral measurements of adolescent boys and girls. This study sought to determine if similar gender-specific differences exist between participants of the Project Healthy Schools (PHS) school-based wellness program, both at baseline and post-PHS intervention. Methods: Demographics, physiological measures and health behaviors were compared between 6 th grade girls and boys enrolled in PHS between 2004-2017 at baseline and post-PHS intervention. Results: Health behavior data were collected in 19,995 students (46.1% girls); physiological measures were collected in 2,922 students (52.7% girls). Boys within the physiological sample were older than girls (11.62 v. 11.55, p&lt;0.001). At baseline, girls had lower HDL cholesterol and higher resting and recovery heart rates, but reported greater consumption of fruits and vegetables and less sugary beverages and fried meats than boys. Boys reported more vigorous exercise but greater hours of television and video game screen time than girls. Post-intervention, girls showed greater improvement in resting heart rate, fruit consumption and video game time. Conclusion: Girls had better health behaviors but poorer physiological markers at baseline. Lower rates of physical activity in girls at baseline highlight a potential area of focus for the PHS intervention in this population. Future exploration of gender-specific targeted strategies to improve health behaviors is warranted.

10. Psychosocial Effects of Homonegative Verbal Interaction Among High School Students In Canada

Homonegative verbal comments, i.e., degrading or stigmatizing comments in reference to sexual orientation, whether they are direct or overheard, can have negative effects on youth. However, less is known about the association between the source (friends and non-friends) of homonegative comments and psychosocial well-being. Canada has adopted clear laws against discrimination based on gender and sexual orientation, and schools have established practices and policies to protect and empower sexual minority youth. In an increasingly inclusive context like Canada, this investigation examined the effect of the sources of hearing and overhearing comments on psychosocial well-being. Further, participants’ gender identity and sexual minority status were tested as moderators of the links between homonegative comments and psychosocial well-being. Data were obtained from a cohort of students in the second year of a four-year school-based Wellness Initiative in urban western Canada (N=1371; 51% male, mean age = 15.26 years, SD 1.5). Students were in grades 8 to 12, and 21% identified as a sexual minority (including mostly heterosexual as members of the sexual minority group). The survey was administered during regular school hours on individual tablets running survey software. Self-reported measures included the Homophobic Content Agent Target (HCAT) Scale, Mattering to Others Questionnaire (MTOQ), Modified Depression Scale (MDS) and Perceived Safety at School Scale. Analyses included chi-square to compare prevalence of overhearing and being targets of homonegative comments by gender and orientation, and by source of the comments (none, friends, others and both). 2 X 4 ANOVAS for gender by source of comments, and for orientation by source, were used to test associations between exposure to homonegative comments and mattering to others, depressive symptoms, and perceived safety. Homonegative comments were pervasive: only one third (34%) reported no homonegative comments, 13% overheard only friends, another 13% overheard only others, and 37% overheard homonegative comments by both; being directly targeted was somewhat less common, with 53% reporting no comments, 12% targeted by friends, 8% by others, and 24% targeted for comments by both friends and others. Boys reported overhearing [χ2(3)=54.76, p<.001] and being targeted [χ2(3)=161.24, p<.001] for homonegative comments more than girls, and sexual minority boys and girls were more likely to overhear homonegative comments than non-sexual minorities. ANOVAs showed regardless of orientation, youth who were both targeted and overhead homonegative comments were less likely to perceive themselves as mattering to friends, and had higher scores on depressive symptoms than youth who never heard or were targeted by comments. Gender moderated the association between comments and mattering to friends with boys affected more than girls. Students’ sense of safety at school was positively associated with the absence of homonegative speech or only hearing it from friends, rather than others. In Canada, despite efforts towards reducing discrimination and fostering inclusion for sexual minority and gender diverse youth, homonegative speech is still present in schools, and sexual minority and heterosexual youth alike continue to experience its negative effects on their sense of safety, mattering to others, and mental wellbeing.