School Health Research Articles

Gender stereotypes in the physical education textbook

Gender stereotypes in media, including books, can play an important role in the process of gender identity construction. The purpose of this study is to analyze gender representation in Elementary School Physical Education, Sports and Health textbooks. The analysis was conducted by tabulating images and looking at the appearance of gender characters in the text in the elementary physical education books from grade one to grade six. Visibility and Firstness refer to the number of times a male or female character appears first in an exercise. Gender stereotypes (such as female characters doing rope games, male characters playing big ball games) were counted. Based on this data, it can be seen that in classes 1,2,4,5 and 6 there are more male images than female, only in class 3 there are more female images than male. Furthermore, the results of Gender Stereotyping data show that males are more dominant in Floor Gymnastics, Water Sports, Physical Fitness Activities, Invasion Games, Net Games, Maintenance of Reproductive Hygiene, Pencak Silat Martial Arts, and Athletics. In contrast gymnastics materials and Rhythmic Gymnastics Activities are dominated by women. Such stereotypes are considered as one of the ways in which gender identity is influenced and constructed. They can limit individuals' choices in relation to their roles, interests and aspirations, as individuals tend to conform to what is perceived as the gender norm in society.

Coverage with Selected Vaccines and Exemption Rates Among Children in Kindergarten - United States, 2023-24 School Year.

In the United States, states and local jurisdictions set vaccination requirements for school attendance, conditions and procedures for exemptions from these requirements, grace periods for submitting documentation, and provisional enrollment for students who need more time to be vaccinated. States annually report data to CDC on the number of children in kindergarten who meet, are exempt from, or are in the process of meeting requirements. Data reported by 49 states and the District of Columbia (DC) for the 2023-24 school year were used for national- and state-level estimates of the following measures: complete vaccination with required doses of measles, mumps, and rubella vaccine (MMR), diphtheria, tetanus, and acellular pertussis vaccine (DTaP), poliovirus vaccine (polio), and varicella vaccine (VAR); exemptions from vaccination; and school attendance while meeting requirements. The 2023-24 kindergarten class became age-eligible to complete most state-required vaccinations during the COVID-19 pandemic, after schools had returned to routine in-person learning. Compared with approximated national coverage levels across all reported vaccines for the 2019-20 (95%) and 2022-23 (93%) school years, coverage dropped below 93% for the 2023-24 school year, ranging from 92.3% for DTaP to 92.7% for MMR. Exemptions increased to 3.3%, compared with those during the 2022-23 (3.0%) and 2021-22 school years (2.6%). Coverage with MMR, DTaP, polio, and VAR decreased in 35, 32, 33, and 36 jurisdictions, respectively, compared with the 2022-23 school year. Exemptions increased in 41 jurisdictions, with 14 reporting that >5% of kindergartners had an exemption from one or more vaccine. Efforts by health departments, schools, and providers are needed to ensure that students begin school fully vaccinated.

Teachers' and Principals' Familiarity with School Wellness Policy: A Health Promoting Schools Assessment.

The current study explored teacher and principal familiarity with school wellness polices in primary schools, including who serves on school wellness committees, and who should implement and enforce wellness policies in the school. An electronic survey guided by the Health Promoting Schools framework was administered from February to May 2020 to teachers and principals from one urban and one suburban school district in the Midwestern United States. There were 450 participants; response rates were 28% (urban), 33% (suburban), and 51% (school principals). Only 41.7% of the aggregate participant pool were familiar with their wellness policy. Participants were more familiar in the suburban compared to the urban district (χ2 = 68.2, p-value ≤ 0.001). Teachers/health teachers, nurses, and principals were most likely to be on wellness committees, and the most preferred wellness champions were teachers, nurses, and food service staff. Teachers and nurses are integral to school wellness and health education as part of multiple systems that can promote school health. The Health Promoting Schools framework is useful for guiding examinations to improve understanding of school wellness within school communities.

Affect heuristics and peer effect on substance use among adolescents in Brazil

Significant changes are observed during adolescence with respect to health-related habits and risky behaviors. Among the behavioral changes, the consumption of substances such as alcoholic beverages, cigarettes, and illicit drugs, and social interactions are relevant factors for the intake of such substances. This study aims to analyze the relationship between the joint decisions of substance use by adolescents and their peers from the perspective of the affect heuristics. To this end, a multivariate probit model was estimated, based on microdata from the 2019 National School Health Survey. The results showed that substance use by adolescents was positively related to substance use by their peers; therefore, having friends who consume alcohol, illicit drugs, and cigarettes or having parents who consume alcohol or cigarettes increases the likelihood of an adolescent consuming these substances. The study also identified that the substance consumption decision was governed by an unobserved common factor compatible with the affect heuristic.

Incidence of Smartphone Addiction, Poor Sleep Quality and Daytime Sleepiness on Academic Performance of High School Students in Marrakech

Excessive use of smartphones has been associated with both poor sleep quality as well as daytime sleepiness. In the educational context, it is established that these factors often have an impact on the academic performance of students. This cross-sectional study is conducted to assess the impact of sleep quality in relation to the use of smartphones on academic performance among Moroccan high school students in the city of Marrakech. It involves 570 students of both sexes, aged 17 to 20 years. Participants answered a self-administered questionnaire assessing Smartphone Addiction (SA), Sleep Quality (SQ), and excessive Daytime Sleepiness (DS). The results show that smartphone addiction is positively correlated with poor sleep quality (r = 0.445; p = 0.000) and daytime sleepiness (r = 0.482; p = 0.000). In the same vein, academic performance is negatively correlated with smartphone addiction (r = -.144; p < 0.05), poor sleep quality (r = -0.074, p > 0.05), and daytime sleepiness (r = -0.073, p > 0.05). Smartphone addiction has proven to have a negative impact on sleep quality, daytime sleepiness, and academic performance of high school students. These results call on parents and school health officials to implement awareness campaigns aimed at promoting rational and moderate use of screens and healthy sleep among high school students.

Experiences and Impact of Domestic Violence on Children: A Qualitative Study in the City of Tshwane, South Africa

South Africa has a high prevalence of domestic violence, and its impact is commonly limited to the partner, and not adequate attention is paid to its consequences on the children who experience such violence in their home. The purpose of this qualitative study was to explore the experiences of children who are raised in homes where there is domestic violence. The participants were 23 male and female children aged 12 to 16 years who were referred to one of the centres of Families South Africa (FAMSA) in the City of Tshwane because of domestic violence in their homes. A descriptive qualitative design, using in-depth interviews, was employed to collect data and NVivo version 12 was used to analyse the data. Three (3) major themes emerged from the data, these being the impact of domestic violence on children, the long-term social impacts of domestic violence, and coping strategies used by the participants to survive domestic violence. Additionally, seven (7) sub-themes emerged from the three major themes. The findings imply the need to acknowledge that children are direct victims of domestic violence that occurs between their parents. It is recommended that the school health programme in South Africa integrate screening for children who witness domestic violence.

Asking for Verbal Sexual Consent and Experiences of Sexual Violence and Sexual Behaviors Among High School Students - Youth Risk Behavior Survey, United States, 2023.

Adolescents' sexual consent behaviors are critical for developing healthy sexual relationships and preventing experiences of sexual violence. This report uses 2023 Youth Risk Behavior Survey data to describe prevalence of asking for sexual consent verbally at last sexual contact among U.S. high school students. Differences in prevalence of asking for sexual consent verbally by sex, age, race and ethnicity, sexual identity, sex of sexual contacts, and gender identity were examined. Differences in asking for sexual consent verbally also were examined by experiences of sexual violence and sexual behaviors. Sex-stratified logistic regression analyses were performed to determine the association between asking for sexual consent verbally with experiences of sexual violence and sexual behaviors. In addition, data were analyzed using adjusted logistic regression models controlling for age, race and ethnicity, and sexual identity. Among high school students who reported ever having sexual contact, 79.8% reported asking for sexual consent verbally at last sexual contact. A lower percentage of female students (74.5%) reported asking for sexual consent verbally than male students (84.6%). In adjusted sex-stratified analyses, female students who asked for sexual consent verbally had higher prevalence of ever having had sexual intercourse. Male students who asked for sexual consent verbally had higher prevalence of ever having had sexual intercourse and being currently sexually active. Female and male students who asked for sexual consent verbally had higher prevalence of having first sexual intercourse before age 13 and using condoms. In addition, female students who asked for sexual consent verbally during last sexual intercourse had lower prevalence of using alcohol or drugs at last sexual intercourse. Public health researchers and practitioners, health care providers, schools, and youth-serving organizations can use these findings to better understand high school students' verbal sexual consent, improve complex measurement of consent-seeking behaviors, and guide multicomponent sexual health and violence prevention efforts across various settings.

The relationship between childhood trauma and mental health status among Chinese vocational high school adolescents: the mediating effect of poor self-control and internet addiction

BackgroundMental health problems among adolescents are a common concern globally. However, its relationship with childhood trauma is not clearly understood from the existing studies. Therefore, this study aims to explore the relationships among childhood trauma, mental health, self-control, and internet addiction in Chinese vocational high school students.MethodsA cross-sectional survey was conducted among vocational high school students in China from October 2020 to December 2020. Standardized questionnaires were used to collect basic information regarding childhood trauma, self-control, psychological state, and social demographics. A structural equation model was used to study the relationships among internet addiction, self-control, childhood trauma, and mental health.ResultsA total of 3368 individuals participated in the study. The results revealed the mediating effects of poor self-control and internet addiction on the association between childhood trauma and mental health.ConclusionsInternet addiction and low self-control play mediating roles in childhood trauma and mental health. Clarifying these relationships will help formulate better-targeted interventions to improve the mental health of Chinese vocational high school students and aid in interventions to treat and prevent mental health problems.

What are the Factors Influencing Service Provider Response to Working with Families Affected by Intimate Partner Violence and Abuse? A Qualitative Systematic Review of the Literature

Abstract Purpose Intimate partner violence and abuse (IPVA) is a major public health issue with long-term negative impacts on abused adults and affected children. Addressing this complex problem requires a multi-agency response, but barriers to effective joint working remain. This review aimed to understand the factors that influence multi-agency response to families who experience IPVA and to their children. Method We undertook a qualitative systematic review of international literature via five electronic databases and supplemented the review by citation searches, online searches of grey literature, and hand searches of relevant journals. We analyzed data thematically. Results The 31 identified papers reported findings from 29 unique studies undertaken in six countries and drew on data from 1049 professionals across health care, social care, the police, courts, schools and voluntary organisations. The main factors influencing service provider response to IPVA were siloed approaches to IPVA, particularly the separation between adult and childrens services. This influenced assessment and response to risk. Risk was also a consideration when child-protection staff were expected to work with perpetrators in ‘family settings’, even in lower-risk cases. Multi-agency working facilitated information sharing between agencies, an understanding of each other’s remit, and building trust. Conclusion Multi-agency collaboration needs to be supported by clear policies of interaction between agencies. Providers of child protection services, health, mental health, housing police and probation need to be supported by specialist training in IPVA, not only in high-risk cases, but also to relieve pressure on an already overstretched workforce.

Book Review: Boys Do Cry: Improving Boys’ Mental Health and Wellbeing in Schools

Book Review: Boys Do Cry: Improving Boys’ Mental Health and Wellbeing in Schools

The Need and Impact of a Brief Educational Seminar on Pediatric Pain-focused CBT for School Providers

Objectives: Pediatric chronic pain is common and can be detrimental to children’s social, emotional, and school functioning. Non-pharmacological approaches to chronic pain, like cognitive behavioral therapy (CBT) can be effective. Schools could provide children with chronic pain access to these interventions. However, school professionals (i.e. nurses and mental health providers) are seldom trained in CBT, creating a barrier to accessing such help. A seminar was created to introduce CBT strategies for chronic pediatric pain to school professionals. Feasibility, acceptability, and self-reported knowledge gain from the seminar were examined. Methods: Two introductory seminars (~2.5 hours each) were held separately for the Michigan Association of School Nurses and the Health Department of Northwest Michigan (n=71 total). The seminar provided an understanding of pain and pain-focused CBT strategies (e.g. activity pacing, positive self-statements, psychoeducation). Fifty-two school nurses, 16 mental health professionals, and three participants (unidentified title) rated program acceptability and self-reported knowledge of CBT before and after training (1=strongly disagree, 5=strongly agree). Results: 89.6% of respondents agreed the training was helpful, and 87.5% were interested in additional training. For all questions relating to knowledge of CBT, a mixed model interaction showed a meaningful, increase of at least one point (on a five-point Likert-scale), F(2, 69.83)=3.93, P=0.024. Discussion: This study underscores the feasibility and acceptability of training school health providers in CBT for pediatric chronic pain. This project also established key partnerships in Michigan to expand future work in this realm with more comprehensive training and assessment of outcomes.

COVID Just-in-Time Extension for Community Health Outcomes: A Collaborative Information-Sharing Platform for a School Health Community.

The COVID-19 pandemic challenged school health professionals to navigate a dynamic public health emergency and to stay aware of changing recommendations. This study aimed to determine the value of the COVID Just-in-Time ECHO (Extension for Community Health Outcomes) Learning Series for Schools among participating school health personnel and to describe their ongoing information needs during the pandemic. School health, public health, and education professionals across Colorado participated in this ECHO series. Participants attended 1-hour sessions every 2 to 4 weeks from March 2020 through December 2021 for a total of 34 sessions. Data collection included postsession and postseries surveys assessing what participants found most valuable and what additional information they needed. School nurses represented 113 of 224 participants (50%). ECHO content noted as being the most valuable included epidemiology updates and special topics as chosen by participant input. Postseries surveys identified the value of experiencing shared knowledge among Just-in-Time ECHO participants. Participants identified ongoing needs for information about COVID-19 guidance and risk mitigation in schools throughout the sessions. In postseries surveys, participants reported additional ongoing information needs related to COVID-19 outside schools. This ECHO series delivered reliable and time-sensitive information for school health personnel and school leaders and may provide a useful model for information sharing among education and public health professionals.

School health services in the Southern District of Israel—between privatization and nationalization

BackgroundFor decades, Israel’s economic policy has favored either outsourcing or privatization of public services, including healthcare, generating an ongoing and prolonged debate of this approach. In 1997 school health services (SHS) for elementary and middle school pupils was outsourced to a sub-contractor firm, reducing budget, but also standards, for nurses and physicians. Consequently, the service has dwindled and was focused more and more on vaccinations. Between 2007 and 2012, under full private contractor delivery, SHS quality diminished substantially, leading to a significant decline in vaccination coverage in the Southern District. In 2012, a decision was made to return SHS to state control.MethodsThis study analyzes the delivery parameters of SHS between the period when the service was operated by a private contractor from 2011to 2/2012, and the subsequent provision of the service directly by Ministry of Health (MoH) between 3/2012 and 2013. We compared the rates of vaccination coverage, screening tests and health education programs.ResultsA statistically significant increase in SHS delivery for vaccinations and screening was observed in the Southern District of MoH after the transfer of service from contractor. The increase was variable in different population subgroups, and especially notable in the Bedouin schools of the District, where the MMRV vaccination rose from 19.3% to 96.8%. However, a substantial and significant reduction in health education activities was also noted, overall from 24.9% to 5.0%.ConclusionsThe findings suggest that substantial benefits can be derived from direct provision of SHS by MoH and its regional offices, especially in the areas of reduced accessibility and lower socio-economic status. The case study of SHS in the Southern District of Israel can serve as an important example highlighting the impacts of privatization vs nationalization, with potential implications in other fields. These insights should be integral to future discussions of healthcare service provision.

The international cases of vaccinology education and its enlightenment to the discipline development in China

Vaccination is an effective public health measure to prevent and control vaccine-preventable diseases for individual and society. However, China currently confronts significant challenges, including a dearth of skilled professionals in the field of vaccination and disparities in the capacity for immunization services. This review introduced the experiences of four prime international vaccinology education models, including London School of Hygiene & Tropical Medicine, Johns Hopkins University, Leading International Vaccinology Education, and the Bill & Melinda Gates Foundation, in the aspect of personnel development, academic research and communication platforms establishment. It is supposed to give some insights and feasible suggestions on the establishment and advancement of vaccinology as a sub-discipline within high-level public health school in China, with the aim of development of a robust vaccinology education framework in China, which is essential for nurturing the next generation of public health leaders and practitioners for our country.

Personal reflection: Working in a social, emotional and mental health school in England

Personal reflection: Working in a social, emotional and mental health school in England

Burden and awareness of anemia among adolescent girls of residential school in Telangana.

Adolescence is an important transition phase and the burden of anemia among adolescent school-going children is not well explored. The present study was carried out to determine the prevalence of anemia among school-going adolescent girls and to explore their awareness on anemia. A cross-sectional study was conducted among 217 adolescent girls studying in a residential school of Bibinagar village, Telangana. A pre-tested, semi-structured questionnaire was administered to collect the data. Hemoglobin (Hb) was estimated using TrueHb. Data was entered into excel and was analyzed using SPSS software version 21. The mean (±SD) age of the adolescent girls was 13.8 (±0.99) years. About 74.2 % of the girls were in 12-14 years' age group. About 91.7 % had attained menarche. The prevalence of anemia was 81.6 % with a mean (±SD) Hb of 9.5 (±2.7) g/dl among adolescent girls. Among the adolescent girls, 32.7 % had severe anemia, 31.8 % had moderate anemia and 17.1 % had mild anemia. About 86.2 % adolescent girls had heard of anemia while 60.8 % adolescent girls felt that anemia is preventable and only 27.6 % were aware about iron-rich foods. About 38 % of adolescent girls were not aware of any causes of anemia. The prevalence of anemia was very high among the school-going adolescent girls of rural Telangana. The awareness regarding causes of anemia and iron-rich foods was low among study adolescent girls. Thus, there is a dire need to conduct frequent Test, Treat and Talk (T3) Anemia camps in schools through district school health program.

Bridging the Gap in Policy Implementation through a Health Equity Lens: Insights from a 2-Year Study on Measurement Development

Background: Policy implementation measurement lacks an equity focus, which limits understanding of how policies addressing health inequities, such as Universal School Meals (USM) can elicit intended outcomes. We report findings from an equity-focused measurement development study, which had two aims: (1) identify key constructs related to the equitable implementation of school health policies and (2) establish face and content validity of measures assessing key implementation determinants, processes, and outcomes. Methods: To address Aim 1, study participants (i.e., school health policy experts) completed a survey to rate the importance of constructs identified from implementation science and health equity by the research team. To accomplish Aim 2, the research team developed survey instruments to assess the key constructs identified from Aim 1 and conducted cognitive testing of these survey instruments among multiple user groups. The research team iteratively analyzed the data; feedback was categorized into “easy” or “moderate/difficult” to facilitate decision-making. Results: The Aim 1 survey had 122 responses from school health policy experts, including school staff (n = 76), researchers (n = 22), trainees (n = 3), leaders of non-profit organizations (n = 6), and others (n = 15). For Aim 2, cognitive testing feedback from 23 participants was predominantly classified as “easy” revisions (69%) versus “moderate/difficult” revisions (31%). Primary feedback themes comprised (1) comprehension and wording, (2) perceived lack of control over implementation, and (3) unclear descriptions of equity in questions. Conclusions: Through adaptation and careful dissemination, these tools can be shared with implementation researchers and practitioners so they may equitably assess policy implementation in their respective settings.

Quality of life of Retinoblastoma survivors in tertiary care eye hospital in South India.

With the increased survival of retinoblastoma (RB) patients, it is important to evaluate the quality of life (QoL) of RB survivors as well as caregivers to provide comprehensive care to the children and caregivers. This study aims to assess the QoL of survivors of RB, as perceived by parents and the self-report by patients, through a pediatric QoL (PEDs-QoL) questionnaire. The study cohort included 86 RB survivors, 86 age-matched controls, and their primary carers. PedsQL 4.0 generic core scale and structured interview were administered. QoL in physical, social, emotional, and school health was evaluated and correlated with clinical and sociodemographic parameters. The mean age of the RB survivors was 5.7 years with an M:F ratio of 1.1:1. Disease was bilateral in 79% of cases. About 45% (39/86) underwent enucleation, while others received combination therapy (16; 18%), chemotherapy (30; 34%), and radiation (1; 1%). As reported by parents, the QoL of physical health domain of RB survivors was 70.2 SD ± 27.8 and 96.15 ± 13 SD, emotional health was 72.1 ± 27.4 SD and 94.4 ± 12.5 SD, social health was 80.4 ± 24.9 SD and 98.6 ± 6.2 SD; and school health was 71.9 ± 2 6.5 SD and 96.1 ± 12.2 SD. As per the self-report perception, the QoL of physical health was 68.2 ± 27.8 SD and 96.2 ± 13 SD, emotional health was 66.2 ± 28.4 SD and 95.3 ± 12.5 SD, social health was 69.5 ± 24.9 SD and 98.7 ± 6.2 SD, and school health was 63.5 ± 26.5 SD and 95.1 ± 12.2 SD. There was a significant relationship between enucleation and QoL domains, where χ2 = 67.75, degrees of freedom (df) = 36, and P < 0.01. There was a significant association between vision in the better eye (6/18 or better = 8, 6/18-6/60 = 8, 3/60 or worse = 42) and QoL scores (χ2 = 95.36, df = 62, P < 0.01). There was a substantial association between socioeconomic status and QoL domains, where χ2= 88.5, df = 56, P < 0.01. The results of the study showed that the QoL of parents of RB survivors and self-proxy reports were negatively affected in many ways, including physical, social, emotional, and school-related dimensions. Despite the small differences, self-proxy reports indicated a lower QoL than the parents' group. The study findings indicate that there are notable correlations between enucleation and visual acuity less than 6/18, as well as socioeconomic status, with various aspects of QoL domains among individuals who have survived RB.

Co-designing place-based co-located health and wellbeing infrastructure and services with high school students, educators, and health service providers

This research involved working with high school students, teachers, Guidance Officers/School Counsellors, and other stakeholders, to co-design a new Community Hub to be co-located at a high school in a high-priority community. This article describes the co-design processes undertaken to engage children and young people and adult stakeholders in the ideation and design phase of infrastructure and service development to support health and wellbeing needs of a high priority community (low service uptake/high health needs). The key insights developed from these engagement processes pointed a way forward for the next stages of infrastructure and service delivery development and led to the development of several visual depictions of the complexities of stakeholder interests. This article argues that meaningful engagement of potential future users of place-based integrated health and wellbeing services enables responsive infrastructure designs that meet future needs of both target communities and service providers.

New Modes of Practice: A Framework Analysis of School Nurses' Accounts of Working With Children and Young People During COVID-19.

To identify new and accelerated modes of practice used by school nurses during the COVID pandemic. To create a quick reference infographic bringing together experiential evidence on the range and considerations regarding different modes of practice for use by the school nursing community of practice. A descriptive qualitative secondary data analysis of open-ended questions in a survey, and focus groups with school nurses. The pragmatic aim was to focus on changes in school nurse modes of practice to ensure continued engagement with children and young people, and school nurses' experience of the benefits and challenges of these modes of practice. Data were collected from 98 school nurse participants across a United Kingdom-wide survey (n78) in April to May 2022, and focus groups (n20) in June to July 2022, within the School Nursing in the Time of COVID project. Data from the seven open-ended questions in the survey and four questions from the focus group were analysed using the framework approach. Modes of practice fell into two categories: individual assessment and support (video-calling platforms, telephone contact, virtual messaging, walk-and-talks and home visits) and group support (wellbeing approaches, social media). Considerations for these modes rooted in school nurses' experience are described. Interpretations were used to create the summarising evidence-based infographic as a quick reference resource for school nurses. There was no 'one size fits all' approach. The modes used by school nurses were adopted or developed out of necessity or resource availability and in response to the specific needs of individuals or groups. The developed infographic provides a quick reference guide to deliver the expressed need for knowledge exchange within the school nursing community by participants in the original studies and can be used to inform current school nurse practice. The developed evidence-based infographic has stand-alone value. It has the potential to raise awareness of the range of different strategies that can be used to facilitate and/or enhance engagement with children and young people, equip school nurses with knowledge to foster innovative and responsive practice and aid critical reflection in a complex post-pandemic landscape. The infographic is a unique resource and is a first step in knowledge exchange based on experiential learning. The resource will be used as the foundation for future work to develop a co-created training resource for school nurse students (undertaking the Specialist Community Public Health Nurses course) and/or continuing professional development resource for established school nurses. This study has been conducted and reported in accordance with COREQ guidelines for qualitative research. A consultation group was closely involved with the planning, conduct and analysis of the original studies. This group consisted of representatives from professional organisations SAPHNA (School and Public Health Nurses Association) and the CPHVA (Community Practitioners' and Health Visitors' Association), a school nurse and a member of the public. SAPHNA have continued in their consultative role for this study and has provided content and usability feedback regarding the infographic. Early findings have been presented to the SN community of practice, and feedback invited, through presentation separately at the CPHVA and SAPHNA annual conference.