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Turner SL, Libert AM, Haase G, Pan Z, Austin A, Timko CA. The unintended consequences of school-based health and nutrition policies: a systematic review. Front Psychol 2024; 15:1356663. [PMID: 39035081 PMCID: PMC11259014 DOI: 10.3389/fpsyg.2024.1356663] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2023] [Accepted: 06/14/2024] [Indexed: 07/23/2024] Open
Abstract
Background Significant funding and attention are directed toward school-based health and nutrition interventions. Less attention is given to the potential unintended consequences of these policies, especially those that target children and adolescents. This systematic review aimed to elucidate the unintended consequences of school-based health and nutrition policies in the United States. Methods We conducted a systematic review, adhering to PRISMA guidelines, to analyze quantitative, qualitative, and mixed methods research conducted between January 2013 and September 2023. The search strategy encompassed three databases, identifying 11 articles that met the inclusion criteria. Results Unintended consequences were organized into four themes: disordered weight control behaviors, parental discomfort or encouragement of disordered weight control behaviors, eating disorder triggers, and financial losses. The analysis of disordered weight control behaviors indicates limited impact on youth, and we noted limited consensus in the assessment of these behaviors. We observed parent concerns about BMI screening and reporting as well as apprehensions about privacy and efficacy. There were fewer articles addressing eating disorder antecedents, although there was evidence that some youths with eating disorders considered school health class a trigger of their disorder. One study was identified that found an increase in food waste following replacement of sugar-sweetened beverages. Implications Findings underscore the importance of comprehensive evaluation and consideration of unintended consequences in the development and implementation of school-based health policies. Recommendations include further longitudinal research, integrating obesity prevention with eating disorder prevention, and de-implementation when unintended consequences potentially outweigh benefits, such as in BMI screening and surveillance.Systematic Review Registration: Identifier CRD42023467355. https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=467355.
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Affiliation(s)
- Samantha L. Turner
- Department of Child and Adolescent Psychiatry and Behavioral Sciences, Children’s Hospital of Philadelphia, Philadelphia, PA, United States
| | - Alexis M. Libert
- Department of Child and Adolescent Psychiatry and Behavioral Sciences, Children’s Hospital of Philadelphia, Philadelphia, PA, United States
| | - Grace Haase
- Department of Child and Adolescent Psychiatry and Behavioral Sciences, Children’s Hospital of Philadelphia, Philadelphia, PA, United States
| | - Zhaoyi Pan
- Department of Child and Adolescent Psychiatry and Behavioral Sciences, Children’s Hospital of Philadelphia, Philadelphia, PA, United States
| | - Andrew Austin
- Department of Child and Adolescent Psychiatry and Behavioral Sciences, Children’s Hospital of Philadelphia, Philadelphia, PA, United States
| | - C. Alix Timko
- Department of Child and Adolescent Psychiatry and Behavioral Sciences, Children’s Hospital of Philadelphia, Philadelphia, PA, United States
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States
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Cho J, Park J, Park C, Lee J, Oh J, Hwang G. What Are the Challenges of School Nurses in South Korea in Managing Obese Children From Low-Income Households? J Sch Nurs 2023; 39:506-516. [PMID: 34662202 DOI: 10.1177/10598405211045888] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Given that the obesity rate among school-age children is increasing, school nurses can play a vital role in managing obesity and encouraging healthy living in school settings. Obese children from low-income backgrounds are more vulnerable than other students and require more careful attention and intervention. This qualitative study aimed to explore and understand the barriers recognized by school nurses in managing obesity in low-income household children. A focus group interview was conducted with 17 school nurses working at an elementary school. Children, home, school, political and structural, and social areas were revealed as intricate factors in obesity management. This study can help understand school nurses' obstacles in managing obese children from low-income families and can help them prepare practical measures to overcome these obstacles.
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Affiliation(s)
- Jeonghyun Cho
- College of Nursing, Institute for Health Science Research, Inje University, Busan, South Korea
| | - Jiyoung Park
- College of Nursing, Institute for Health Science Research, Inje University, Busan, South Korea
| | - Chongwon Park
- Division of English Language and Literature, Pukyong National University, Busan, South Korea
| | - Jinah Lee
- Department of Social Welfare and Counseling, Catholic University of Pusan, Busan, South Korea
| | - Jina Oh
- College of Nursing, Institute for Health Science Research, Inje University, Busan, South Korea
| | - Gahui Hwang
- College of Nursing, Yonsei University, Seoul, South Korea
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Wilson OWA, Thai M, Williams L, Nutter S, Myre M, Russell-Mayhew S. A scoping review of school-based anthropometric measurement. Obes Rev 2023; 24:e13610. [PMID: 37653624 DOI: 10.1111/obr.13610] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Revised: 05/15/2023] [Accepted: 05/21/2023] [Indexed: 09/02/2023]
Abstract
Though anthropometric measurement (AM) frequently occurs in school settings, it is not without risks to child wellbeing. The aim of this scoping review was to examine how AM in school settings takes place and is reported on to make recommendations on best practices. We identified and extracted data from 440 studies published since 2005 that conducted AM in school (pre-school through secondary/high school) settings. Privacy and sensitivity of AM were unclear in over 90% of studies. Thirty-one studies (7.0%) reported protecting student privacy, while nine (2.0%) reported public measurement. Only five studies reported sensitivity regarding AM (1.1%). Exactly who conducted AM was not specified in 201 studies (45.7%). Sixty-nine studies did not provide a weight status criteria citation (19.2%), and 10 used an incorrect citation (2.7%). In summary, serious shortcomings in the reporting of how AM is conducted and by whom, along with details concerning weight status classification, are evident. There is considerable room for improvement regarding the reporting of key methodological details. We propose best practices for AM in school settings, which also double as conditions that should be met before AM takes place in school settings.
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Affiliation(s)
- Oliver W A Wilson
- Werklund School of Education, University of Calgary, Calgary, Alberta, Canada
- Te Hau Kori, Te Wāhanga Tātai Hauora Faculty of Health, Te Herenga Waka, Victoria University of Wellington, Wellington, New Zealand
| | - Michella Thai
- Werklund School of Education, University of Calgary, Calgary, Alberta, Canada
| | - Lindsay Williams
- Werklund School of Education, University of Calgary, Calgary, Alberta, Canada
| | - Sarah Nutter
- Department of Educational Psychology and Leadership Studies, University of Victoria, Victoria, British Columbia, Canada
| | - Maxine Myre
- Werklund School of Education, University of Calgary, Calgary, Alberta, Canada
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Thompson HR, Madsen KA, Nguyen C, Argenio K, D'Agostino E, Konty K, Day S. School-level self-reported versus objective measurements of body mass index in public high school students. Prev Med 2023; 174:107616. [PMID: 37451556 PMCID: PMC10529345 DOI: 10.1016/j.ypmed.2023.107616] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Revised: 06/15/2023] [Accepted: 07/09/2023] [Indexed: 07/18/2023]
Abstract
Population-level surveillance of student weight status (particularly monitoring students with a body mass index (BMI) ≥95th percentile) remains of public health interest. However, there is mounting concern about objectively measuring student BMI in schools. Using data from the nation's largest school district, we determined how closely students' self-reported BMI approximates objectively-measured BMI, aggregated at the school level, to inform decision-making related to school BMI measurement practices. Using non-matched data from n = 82,543 students with objective height/weight data and n = 7676 with self-reported height/weight from 84 New York City high schools (88% non-white and 75% free or reduced-price meal-eligible enrollment), we compared school-level mean differences in height, weight, BMI, and proportion of students by weight status, between objective and self-reported measures. At the school-level, the self-reported measurement significantly underestimated weight (-1.38 kg; 95% CI: -1.999, -0.758) and BMI (-0.38 kg/m2; 95% CI: -0.574, -0.183) compared to the objective measurement. Based on the objective measurement, 12.1% of students were classified as having obesity and 6.3% as having severe obesity (per CDC definition); the self-report data yielded 2.5 (95% CI: -1.964, -0.174) and 1.4 (95% CI: -2.176, -0.595) percentage point underestimates in students with obesity and severe obesity, respectively. This translates to 13% of students with obesity and 21% of students with severe obesity being misclassified if using self-reported BMI. School-level high school students' self-reported data underestimate the prevalence of students with obesity and severe obesity and is particularly poor at identifying highest-risk students based on BMI percentile.
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Affiliation(s)
- Hannah R Thompson
- University of California Berkeley, School of Public Health, Community Health Sciences, 2121 Berkeley Way West, Berkeley, CA 94720, United States.
| | - Kristine A Madsen
- University of California Berkeley, School of Public Health, Community Health Sciences, 2121 Berkeley Way West, Berkeley, CA 94720, United States.
| | - Caroline Nguyen
- University of California Berkeley, School of Public Health, Community Health Sciences, 2121 Berkeley Way West, Berkeley, CA 94720, United States.
| | - Kira Argenio
- NYC Department of Health and Mental Hygiene, Office of School Health, 125 Worth St, New York, NY 10013, United States.
| | - Emily D'Agostino
- Duke University School of Medicine, Department of Population Health Sciences, Department of Family Medicine & Community Health, 311 Trent Drive, Durham, NC 27710, United States.
| | - Kevin Konty
- NYC Department of Health and Mental Hygiene, Office of School Health, 125 Worth St, New York, NY 10013, United States.
| | - Sophia Day
- NYC Department of Health and Mental Hygiene, Office of School Health, 125 Worth St, New York, NY 10013, United States.
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Tovar A, Miller ME, Stage VC, Hoffman JA, Guseman EH, Sisson S, Shefet D, Bejamin-Neelon SE, Swindle T, Hasnin S, Beltran M. BMI Data Collection and Communication Practices in a Multistate Sample of Head Start Programs. Child Obes 2022; 18:309-323. [PMID: 34874782 PMCID: PMC9464080 DOI: 10.1089/chi.2021.0199] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Background: Although there is a federal mandate to collect anthropometric data in Head Start (HS), little is currently known about the processes used to collect the height and weight measurements across programs and how the results are communicated to parents/guardians. The goal of this study was to understand anthropometric data collection and dissemination procedures in a sample of HS programs serving children 3-5 years. Methods: A convenience sample of HS Health or Nutrition managers were recruited via personal contacts and HS state directors to complete an electronic survey. Quantitative data were analyzed using descriptive statistics (means, standard deviations and frequencies). Open-ended questions were coded using thematic analysis. All protocols and procedures were approved by the Institutional Review Board at Miami University. Results: Approximately half of the programs reported that they have a protocol in place to guide measurements (57.1%) and those measurements are primarily taken by HS staff (64.5%). Most programs explain measurements to parents (82.3%) and report that collecting height/weight data is helpful in supporting children's health (76.0%). Most programs (80.3%) provide resources to parents of children with overweight or obesity. Four themes emerged from open-ended responses: (1) Role of Community Partners (e.g., providing information that conflicts with others); (2) Communicating Children's Weight Status with Families (e.g., using sensitive communication methods); (3) Challenges Measuring Children's Weight Status (e.g., accuracy of data, children's awareness); and (4) Family Reaction to Weight Status Communication (e.g., positive or negative experiences). Conclusion: Opportunities for quality improvement include wider use of standardized, written protocols and policies on data collection and enhanced communication practices to share information with parents.
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Affiliation(s)
- Alison Tovar
- Department of Nutrition and Food Sciences, University of Rhode Island, Kingston, RI, USA.,Address correspondence to: Alison Tovar, PhD, MPH, Department of Nutrition and Food Sciences, University of Rhode Island, 41 Lower College Road, Kingston, RI 02881, USA
| | - M. Elizabeth Miller
- Department of Kinesiology, Nutrition, and Health, Miami University, Oxford, OH, USA
| | - Virginia C. Stage
- Department of Nutrition Science, East Carolina University, Greenville, NC, USA
| | - Jessica A. Hoffman
- Department of Applied Psychology, Northeastern University, Boston, MA, USA
| | - Emily Hill Guseman
- Diabetes Institute, Ohio University Heritage College of Osteopathic Medicine, Athens, OH, USA.,Department of Primary Care, Ohio University Heritage College of Osteopathic Medicine, Athens, OH, USA
| | - Susan Sisson
- Department of Nutrition Sciences, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Dana Shefet
- Department of Nutrition Science, East Carolina University, Greenville, NC, USA
| | - Sara E. Bejamin-Neelon
- Division of Human Nutrition, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Taren Swindle
- Department of Family and Preventive Medicine, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Saima Hasnin
- Department of Child, Youth and Family Studies, University of Nebraska-Lincoln, Lincoln, NE, USA
| | - Marco Beltran
- Office of Head Start, Administration for Children and Families, U.S. Department of Health and Human Services, Washington, DC, USA
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Levine MP. Prevention of eating disorders: 2021 in review. Eat Disord 2022; 30:121-143. [PMID: 35167430 DOI: 10.1080/10640266.2022.2030882] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
This review of 19 prevention-related publications in Eating Disorders during 2021 is framed by four models: (1) Mental Health Intervention Spectrum: health promotion → types of prevention → case identification/referral → treatment; (2) the prevention cycle: rationale and theory, shaped by critical reviews → clarifying risk and protective factors → program innovation and feasibility studies → efficacy and effectiveness research → program dissemination; (3) links between disordered eating (DE) and eating disorders (EDs); and (4) Kraemer and Jacobi's criteria for variable, causal risk factors (RFs). Twelve articles demonstrated the strengths and limitations of cross-sectional investigations of RFs for DE and EDs: five explored the role of trauma in activating genetic and psychological RFs (e.g., anxiety and experiential avoidance), while five suggest other variables meriting further evaluation: ergogenic supplement use, "feeling fat," internalized weight bias, food insecurity, and compulsive exercising. One article presents a pilot program that reduced risk factors in a high-risk group: professional ballerinas. Implications of the absence of efficacy, effectiveness, dissemination, and advocacy studies, along with the need to develop tailored programs for various high-risk groups, are discussed.
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Affiliation(s)
- Michael P Levine
- Department of Psychology (emeritus), Kenyon College, Gambier, Ohio, USA
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Wang H, Wang Y, Wang G, Wilson A, Jin T, Zhu L, Yu R, Wang S, Yin W, Song H, Li S, Jia Q, Zhang X, Yang Y. Structural family factors and bullying at school: a large scale investigation based on a Chinese adolescent sample. BMC Public Health 2021; 21:2249. [PMID: 34895204 PMCID: PMC8665508 DOI: 10.1186/s12889-021-12367-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Accepted: 11/30/2021] [Indexed: 11/10/2022] Open
Abstract
Backgrounds Various family factors have been identified in association with school bullying and the involvement of children and adolescents in bullying behaviors. Methods A total of 11,919 participants (female = 6671, mean age = 15) from 22 middle schools in Suzhou City, China completed the questionnaire. The associations between structural family factors (family socio-economic status, living arrangement, number of siblings, whether they were local residents/migrants, had an urban/rural hukou [a household registration system in China], parental and maternal education levels, and other various bullying-related constructs (i.e. bullying witnessing, bullying involvement, bystander intervention, and fear of being bullied) were all examined. Odds ratios (ORs) adjusted for covariates were calculated for the four bullying-related constructs (bullying witness, bullying involvement, bystander intervention, and reactions to being bullied) using structural family factors. Results The result showed that all demographic household characteristics were associated with bullying at school except for being from a single-child family. Adolescents from rural families witnessed more bullying incidents than those from local families (OR = 1.35, 95% CI: [1.09, 1.68]). Adolescents who come from migrant families (OR = 1.12, 95% CI: [1.07, 1.43]) with a rural hukou (OR = 1.31, 95% CI: [1.00, 1.74]) and low parental education levels (OR = 1.42, 95% CI: [1.01, 2.57]) were more likely to be bullies. Adolescents who came from migrant families (OR = 1.37, 95% CI: [1.03, 1.82]), with low maternal education levels (OR = 1.42, 95% CI: [1.06, 1.91]) engaged in more negative bystander intervention behaviors. Furthermore, adolescents with less educated mothers experienced a higher fear of being bullied (never versus sometimes: OR = 1.33, 95% CI: [1.00, 1.85]; never versus usually OR = 1.39, 95% CI: [1.01, 1.20]). Conclusions A systematic examination of the relationship between school bullying and demographic household characteristics may be used to inform school policies on bullying, such as training management on the importance of paying attention to adolescents from disadvantage household backgrounds. Identifying demographic factors that may predict bullying can also be used to prevent individuals from becoming involved in bullying and reduce the related negative consequences from being bullied. Supplementary Information The online version contains supplementary material available at 10.1186/s12889-021-12367-3.
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Affiliation(s)
- Haoran Wang
- Dalian Seventh People's Hospital, 179# Lingshui Road, Dalian, 116023, China
| | - Yuanyuan Wang
- Division of Psychology, Faculty of Health and Life Sciences, De Montfort University, Leicester, UK
| | - Guosheng Wang
- Suzhou Guangji Hospital, 11# Guangqian Road, Suzhou, 215137, China
| | - Amanda Wilson
- Division of Psychology, Faculty of Health and Life Sciences, De Montfort University, Leicester, UK
| | - Tingting Jin
- Suzhou Guangji Hospital, 11# Guangqian Road, Suzhou, 215137, China
| | - Longjun Zhu
- Suzhou Guangji Hospital, 11# Guangqian Road, Suzhou, 215137, China
| | - Renjie Yu
- Suzhou Guangji Hospital, 11# Guangqian Road, Suzhou, 215137, China
| | - Shuilan Wang
- Suzhou Guangji Hospital, 11# Guangqian Road, Suzhou, 215137, China
| | - Weijia Yin
- Suzhou Guangji Hospital, 11# Guangqian Road, Suzhou, 215137, China
| | - Huihui Song
- Suzhou Guangji Hospital, 11# Guangqian Road, Suzhou, 215137, China
| | - Shun Li
- Suzhou No.1 High School of Jiangsu Province, , 279# Gongyuan Road, Suzhou, 215011, China
| | - Qiufang Jia
- Suzhou Guangji Hospital, 11# Guangqian Road, Suzhou, 215137, China
| | - Xiaobin Zhang
- Suzhou Guangji Hospital, 11# Guangqian Road, Suzhou, 215137, China
| | - Yong Yang
- Suzhou Guangji Hospital, 11# Guangqian Road, Suzhou, 215137, China.
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