Punitive school discipline as a mechanism of structural marginalization with implications for health inequity: A systematic review of quantitative studies in the health and social sciences literature

Report of Unfair Discipline at School and Associations with Health Risk Behaviors and Experiences - Youth Risk Behavior Survey, United States, 2023

Relatively little is known about the association between school discipline and student health and well-being. Using CDC's 2023 Youth Risk Behavior Survey, CDC analyzed the prevalence of report of unfair discipline at school and associations with experiences at school, mental health, suicidal thoughts and behaviors, and health risk behaviors among high school students overall and stratified by race and ethnicity. Prevalence estimates, prevalence differences, and prevalence ratios adjusted for race (in overall models), grade, and sex were calculated. Overall, 19.3% of students reported receiving unfair discipline during the previous 12 months; Black or African American students had a higher prevalence (23.1%) compared with Hispanic or Latino students (18.4%) and White students (18.1%). Unfair discipline was reported among a majority of students who describe their sexual identity in some other way (besides gay, heterosexual, lesbian, bisexual, or questioning) for American Indian or Alaska Native (81.7%) and multiracial (57.1%) subgroups. Overall, report of unfair discipline was associated with every health risk behavior and experience examined, including being bullied at school or electronically, skipping school due to feeling unsafe, carrying a weapon at school, prescription opioid misuse, poor mental health, persistent feelings of sadness or hopelessness, seriously considered attempting suicide, and attempted suicide. This pattern of association was similar among most student groups in models stratified by race and ethnicity. This analysis is the first to demonstrate, among a nationally representative sample of high school students, that reports of unfair discipline are associated with various health risk behaviors and experiences. With these findings, public health and education practitioners can create interventions that equitably promote safe, supportive, and inclusive school environments for student health.

Systematic review of the associations of SWPBS with exclusionary discipline and disproportionality in U.S. schools

In response to patterns of educational inequity, many schools implement system-wide behavioral frameworks to reduce exclusionary discipline. School-wide positive behavior supports (SWPBS) is one such framework that seeks to support socially appropriate behavior by enhancing the capacity of schools to implement research-validated practices. However, there remains to be a systematic analysis of the extent to which SWPBS improves educational equity by reducing disparities in exclusionary discipline. The purpose of the systematic review was to evaluate research on the association of SWPBS with exclusionary discipline and racial discipline disproportionality. In total, 42 articles met the full inclusion criteria of a literature search conducted between 2018 and 2020. Study results were mixed regarding whether SWPBS was associated with reductions in exclusionary discipline and only a few studies provided evidence that SWPBS helps reduce exclusionary discipline disproportionality. Limitations of this research signal a need for attention to both data disaggregation and root causes of continued disproportionate discipline practices.

Review of Policies and Practices to Prevent Technology-Facilitated Child Sexual Abuse Within Youth-Serving Organizations in the United States

Technology-facilitated child sexual abuse (TF-CSA), or child sexual abuse that occurs online or through electronic communication, is a preventable public health problem that can be addressed within youth-serving organizations (YSOs). This study is a review of a purposive sample of organizational policies and practices designed to prevent TF-CSA collected from 13 national and local YSOs in the United States. Documents were coded to identify practices to prevent TF-CSA related to YSO activities or YSO staff, volunteers, or participants. Qualitative analysis indicated that YSOs included seven common practices to prevent TF-CSA in their documents. These practices included transparent electronic communication between youth and YSO staff; codes of conduct and online behavior agreements related to youth; monitoring the YSO's online presence; parental controls for youth online activity; safety behaviors for online activity for staff, parents, and youth; parent and youth trainings for youth online engagement and prevention of TF-CSA; and practices to address staff policy violations. Most prevention practices documented by YSOs identified in this study are consistent with emerging literature on TF-CSA prevention. Key gaps include protections for youth from groups inequitably burdened by TF-CSA and evaluation of the implementation and effectiveness of practices in preventing TF-CSA across settings and populations.

Disciplinary behaviour management strategies in schools and their impact on student psychosocial outcomes: A systematic review

Background

Disciplinary behaviour management strategies are implemented in schools to manage pupil behaviour. There is limited evidence of their intended impact on behaviour but there is growing concern around the potential negative impacts on pupil wellbeing.

Methods

We carried out a systematic review to examine the impact of these strategies on psychosocial outcomes in pupils (PROSPERO Registration: CRD42021285427). We searched multiple sources and double-screened titles, abstracts, and full texts. Data extraction and risk of bias assessment were done by one reviewer and checked by another. Results were narratively synthesised.

Results

We included 14 studies, from 5375 citations, assessing temporary suspension (n=10), verbal reprimand (n=2), and mixed strategies (n=2). Depression was the most common outcome (n=7), followed by academic grades (n=4) and behaviour in class (n=4). All except one study were at high risk of bias. We found a recurring pattern in the evidence of disciplinary strategies associated with poor mental wellbeing and behaviour in pupils. The effect on academic attainment was unclear.

Conclusions

Disciplinary behaviour management strategies may have negative impact on pupil mental wellbeing and class behaviour. These important consequences should be assessed in better designed studies before these strategies are implemented.

Structural racism in primary schools and changes in epigenetic age acceleration among Black and White youth

Structural racism generates racial inequities in U.S. primary education, including segregated schools, inequitable funding and resources, racial disparities in discipline and achievement, and hostile racial climates, which are risk factors for adverse youth health and development. Black youth are disproportionately exposed to adverse school contexts that may become biologically embedded via stress-mediated epigenetic pathways. This study examined whether childhood exposure to adverse school contexts is associated with changes in epigenetic aging during adolescent development. DNA methylation-based epigenetic clocks were calculated from saliva samples at ages 9 and 15 among Black (n = 774) and White (n = 287) youth in the Future of Families and Child Wellbeing Study (2009-2015). We performed latent class analyses to identify race-specific primary school contexts using administrative data on segregation, discipline, achievement, resources, economic disadvantage, and racial harassment. We then estimated change in epigenetic age acceleration from childhood to adolescence across school typologies using GrimAge, PhenoAge, and DunedinPACE epigenetic clocks. Three distinct school contexts were identified for Black youth: segregated and highly-disadvantaged (17.0%), segregated and moderately-disadvantaged (52.1%), and integrated and moderately-disadvantaged (30.8%). Two school contexts emerged for White youth: integrated and unequal (46.5%) and predominantly White & advantaged (53.5%). At age 15, Black youth who attended segregated and highly-disadvantaged primary schools experienced increases in their speed of epigenetic aging with GrimAge and DunedinPACE. Slowed epigenetic aging with GrimAge was observed for Black youth who attended integrated and moderately-disadvantaged schools. School contexts were not associated with changes in epigenetic age acceleration for White youth. Our findings suggest that manifestations of structural racism in primary school contexts are associated with early-life epigenetic age acceleration and may forecast future health inequities.

Nurturing positive mental health and wellbeing in educational settings - the PRICES model

This article presents a comprehensive framework for the implementation of social and emotional learning (SEL) programs as a means of health promotion in educational settings, to positively impact student, school, and adult mental health and wellbeing across education. It emphasizes the profound impact of education on life trajectories and success definitions. Drawing inspiration from the Greek myth of Icarus and Maya Angelou's poem "Still I Rise," it explores contrasting notions of success and their consequences. Schools play a pivotal role in shaping students' wellbeing across multiple dimensions and developmental stages. Because of this, holistic mental health and wellbeing promotion that takes a whole-school approach is critical. The paper introduces the PRICES framework (Preparation and Access, Restoration, Integration, Connection and Community, Educator Support, Strengths-Based Cultivation and Student Voice) as a comprehensive method for implementing SEL programs in educational systems. Each component of the PRICES framework is discussed in detail, emphasizing its role in fostering positive health promotion within schools. Examples of implementation plans that operationalize this model through a co-development process focusing on the Social, Emotional, and Ethical (SEE) Learning program are also presented. The PRICES model encourages a shift towards a more holistic approach to education, nurturing social and emotional development alongside academic achievement. By prioritizing wellbeing, fostering a sense of community, and integrating evidence based SEL interventions, schools can positively impact the mental health and overall flourishing of students and educators, contributing to thriving communities.

The Water Surrounding the Iceberg: Cultural Racism and Health Inequities

Policy Points Cultural racism-or the widespread values that privilege and protect Whiteness and White social and economic power-permeates all levels of society, uplifts other dimensions of racism, and contributes to health inequities. Overt forms of racism, such as racial hate crimes, represent only the "tip of the iceberg," whereas structural and institutional racism represent its base. This paper advances cultural racism as the "water surrounding the iceberg," allowing it to float while obscuring its base. Considering the fundamental role of cultural racism is needed to advance health equity.

CONTEXT

Cultural racism is a pervasive social toxin that surrounds all other dimensions of racism to produce and maintain racial health inequities. Yet, cultural racism has received relatively little attention in the public health literature. The purpose of this paper is to 1) provide public health researchers and policymakers with a clearer understanding of what cultural racism is, 2) provide an understanding of how it operates in conjunction with the other dimensions of racism to produce health inequities, and 3) offer directions for future research and interventions on cultural racism.

METHODS

We conducted a nonsystematic, multidisciplinary review of theory and empirical evidence that conceptualizes, measures, and documents the consequences of cultural racism for social and health inequities.

FINDINGS

Cultural racism can be defined as a culture of White supremacy, which values, protects, and normalizes Whiteness and White social and economic power. This ideological system operates at the level of our shared social consciousness and is expressed in the language, symbols, and media representations of dominant society. Cultural racism surrounds and bolsters structural, institutional, personally mediated, and internalized racism, undermining health through material, cognitive/affective, biologic, and behavioral mechanisms across the life course.

CONCLUSIONS

More time, research, and funding is needed to advance measurement, elucidate mechanisms, and develop evidence-based policy interventions to reduce cultural racism and promote health equity.