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Santano-Mogena E, Franco-Antonio C, Cordovilla-Guardia S. Gender differences in susceptibility to smoking among high school students. J Adv Nurs 2022; 79:1912-1925. [PMID: 35867336 DOI: 10.1111/jan.15382] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Revised: 06/17/2022] [Accepted: 07/09/2022] [Indexed: 12/01/2022]
Abstract
AIMS To analyse the degree of susceptibility to smoking according to gender in students between 12 and 16 years of age and study the role of factors associated with gender and the extended index of susceptibility to smoking. DESIGN Cross-sectional study. METHODS Between November 2019 and March 2020, 12- to 16-year-old students were recruited from three educational centres in western Spain. Sociodemographic, environmental, social and personal variables were analysed. The value of the extended index of susceptibility to smoking was calculated, and the associations between the students' genders and smoking susceptibility were studied. Multinomial logistic regression was used to study associations between the independent variables and Expanded Susceptibility Index (ESSI) results. The roles of factors in this association were explored through mediation analysis. RESULTS A total of 364 students participated in the study (53% females). A total of 79.3% of females and 61.4% of males presented a medium-high level of the extended index of susceptibility. Females reported greater cigarette use (28% vs. 12.3%), hookah (19.9% vs 9.9%) and alcohol consumption (20.7% risk alcohol consumption). They obtained higher scores on the impulsivity scale in the urgency domain and the negative affect scale. Regardless of other factors, females showed more than double the smoking susceptibility (aOR: 2.05, 95% CI: 1.03-4.07, p = .041). Mediation analysis showed that gender had a total effect on the extended susceptibility index β = .023 (95% CI: 0.07-0.38, p = .01). The effect appeared to be mediated only by having smoking friends (0.08; 95% CI: 0.03-0.15, p = .001). CONCLUSIONS The greater susceptibility to smoking found in females may be related to a greater influence of smoking among friends. IMPACT These results show that smoking friends have a strong influence among adolescent females; therefore, developing preventive programmes with gender approaches aimed at reducing the influence of these environmental factors would be of interest.
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Affiliation(s)
- Esperanza Santano-Mogena
- Nursing Department, Nursing and Occupational Therapy College, Universidad de Extremadura, Cáceres, Spain.,Health and Care Research Group (GISyC), Universidad de Extremadura, Cáceres, Spain
| | - Cristina Franco-Antonio
- Nursing Department, Nursing and Occupational Therapy College, Universidad de Extremadura, Cáceres, Spain.,Health and Care Research Group (GISyC), Universidad de Extremadura, Cáceres, Spain
| | - Sergio Cordovilla-Guardia
- Nursing Department, Nursing and Occupational Therapy College, Universidad de Extremadura, Cáceres, Spain.,Health and Care Research Group (GISyC), Universidad de Extremadura, Cáceres, Spain
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Haeder SF, Maxfield E, Ulmen K, Anderson S. When a school is more than just a school: Improving school-based health in the wake of COVID-19. WORLD MEDICAL & HEALTH POLICY 2022; 14:150-177. [PMID: 35600495 PMCID: PMC9111193 DOI: 10.1002/wmh3.498] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2021] [Revised: 12/21/2021] [Accepted: 01/24/2022] [Indexed: 11/19/2022]
Abstract
The ongoing COVID-19 pandemic has posed tremendous challenges for economies and individuals around the world. At the same time, it has also laid bare the blatant and growing inequities that many individuals, particularly children, are confronted with on a daily basis. With communities in lockdowns and schools going virtual in many parts of the United States, the important role that schools and school-based services play in the lives of many children have gained new attention. Nonetheless, only 3% of American schools have school-based health centers on campus, and they remain relegated to the fringes of both health care and education. One key limitation has been the lack of appropriately trained health-care professionals. Over the past 2 years, we have interviewed dozens of individuals about their experiences in school-based health centers. Based on this study, we explore what it means for a health-care professional to work in school-based health care and how it differs from more traditional health-care settings. Our analysis particularly focuses on training and education, work environments, and their unique demands that come from being embedded within the educational setting. We conclude by addressing the important role that governmental policies could play in augmenting this crucial workforce.
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Affiliation(s)
- Simon F. Haeder
- School of Public PolicyThe Pennsylvania State UniversityUniversity ParkPennsylvaniaUSA
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Habiyaremye MA, Clary K, Morris H, Tumin D, Crotty J. Which Children Use School-Based Health Services as a Primary Source of Care? THE JOURNAL OF SCHOOL HEALTH 2021; 91:876-882. [PMID: 34494271 DOI: 10.1111/josh.13085] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Revised: 02/08/2021] [Accepted: 03/22/2021] [Indexed: 06/13/2023]
Abstract
BACKGROUND School-based health centers (SBHCs) offer primary and preventive health care for children and adolescents. Using nationally representative data, we aimed to examine which child and family characteristics are associated with using school-based health care providers as the primary source of health care, and whether care received from these providers met the criteria for a medical home. METHODS Using data from the 2016-2018 National Survey of Children's Health (NSCH), we analyzed children's usual source of care (school-based provider, doctor's office or clinic, other location, or none), and whether they received care meeting medical home criteria. RESULTS Based on a sample of 64,710 children, 0.5% identified school-based providers as their primary source of health care. Children who were older, uninsured, or living in the Northeast were significantly more likely to report school-based providers as their usual source of care. Children whose usual source of care was a school-based provider were less likely to receive care meeting medical home criteria than children who usually received care at a doctor's office. CONCLUSIONS While SBHCs improve access to care, our findings indicate potential challenges with establishing a medical home for children who usually receive health care from a school-based provider.
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Affiliation(s)
- Marie A Habiyaremye
- Department of Sociology, East Carolina University, 600 Moye Blvd, Greenville, NC, 27834, USA
| | - Kathryn Clary
- Department of Internal Medicine and Psychiatry, Duke University, 3710 Duke University Medical Center, Durham, NC, 27710, USA
| | - Hannah Morris
- Department of Pediatrics, Brody School of Medicine at East Carolina University, 600 Moye Blvd, Greenville, NC, 27834, USA
| | - Dmitry Tumin
- Department of Pediatrics, Brody School of Medicine at East Carolina University, 600 Moye Blvd, Greenville, NC, 27834, USA
| | - Jennifer Crotty
- Department of Pediatrics, Brody School of Medicine at East Carolina University, 600 Moye Blvd, Greenville, NC, 27834, USA
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Academic, Psychosocial, and Demographic Correlates of School-Based Health Center Utilization: Patterns by Service Type. CHILD & YOUTH CARE FORUM 2019. [DOI: 10.1007/s10566-019-09495-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Kivimäki H, Saaristo V, Wiss K, Frantsi-Lankia M, Ståhl T, Rimpelä A. Access to a school health nurse and adolescent health needs in the universal school health service in Finland. Scand J Caring Sci 2018; 33:165-175. [PMID: 30276842 PMCID: PMC7432168 DOI: 10.1111/scs.12617] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2018] [Accepted: 08/20/2018] [Indexed: 11/28/2022]
Abstract
Universal school health services are expected to offer similar, needs‐based services to all students across schools, service providers and students’ socio‐economic statuses and health needs. This study investigates access to school health nurses in Finland. The objectives were to study the differences in access to school health nurse between service providers, schools, students’ characteristics and school health nurse resources. Access was examined through a nationwide School Health Promotion study, which is a self‐reporting, voluntary and anonymous survey for 8th and 9th graders (15 to 16‐year old, N = 71865). The ethical committee of the National Institute for Health and Welfare has approved procedure for the School Health Promotion study. Data on school health nurse resources and service providers were obtained from the national database (534 schools; 144 service providers). Multilevel logistic regression was used. Of the pupils, 15% of girls and 11% of boys reported difficult access to a school health nurse. The number of adolescents who reported difficult access ranged between service providers (0%–41%) and schools (0%–75%). Students with lower socio‐economic background, poorer well‐being at school, lack of support for studying and greater health needs reported difficult access more often. School health nurse resources were associated with difficult access only among boys, when resources were under the national recommendations. These findings raise concern about equality and unmet health needs in school health services.
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Affiliation(s)
- Hanne Kivimäki
- Researcher, National Institute for Health and Welfare, Helsinki, Finland
| | - Vesa Saaristo
- National Institute for Health and Welfare, Helsinki, Finland
| | - Kirsi Wiss
- National Institute for Health and Welfare, Helsinki, Finland
| | | | - Timo Ståhl
- National Institute for Health and Welfare, Helsinki, Finland
| | - Arja Rimpelä
- Faculty of Social Science, Health Sciences, University or Tampere, Tampere, Finland.,Department of Adolescent Psychiatry, Tampere University Hospital, Tampere, Finland
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Doi L, Wason D, Malden S, Jepson R. Supporting the health and well-being of school-aged children through a school nurse programme: a realist evaluation. BMC Health Serv Res 2018; 18:664. [PMID: 30153849 PMCID: PMC6114697 DOI: 10.1186/s12913-018-3480-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2018] [Accepted: 08/17/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The school nurse's role varies across countries. In Scotland, the Chief Nursing Officer recommended that the role should be refocused. The refocused programme emphasises nine care pathways with a view to improve pupils' health and wellbeing. Two sites were identified to test this new programme. Our aim was to assess how, for whom and under what circumstances the programme works in order to provide learning to support school nurse training and intended national roll-out. METHODS This study was a mixed methods study, using a realist evaluation approach, and conducted in three phases. In phase one, six nurse managers from both study sites took part in individual interviews or focus groups and this was complemented by programme documents to develop initial programme theory. In phase two, the programme theory was tested using qualitative data from 27 school nurses, and quantitative data from the first 6 months of the programme that captured patterns of referral. The programme theory was refined through analyses and interpretation of data in phase three. RESULTS The findings show that the programme enhanced opportunities for early and improved identification of health and wellbeing needs. The context of the nine pathways worked through the mechanism of streamlining referral of relevant cases to school nurses, and yielded positive outcomes by extending school nurses and thus children's engagement with wider services. The mental health and wellbeing pathway was the most frequently used, and nurses referred complex mental health cases to more specialist mental health services, but felt less equipped to deal with low to moderate cases. CONCLUSIONS The programme facilitated early identification of risk but was less successful at equipping school nurses to actually deliver specific interventions as intended. Capacity building strategies for school nurses should seek to enhance intervention delivery skills within the parameters of the pathways. Realist evaluation provided a useful framework in terms of identifying contextual and mechanistic influences that required strengthening prior to wider implementation.
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Affiliation(s)
- Lawrence Doi
- Scottish Collaboration for Public Health Research and Policy, School of Health in Social Science, Doorway 6, Old Medical School, Teviot Place, University of Edinburgh, Edinburgh, EH8 9AG UK
| | | | - Stephen Malden
- Scottish Collaboration for Public Health Research and Policy, School of Health in Social Science, Doorway 6, Old Medical School, Teviot Place, University of Edinburgh, Edinburgh, EH8 9AG UK
| | - Ruth Jepson
- Scottish Collaboration for Public Health Research and Policy, School of Health in Social Science, Doorway 6, Old Medical School, Teviot Place, University of Edinburgh, Edinburgh, EH8 9AG UK
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Bains RM, Cusson R, White-Frese J, Walsh S. Utilization of Mental Health Services in School-Based Health Centers. THE JOURNAL OF SCHOOL HEALTH 2017; 87:584-592. [PMID: 28691171 DOI: 10.1111/josh.12528] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/09/2015] [Revised: 11/02/2016] [Accepted: 12/09/2016] [Indexed: 06/07/2023]
Abstract
BACKGROUND We summarize utilization patterns for mental health services in school-based health centers. METHODS Administrative data on school-based health center visits in New Haven, Connecticut were examined for the 2007-2009 school years. Relative frequencies of mental health visits by age were calculated as a percentage of all visits and were stratified by sex, ethnicity/race, and insurance status. RESULTS Mental health visits accounted for the highest proportion of visits (31.8%). The proportion of mental health visits was highest at 8 years (42.8%) and at 13 years (39.0%). The proportion of mental health visits among boys (38.4%) was higher than among girls (26.7%). Hispanic students had a lower proportion of mental health visits than black students (23.5% vs 35.8%) in all but 2 age groups. Students in the white/other ethnicity category had higher proportions of mental health visits than Hispanic and black students between ages 12 and 15. Students with no health insurance (22.5%) had lower proportions of mental health visits than students covered by Medicaid (34.3%) or private insurance (33.9%). The percentage of mental health visits by students with private insurance was highest (37.2%-49%) in the 13-15 age range. CONCLUSIONS Usage patterns for mental health issues show pronounced, nonrandom variation relative to age and other demographic characteristics especially with 8-year-old boys.
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Affiliation(s)
- Ranbir M Bains
- Barnard Environmental Magnet School Based Health Center/Yale New Haven Hospital, 170 Derby Avenue, New Haven, CT 06511
| | - Regina Cusson
- School of Nursing, University of Connecticut, Storrs Hall, Room 203, 231 Glenbrook Road, Unit 4026, Storrs, CT 06269
| | - Jesse White-Frese
- Connecticut Association of School Based Health Centers, P.O. Box 771, North Haven, CT
| | - Stephen Walsh
- School of Nursing, University of Connecticut, Storrs Hall, Room 313E, 231 Glenbrook Road, Unit 4026, Storrs, CT 06269
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Abstract
BACKGROUND Internationally, nurses have been in the forefront of delivering health care services in the school environment and whilst health care delivery in secondary and high schools is evaluated, this is not the case for services delivered in primary/elementary schools. In countries such as New Zealand there is no significant inter-service collaboration between health and education; therefore, the delivery of health services remains fragmented and underdeveloped. OBJECTIVES This discussion paper reviews the history and development of nurse-led school-based health services internationally and provides an insight into the current provision of primary school-based health services in New Zealand. DESIGN The initial approach to this paper was to gain an understanding of the history of school-based health services internationally and to explore the relationship between health and education in relation to this. This assisted in providing some context and comparison with the current provision of school-based health services in New Zealand. Discussion outcome: Internationally, it is acknowledged that schools provide not only a location to deliver health services to children but also the opportunity to reach entire families and communities yet surprisingly, the development of school-based health services within the primary/elementary school sector has received minimal attention in New Zealand and worldwide. CONCLUSIONS This paper supports the need for further research concerning the feasibility, provision and effectiveness of school-based health services in primary/elementary schools. In order to be effective, this should incorporate the shared needs and values of all stakeholders. The authors argue the need to develop an inter-service, collaborative, national framework for the delivery of school nursing services within the primary school sector in New Zealand. Impact statement: A collaborative framework for health service delivery into primary schools can enable early establishment of supportive health relationships with families.
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Affiliation(s)
- Sarah Williams
- a Starship Children's Health , Auckland District Health Board , Auckland , New Zealand
| | - Annette Dickinson
- b School of Clinical Sciences/Faculty of Health and Environmental Sciences , Auckland University of Technology , South Campus (M2), Private Bag 92006, Auckland 1142 , New Zealand
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Moriarty Daley A, Polifroni EC. "Contraceptive Care for Adolescents in School-Based Health Centers Is Essential!": The Lived Experience of Nurse Practitioners. J Sch Nurs 2017; 34:367-379. [PMID: 28535706 DOI: 10.1177/1059840517709503] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Adolescents often face hurdles that may interfere with accessing contraceptive services. School-based health centers (SBHCs) are available to many teens in the United States; however, only half of SBHCs that serve adolescents are permitted to provide contraception. The aim of this descriptive phenomenological study was to describe the lived experience of nurse practitioners (NPs) providing contraceptive care to teens in SBHCs. Twelve NPs were interviewed and Colaizzi's method of descriptive phenomenological analysis was used to describe the lived experience of NPs providing contraceptive care to adolescents in SBHCs. Three themes emerged: Contraception is an Essential Part of Care for Teens Using SBHCs; Frustration! There are so Many Hurdles to Negotiate; and Walking a Fine Line. Despite the restrictions on SBHC services and the hurdles the NPs encountered, they remained committed to providing contraceptive services and seized available opportunities to provide health education and support for the adolescents accessing the SBHCs.
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Bersamin M, Garbers S, Gold MA, Heitel J, Martin K, Fisher DA, Santelli J. Measuring Success: Evaluation Designs and Approaches to Assessing the Impact of School-Based Health Centers. J Adolesc Health 2016; 58:3-10. [PMID: 26707224 PMCID: PMC4693147 DOI: 10.1016/j.jadohealth.2015.09.018] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2015] [Revised: 09/08/2015] [Accepted: 09/08/2015] [Indexed: 10/22/2022]
Abstract
Since the founding of the first school-based health centers (SBHCs) >45 years ago, researchers have attempted to measure their impact on child and adolescent physical and mental health and academic outcomes. A review of the literature finds that SBHC evaluation studies have been diverse, encompassing different outcomes and varying target populations, study periods, methodological designs, and scales. A complex picture emerges of the impact of SBHCs on health outcomes, which may be a function of the specific health outcomes examined, the health needs of specific communities and schools, the characteristics of the individuals assessed, and/or the specific constellation of SBHC services. SBHC evaluations face numerous challenges that affect the interpretation of evaluation findings, including maturation, self-selection, low statistical power, and displacement effects. Using novel approaches such as implementing a multipronged approach to maximize participation, entering-class proxy-baseline design, propensity score methods, data set linkage, and multisite collaboration may mitigate documented challenges in SBHC evaluation.
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Affiliation(s)
- Melina Bersamin
- Prevention Research Center, Pacific Institute for Research and Evaluation, Oakland, California.
| | - Samantha Garbers
- Heilbrunn Department of Population & Family Health, Columbia University Mailman School of Public Health, New York, New York
| | - Melanie A Gold
- Heilbrunn Department of Population & Family Health, Columbia University Mailman School of Public Health, New York, New York; Department of Pediatrics, Columbia University Medical Center, New York, New York; School Based Health Centers, New York-Presbyterian Hospital, New York, New York
| | - Jennifer Heitel
- Heilbrunn Department of Population & Family Health, Columbia University Mailman School of Public Health, New York, New York
| | - Kathryn Martin
- Heilbrunn Department of Population & Family Health, Columbia University Mailman School of Public Health, New York, New York
| | - Deborah A Fisher
- Pacific Institute for Research and Evaluation, Calverton, Maryland
| | - John Santelli
- Heilbrunn Department of Population & Family Health, Columbia University Mailman School of Public Health, New York, New York
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