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Johnson KE, Thurman W, Hoskote A, Preston A, Rew L, Maughan ED. School Nurse Staffing in Texas Alternative High Schools: A Mixed Methods Exploration. J Sch Nurs 2022:10598405221126178. [PMID: 36237131 PMCID: PMC10097838 DOI: 10.1177/10598405221126178] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
School nurses represent cost-effective investments in students' health and educational success. Alternative high schools (AHSs) serve an understudied population of youth who are at risk for school dropout and face numerous social inequities, heightening their risk for poor health outcomes. In this two-phase explanatory sequential mixed methods study, we examined school nurse staffing in Texas AHSs. Findings suggest Texas AHSs face understaffing for familiar reasons common across districts (e.g., lack of funding), but also reveal potential deeper inequities. Quantitative findings indicate 71% of Texas AHSs have some form of nursing support, most often an on-call or part-time nurse. Qualitative findings support and enrich this finding with insights into the negative consequences of not having a full-time nurse, indiscriminate approaches to staffing AHSs, and how AHSs can be the only school in the district without a full-time nurse. Altogether, our findings reveal opportunities to better support AHSs with adequate nursing support.
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Affiliation(s)
- Karen E. Johnson
- The University of Texas at Austin School of Nursing, Austin, TX, USA
| | - Whitney Thurman
- The University of Texas at Austin School of Nursing, Austin, TX, USA
| | - Ashwini Hoskote
- The University of Texas at Austin School of Nursing, Austin, TX, USA
| | - Angela Preston
- The University of Texas at Austin School of Nursing, Austin, TX, USA
| | - Lynn Rew
- The University of Texas at Austin School of Nursing, Austin, TX, USA
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Analysis of behavioral interventions in alternative school settings. PSYCHOLOGY IN THE SCHOOLS 2021. [DOI: 10.1002/pits.22591] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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Johnson KE, Hoskote AR, Rolin DG, Kesler SR. Correlates of mental health problems among students in Texas alternative high schools and school-level efforts to address mental health. Res Nurs Health 2021; 45:183-193. [PMID: 34822199 DOI: 10.1002/nur.22197] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Revised: 11/08/2021] [Accepted: 11/09/2021] [Indexed: 12/28/2022]
Abstract
Students in alternative high schools (AHSs) are an understudied population who experience disproportionate levels of risk factors that contribute to mental health problems. Using logistic regression, we explored associations between mental health problems and risk and protective factors among students in Texas AHSs (n = 515; mean age 17.1 years; 51% female, 78% youth of color, 64% eligible for free/reduced lunch). Principals (n = 14) and lead health educators (n = 14) reported on school-level efforts to address mental health. Students reported, on average, 1.55 of 4 mental health problems in the past year. Logistic regression indicated that greater number of adverse childhood experiences, lower self-esteem, female gender, and sleep disruption (getting <8 h of sleep per night) were common contributors to symptoms of depression, anxiety, suicidal ideation, and PTSD with models showing medium-to-large effects (AUC: 0.73-0.81). We assessed school-level efforts to address mental health using descriptive statistics. At the school level, most (>50%) principals reported having policies and services to support student mental health, with the exception of having mental health/social services staff represented on school health councils (36%) and having Gay-Straight Alliances (21%). Most lead health educators (86%) reported educating AHS students about mental health, and many (57%) reported receiving professional development in mental health. Future research with a larger number of schools is needed to analyze whether school policies are statistically associated with student-level mental health outcomes. Such multi-level research can inform policies and practices for AHS student mental health.
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Affiliation(s)
- Karen E Johnson
- University of Texas at Austin School of Nursing, Austin, Texas, USA
| | | | - Donna G Rolin
- University of Texas at Austin School of Nursing, Austin, Texas, USA
| | - Shelli R Kesler
- University of Texas at Austin School of Nursing, Austin, Texas, USA
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Pike JR, Fadardi JS, Stacy AW, Xie B. The prospective association between illicit drug use and nonprescription opioid use among vulnerable adolescents. Prev Med 2021; 143:106383. [PMID: 33359759 PMCID: PMC7856303 DOI: 10.1016/j.ypmed.2020.106383] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2020] [Revised: 11/30/2020] [Accepted: 12/21/2020] [Indexed: 12/14/2022]
Abstract
In recent years, more than half of all drug overdose deaths in United States involved an opioid. To address this epidemic, antecedents to opioid misuse must be identified and empirically validated. The objective of the current investigation was to examine whether illicit drug use was prospectively associated with nonprescription opioid use among adolescents from a vulnerable population with a greater prevalence of substance abuse. A population-based cohort study of 1060 adolescents from 29 alternative high schools in southern California was conducted over a two-year period. A total of 929 adolescents (mean age 17.5 years, 49.9% female, 76.4% Hispanic) who had not experimented with nonprescription opioids at the baseline assessment were included in the analytic sample. The outcome was self-reported use of nonprescription opioids within two years. The predictors tested were illicit drug use, illicit drug use excluding marijuana, and the use of nonmedical marijuana. Covariates included age, sex, ethnicity, socioeconomic status, parental education, weekly income, sensation seeking, stress, anxiety, depression, and the use of alcohol and nicotine products. Multilevel, covariate-adjusted logistic regression models indicated that the odds of experimentation with nonprescription opioids was greater among adolescents who had used illicit drugs or illicit drugs excluding marijuana. Nonmedical marijuana use alone was a statistically significant predictor in unadjusted but not covariate-adjusted models. While prior studies have examined the progression from nicotine, alcohol, and marijuana use to nonprescription opioid use, the present findings emphasize the importance of illicit drug use as a detectable and empirically supported risk factor for future opioid misuse.
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Affiliation(s)
- James Russell Pike
- Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States.
| | - Javad Salehi Fadardi
- School of Education and Psychology, Ferdowsi University of Mashhad, Mashhad, Iran; School of Psychology, Bangor University, Bangor, United Kingdom; School of Community and Global Health, Claremont Graduate University, Claremont, CA, United States
| | - Alan W Stacy
- School of Community and Global Health, Claremont Graduate University, Claremont, CA, United States
| | - Bin Xie
- School of Community and Global Health, Claremont Graduate University, Claremont, CA, United States
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Resilience among students at risk of dropout: Expanding perspectives on youth suicidality in a non-clinical setting. SCHOOL MENTAL HEALTH 2020; 12:567-579. [PMID: 33343759 DOI: 10.1007/s12310-020-09366-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
While research supports a strong association between risk of school dropout and suicidality, this youth population remains understudied. This qualitative study addresses this gap by examining self-reported risk and protective factors among 44 alternative high school students who endorsed varying levels of suicidal ideation. Criterion sampling of Suicidal Ideation Questionnaire-JR scores informed student selection for semi-structured interviews. Students were grouped by low, moderate, or high suicidal ideation scores. Transcribed interviews were analyzed using thematic analysis. The findings demonstrate subgroup differences of suicide risk and resiliency among students at risk of dropout and offer points for prevention and intervention. School practitioners can advocate for school-based suicide preventive interventions that are tailored for students who are both at risk of suicide and academic failure.
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Johnson KE, Sales A, Rew L, Haussler Garing J, Crosnoe R. Using polytomous latent class analysis to compare patterns of substance use and co-occurring health-risk behaviors between students in alternative and mainstream high schools. J Adolesc 2019; 75:151-162. [PMID: 31398476 PMCID: PMC10460516 DOI: 10.1016/j.adolescence.2019.07.010] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2018] [Revised: 06/14/2019] [Accepted: 07/26/2019] [Indexed: 11/25/2022]
Abstract
INTRODUCTION Alternative high school (AHS) students, an understudied and underserved population, experience educational, social, and health disparities relative to students in mainstream high schools. Disparities in single types of substance use are particularly high, yet no known studies have compared patterns of substance use or relationships between these patterns and other health-risk behaviors between AHS and mainstream high schools. METHODS Using data from the Texas Alternative School Health Survey (n = 515; mean age 17.1 years, 49% male, 59% Hispanic, 23% White, 15% Black) and the Texas Youth Risk Behavior Survey (n = 2,113; mean age 16 years, 47% male, 64% Hispanic, 22% White, 7% Black), we used latent class analyses to compare patterns of substance use in AHSs and mainstream high schools. We used latent class regression to examine relationships between patterns of substance use and involvement in other health-risk behaviors in each school setting. RESULTS Students in AHSs and mainstream high schools had similar patterns of substance use, and youth in higher risk categories engaged in higher levels of other health-risk behaviors. A substantially greater proportion of AHS students, however, fell into the moderate and high use categories, in support of continuing disparities for AHS students. CONCLUSIONS Additional support is needed in AHSs to address the prevalence of high-risk patterns of substance use and associated health-risk behaviors. For example, ongoing public health surveillance is needed in AHSs, just as is done in mainstream high schools, to monitor trends in substance use and impact of policies and interventions.
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Affiliation(s)
- Karen E Johnson
- School of Nursing; Faculty Research Associate, Population Research Center, The University of Texas at Austin, 1710 Red River, Austin, TX, 78712, USA.
| | - Adam Sales
- Research Design Techniques Consulting Office, College of Education, The University of Texas at Austin, 1912 Speedway, Stop D5000, Austin, TX, 78712, USA.
| | - Lynn Rew
- School of Nursing, The University of Texas at Austin, 1710 Red River, Austin, TX, 78712, USA.
| | - Jennifer Haussler Garing
- Epidemiologist, YRBS Coordinator, Center for Health Statistics, Texas Department of State Health Services, 1100 West 49(th) Street, MC 1898, Austin, TX 78756, USA.
| | - Robert Crosnoe
- Rapoport Centennial Professor of Sociology and Associate Dean of Liberal Arts, Population Research Center, University of Texas at Austin, 305 East 23(rd) Street G1800, Austin, TX 78712, USA.
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Richardson E, Komro KA, Samarah E, Staras SAS. Increasing adolescent girls' ability to identify STI-risk characteristics of sexual partners: a pilot study within an alternative disciplinary school. Sex Transm Infect 2019; 95:580-583. [PMID: 30733423 DOI: 10.1136/sextrans-2018-053674] [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: 05/03/2018] [Revised: 12/10/2018] [Accepted: 12/27/2018] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVES We evaluated the feasibility of conducting a 9-week long sexually transmitted infection (STI) prevention intervention, Angels in Action, within an alternative disciplinary school for adolescent girls. METHODS All girls who were 16-18 years old, enrolled in the school and did not have plans to transfer from the school were eligible to participate. We measured process feasibility with recruitment, retention and participant enjoyment. Using a pretest-post-test design with a double post-test, we used χ² tests to estimate the intervention effect on participants' sexual partner risk knowledge, intentions to reduce partner risk and sexual activities in the past 60 days with three behavioural surveys: prior to, immediately following and 3 months after the intervention. RESULTS Among the 20 girls who were eligible, 95% (19/20) of parents consented and all girls (19/19) agreed to participate. Survey participation was 100% (19/19) prior to, 76% (13/17) immediately following and 53% (9/17) 3 months after the intervention. The intervention was administered twice and a total 17 girls participated. Session attendance was high (89%) and most participants (80%) reported enjoying the intervention. The intervention increased the percentage of girls who could identify partner characteristics associated with increased STI risk: 38% before, 92% immediately following and 100% 3 months after the intervention (p=0.01). Girls also increased their intentions to find out four of the most highly associated partner characteristics (partner's age, recent sexual activity and STI or jail history): 32% before to 75% immediately following (p=0.02) and 67% 3 months after the intervention (p=0.09). CONCLUSIONS This pilot study suggests girls at alternative disciplinary schools participated in and enjoyed a 9-week STI preventive intervention. Within alternative disciplinary schools, it is potentially feasible to increase girls' consideration of partner risk characteristics as a means to enhance their STI prevention skills.
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Affiliation(s)
- Eric Richardson
- School of Human Development and Organizational Studies, College of Education, University of Florida, Gainesville, Florida, USA
| | - Kelli A Komro
- Department of Behavioral Sciences and Health Education, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
| | - Esaa Samarah
- Department of Health Outcomes and Biomedical Informatics, College of Medicine, University of Florida, Gainesville, Florida, USA.,Institute for Child Health Policy, University of Florida, Gainesville, Florida, USA
| | - Stephanie A S Staras
- Department of Health Outcomes and Biomedical Informatics, College of Medicine, University of Florida, Gainesville, Florida, USA .,Institute for Child Health Policy, University of Florida, Gainesville, Florida, USA
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Brown LK, Whiteley L, Houck CD, Craker LK, Lowery A, Beausoleil N, Donenberg G. The Role of Affect Management for HIV Risk Reduction for Youth in Alternative Schools. J Am Acad Child Adolesc Psychiatry 2017; 56:524-531. [PMID: 28545758 PMCID: PMC5465640 DOI: 10.1016/j.jaac.2017.03.010] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2016] [Revised: 02/28/2017] [Accepted: 03/27/2017] [Indexed: 11/19/2022]
Abstract
OBJECTIVE Adolescents in alternative schools for behavioral and emotional problems have an earlier sexual onset and higher rates of sexual risk than their peers. They also often have difficulty managing strong emotions, which can impair sexual decision making. Human immunodeficiency virus (HIV) prevention programs for these adolescents may be most effective if skills for coping with strong emotions during sexual situations are included. METHOD This article reports the 6-month outcomes of a three-arm randomized controlled trial comparing an HIV prevention intervention with affect management (AM) to a standard, skills-based HIV prevention intervention (SB), and a general health promotion intervention (HP). HP was similar to a general health class, and SB was based on previous effective HIV prevention programs used with community adolescents, whereas AM included affect management skills in addition to effective HIV prevention skills. Youth (N = 377) in two US cities were 13 to 19 years of age and attending alternative schools for behavioral and emotional problems. RESULTS Multiple logistic regression analyses, adjusted for the baseline scores, age, and gender, found that adolescents in AM were significantly less likely to report being sexually active at follow-up (80% versus 91%, adjusted odds ratio = 0.28, 95% CI = 0.08-0.96) and more consistently using condoms than those in HP at follow-up (62%, versus 39%, adjusted odds ratio = 3.42, CI = 1.10-10.63). CONCLUSION Affect management techniques tested in this project, focused on sexual situations, are similar to those that are used in dialectical behavioral therapy (DBT) and in clinical practice. These data suggest that these techniques might decrease risk behaviors and improve the health of adolescents with emotional/behavioral problems. Clinical trial registration information-Therapeutic Schools: Affect Management and HIV Prevention; http://clinicaltrials.gov/; NCT00500487.
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Affiliation(s)
- Larry K Brown
- Rhode Island Hospital in Providence, RI; Warren Alpert Medical School, Brown University, Providence.
| | - Laura Whiteley
- Rhode Island Hospital in Providence, RI; Warren Alpert Medical School, Brown University, Providence
| | - Christopher D Houck
- Rhode Island Hospital in Providence, RI; Warren Alpert Medical School, Brown University, Providence
| | | | | | | | - Geri Donenberg
- College of Medicine at the University of Illinois-Chicago
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Johnson KE, Goyal M, Simonton AJ, Richardson R, Morris M, Rew L. Methods Matter: Tracking Health Disparities in Alternative High Schools. Public Health Nurs 2017; 34:303-311. [PMID: 28181295 DOI: 10.1111/phn.12314] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Alternative high school (AHS) students are at-risk for school dropout and engage in high levels of health-risk behaviors that should be monitored over time. They are excluded from most public health surveillance efforts (e.g., Youth Risk Behavior Survey; YRBS), hindering our ability to monitor health disparities and allocate scarce resources to the areas of greatest need. Using active parental consent, we recruited 515 students from 14 AHSs in Texas to take a modified YRBS. We calculated three different participation rates, tracked participation by age of legal consent (≥18 and <18 years), and identified other considerations for obtaining quality data. Being required to use active consent resulted in a much lower cooperation rate among students <18 years (32%) versus those who were ≥18 years and could provide their own consent (57%). Because chronic truancy is prevalent in AHS students, cooperation rates may be more accurate than participation rates based off of enrollment or attendance. Requiring active consent and not having accurate participation rates may result in surveillance data that are of disparate quality. This threatens to mask the needs of AHS students and perpetuate disparities because we are likely missing the highest-risk students within a high-risk sample and cannot generalize findings.
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Affiliation(s)
- Karen E Johnson
- School of Nursing, The University of Texas at Austin, Austin, Texas
| | - Mohit Goyal
- School of Medicine, Virginia Commonwealth University, Richmond, Virginia
| | | | | | - Marian Morris
- School of Nursing, The University of Texas at Austin, Austin, Texas
| | - Lynn Rew
- School of Nursing, The University of Texas at Austin, Austin, Texas
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