A Cost-Benefit Analysis of School Nursing in One Large Urban School District

This study is a cost-benefit analysis examining an urban district's partial school nurse coverage conversion to full-time coverage. Through a partnership with a health care system, the district received funding, resulting in the hiring of full-time nurses to cover all K-8 elementary schools. Researchers compared the cost of nursing services to the savings in teacher, secretary, principal, and parent productivity, reduced medical procedure costs, and grants nurses managed. The year before implementing additional nurses, the return on investment (ROI) to the community for nursing services was calculated to be $1.59 for every dollar invested in schools with full-time coverage and $1.29 for schools with partial coverage. After implementing full-time nurses in each school, there was an ROI of $1.50 during the 2015-2016 school year, $1.64 for 2016-2017, and $1.67 for 2017-2018. The analysis provides evidence that full-time coverage could result in a positive ROI for schools and the community.

Parent Perceptions regarding High School Drug Testing

Adolescent drug use remains a critical public health issue. Almost 38 percent of school districts currently implement student drug testing, and more schools may be considering implementation due to emerging recreational drug use laws. Parents are an essential key stakeholder and decision-maker in school policies. Purpose: The purpose of this study was to examine Colorado parents' perceptions regarding high school drug testing. Methods: A cross-sectional research design was used to assess parental support for implementing drug testing in public high schools. A total of 205 participants completed a survey evaluating support, attitude, and beliefs regarding this policy. Descriptive statistics, chi-square, and logistic regression analyses were conducted to examine the data. Results: The majority of parents perceived that alcohol (68.3%), cannabis (77.6%), and illicit drugs (51.2%) were a problem amongst students at their child's high school. Parents overall were supportive of drug testing students (61.9%), except for parents who were current cannabis users (p = .002). The majority of parents are supportive of drug testing because they believe it could help students resist peer pressure (65.9%), facilitate early intervention (e.g. counseling; 71.2%), while not violating student privacy rights (57.6%) or creating a negative school climate (50.7%). Conclusions/Importance: Parents recognize there may be an adolescent drug use problem. Parental support of drug testing is an important consideration for superintendents/school districts who are contemplating implementation of a drug testing policy for high schools.

Access to School Health Services: Differences Between Full-Time and Part-Time School Nurses

This study examined differences in student access to health services between schools with nurses 2 days/week ( n = 7) compared to schools with nurses 5 days/week ( n = 7). The study found statistically significant differences in numbers of nurse visits per 100 students. Of the 30 health conditions/activities investigated, 28 were statistically significantly higher with full-time school nurses than with part-time school nurses. It would be expected that 5-day/week nurses would be involved in health service activities 2.5 times as often as 2-day/week nurses. However, this study found that 21 of the 30 health service activities in schools with 5-day/week nurses were accessed by students more often than the expected 2.5 times that of the schools with nurses 2 days/week. This suggests a significant unmet need for access to health care services in schools with only 2-day/week nurses.

Principals’ Perceptions and Practices of School Bullying Prevention Activities

The purpose of this study was to examine principals’ perceptions and practices regarding bullying prevention. A survey instrument was developed to assess principals’ stages of change and perceived barriers regarding selected bullying prevention activities as well as the effectiveness of bullying prevention activities. Of a national random sample of 700 principalsto which the survey was mailed, 55% responded. None of the school-based bullying prevention activities were being done by more than one in five schools even though principals perceived there to be no barriers regarding these activities. Characteristics that affected the offering of these activities included number of perceived barriers to implementing the activity, whether the principal had received violence/bullying prevention training, perceptions regarding the extent of bullying, and the number of bullying problems reported to them. The findings suggest that preprofessional training and continuing education are needed to educate principals regarding this area.

A whole school approach: collaborative development of school health policies, processes, and practices

BACKGROUND

The Whole School, Whole Community, Whole Child (WSCC) model shows the interrelationship between health and learning and the potential for improving educational outcomes by improving health outcomes. However, current descriptions do not explain how to implement the model.

METHODS

The existing literature, including scientific articles, programmatic guidance, and publications by national agencies and organizations, was reviewed and synthesized to describe an overview of interrelatedness of learning and health and the 10 components of the WSCC model.

RESULTS

The literature suggests potential benefits of applying the WSCC model at the district and school level. But, the model lacks specific guidance as to how this might be made actionable. A collaborative approach to health and learning is suggested, including a 10-step systematic process to help schools and districts develop an action plan for improving health and education outcomes. Essential preliminary actions are suggested to minimize the impact of the challenges that commonly derail systematic planning processes and program implementation, such as lack of readiness, personnel shortages, insufficient resources, and competing priorities.

CONCLUSIONS

All new models require testing and evidence to confirm their value. District and schools will need to test this model and put plans into action to show that significant, substantial, and sustainable health and academic outcomes can be achieved.

A national assessment of colleges and university school health education methods courses

BACKGROUND

Across the United States, school health education programs provide a wide variety of knowledge and skills to their students. There are currently no guidelines for school health methods courses.

METHODS

Using a 2-wave mailing followed by a third wave e-mail reminder, a final population of 226 university school health methods instructors at school health preparation programs were surveyed.

RESULTS

A total of 138 completed surveys (61%) were returned. The topics taught in school health education methods courses emphasized the most included aligning objectives, instruction, and assessment (79%); development of lesson plans (73%); teaching methods that engage learners (72%); and application of the National Health Education Standards and performance indicators (69%). The content taught and how the instructors assessed their students differed statistically by 1 or more of the following: whether they had a health education degree, had experience teaching in the public schools, and if their program was accredited.

CONCLUSIONS

This study provides information regarding what school health methods instructors across the United States are teaching in their classes. Using this information as a baseline can serve as a guide for preservice faculty teaching a school health methods course.

Providing assistance to the victims of adolescent dating violence: a national assessment of school nurses' practices

BACKGROUND

This study assessed the perceptions and practices of school nurses regarding adolescent dating violence (ADV).

METHODS

The membership list of the National Association of School Nurses was used to identify a national random cross-sectional sample of high school nurses in the United States (N = 750). A valid and reliable survey instrument was developed and a 3-wave postal mailing procedure was used to maximize the return rate (57%).

RESULTS

Most school nurses (86.4%) reported that they did not have a protocol in their schools to respond to an incident of ADV. The majority of nurses reported that in the past 2 years, training to assist victims of ADV had not been provided to personnel in their schools (88.1%) and their schools did not conduct periodic student surveys that include questions on teen dating abuse behaviors (71.5%). Nurses who had a school protocol for responding to an incident of ADV perceived significantly fewer barriers to assisting victims of ADV and assisted more victims. Over half (55.3%) of high school nurses reported assisting a victim of ADV in the past 2 years.

CONCLUSION

Nurses appear to need more training in ADV. In addition, nurses found a number of barriers (eg, lack of training on ADV, lack of time, and lack of private space) to assisting student victims of ADV. Schools need to establish a means for assessing the status of ADV in their student population. Schools also need to provide in-service education for school personnel regarding prevention, assessment, and interdiction of ADV.

High school health-education teachers' perceptions and practices related to teaching HIV prevention

BACKGROUND

HIV/AIDS is one of the leading causes of illness and death in the United States with individuals between the ages of 13 and 19 years being especially vulnerable for infection. The purpose of this study was to examine the attitudes, perceptions, and instructional practices of high school health teachers toward teaching HIV prevention.

METHODS

A total of 800 surveys were sent to a national random sample of high school health teachers and 50% responded.

RESULTS

There was almost complete agreement (99%) among respondents that HIV prevention instruction is needed. The factors that emerged as significantly influencing the attitudes and perceptions of high school health teachers about teaching HIV prevention were related to teacher preparation, training, and years of experience teaching health education. A state mandate requiring HIV prevention instruction was significantly associated with higher teacher efficacy expectations and more perceived benefits, but did not have a significant influence in relation to practices in the classroom. Characteristics of high school health teachers that were significantly related to attitudes, perceptions, and instructional practices included the instructor's age, sex, and race/ethnicity.

CONCLUSIONS

High school health teachers who reported the least experience teaching health education had the least supportive attitudes, perceived the most barriers, and had the lowest efficacy and outcome expectations related to teaching about HIV prevention. Whereas these findings support the importance of teacher preparation and training, they also suggest that more recent college graduates may not be fully prepared to provide effective instruction in HIV prevention.

Adolescent dating violence: a national assessment of school counselors' perceptions and practices

BACKGROUND AND OBJECTIVES

Adolescent dating violence (ADV) is a significant public health problem that, according to various estimates, affects 9% to 34% of adolescents in the United States. Schools can play an important role in preventing ADV. However, little is known about school personnel's practices and perceptions regarding ADV. This study assessed high school counselors' knowledge, training, perceptions, and practices on dealing with ADV incidents.

METHODS

A national random sample (n = 550) of high school counselors who were members of the American School Counselors Association were sent a valid and reliable questionnaire on ADV. A 3-wave mailing procedure was used to increase the response rate, which was 58%. Statistically significant differences (P < .05) were calculated by using t tests, χ(2) tests, analysis of variance, and logistic regression.

RESULTS

A majority of the school counselors reported that they did not have a protocol in their schools to respond to an incident of ADV (81.3%). Additionally, the majority (90%) of counselors reported that in the past 2 years, training to assist survivors of teen dating abuse has not been provided to personnel in their schools, their school did not conduct periodic student surveys that include questions on teen dating abuse behaviors (83%), and their school did not have a committee that meets periodically to address health and safety issues that include teen dating abuse (76%).

CONCLUSIONS

The results of this study indicate that schools do not find ADV a high-priority issue to be addressed in their student populations.

School superintendents' perceptions of schools assisting students in obtaining public health insurance

BACKGROUND

Superintendents' perceptions regarding the effect of health insurance status on academics, the role schools should play in the process of obtaining health insurance, and the benefits/barriers to assisting students in enrolling in health insurance were surveyed. Superintendents' basic knowledge of health insurance, the link between health and learning, and specific school system practices for assisting students were also examined.

METHODS

A 4-page questionnaire was sent to a national random sample of public school superintendents using a 4-wave postal mailing.

RESULTS

Only 19% of school districts assessed the health insurance status of students. School districts' assistance in helping enroll students in health insurance was assessed using Stages of Change theory; 36% of superintendents' school districts were in the action or maintenance stages. The schools most often made health insurance materials available to parents (53%). The perceived benefits identified by more than 80% of superintendents were to keep students healthier, reduce the number of students with untreated health problems, reduce school absenteeism, and improvement of students' attention/concentration during school. The 2 most common perceived barriers identified by at least 50% of superintendents were not having enough staff or financial resources.

CONCLUSIONS

Most superintendents believed schools should play a role in helping students obtain health insurance, but the specific role was unclear. Three fourths of superintendents indicated overwhelmingly positive beliefs regarding the effects of health insurance status on students' health and academic outcomes. School personnel and public policy makers can use the results to support collaboration in getting students enrolled in health insurance.

African American parents'/guardians' health literacy and self-efficacy and their child's level of asthma control

Nearly 1 of 10 American children has asthma. Asthma is addressed in Healthy People 2010 as a public health problem. This study examined the relationship between parents'/guardians' health literacy levels and their perceived self-efficacy to manage their child's asthma. A four-page asthma questionnaire was developed to assess the self-efficacy of parents/guardians of African American children with asthma. There was a statistically significant relationship among the parents'/guardians health literacy levels and their perceived efficacy expectations to manage their child's asthma. There is evidence that high parental/guardian self-efficacy and successful asthma management contribute to a child with well-controlled asthma. It is necessary for patient educators to capitalize on physician/nurse visits and use the time for asthma education, particularly to increase the efficacy expectations of parents/guardians with limited health literacy skills.

Clinical psychologists' firearm risk management perceptions and practices

The purpose of this study was to investigate the current perceptions and practices of discussing firearm risk management with patients diagnosed with selected mental health problems. A three-wave survey was mailed to a national random sample of clinical psychologists and 339 responded (62%). The majority (78.5%) believed firearm safety issues were greater among those with mental health problems. However, the majority of clinical psychologists did not have a routine system for identifying patients with access to firearms (78.2%). Additionally, the majority (78.8%) reported they did not routinely chart or keep a record of whether patients owned or had access to firearms. About one-half (51.6%) of the clinical psychologists reported they would initiate firearm safety counseling if the patients were assessed as at risk for self-harm or harm to others. Almost half (46%) of clinical psychologists reported not receiving any information on firearm safety issues. Thus, the findings of this study suggest that a more formal role regarding anticipatory guidance on firearms is needed in the professional training of clinical psychologists.

Adolescents' sleep behaviors and perceptions of sleep

BACKGROUND

Sleep duration affects the health of children and adolescents. Shorter sleep durations have been associated with poorer academic performance, unintentional injuries, and obesity in adolescents. This study extends our understanding of how adolescents perceive and deal with their sleep issues.

METHODS

General education classes were randomly selected from a convenience sample of three high schools in the Midwest. Three hundred eighty-four ninth- to twelfth-grade students (57%) completed a self-administered valid and reliable questionnaire on sleep behaviors and perceptions of sleep.

RESULTS

Most respondents (91.9%) obtained inadequate sleep (<or= 9 hours) on most school nights of the week, with 10% reporting less than 6 hours of sleep each week night. The majority indicated that not getting enough sleep had the following effects on them: being more tired during the day (93.7%), having difficulty paying attention (83.6%), lower grades (60.8%), increase in stress (59.0%), and having difficulty getting along with others (57.7%). Some students reported engaging in harmful behaviors to help them sleep: taking sleeping pills (6.0%), smoking a cigarette to relax (5.7%), and drinking alcohol in the evening (2.9%). Students who received fewer hours of sleep were significantly more likely to report being stressed (p = .02) and were more likely to be overweight (p = .04).

CONCLUSIONS

Inadequate sleep time may be contributing to adolescent health problems such as increased stress and obesity. Findings indicate a need for sleep hygiene education for adolescents and their parents. A long-term solution to chronic sleep deprivation among high school students could include delaying high school start times, such as was done successfully in the Minneapolis Public School District.

Elementary school nurses' perceptions and practices regarding body mass index measurement in school children

This study examines elementary school nurses' perceived efficacy expectations, perceived barriers, and perceived benefits to measuring body mass index (BMI) in students in schools with mandated BMI policies versus schools without mandated policies. Of the 2,629 school nurses participating in the study, 67% believe nurses should measure BMI in schools, 62% believe BMI results should be sent home, and 81% believe nurses should be designing programs to help children address overweight issues. In schools with a BMI assessment mandate, the nurses' efficacy expectations are statistically significantly greater and nurses' perceptions of barriers to measuring BMI are significantly lower. The most common perceived barriers to measuring BMI are inadequate school resources (57.6%) and inadequate or inappropriate parental responses (55.2%). Obese school nurses perceive significantly more barriers to measuring youths' BMIs than do nonobese school nurses. Having mandates has a positive influence on school nurses and their measurement of BMI and increases the likelihood that nurses will measure BMI.

Elementary school parents'/guardians' perceptions of school health service personnel and the services they provide

BACKGROUND

The school nurse, the school social worker, and the school counselor play an important role in promoting the health of children. Health services in the school setting provide opportunities to appraise, protect, and promote student health. The purpose of this study was to identify parents' or caregivers' perceptions and beliefs regarding the importance of schools providing various health services to their elementary school-aged children. In addition, the study examined the levels of parental support for, perceptions of, and contact with school health service personnel.

METHODS

In 2005, a nationally representative random sample of 369 (51% return rate) parents of elementary school-aged children completed the questionnaire developed for this study.

RESULTS

A majority of parents/caregivers reported that their child's school had a school nurse (78.8%) and counselor (60.5%), but only 22.6% reported their school had a social worker. A majority of parents/caregivers perceived full-time school nurses (86.3%), school counselors (78.6%), and school social workers (56.3%) as important or extremely important and that schools should be held responsible for having each in their child's elementary school. A majority of parents/caregivers were willing to pay an increase in yearly tax dollars to have full-time school health personnel.

CONCLUSIONS

This study established a level of parental support for, perceptions of, and contact with school health service personnel. Parents were most supportive of school nurses and should be perceived as allies in ensuring job security.

Health education: results from the School Health Policies and Programs Study 2006

BACKGROUND

School health education can effectively help reduce the prevalence of health-risk behaviors among students and have a positive influence on students' academic performance. This article describes the characteristics of school health education policies and programs in the United States at the state, district, school, and classroom levels.

METHODS

The Centers for Disease Control and Prevention conducts the School Health Policies and Programs Study every 6 years. In 2006, computer-assisted telephone interviews or self-administered mail questionnaires were completed by state education agency personnel in all 50 states plus the District of Columbia and among a nationally representative sample of districts (n=459). Computer-assisted personal interviews were conducted with personnel in a nationally representative sample of elementary, middle, and high schools (n=920) and with a nationally representative sample of teachers of classes covering required health instruction in elementary schools and required health education courses in middle and high schools (n=912).

RESULTS

Most states and districts had adopted a policy stating that schools will teach at least 1 of the 14 health topics, and nearly all schools required students to receive instruction on at least 1 of these topics. However, only 6.4% of elementary schools, 20.6% of middle schools, and 35.8% of high schools required instruction on all 14 topics. In support of schools, most states and districts offered staff development for those who teach health education, although the percentage of teachers of required health instruction receiving staff development was low.

CONCLUSIONS

Health education has the potential to help students maintain and improve their health, prevent disease, and reduce health-related risk behaviors. However, despite signs of progress, this potential is not being fully realized, particularly at the school level.

Primary grade teachers' perceptions and practices regarding pedestrian safety education

BACKGROUND

Pedestrian injury is the third leading cause of unintentional injury and death among children 1-14 years old. The purpose of this study was to examine primary grade teachers' perceived role in pedestrian safety education.

METHODS

A total of 630 surveys were sent to a national random sample of primary school teachers and 54% responded.

RESULTS

The results of the study found that 85% of primary grade teachers believed it was extremely important or important to teach pedestrian safety. Forty percent of the teachers identified that they had been teaching pedestrian safety for more than 1 year (maintenance stage), whereas 1 in 3 teachers had never thought about (precontemplation stage) teaching pedestrian safety to their students. Eighty-eight percent of primary grade teachers were very confident about teaching students how to safely cross the street, where to safely cross the street (87%), when to safely cross the street (86%), and how to safely walk along streets with sidewalks (83%). An examination of how pedestrian safety information was presented found that a plurality (39%) of the teachers who taught pedestrian safety presented information through classroom discussion. Also, 46% of the teachers who taught pedestrian safety identified the following as the most common curriculum content: when to safely cross the street (46%), how to safely cross the street (45%), and where to safely cross the street (43%).

CONCLUSIONS

Only 16% of primary school teachers reported pedestrian safety education was required for their grade levels. Yet, pedestrian safety education decreases pedestrian-related deaths. Therefore, it is important for schools and primary grade teachers to expose their students to this essential topic.

Parents' perceptions of curricular issues affecting children's weight in elementary schools

The purpose of this study was to examine Ohio parents' perceptions of the role of elementary schools in preventing childhood overweight. In the United States, overweight is the most widespread health threat facing children and adolescents. Schools may be a useful point of intervention in addressing the escalating prevalence of childhood overweight because children spend over half their day at school. A questionnaire was developed based primarily on the School Health Index, a tool developed by the Centers for Disease Control and Prevention to help schools assess and improve their physical activity, healthy eating, tobacco use prevention, and safety policies and programs. Seven hundred surveys were sent to a random sample of Ohio parents of elementary school-aged children. This study (53% response rate) found that the majority (51-73%) of parents identified 14 items as very important in preventing childhood overweight, which is indicative of their support for these curricular topics within the elementary school. All items from the physical education component had less than 50% of the parents identifying these items as very important. The item that was least supported (16%) by the parents was measuring a child's body mass index. The majority (51%) of parents indicated their preference for elementary students' access to vending machines only if they contained nutritious foods and beverages, while 42% of parents preferred that elementary students should not be allowed access to vending machines at all. The findings from this study suggest that Ohio parents would be supportive of school-based interventions focusing on healthy eating, physical activity, and the school environment to help reduce the prevalence of overweight in elementary children.

Parents' perceptions of the role of schools in tobacco use prevention and cessation for youth

The purpose of this study was to examine Ohio parents' perceptions of the role of schools in smoking prevention, cessation, and anti-tobacco policy for their children. A 46-item questionnaire was based on the CDC Guidelines for School Health Programs to Prevent Tobacco Use and Addiction. Surveys (n = 800) were sent to a stratified random sample of parents of junior high and high school aged students and 57% responded. Parents were supportive of smoking prevention activities, but almost two-thirds believed their child's school should get parents' input. Furthermore, mothers/step-mothers were more likely than fathers/step-fathers to agree that the school had a role in smoking prevention activities. The majority of parents were also supportive of smoking cessation activities. However, only 8% of parent respondents supported schools providing nicotine gum or patches to students trying to quit smoking. Overall, the majority of parents were supportive of the seven recommendations developed by the CDC as guidelines for school health programs to prevent tobacco use and addiction. Schools have the opportunity to impact student smoking through prevention and cessation activities. Schools need to know that parents are supportive of these activities and want to be included in the process of implementing effective prevention or cessation programs.

Availability of services for emergency contraceptive pills at high school-based health centers

CONTEXT

School-based health centers have the potential to increase adolescents' awareness of, access to and use of emergency contraceptive pills, which can prevent unintended pregnancy following unprotected sex.

METHODS

In 2001, 250 high school-based health centers responded to a nationwide mail survey that assessed the provision of education, referral and prescription services for emergency contraceptive pills, as well as the perceived benefits and barriers related to offering these services. Frequencies, cross-tabulations and logistic regression models were used to analyze the data.

RESULTS

Fifty-nine percent of the centers provided education and referrals for emergency contraceptive pills, while 30% provided prescriptions. Staff generally identified the same benefits of and barriers to services, although centers that provided services were more likely than nonproviders to report benefits and less likely to report barriers. Predictors of offering education were providing reproductive health services (odds ratio, 4.6) and citing the increased likelihood that students would use the method (3.5) and have the opportunity to discuss contraception (2.6). Reporting the benefit of pregnancy prevention was a predictor of offering referrals (2.9), while providing reproductive health services (30.4) and citing pregnancy prevention (6.3) were predictors of offering prescriptions. Predictors of the decreased likelihood of offering services were also identified.

CONCLUSIONS

School centers that provide all three services have the greatest potential to ensure the successful use of emergency contraceptive pills by adolescents. While the number of centers offering services appears to be increasing, greater efforts are needed to improve students' awareness of and access to the method so they can make informed decisions regarding their reproductive health.

Elementary school teachers' involvement in firearm safety education

This national study assessed elementary school teachers' (n = 352) firearm safety education activities and perceptions using a 3-wave mailing survey. One percent of the teachers reported receiving undergraduate training regarding firearm safety. Yet, 12% claimed to be well prepared or very well prepared to teach firearm safety. Most teachers had high perceived self-efficacy regarding teaching firearm safety and perceived firearm safety education as important. Ten percent were currently teaching firearm safety. Teachers perceived 3 main barriers to teaching firearm safety: not enough expertise (66%), not sure what topics should be taught (58%), and not enough time to include firearm safety in the curriculum (54%). About one third (35%) desired further information regarding teaching firearm safety.

Effect of full-time versus part-time school nurses on attendance of elementary students with asthma

Asthma, the most common chronic disease in children today, is the leading cause of absenteeism among students. It accounts for nearly 20 million lost school days annually. This study examined whether full-time (5 days per week) or part-time (2 days per week) school nurses would have a differential effect on the frequency of absences among elementary school students with asthma. This study found that students with asthma who were poor or who were African American and in schools with full-time nurses missed significantly fewer days (3 days, or 23% fewer missed days) than did their counterparts with asthma in schools with part-time nurses.

Health Department Activities Regarding Nonmotorized Small-Wheel Forms of Recreation

The Stages of Change Model and perceived benefits and barriers to providing injury prevention activities for nonmotorized small-wheel forms of recreation by local health departments were used to determine the status of injury prevention activity. A questionnaire mailed to a national random sample of 600 health departments resulted in a response rate of 67%. Approximately 10% of health departments were in the action and maintenance stages of the Stages of Change Model in relation to nonmotorized small-wheel forms of recreation, while the majority (70%) was in the precontemplation stage. More than 98% of health departments agreed that there were benefits to providing nonmotorized small-wheel forms of recreation injury prevention activities, including "decrease injury," "increase likelihood of wearing recommended safety equipment," and "increase awareness of injury." The vast majority (96%) of health departments believed there were barriers to providing injury prevention activities, including lack of financial resources, not enough expertise, and not enough time.

Perceptions of nursing faculty regarding ethical issues in nursing research

A major premise of any research activity is that ethical conduct will be identified and observed during the research process. Yet a comprehensive review of the nursing literature failed to find any research assessing nurses' perceptions of ethical issues related to authorship, publication, reporting results, or funding. This study assessed nursing faculty members' perceptions of ethical scenarios related to the areas of authorship, publication, reporting results, and funding. A 34-item questionnaire, consisting of ethical issues related to research, was mailed to a national random sample of nursing faculty who were teaching at graduate degree-granting institutions. A three-wave mailing was used to maximize response rate. A total of 388 nurses responded to the survey (77.6% response rate). Less than half of the respondents reported that content included in their curriculum was related to the issues under study. Respondents' perceptions of the ethical scenarios varied. A majority of the respondents considered six of the scenarios ethical, eight unethical, one questionable, and one not an ethical issue. Five of the scenarios received widely varied responses. Faculty members who had chaired student dissertations found three questionnaire items significantly (p < .05) more unethical than faculty members who had not chaired dissertations. Faculty teaching in programs in which the highest degree offered was a doctorate found two items unethical significantly more often than faculty teaching at programs in which the highest degree offered was a master's degree. Results of this study demonstrate the potential that students are not being taught necessary issues related to ethical authorship and publication practices. Faculty members themselves may not have had the education needed to educate their own students in the area of research ethics.

Continuing-education needs of public health educators: their perspectives

The objective of the study described in this article was to determine the perceived continuing-education needs of employed public health educators. A three-wave mailing of a questionnaire was sent to a national sample of 500 public health educators who were asked to rate their preparation on 41 subcompetencies. Of 299 returned surveys (63%), 149 indicated that they were not currently practicing public health educators. Thus, analysis was based on 150 respondents. Six subcompetencies were perceived by 25% or more of the respondents as topics in which they needed more training. Health educators reported a need for continuing education, focused primarily on administration and evaluation of programs and applying appropriate research principles. Furthermore, the public health educators overwhelmingly preferred to attend a conference or workshop (85%) as their method of obtaining further continuing education. Health education programs and professional organizations need to take note of the identified continuing-education needs when developing future educational programs to adequately update health educators.

Elementary school secretaries' experiences and perceptions of administering prescription medication

This study assessed elementary school secretaries' (n = 385) experiences and perceptions with student prescription medication. Sixty-nine percent (n = 246) reported dispensing student medication, and this group represents the focus of this study. One in four secretaries reported not receiving any training regarding administration of student medication. Of those who were trained, 28% received training of less than one hour, and 24% received training of one to two hours duration. Secretaries generally disliked the responsibility of dispensing medication to students, but felt prepared to do so. Most (63%) administered student medication five days per week. The most commonly administered categories included attention deficit/hyperactivity medication (92%), asthma medication (87%), and antibiotics (68%). Most (85%) reported they had made no medication errors during the past year.

Teacher perceptions and practices regarding school bullying prevention

This study examined a national random sample of teachers regarding their perceptions and practices concerning school bullying prevention activities. A total of 359 of 700 (52.4%) teachers responded. Most (86.3%) teachers had serious talks with both the bully and victim. Less than one-third set aside classroom time to discuss bullying (31.7%) or involved students in creating classroom rules against bullying (31.2%). Most perceived no barriers to implementing these activities. Teachers perceived post-bullying activities as the most effective means of reducing bullying problems, followed by improved student supervision, and by environmental bullying prevention activities. The findings suggest that preprofessional and continuing education are needed to improve teacher knowledge about effective classroom-based bullying prevention activities.

Pediatricians' perceptions and practices regarding prevention and treatment of type 2 diabetes mellitus in children and adolescents

OBJECTIVE

To assess pediatricians' perceptions and practices regarding the prevention and treatment of type 2 diabetes mellitus in children and adolescents in a cross-sectional study.

DESIGN

A 3-wave mailing of a questionnaire to 550 pediatricians. Descriptive statistics, analysis of variance, and logistic regression were used for data analyses.

SETTING

A national random sample of pediatricians who work in private practice, hospital settings, and/or clinics.

RESULTS

Every 1 in 9 respondents referred their patients with type 2 diabetes mellitus for exercise, while most pediatricians referred their patients for dietary interventions (62.3%) and educational services (62.6%). Pediatricians who were confident during counseling and follow-up were significantly (P =.02) more likely than pediatricians who were less confident to refer their patients for exercise, dietary interventions, and educational services. Of the respondents, 15.3% perceived they were well prepared to counsel and provide follow-up to patients with type 2 diabetes mellitus. The leading perceived barriers to counseling and follow-up were inadequate time for counseling, poor adherence of patients, lack of family support, lack of familiarity of clinical practice recommendations, and lack of health care insurance coverage.

CONCLUSIONS

Pediatricians who had a higher perceived confidence level and who perceived they were better prepared for the counseling and follow-up of patients with type 2 diabetes mellitus had a greater potential to positively affect their diabetic patients. Improving continuing medical education and residency-based programs is imperative to adequately address the emerging epidemic of type 2 diabetes mellitus in children and adolescents.

The nature and extent of bullying at school

In elementary schools, the prevalence of bullying ranges from 11.3% in Finland to 49.8% in Ireland. The only United States study of elementary students found that 19% were bullied. Bullying behavior declines as students progress through the grades. School bullying is associated with numerous physical, mental, and social detriments. A relationship also exists between student bullying behavior and school issues such as academic achievement, school bonding, and absenteeism. Prevention of school bullying should become a priority issue for schools. The most effective methods of bullying reduction involve a whole school approach. This method includes assessing the problem, planning school conference days, providing better supervision at recess, forming a bullying prevention coordinating group, encouraging parent-teacher meetings, establishing classroom rules against bullying, holding classroom meetings about bullying, requiring talks with the bullies and victims, and scheduling talks with the parents of involved students. Finally, this review suggests further studies needed to help ameliorate the bullying problem in US schools.

Adolescent smoking cessation services of school-based health centers

A national sample of 390 junior and senior high school-based centers were mailed an 18-item survey to assess their institutional stages of change regarding smoking cessation education, referral, and prescription nicotine replacement therapy (NRT) services and their perceived barriers and benefits regarding the provision of these services. Nearly half were in the maintenance stage for cessation education programs, one-third were in maintenance stage for referral services, and 12% were in the maintenance stage for NRT. The most frequently cited perceived benefits included an increased awareness of short- and long-term effects of smoking (education programs and referral services) and increasing student access to cessation methods (NRT). The greatest barriers cited were a lack of financial resources (education programs), problems with student transportation (referral services), and staff not having the authority to provide prescription services (NRT). School-based centers can do more to help stop adolescents from using tobacco.

Elementary school teachers' techniques of responding to student questions regarding sexuality issues

Fifth- and sixth-grade elementary school teachers' (n = 277) techniques of responding to students' human sexuality-related questions were assessed. Few teachers (34%) reported receiving formal training in sexuality education. The most commonly asked student questions dealt with STDs, puberty, homosexuality, pregnancy, and abortion. Teachers' willingness to answer sexually-related questions in front of the class varied (73% to 14%) by content of the question. There were no questions on the questionnaire in which more than one in five teachers would choose not to answer. The most common questions the teachers identified they would not respond to dealt with topics such as abortion, masturbation, homosexuality, and issues about the male genitals. Finally, none of the questions was perceived by more than one in eight of the teachers as questions they would not be allowed to answer.

Survey return rates using a covering letter signed by a graduate student or faculty member

This study assessed differences in response rate when the author of a survey was identified as a graduate student or a faculty member. A survey on research ethics was mailed to 500 nurse faculty members with half of the covering letters signed as a graduate student and half signed as a faculty member. There were 388 (78%) out of a possible 495 surveys returned. The response rate was 78% for graduate student and 77% for faculty identifications, not significant by chi-square test.

Urban elementary school students' perceptions of fighting behavior and concerns for personal safety

This study assessed urban elementary school students' experience with weapon carrying and violence, concerns for personal safety, and perceptions of passive and direct interventions in resolving fights. The survey was completed by 1,912 urban students in the fourth and fifth grades. This cross-sectional study found that one in 12 students reported weapon carrying one or more times during the past month. One-third indicated that they would hit peers back if struck by them. One-quarter of students did not feel safe going to or from school, and 23%-43% worried about being physically attacked in or around school. Adjusted odds ratios and 95% confidence intervals were calculated using logistic regression. Significant associations were found between the independent variables of age, race, gender, and academic success (grades) and the dependent variables of weapon carrying, hitting a peer back, concerns of safety, and passive solutions or direct interventions for peer fighting.

Primary grade teachers' knowledge and perceptions of head lice

This study examined primary grade teachers' knowledge of head lice, perceived self-efficacy in dealing with head lice, and preferred resources of additional information on head lice. Survey data from a three-wave mailing (M = 292; 60%) found that teachers needed more knowledge regarding head lice and were significantly more knowledgeable as teaching experience increased. A plurality (46%) had high efficacy expectations scores regarding their ability to control the spread of head lice. Most (71%) primary teachers reported they received most of their head lice information from school nurses. Most (63%) said they would like more information on how to prevent head lice infestation, and they wanted the information in the form of videotapes (68%) and brochures (51%). Only 23% provided yearly instruction regarding head lice.

Predictors of sixth graders engaging in sexual intercourse

Researchers explored factors related to sixth graders' sexual behavior. First, level of sexual behavior and sexual behavior intentions were examined. Second, health-related risk behaviors and constructs from Social Support and Social Cognitive theories were analyzed based on race and gender to determine their predictive value for sixth graders engaging in sexual intercourse. Findings indicated that very few sixth graders engaged in sexual intercourse or in high-risk behaviors such as smoking. Of the risk factors examined, smoking was the highest predictor of engaging in sexual intercourse for all categories of race and gender. Of the constructs, Efficacy Expectations consistently predicted engaging in sexual intercourse for all race and gender categories.

Mothers' perceptions of factors influencing violence in schools

This study investigated mothers' perceptions of factors contributing to school violence. Of 345 mothers, 225 (65%) from urban public schools and 120 (35%) from suburban public schools, significant differences in perceptions of school violence were found on the enabling factors subscale for school location. Urban school mothers were significantly more likely than suburban mothers to attribute violence problems at their child's school to the lack of dress codes, violent messages in rap music, and poor parent/teacher communication. Significant differences in perceptions of school violence were found on the reinforcing factor subscale for school location, income, family structure, and race. Mothers of low- and middle-income, single parents, and African Americans were much more optimistic about the possibility that violence prevention programs for students, parents, and teachers would work well to stop or reduce school violence than were higher-income, married, and White mothers. These mothers also were more likely to believe it was acceptable for their child to fight at school than were their counterparts.

High school health teachers' perceived self-efficacy in identifying students at risk for suicide

A national random sample of 228 high school health teachers completed a 45-item survey to examine their perceived self-efficacy regarding adolescent suicide. Most respondents were female, White, and held master's degrees. Most believed it was their role to recognize students at risk for suicide, believed that if they did recognize students at risk it would reduce the chances that the student would commit suicide, and believed that one of the most important things they could do would be to prevent a suicidal student from committing suicide. However, only 9% believed they could recognize a student at risk for suicide. High efficacy expectations scores were associated with working at a school that offered an inservice program on adolescent suicide, included teaching about suicide prevention in the curriculum, and had a crisis intervention team. This study suggests that teacher health education programs should spend more time on developing the skills necessary to identify students at risk. In addition, a comprehensive school suicide prevention program is strongly encouraged for all high schools.

School nurses' perceptions of and experience with school health research

This survey examined school nurses' perceptions of and experience with school health research. A random sample of school nurses who were either members of the school nurse section of the American School Health Association (ASHA) or members of the National Association of School Nurses (NASN) comprised the sample (n = 590). The response rate was 81%; the nurses were all females. A plurality held masters degrees (40%) and had worked an average of 12.0 years as a school nurse. Most (67%) were employed at the elementary school level. Slightly more than one-third (37%) had ever been involved in a research study as a school nurse. Perceived barriers to engaging in research were lack of time, clerical help, and money. Perceived benefits of school nurses engaging in research were: adds new knowledge on school nursing issues (97%), benefits the health care of children at school (93%), and helps peers do their job better (86%). School nurses also indicated they would become involved in research if someone would assist them (78%).

Junior high school students' perceptions regarding nonconsensual sexual behavior

This study assessed early adolescents' attitudes and perceptions regarding nonconsensual sexual activity. A total of 371 surveys (94% return rate) was completed. More than one-third of respondents (35%) reported they had engaged in sexual intercourse; 17% reported having been sexually coerced by a teen-ager; 19% reported feeling pressure from their friends to have intercourse; 7% reported having been sexually coerced by an adult; and 6% reported having sexually coerced someone else. Students also demonstrated lack of knowledge regarding nonconsensual sexual behaviors. Analysis of variance tests determined if knowledge (KN), attitudes (AT), behavioral intentions (BI), and locus of control (LC) changed across specific background and demographic variables. One background variable (having been sexually coerced by a teen-ager) was associated with high risk orientation (lower scores) on all four subscales. Lower scores also were associated with being male (KN, AT, BI), having sexually coerced someone else (KN, AT, BI), having been sexually coerced by an adult (AT, BI), and having engaged in sexual intercourse (AT, BI).

Evaluation of a three-year urban elementary school tobacco prevention program

The longitudinal study compared effects of varying amounts of tobacco instruction (one, two, and three years) on the knowledge, attitudes, and behavioral intentions of urban elementary students. A three-year, fourth-through-sixth grade tobacco prevention curriculum was developed based on the Centers for Disease Control and Prevention's Guidelines for School Health Programs to Prevent Tobacco Use and Addiction. The curriculum comprised five, 45-minute lessons per year. The same trained instructor taught the curriculum all three years. Six intervention schools were taught the curriculum, and two control schools were not. A 49-item questionnaire was used to assess tobacco knowledge, attitudes, and behavioral intentions. The experimental group's posttest knowledge and attitude scores were significantly higher than the control group's posttest scores. No significant differences occurred in posttest behavioral intention scores between the control and intervention groups.

An informational versus monetary incentive in increasing physicians' response rates

This study examined return rates for a cancer prevention survey by pediatricians in relation to an informational booklet versus a monetary incentive in the first of a three-wave mailing. Of the 300 surveys sent which included an informational booklet incentive, 189 (64%) were returned. Of the 300 surveys sent which included a $1.00 incentive 227 (79%) were returned, indicating the $1.00 incentive was more effective than the informational incentive in increasing return rates in this sample of physicians.

Sun protection counseling by pediatricians

OBJECTIVE

To establish a national baseline regarding pediatricians' sun protection counseling perceptions and behaviors.

INTERVENTIONS

A survey was mailed to a random sample of 600 pediatricians selected from the 1996 American Academy of Pediatrics Directory using a 3-wave mailing technique to maximize the response rate. The 3-wave mailing resulted in 414 returned surveys of 583 surveys (17 surveys were nondeliverable) (a 71% response rate).

RESULTS

Most (60%) of the pediatricians lacked formal training on how to counsel parents and children about sun protection. Approximately 3 (78%) of 4 indicated that not enough time was spent in their residency program on how to educate parents and children about sun protection. Greater than half (60%) of the respondents indicated that they usually (47%) or always (13%) counseled about sun protection. Seventy-seven percent of the respondents indicated that pediatricians have a professional responsibility to counsel parents and children about sun protection.

CONCLUSIONS

The results of this investigation suggest that most pediatricians surveyed believed that they had a professional responsibility to counsel about sun protection and that such counseling would be effective in decreasing skin cancer and the number of sunburns. Although most had not had training on sun protection counseling in their residency program, 6 of 10 indicated that they usually or always counseled about sun protection. Sun protection counseling training in residency programs can potentially extend pediatricians' knowledge of skin cancer and the importance of a broad spectrum of preventive measures, as well as increase their ability to counsel about such measures.