Supporting and Establishing Gender and Sexuality Alliances in Chicago Public Schools

School nurses are uniquely positioned to support lesbian, gay, bisexual, transgender, and questioning/queer (LGBTQ) students. One approach is involvement in Gender and Sexuality Alliances (GSAs). GSAs have been found to improve outcomes for LGBTQ students. The purposes of this quality improvement project were to build infrastructure for GSAs by implementing a GSA Support Plan including a digital resource binder, GSA advisor trainings, and establishment of an Advisor Leadership Committee and increase the number of schools with a GSA. The binder was distributed electronically to 95 advisors. Forty-nine participants attending virtual trainings. A statistically significant increase in all measures of participant confidence occurred between the pre- and post-training surveys. The Advisor Leadership Committee was established. This paper adds to the literature by showing that support for GSAs is important to aiding LGBTQ students. Further, authors suggest ways in which school nurses can harness their expertise to be involved with GSAs.

Parents' Participation in School Health Examinations for Their Adolescent Children in Finland

Engaging parents in school health examinations can promote adolescents' well-being. We examined parents' participation in universal school health examinations in Finland reported by adolescents in school surveys (14 to 16-year-olds, N = 58,232). Further we studied variation between service providers and schools, and student and school-level factors in participation. National data were analyzed using multilevel logistic regression models. Less than half of the adolescents reported parents' participation. The variation between service providers and schools was large. Non-participation was associated with mother's low education, students' immigrant background, daily health complaints, heavy drinking, and discussion difficulties with parents. Boys and those who did not live with both mother and father had a higher risk for parents' non-participation. Adolescents with a long-term illness or being bullied reported participation more often. Inviting parents and the school health nurse resource were not associated with participation. Our results raise the question of barriers to participation in health examinations.

A Systematic Scoping Review of Psychological Capital Related to Mental Health in Youth

Psychological capital (PsyCap) is a term coined in organizational psychology and refers to a person's development of states that motivate behavior. Also known in the literature as PsyCap, this construct typically refers to positive states of hope, self-efficacy, resilience, and optimism that are amenable to intervention and that are related to subjective well-being and life satisfaction. The aims of this systematic scoping review were to explore how PsyCap is described in youth mental health literature and how PsyCap and mental health are related. Results from four databases were reported following PRISMA guidelines. A total of 772 studies were identified and 16 studies were fully reviewed, including an overall sample of 6,772 youth from six countries. PsyCap has a positive relationship with mental health in youth. Future studies should involve school nurses to validate the constructs that characterize PsyCap and validate an instrument for measuring PsyCap in youth mental health in English.

School-Based Nurse Practitioners' Perceptions of the Health Care Needs of Transgender and Gender Nonconforming Adolescents

School-based nurse practitioners (NPs) can reduce health disparities for transgender and gender nonconforming (TGNC) adolescents. However, research is limited regarding their understanding of TGNC health. This study aimed to explore school-based NPs' perceptions of the health needs of TGNC adolescents. A qualitative, descriptive analysis utilizing a demographic survey and semi-structured interview questionnaire was conducted. School-based NPs (N = 6) were recruited via the New York School-Based Health Alliance listserv and through clinical networking. An essentialist, reflexive approach utilizing inductive thematic analysis was utilized. Four key themes and an overarching theme were identified. The overarching theme was the following: School-based NPs are primary resources-or "point people"-for TGNC adolescents seeking support, safety, and accessibility to health care. Findings identified the need for improvements in the areas of TGNC advocacy and education.

A Nationwide Study of Myopia in Taiwanese School Children: Family, Activity, and School-Related Factors

The purpose of the study was to explore how fixed and modifiable family, activity, and school factors affect a student's myopia risk and severity. We used national cross-sectional data from Taiwanese children in Grades 4-6. Bivariate and multivariate analyses, including logistic and ordinary least squares regression, examined factors related to children's myopia status and severity. Age, parent myopia, and school district were associated with risk of myopia. One hour or more per day of near work (OR = 1.26) increased the odds of myopia. The same amount of time in outdoor activities (OR = 0.85) or moderate or vigorous physical activities (OR = 0.82) was associated with lower risk. Near work (β = 0.06), outdoor activity (β = -0.04), and outdoor recess (β = -0.03) predicted myopia severity. To promote healthy vision, nurses should advocate for and implement interventions that increase school children's time outdoors and in physical activities and reduce their time on near work.

"Bringing Tap Back": Expanding the "Sodabriety" Teen Advisory Council Approach in Tennessee High Schools

Sugar-sweetened beverages (SSBs) are a large source of added sugar in teenagers' diets, comprising 20-25% of daily calories. Despite efforts, teens in rural and southern states continue to have the high SSB consumption rates. Using Teen Advisory Councils (TAC), students designed and delivered school-specific interventions at five Tennessee schools. Using repeated measures models with Bonferroni correction, data were collected on SSBs and water consumption at baseline and 30 days postintervention. The 573 participants ranged from 13 to 19 years; mean age 15.97 years (SD = 1.4). Daily SSB servings decreased from a mean of 2.37 (SD = 2.06) to 1.87 (SD = 1.89; p = .024). Weekly SSB behaviors decreased 10%. Daily water consumption increased 19.5% to 4.46 (SD = 2.97) servings (p = .03). Student-led efforts supported behavioral changes. TACs were effective at changing lifestyle behaviors. Community-driven solutions may result in manageable changes to sustain behaviors.

School Health Policy Implementation: Facilitators and Challenges

Schools are uniquely positioned to impact student health and academic outcomes through health and wellness policies. The purpose of this study was to describe factors influencing implementation of school health and wellness policies, specifically those focused on physical activity and nutrition. In-depth, stakeholder interviews were conducted with key informants at eight Chicago Public Schools (K-eighth grade). Data were analyzed using summative content analysis. Two themes were identified, facilitators and challenges to policy implementation. Facilitators included district support and motivation (internal and external). Challenges included limited school nurse availability, breaking tradition and budget. The external community and wellness team composition fell within both themes. Specific strategies are suggested to build upon policy implementation facilitators and overcome challenges. While school nurses play an integral role in student health and wellness, further research is needed to understand school nurse impact on student health and academic outcomes through school health policy.

Impact on Healthy Behaviors of Group Obesity Management Visits in Middle School Health Centers

This mixed-methods community-based participatory pilot study examined the feasibility and preliminary efficacy of group obesity management visits offered through school-based health centers. The study was implemented through an academic-community partnership in three school health centers serving primarily Latinx and African American youth. Participants (n = 71) completed pre- and post-surveys about intention to change diet and exercise habits, knowledge and self-efficacy related to healthy eating, and social support. Focus groups were conducted after the intervention and 18 months later. Group visits were feasible and highly valued by study participants. Quantitative results showed a significant decrease in soda consumption, increased support from classmates, and an increased number of exercise days. In focus groups, youth endorsed cooking, tasting, and shopping activities, noted the importance of family involvement in behavior change, and stated that stress reduction mindfulness exercises helped to change eating habits. Implications for school-based health care and school nursing are discussed.

Effect of a School-Based Activity Tracker, Companion Social Website, and Text Messaging Intervention on Exercise, Fitness, and Physical Activity Self-Efficacy of Middle School Students

This study examined the effect of a 10-week activity tracker, companion social website, and text messaging intervention on body mass index (BMI), body fat percentage, physical fitness, and physical activity (PA) self-efficacy of children. Children (n = 98) were assigned to one of three groups: activity tracker group, text messaging group, and activity tracker + text messaging group. Pre-/posttest fitness, BMI, PA self-efficacy, and body fat percentage were measured. The activity tracker group had a significant increase in fitness, no significant difference in PA self-efficacy, and an increase in body fat percentage and BMI (p < .05). The text messaging group had a significant increase in BMI (p < .05). The activity tracker + text messaging group had no significant differences in fitness, BMI, PA self-efficacy, or body fat percentage. This study gives no clear support to the hypothesis that use of activity trackers and a text messaging intervention have a positive effect on fitness, PA self-efficacy, or body fat percentage.

Do Schools That Screen for Body Mass Index Have Recommended Safeguards in Place?

The Centers for Disease Control and Prevention recommends that schools adopt 10 safeguards before launching a body mass index (BMI) screening program; however, little is known about schools' safeguard adoption. Authors identified questions from the 2014 School Health Policies and Practices Study that aligned with 4 of the 10 safeguards to estimate safeguard prevalence among schools that screened students for BMI (40.7%, N = 223). Among these schools, 3.1% had all four safeguards and 56.5% had none or one. The most prevalent safeguard was having reliable and accurate equipment (54.1%, 95% confidence interval [CI] = [46.1, 62.1]). Providing staff with appropriate expertise and training was the least prevalent; respondents in 26.4% (95% CI [17.1, 35.6]) of schools received recent training on weight status assessment, weight management, and eating disorder identification. School-based BMI screening is common, but adopting multiple recommended safeguards is not. Absent these safeguards, BMI screening programs may fall short of intended outcomes and potentially incur unintended consequences.

Neighborhood-Level Factors Related to Asthma in Children Living in Urban Areas

Asthma disproportionately affects children who are non-White and of low socioeconomic status. One innovative approach to address these health disparities is to investigate the child's neighborhood environment and factors influencing asthma symptoms. The purpose of this integrative review is to critique research investigating the relationships between neighborhood-level factors and asthma morbidity in urban children. Three literature databases were searched using the terms "asthma," "child," "neighborhood," and "urban." The articles included were organized into six themes within the larger domains of prevalence, physical, and social factors. Literature tables provide in-depth analysis of each article and demonstrate a need for strengthening analysis methods. The current research points to the necessity for a multilevel study to analyze neighborhood-level factors that are associated with increased asthma morbidity in urban children. School nurse clinicians, working within children's neighborhoods, are uniquely positioned to assess modifiable neighborhood-level determinants of health in caring for children with asthma.

Understanding the Nonmedical Use of Prescription Medications in the U.S. High School Adolescents

The purpose of the study was to examine relationships between sleep insufficiency, depressive symptoms, demographic factors, and the nonmedical use of prescription medications (NMUPMs) in the U.S. high school students. Data from the 2013 Youth Risk Behavioral Surveillance System were used ( n = 13,570) and analyzed using IBM SPSS 23™ (complex samples). Significant bivariate relationships were found between the NMUPMs and sleep ( p < .01), feeling sad ( p < .001), grade level ( p < .001), and race/ethnicity ( p < .01). Logistic regression analyses found that all of the independent variables were significant in predicting the likelihood of the NMUPMs. Findings underscore the potential impact of preventing NMUPMs in high school adolescents by improving their sleep behaviors and assessing adolescents for depressive symptoms.

High School Students' Self-Reported Use of School Clinics and Nurses

Access to school health clinics and nurses has been linked with improved student achievement and health. Unfortunately, no studies have examined how many students report using school clinics or nurses and for which services. This study addressed this gap with data from a nationally representative sample of 15- to 25-year-olds. Respondents who reported being in high school were provided a list of services and asked whether they had gone to a school nurse or clinic for any of the listed services. Nearly 90% reported having access to a school clinic or nurse. Among students with access, 65.6% reported using at least one service. Non-White students and younger students were more likely to report having access to a clinic or nurse. These results show many students have access to clinics or nurses and are using these services, although not uniformly for all services.

A Systematic Review of Literature on Culturally Adapted Obesity Prevention Interventions for African American Youth

Obesity and overweight prevalence in African American (AA) youth continues to be one of the highest of all major ethnic groups, which has led researchers to pursue culturally based approaches as a means to improve obesity prevention interventions. The purpose of this systematic review was to evaluate culturally adapted obesity prevention interventions targeting AA youth. A search of electronic databases, limited to multicomponent culturally adapted obesity prevention controlled trials from 2003 to 2013, was conducted for key terms. Eleven studies met inclusion criteria. We used the PEN-3 model to evaluate the strengths and weaknesses of interventions as well as to identify cultural adaptation strategies. The PEN-3 model highlighted the value of designing joint parent-youth interventions, building a relationship between AA mentors and youth, and emphasizing healthful activities that the youth preferred. The PEN-3 model shows promise as an overarching framework to develop culturally adapted obesity interventions.

Measurement and Interpretation of Body Mass Index During Childhood and Adolescence

The landscape of childhood health and disease has changed over the past century, and school nurses are now in a unique position to address the conditions that lead to chronic disease, such as obesity. Measuring body mass index (BMI) during childhood and adolescence is the recommended method for screening and/or monitoring obesity in school communities. Yet changes in the size, proportion, and distribution of fat mass and fat-free mass during growth and development introduce challenges to interpreting BMI measurements. Understanding these challenges and ensuring accurate measurement techniques are the foundation for implementing school-based BMI measurement programs. This article will provide an overview of body composition during childhood and adolescence, introduce strategies to improve the accuracy of BMI measurements, and explore the school nurse's role in BMI surveillance and/or screening activities.

Association of a behaviorally based high school health education curriculum with increased exercise

Increasing exercise in children and adolescents through academic classes is an understudied area. Potential benefits include associated improvements in health, psychosocial, and quality-of-life factors. A sample of 98 students (M(age) = 14.3) from high school health education classes received six, 40-min lessons incorporating cognitive-behavioral methods to increase exercise over 6 weeks. Significant within-group improvements in exercise, mood, and body satisfaction were found, with slightly larger effect sizes identified for the boys. Increase in exercise was significantly associated with reduced mood distress (β = -.17, p < .001). For the girls only, change in body satisfaction significantly mediated that relationship, and a reciprocal relationship between changes in mood and body satisfaction was also identified. Incorporation of lessons emphasizing goal setting and self-regulation within high school health education classes may foster increased exercise and associated improvements in mood and body satisfaction. For girls, the positive effects may reinforce one another.

Influence of perceptions on school nurse practices to prevent childhood obesity

Comprehensive childhood obesity prevention (COP) strategies should include increasing school nurse involvement. This study was conducted to determine the influence of key school nurse perceptions (self-efficacy, perceived benefits, and perceived barriers) on participation in COP practices at the individual child and school level. Florida registered nurse (RN) school nurses (n = 171) anonymously completed online or paper questionnaires. Linear regression analyses identified a model of self-efficacy with perceived benefits and barriers that explained 12% and 9.1% (p < .001) of variance in child-level and school-level COP practices, respectively. Self-efficacy explained the most variance in both models (p < .001). Mediation testing identified perceived barriers as a partial mediator of the influence of self-efficacy on child-level practices. These findings support interventions and policy changes to increase self-efficacy and reduce perceived barriers to promote school nurse involvement in preventing childhood obesity.

Relative weights of the backpacks of elementary-aged children

The purpose of the study was to describe the range of relative backpack weights of one group of elementary-aged children and the extent to which they exceeded recommended levels. A second purpose was to explore whether gender and age help predict the relative weight of children's backpacks. Ninety-five 8- to 12-year-old elementary school students (56% girls; 88% car or bus riders) participated. Their school backpacks were weighed, and their age, gender, and mode of transportation to school were recorded. Only 40% of the sample carried backpacks that were less than 10% of their body weights. Five percent of the students' backpacks exceeded 20% of their body weights. Neither age group nor gender significantly predicted relative backpack weight or relative weight levels. Recommendations are made for ways to reduce the weight these young children carry.

Feasibility of using actigraphy and motivational-based interviewing to improve sleep among school-age children and their parents

Inadequate sleep occurs in 25% of our nation's children; poor sleep is associated with physical, cognitive, and social consequences. Developing good sleep hygiene in middle childhood is important, because habits typically extend to adolescence and adulthood; yet, there has been little research on sleep interventions for school-age children. The purpose of this study was to determine the feasibility of a developmentally tailored, motivation-based intervention (MBI) focused on improving sleep behaviors in school-age children aged 8-11. Nine parent-child dyads participated in an 8-week protocol utilizing MBI and comparisons of objective (actigraphy) and subjective (sleep diaries) data. Results suggest that parent and children are able to identify a target behavior to change and complete the protocol. Further, preliminary evidence indicates that sleep patterns change using MBI. Future research will be directed toward comparative effectiveness testing and exploring ways in which it can be adapted and incorporated into school nursing practice.

Comparing the effects of teen mentors to adult teachers on child lifestyle behaviors and health outcomes in Appalachia

Childhood obesity prevalence rates in the United States are the highest in the rural Appalachian areas. Teens mentoring younger children to reverse obesity health risks are an understudied approach. This randomized-controlled trial compared the effects of two curriculum delivery methods and assessed the mediating effects of the number of sessions attended on the outcomes. The control group received the 8-week Just for Kids! curriculum via an adult teacher in a classroom and the experimental group received the same curriculum via individual teen mentoring. Data collected at baseline and postintervention were analyzed using multilevel linear models. Each of the outcomes (e.g., body mass index, blood pressure, current lifestyle behaviors) were modeled separately. Only the mentored children demonstrated improved current lifestyle behaviors (e.g., physical activity and dietary patterns) and health outcomes. Teen mentoring was an effective and efficacious approach to impact the lifestyle patterns and health outcomes of children in a school setting.

School nurses can address existing gaps in school-age sleep research

Sleep has been linked to a host of physical, behavioral, and emotional outcomes, and research has documented that youth across the globe are experiencing inadequate sleep. Despite this knowledge, however, very little research has been conducted on school-age children; much of the extant research has focused on infants, toddlers, preschoolers, adolescents, and adults. School-age children exhibit increasing independence around health-related behaviors, which provide health professionals the opportunity to educate and promote healthy sleep behaviors. This commentary extends previous research reviews by identifying the current gaps in sleep research, highlighting future directions needed in sleep research, and explaining why school nurses are best suited to address this growing public health issue.