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To determine whether school-level participation in the federal Community Eligibility Provision (CEP), which provides free school lunch to all students, is associated with school meal participation rates. Participation in school meals is important for decreasing food insecurity and improving child health and well-being.
Quasi-experimental evaluation using negative binomial regression to predict meal count rates per student-year overall and by reimbursement level adjusted for proportion eligible for free and reduced-price lunch (FR eligibility) and operating days.
Schools (grades kindergarten to 12th) participating in the National School Lunch Program (NSLP) in Maryland and Pennsylvania, USA, from the 2013–2015 (n 1762) and 2016–2017 (n 2379) school years.
Administrative, school-level data on school lunch counts and student enrolment.
CEP was associated with a non-significant 6 % higher total NSLP meal count adjusting for FR eligibility, enrolment and operating days (rate ratio = 1·06, 95 % CI 0·98, 1·14). After controlling for participation rates in the year prior to CEP implementation, the programme was associated with a significant 8 % increase in meal counts (rate ratio = 1·08, 95 % CI 1·03, 1·12). In both analyses, CEP was associated with lower FR meal participation and substantial increases in paid meal participation.
School-level implementation of CEP is associated with increases in total school meal participation. Current funding structures may prevent broader adoption of the programme by schools with fewer students eligible for FR meals.
To assess the nutritional quality of student canteen purchases at recess and lunch, including: (i) the mean energy (kilojoules), saturated fat (grams), total sugar (grams) and Na (milligrams) and percentage of energy from saturated fat and total sugar; and (ii) the proportion and types of foods purchased that are healthier (green) and less healthy (amber/red) according to a state school canteen policy.
A cross-sectional study of student canteen food and beverage recess and lunch purchases.
Twenty-six randomly selected government primary schools that were non-compliant with a state school canteen policy from a region of New South Wales, Australia, were approached to participate.
Students (aged 5–12 years) of participating schools.
Eighteen schools (69 %) consented to participate. On average students’ recess purchases contained 571·2 kJ energy, 1·6 g saturated fat, 11·6 g total sugar and 132·4 mg Na with 10·0 % of energy from saturated fat and 37·8 % of energy from total sugar. Students’ lunch purchases contained 685·4 kJ energy, 1·8 g saturated fat, 12·7 g total sugar and 151·4 mg Na with 9·5 % of energy from saturated fat and 31·8 % of energy from total sugar. Less healthy items represented 72 and 76 % of all items purchased at recess and lunch, respectively, with ‘savoury snacks’ and ‘sugar-sweetened ice blocks and slushies’ being the most common recess and lunch purchases, respectively.
There is considerable scope to improve the nutritional quality of student purchases from primary-school canteens, with a high percentage of energy from total sugar. Future research is required to identify effective strategies to enhance compliance with canteen policies and support the purchase of healthier foods from school canteens.
Low IQ is a risk factor for psychosis, but the effect of high IQ is more controversial. The aim was to explore the association of childhood school success with prodromal symptoms in adolescence and psychoses in adulthood.
In the general population-based Northern Finland Birth Cohort 1986 (n = 8 229), we studied the relationship between teacher-assessed learning deficits, special talents and general school success at age 8 years and both prodromal symptoms (PROD-screen) at age 15–16 years and the occurrence of psychoses by age 30 years.
More prodromal symptoms were experienced by those talented in oral presentation [boys: adjusted odds ratio (OR) 1.49; 95% confidence interval 1.14–1.96; girls: 1.23; 1.00–1.52] or drawing (boys: 1.44; 1.10–1.87). Conversely, being talented in athletics decreased the probability of psychotic-like symptoms (boys: OR 0.72; 0.58–0.90). School success below average predicted less prodromal symptoms with boys (OR 0.68; 0.48–0.97), whereas above-average success predicted more prodromal symptoms with girls (OR 1.22; 1.03–1.44). The occurrence of psychoses was not affected. Learning deficits did not associate with prodromal symptoms or psychoses.
Learning deficits in childhood did not increase the risk of prodromal symptoms in adolescence or later psychosis in this large birth cohort. Learning deficits are not always associated with increased risk of psychosis, which might be due to, e.g. special support given in schools. The higher prevalence of prodromal symptoms in talented children may reflect a different kind of relationship of school success with prodromal symptoms compared to full psychoses.
The present study tested the validity of a digital image-capture measure of food consumption suitable for use in busy school cafeterias.
Lunches were photographed pre- and post-consumption, and food items were weighed pre- and post-consumption for comparison.
A small research team recorded children’s lunchtime consumption in one primary and one secondary school over seven working days.
A primary-school sample of 121 children from North Wales and a secondary-school sample of 124 children from the West Midlands, UK, were utilised. Nineteen children were excluded because of incomplete data, leaving a final sample of 239 participants.
Results indicated that (i) consumption estimates based on images were accurate, yielding only small differences between the weight- and image-based judgements (median bias=0·15–1·64 g, equating to 0·45–3·42 % of consumed weight) and (ii) good levels of inter-rater agreement were achieved, ranging from moderate to near perfect (Cohen’s κ=0·535–0·819). This confirmed that consumption estimates derived from digital images were accurate and could be used in lieu of objective weighed measures.
Our protocol minimised disruption to daily lunchtime routine, kept the attrition low, and enabled better agreement between measures and raters than was the case in the existing literature. Accurate measurements are a necessary tool for all those engaged in nutrition research, intervention evaluation, prevention and public health work. We conclude that our simple and practical method of assessment could be used with children across a range of settings, ages and lunch types.
The Healthy Food and Drink Policy was implemented in Western Australian government schools in 2007. The aim of the present study was to assess the compliance of Western Australian school canteen menus with the policy a decade after its introduction.
The traffic-light system that underpins the Healthy Food and Drink Policy categorises foods and drinks into three groups: ‘green’ healthy items, ‘amber’ items that should be selected carefully and ‘red’ items that lack nutritional value. Canteen menus were collected online and each menu item was coded as a green, amber or red choice.
Online canteen menus from 136 primary and secondary government schools.
The majority of audited school menus met policy requirements to include ≥60 % green items (84 %) and ≤40 % amber items (90 %), but only 52 % completely excluded red items. Overall, approximately half (48 %) of school canteen menus met all three traffic-light targets. On average, 70 % of the menu items were green, 28 % were amber and 2 % were red. Primary-school canteen menus were more likely than those from secondary schools to meet the requirements of the policy.
While the sampled Western Australian government school canteen menus were highly compliant with most of the requirements of the Healthy Food and Drink Policy, many offered red foods and/or drinks. Providing all schools with further education about identifying red items and offering additional services to secondary schools may help improve compliance rates.
The US Department of Agriculture’s Summer Food Service Program and Seamless Summer Option (summer nutrition programmes (SNP)) aim to relieve food insecurity for children and teens during summer months. More needs to be known about when and where SNP are available, and how availability varies by community characteristics, particularly in rural areas where food insecurity and reduced food access are more prevalent.
The present study examined the geographic availability of SNP and summer meal uptake rates in 2016, using state-wide administrative claims data.
Public schools and SNP in California, USA.
Schools (n 8842) and SNP (n 4685).
Urban counties were more likely than rural counties to have higher summer uptake rates, calculated as the percentage of summer meals served relative to eligible students utilizing school meal programmes during the academic school year, but uptake overall was low at 18·2 % of target populations. Geographic availability analyses showed that 63·9 % of public urban schools had an SNP available within 1·6 km (1 mile), but availability was significantly higher within the proximity of larger, higher-poverty high schools with diverse or majority non-White students, and those with higher school-year breakfast participation rates. Availability of an SNP within 16 km (10 miles) of rural schools averaged 68·1 % but was significantly higher around larger schools, higher-poverty schools and those with diverse or majority non-White students.
While many communities have SNP available, much more work is needed to increase the availability of these programmes to reduce summer food insecurity for children, particularly in rural communities.
African American youths are overrepresented in the American juvenile justice system relative to Caucasians. Yet, research on antisocial behaviors (ASB) has focused on predominantly Caucasian populations. Furthermore, relatively little is known about how environmental factors, such as supportive parenting (e.g., how close adolescents feel to their parent) and school connectedness (e.g., how supported adolescents feel at school), affect trajectories of ASB in Caucasians versus African Americans. This study mapped developmental trajectories of ASB in Caucasians (n = 10,764) and African Americans (n = 4,091) separately, using four waves of data from the National Longitudinal Study of Adolescent to Adult Health. We then examined supportive parenting and school connectedness on the trajectories of ASB. Four trajectories of ASB were identified for both Caucasians and African Americans: negligible, adolescence-peaked, low-persistence, and high-persistence ASB, although prevalence rates differed by racial-ethnic status. Supportive parenting reduced the risk of membership into the adolescence-peaked trajectory for both Caucasians and African Americans. However, school connectedness was less protective for African Americans than for Caucasians because it only predicted a lower risk of adolescence-peaked membership for African Americans. Findings may reflect the complex social dynamics between race and schools in the development of ASB.
This study examined the effects of a school-based cognitive-behavioural group intervention for anxiety in young children, Get Lost Mr Scary, on child self-reported anxiety and coping skills. Participants included 65 children (Mage = 6.50 years, SDage = 0.75) drawn from 13 public primary schools located in Western Sydney, Australia. The children participated in seven weekly 1-hour Get Lost Mr Scary sessions, and their parents attended three information sessions. The pictorial semistructured Child Anxiety and Coping Interview (CACI) was used to elicit the children's self-report of their anxiety symptoms, emotions, coping strategies, and coping efficacy before and after the 7-week intervention. Although children rated their maladaptive coping strategies as helpful, the postintervention results indicated a significant decrease in the use of maladaptive strategies such as behavioural avoidance and an increase in adaptive cognitive strategies, particularly cognitive restructuring. Consistent with parent and teacher reports, child self-reports indicated a significant reduction in anxiety and negative emotional distress. The clinical implications of the findings are discussed.
To (i) describe the proportion of foods and beverages available on school canteen menus classified as having high (‘green’), moderate (‘amber’) or low (‘red’) nutritional value; (ii) describe the proportion of these items purchased by students; and (iii) examine the association between food and beverage availability on school canteen menus and food and beverage purchasing by students.
A cross-sectional study was conducted as part of a larger randomised controlled trial (RCT).
A nested sample of fifty randomly selected government schools from the Hunter New England region of New South Wales, Australia, who had participated in an RCT of an intervention to improve the availability of healthy foods sold from school canteens, was approached to participate.
School principals, canteen managers and students.
The average proportion of green, amber and red items available on menus was 47·9, 47·4 and 4·7 %, respectively. The average proportion of green, amber and red items purchased by students was 30·1, 61·8 and 8·1 %, respectively. There was a significant positive relationship between the availability and purchasing of green (R2=0·66), amber (R2=0·57) and red menu items (R2=0·61). In each case, a 1 % increase in the availability of items in these categories was associated with a 1·21, 1·35 and 1·67 % increase in purchasing of items of high, moderate and low nutritional value, respectively.
The findings provide support for school-based policies to improve the relative availability of healthy foods for sale in these settings.
Within the North American public education system, institutionalised structures of schooling often prevent teachers from aligning their values with their practice when it comes to environmental education (Bowers, 1997; Weston, 2004). In response to this, this article will outline our lived experiences, as teachers and researcher, in disrupting the traditional school system as we work toward building a new culture in schooling through nature-based education. Acts of disruption that we will speak to include: going outside for learning on a regular basis, teaching for empowerment, involving families in the education, attempts to play with structural confines of schooling, and finding ways to stay empowered ourselves. Through this work, we have found that there is a rippling effect to the disruption that requires courage, grit, and resilience such that we do not slide back into conventional approaches. We have also become empowered in our practices through implementing these changes, watching our students become active stewards within their communities and beyond. We are learning deeply about the work of structural change within a public school district and offer words here as inspiration and support for others wishing to make changes within their own context.
School students are increasingly using apps for health-related purposes, either on their own or when recommended by psychologists or counsellors, as apps offer a way to assist students to change their behaviour. However, there is a growing need for psychologists and counsellors to be able to evaluate the quality and usefulness of such apps to effect behaviour change. This study was therefore undertaken to identify methods by which school psychologists and counsellors could evaluate health-related apps for clinical use or research purposes. After examining 15 studies of apps that met the inclusion criteria, it was clear that researchers used a number of taxonomies to evaluate the apps. There were seven taxonomies identified, of which five were generalisable to all health conditions, with the behaviour change technique (BCT) taxonomy being the most comprehensive, containing 13 key behaviour strategies. Despite the utility of the taxonomies to identify the amount of behaviour change content within the apps, it was difficult to determine how the behaviour change strategies were measured, thus reducing the ability to predict app effectiveness. Approaches to improving methods by which apps can be developed and evaluated are proposed.
Children with chronic illness often experience difficulties at school, yet little is known about the impact of the child's illness on siblings’ school experiences. This study investigated parents’ perceptions of siblings’ school experiences and school support. We conducted semi-structured telephone interviews with 27 parents of children with a chronic illness who had a sibling or siblings (4–25 years), representing the experiences of 31 siblings. Interviews were audio-recorded, transcribed, and analysed using content analysis. Parents believed that 14 of 31 (45.2%) siblings had school difficulties related to the ill child, such as increased anxiety or stress at school, lack of attention from teachers, and changes in behaviour as a result of increased carer responsibilities. Parents identified increased absenteeism due to the ill child's hospitalisation and the impact of parent absences on sibling school functioning. Parents described general and psychological support from the school, and the importance of monitoring the sibling at school and focusing on their unique needs. Overall, our findings suggest the need for a school-based sibling support model that combines psycho-education for siblings and school personnel, individualised sibling psychological support, and shared school and parent responsibility in normalising the sibling experience and providing consistent support.
Overweight and obesity in childhood are serious public health issues, both in developing and developed countries. The present study aimed to ascertain overweight and obesity prevalence rates among Togolese schoolchildren in Lomé, Togo, and their correlation with physical activity, socio-economic conditions and eating habits.
Cross-sectional survey conducted in December 2015. Overweight and obesity were defined using age- and sex-specific BMI cut-off points of the International Obesity Task Force. Physical activity, socio-economic conditions and eating habits were assessed with a standardized questionnaire. Specially trained medical students interviewed children and collected the data. After bivariate regression analyses, factors associated with overweight/obesity were identified by multivariate logistic regression. Statistical significance was two-sided P<0·05.
Representative sample of 634 children (288 boys, 346 girls), aged 8–17 years, who were studying in primary schools.
Overweight and obesity respectively affected 5·2 and 1·9 % of children surveyed. Watching television (>4 h) on weekends (OR; 95 % CI: 3·8; 1·2, 12·0, P=0·02) and medium dietary diversity score (3·0; 1·1, 8·1, P=0·03) were independently associated with overweight/obesity in a multivariate regression model. Eating breakfast in the school cafeteria (0·2; 0·1, 0·8, P=0·03) and eating fruits (0·4; 0·1, 0·9, P=0·03) significantly reduced the risk of overweight/obesity.
Overweight and obesity prevalence were linked with sedentary behaviour and non-optimal food diversity. Promoting physical activity and fruit consumption should be explored as interventions to reduce and prevent overweight and obesity in Lomé schoolchildren. In addition, preventive approaches in the social environment of children should be considered.
Children with poor mental health often struggle at school. The relationship between childhood psychiatric disorder and exclusion from school has not been frequently studied, but both are associated with poor adult outcomes. We undertook a secondary analysis of the British Child and Adolescent Mental Health Surveys from 2004 and its follow-up in 2007 to explore the relationship between exclusion from school and psychopathology. We predicted poorer mental health among those excluded.
Psychopathology was measured using the Strengths and Difficulties Questionnaire, while psychiatric disorder was assessed using the Development and Well-Being Assessment and applying Diagnostic and Statistical Manual of Mental Disorders Fourth Edition (DSM IV) criteria. Exclusion from school and socio-demographic characteristics were reported by parents. Multi-variable regression models were used to examine the impact of individual factors on exclusion from school or psychological distress.
Exclusion from school was commoner among boys, secondary school pupils and those living in socio-economically deprived circumstances. Poor general health and learning disability among children and poor parental mental health were also associated with exclusion. There were consistently high levels of psychological distress among those who had experienced exclusion at baseline and follow-up.
We detected a bi-directional association between psychological distress and exclusion. Efforts to identify and support children who struggle with school may therefore prevent both future exclusion and future psychiatric disorder.
The role of schools in providing community-based support for children's mental health and well-being is widely accepted and encouraged. Research has mainly focused on designing and evaluating specific interventions and there is little data available regarding what provision is available, the focus and priorities of schools and the professionals involved in providing this support. The current study presents these data from schools in 10 European countries.
Online survey of 1466 schools in France, Germany, Ireland, Netherlands, Poland, Serbia, Spain, Sweden, UK and Ukraine. The participating countries were chosen based on their geographical spread, diversity of political and economic systems, and convenience in terms of access to the research group and presence of collaborators.
Schools reported having more universal provision than targeted provision and there was greater reported focus on children who already have difficulties compared with prevention of problems and promotion of student well-being. The most common interventions implemented related to social and emotional skills development and anti-bullying programmes. Learning and educational support professionals were present in many schools with fewer schools reporting involvement of a clinical specialist. Responses varied by country with 7.4–33.5% between-country variation across study outcomes. Secondary schools reported less support for parents and more for staff compared with primary schools, with private schools also indicating more staff support. Schools in rural locations reported less student support and professionals involved than schools in urban locations.
The current study provides up-to-date and cross-country insight into the approaches, priorities and provision available for mental health support in schools; highlighting what schools prioritise in providing mental health support and where coverage of provision is lacking.
Advancements in medical and surgical treatment have increased the life expectancy of patients with CHD. Many patients with CHD, however, struggle with the medical, psychosocial, and behavioural challenges as they transition from childhood to adulthood. Specifically, the environmental and lifestyle challenges in school are very important factors that affect children and adolescents with CHD. This study aimed to evaluate school-related adjustments depending on school level and disclosure of disease in children and adolescents with CHD. This was a descriptive and exploratory study with 205 children and adolescents, aged 7–18 years, who were recruited from two congenital heart clinics from 5 January to 27 February, 2015. Data were analysed using the Student’s t-test, analysis of variance, and a univariate general linear model. School-related adjustment scores were significantly different according to school level and disclosure of disease (p<0.001) when age, religion, experience being bullied, and parents’ educational levels were assigned as covariates. The school-related adjustment score of patients who did not disclose their disease dropped significantly in high school. This indicated that it is important for healthcare providers to plan developmentally appropriate educational transition programmes for middle-school students with CHD in order for students to prepare themselves before entering high school.
There is limited research detailing school-based counselling services and how they are utilised by students. This study presented counselling service data for a Preparatory to Grade 12 school. Specifically, it examined the number of students seen and sessions provided, and differences between users and non-users of the service. The results showed that approximately 20% of students engaged in counselling. Frequency data indicated that many students had brief contact with counselling and that there is no clear relationship for when this occurs during the term or year. There were also significant differences between users and non-users within key demographics. Implications for use of this information in school as well as recommendations for effective use of counselling service data are presented.