An Evidence Base for School Health Policy during the COVID-19 Pandemic

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An Open Access article published in the Health Behavior and Policy Review Journal.
The full article is available as a PDF download.

Authors:

Saif Badran, MD, MRCS(Ed)*
Omran A.H. Musa, MA* Twitter
Somaya Al-maadeed, PhD, SMIEE
Egon Toft, MD, PhD
Suhail A. Doi, MBBS, PhD

* These authors contributed equally.

Objective:

Children represent a small fraction of confirmed COVID-19 cases, with a low case fatality rate (CFR). In this paper, we lay out an evidence-based policy for reopening schools.

Methods:

We gathered age-specific COVID-19 case counts and identified mortality data for 14 countries. Dose-response meta-analysis was used to examine the relationship of the incremental case fatality rate (CFR) to age. In addition, an evidence-to-decision framework (EtD) was used to correlate the dose-response data with other epidemiological characteristics of COVID-19 in childhood.

Results:

In the dose-response analysis, we found that there was an almost negligible fatality below age 18. CFR rose little between ages 5 to 50 years. The confidence intervals were narrow, suggesting relative homogeneity across countries. Further data suggested decreased child-hood transmission from respiratory droplets and a low viral load among children.

Conclusions:

Opening up schools and kindergartens is unlikely to impact COVID-19 case or mortality rates in both the child and adult populations. We outline a robust plan for schools that recommends that general principles not be micromanaged, with authority left to schools and monitored by public health authorities.

Source: Health Behavior and Policy Review, Volume 8, Number 1, January 2021, pp. 40-47(8)
Publisher: Paris Scholar Publishing Ltd.
DOI: https://doi.org/10.14485/HBPR.8.1.4

2021-02-22T08:41:57-07:00February 22nd, 2021|COVID19, Health Policy, School Health|

North American Jewish Day Schools’ Online Promotion of Physical Education

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An Open Access article published in the Health Behavior and Policy Review Journal.
The full article is available as a PDF download.

Authors:

David Kahan, PhD
Thomas L. McKenzie, PhD
Roman Fedoriouk

Objective:

Parents and other stakeholders regularly view school websites for important information including curricula. Over 300,000 students are enrolled in North American Jewish day schools, but little is known about schools’ online promotion of physical education (PE). We conducted a content analysis of the mention of various PE characteristics and their association with school characteristics.

Methods:

We systematically tallied mention of 7 PE characteristics and 4 school characteristics on the websites of 516 Jewish day schools located in 237 North American cities. Descriptive statistics and cross-tabulations were used to analyze proportions for each characteristic and associations among them.

Results:

PE and curriculum were the only characteristics mentioned on over 50% of the websites. The mention of 4 PE characteristics (health messaging, facilities, PE, curriculum) was strongly associated with the religious affiliation of schools. Specifically, websites of liberal schools and traditional schools were more and less likely, respectively, to mention the characteristics.

Conclusions:

The websites of Jewish day schools insufficiently promoted PE characteristics with large differences based on religious affiliation. Surveying school officials responsible for website content about their beliefs on PE generally and the appropriateness of websites for promoting it may help inform strategies for boosting its online presence.

Source: Health Behavior and Policy Review, Volume 8, Number 1, January 2021, pp. 28-39(12)
Publisher: Paris Scholar Publishing Ltd.
DOI: https://doi.org/10.14485/HBPR.8.1.3

2021-02-22T08:38:19-07:00February 22nd, 2021|Physical Activity, School Health|

The Gap between Perception and Reality: Obstacles to Public School Use of Produce from Small Local Farms in the Southeastern United States

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An Open Access article published in the Health Behavior and Policy Review Journal.
The full article is available as a PDF download.

Authors:

Kathryn A. Boys, PhD
Angela M. Fraser, PhD

Objective:

Connecting farms to school foodservice operations is complex. Our purposes in this study were to: (1) identify and assess self-reported benefits and challenges to procurement and use of produce purchased directly from small farms in school foodservice operations, and (2) determine if opinions about procurement from small farms significantly differs between those with and without experience purchasing these products.

Methods:

An online survey was conducted with child nutrition directors from 3 southeastern states in the United States. Statistical tests assessed differences in opinions between those with and without experience purchasing with these products.

Results:

Directors without experience understood the benefits but significantly overestimated the difficulty in obtaining and using these products. Experience shaped director perceptions regarding perceived procurement challenges related to contract terms, ordering challenges, food safety practices, and ability of small farms to supply foodservice needs.

Conclusions:

Challenges exist in procuring produce from small farms (eg, lack of coordinated ordering, delivery, and communications processes, insufficient availability of products, and limited value-added processing). Sourcing products directly from these farms is not as onerous as perceived to be. Bridging the identified information gaps could increase participation in farm-to-school programs.

Source: Health Behavior and Policy Review, Volume 8, Number 1, January 2021, pp. 13-27(15)
Publisher: Paris Scholar Publishing Ltd.
DOI: https://doi.org/10.14485/HBPR.8.1.2

2021-02-22T08:36:56-07:00February 22nd, 2021|Nutrition, School Health|

Assessing Fish to School Programs at 2 School Districts in Oregon

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An Open Access article published in the Health Behavior and Policy Review Journal.
The full article is available as a PDF download.

Authors:

Addison Virta, MPH, RD
David C. Love, MSPH, PhD

Objective:

Farm to school (FTS) programs provide many established benefits to students and the community; however, fish to school programs are a less studied subset of FTS. The objective was to identify how fish to school programs are implemented, their impacts, and the enabling factors to support these programs.

Methods:

We conducted formative research and interviewed stakeholders from 2 school districts in Oregon in 2019.

Results:

Interviewees reported benefits of connecting students and the larger school community with local food and creating excitement from new lunch offerings. Factors that facilitated fish to school programs included strong program leaders and partnerships, FTS grant funding, and the creative use of resources. Challenges in maintaining the program included sustainable program funding, seafood distribution networks, recipe development, and higher cost per serving of seafood compared to other proteins.

Conclusions:

Resources exist for school professionals interested in starting or sustaining fish to school programs. These programs are difficult to launch and sustain, and thus, require many forms of support (institutional, financial, industry, culinary, etc) and benefit from innovations like fish to school aggregators and product development such as pre-prepared fish options.

Source: Health Behavior and Policy Review, Volume 7, Number 6, December 2020, pp. 557-569(13)
Publisher: Paris Scholar Publishing Ltd.
DOI: https://doi.org/10.14485/HBPR.7.6.5

2020-12-30T13:56:29-07:00December 30th, 2020|Nutrition, Open Access, School Health|

When US and State Governments Go Viral: In-person Reopening of Schools during the COVID-19 Pandemic – and Then What? – A Commentary

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An Open Access article published in the Health Behavior and Policy Review Journal.
The full article is available as a PDF download.

Authors:

Robert J. McDermott, PhD Twitter

Objective:

In this commentary I argue that rapid reopening of schools for in-person instruction in the United States is unwise and likely to extend the duration of the COVID-19 pandemic.

Methods:

I review various sources of information and raise issues less frequently and thoroughly addressed in noted plans to expedite school reopening.

Results:

Whereas the focus has been on preparing plans of action for in-person instruction on the first day of school that minimize risk to pupils and school personnel, aspects of these plans are operationally unsound. Additionally, opinions among school personnel and parents for rapid reopening are far from unanimous. Moreover, the potential health impact on teachers, bus drivers, and other school personnel, as well as pupils, and the potential for another shutdown are phenomena with real probability.

Conclusion:

Despite government-led arguments favoring rapid restoration of in-person instruction, I argue that school reopening should take a wiser approach, sustaining remote instruction until pandemic statistics place people at substantially reduced disease risk.

Source: Health Behavior and Policy Review, Volume 7, Number 4, July 2020, pp. 366-373(8)
Publisher: Paris Scholar Publishing Ltd.
DOI: https://doi.org/10.14485/HBPR.7.4.10

2020-08-21T17:27:28-06:00August 21st, 2020|COVID19, Open Access, School Health, Youth|

Effects of a School Tobacco Policy on Student Smoking and Snus Use

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An Open Access article published in the Health Behavior and Policy Review Journal.
The full article is available as a PDF download.

Authors:

Håkan Källmén, PhD
Peter Wennberg, PhD
Tove Sohlberg, PhD
Matz Larsson, PhD, MD

Objective:

A school tobacco policy (STP) commonly is used to reduce smoking among adolescents, but the effectiveness of such programs is unclear. We evaluated the impact of an STP on tobacco use in 4 schools.

Methods:

The study included 4 intervention and 4 control schools, located in the inner city of Stockholm, Sweden. Schools self-selected for assignment to either an intervention program or a comparison group. In total, the study was comprised of 2671 students in grades 9 and 11, ages 15 to 18, and 1998 students (75%) responded to the questionnaire. We used a repeated cross-sectional design with assessment of tobacco use prevalence before implementation of the STP in 2016 and after 2 years under the program, in 2018.

Results:

Two years after the STP, the intervention school in grade 9 showed a lower prevalence (13.5% vs 1.6%) in the proportion of students who reported smoking (χ2 = 4.54; p < .05) whereas the proportion reporting snus use was practically unchanged. We found no statistically significant impact of the STP for grade 11.

Conclusion:

The results are promising with regard to smoking, when the STP is implemented in early adolescence.

Source: Health Behavior and Policy Review, Volume 7, Number 4, July 2020, pp. 358-365(8)
Publisher: Paris Scholar Publishing Ltd.
DOI: https://doi.org/10.14485/HBPR.7.4.9

2020-08-21T17:36:10-06:00August 21st, 2020|Open Access, School Health, Tobacco|

COVID-19 School Closures: Implications for Pediatric Diabetes Management – A Commentary

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An Open Access article published in the Health Behavior and Policy Review Journal.
The full article is available as a PDF download.

Authors:

Rohit Jaswaney, BA Twitter
Jessica P. Cerdeña, MPhil Twitter

Objective:

The United States COVID-19 outbreak shuttered public and private schools, confining more than 55.1 million students to their homes. In this paper, we discuss the unique vulnerabilities faced by families affected by pediatric diabetes as well as structural issues exposed by the COVID-19 pandemic.

Methods:

Drawing on clinical and anthropological expertise, we review the unintended consequences of remote schooling for management of pediatric diabetes and other chronic health conditions.

Results:

We identify multiple barriers to pediatric diabetes care imposed by conditions during the COVID-19 pandemic. We propose a 4-tiered policy solution that aims to improve crisis response and to protect the health of children with chronic conditions, like diabetes, long-term.

Conclusion:

The COVID-19 pandemic has precipitated wide disruptions to schooling, employment, finances, and transportation, placing enormous burdens on families that care for a child with diabetes. Comprehensive policies supporting integrated diabetes care, student accommodations in remote learning conditions, extended medication
supplies, and increased healthcare access would not only prevent adverse outcomes for children with diabetes in crisis settings, but also lay a durable foundation needed to increase health equity of all children living with chronic conditions.

Source: Health Behavior and Policy Review, Volume 7, Number 4, July 2020, pp. 325-328(4)
Publisher: Paris Scholar Publishing Ltd.
DOI: https://doi.org/10.14485/HBPR.7.4.5

2020-08-21T17:33:03-06:00August 21st, 2020|COVID19, Open Access, School Health, Youth|

Creating Healthy Schools with Middle School Students as Change Makers

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An Open Access article published in the Health Behavior and Policy Review Journal.
The full article is available as a PDF download.

Authors:

Elaine S. Belansky, PhD Twitter
Kathleen Lohmiller, PhD
Benjamin C. Ingman, PhD
Nick Cutforth, PhD
Sharon Scarbro, MS
Laura Borley, MS

Objective:

The Working Together Project (WTP) is a classroom-based curriculum in which rural, low-income middle school students completed “Assess. Identify. Make it Happen,” a strategic planning process to improve student health by implementing evidence-based initiatives. The curriculum consisted of 30, 55-minute lessons and 28 “workdays” for students to conduct research, create communication materials, and develop presentations. Study goals were to: (1) assess the extent to which the WTP led to the implementation of evidence-based practices; and (2) describe student-level outcomes that resulted from participating in the WTP.

Methods:

We conducted a quasi-experimental, convergent mixed-methods study with 4 intervention and 2 control middle schools located in a low-income, rural region. We carried out pre/post student surveys and interviews with teachers, principals, and students.

Results:

Two of the 4 intervention schools completed the entire curriculum and implemented evidence-based practices. Students in control schools showed a decline in school connection, academic engagement, and knowledge of health problems, whereas students in the intervention arm showed increases in personal responsibility to solve problems, 21st century skills, school connectedness, and program planning skills.

Conclusion:

When implemented fully, the WTP is a promising youth-led, adult-supported strategy for implementing evidence-based practices to promote health in schools.

Source: Health Behavior and Policy Review, Volume 7, Number 3, May 2020, pp. 260-270(11)
Publisher: Paris Scholar Publishing Ltd.
DOI: https://doi.org/10.14485/HBPR.7.3.10

2020-06-25T11:39:36-06:00June 20th, 2020|Adolescents, Open Access, School Health|

The Effects of School Staff Food Allergy Education in a Large Urban School District

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An Open Access article published in the Health Behavior and Policy Review Journal.
The full article is available as a PDF download.

Authors:

Atoosa Kourosh, MD, MPH Twitter
Chinelo K. Nsobundu, RN, BSN, MPH, CHES
Ritu Khosla, BDS, MPH
Danielle Guffey, MS
Charles G. Minard, PhD
Anthony J. Levinson, MD, FRCPC, MSc
Carla M. Davis, MD

Objective:

In this study, we examined program feasibility and evaluated change in staff food allergy knowledge using an online course, in-person trainings, or a combination of these in a large urban school district.

Methods:

We used online surveys to identify and gather data on target and control school staff. In Year 1, target school staff were mandated to take online training with optional in-person training; in Year 2, all staff were mandated to take online training and target school staff received additional in-person training. Changes in food allergy knowledge, epinephrine availability, and reaction recognition were measured between groups and years.

Results:

Mandatory online training improved course completion among school staff members. Pre- and post-test scores demonstrated increased food allergy knowledge in those completing the online training course. The school-based food allergy awareness program led to heightened reaction recognition and treatment in target schools that received in-person education. Target school reactions were more appropriately treated than in controls.

Conclusion:

Online training is a feasible and effective tool for food allergy awareness, but in-person skills training may help prepare staff. The heightened reaction recognition and treatment in target schools reflects improved awareness and anaphylaxis preparedness.

Source: Health Behavior and Policy Review, Volume 7, Number 3, May 2020, pp. 238-247(10)
Publisher: Paris Scholar Publishing Ltd.
DOI: https://doi.org/10.14485/HBPR.7.3.8

2020-06-25T11:28:51-06:00June 20th, 2020|Food Allergy, Open Access, School Health|

Parents’ Experiences with a School-based Dental Sealant Project in Central Appalachia: A Qualitative Study

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An Open Access article published in the Health Behavior and Policy Review Journal.
The full article is available as a PDF download.

Authors:

Sarah E. Raskin, PhD, MPH Twitter

Objective:

In this study, I describe parents’ experiences with a rural school-based dental sealant project (SBSP), a Healthy People 2020 objective for optimizing population-level protection against dental decay and reducing oral health disparities.

Methods:

I conducted parent interviews (N = 16) and coded them with NVivo 10, using deductive and inductive codes, from which I identified themes.

Results:

Parents enrolled children in the SBSP based on their confidence in local public institutions and the project’s convenience and accessibility. Parents did not understand the prevention orientation of the project, what services were offered or delivered, service limitations, or next steps, in particular their need to complete referrals to dentists. Parents’ recommendations for program improvement included strengthening communications and reviving a defunct dental public health mobile unit that had previously treated children’s existing dental problems.

Conclusion:

SBSPs should proactively identify and address family and contextual factors when planning and implementing projects. SBSPs should also strengthen case management capacity, collaborate with schools to bolster communications and message clarification, and be relieved of administrative and duplicate travel burdens that impede team members’ capacity to fulfill technical and case management-oriented duties, namely support the transition and maintenance of children into dental homes.

Source: Health Behavior and Policy Review, Volume 7, Number 3, May 2020, pp. 215-222(8)
Publisher: Paris Scholar Publishing Ltd.
DOI: https://doi.org/10.14485/HBPR.7.3.6

2020-07-07T22:12:20-06:00June 20th, 2020|Open Access, Oral Health, Rural Health, School Health|
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