(An item from the ISHN Member information service) Last week, we noted several news stories covering the release of an American report (CDC) suggesting that schools adjust their start times for students, especially adolescents, so that they can get more sleep. The CDC noted several health and academic benefits. An article in Volume 81, 2015 of Accident Analysis & Prevention reports on a French study that shows a strong correlation between injuries and sleep problems."The study population included 1559 middle-school adolescents from north-eastern France who completed at the end of school year a self-administered questionnaire to gather school and out-of-school injuries during the school year, and to assess sleep difficulty and previous injury risk factors which were socioeconomic factors, school performance, obesity, alcohol/tobacco/cannabis/hard drugs use, health status, psychological health, and involvement-in-violence. For sleep difficulty and behaviour and health-related difficulties their first occurring over adolescent’s life course was gathered. Multinomial logistic regression models were used retaining only sleep difficulty and other risk factors which had started before the school year (thus before the injuries studied). School and out-of-school injuries and sleep difficulty were frequent. The adolescents with sleep difficulty without medical treatment had a higher risk of single school and out-of-school injuries and a much higher risk of repeated school and out-of-school injuries. The adolescents with persistent sleep difficulty despite a medical treatment also had a higher risk of single school and out-of-school injury, and a much higher risk of repeated school and out-of-school injuries." The authors conclude that "Injury prevention should focus on sleep difficulty, especially among adolescents with socioeconomic difficulties, via physician–parent–school–adolescent collaborations."  Read more>>

(An item from the ISHN Member information service)  Two news stories identified this week help to explain the potential confusion and debates about e-cigarettes. On August 18th, the US government (National Institutes of Health) released a report noting that e-cigarette use by teens would likely lead to smoking tobacco. On August 19th, the Health Department in England released a research review stating that e-cigarettes were 95% less harmful than tobacco. Both of these studies are likely accurate. What is confusing is the government intentions in both cases and what fact-based health messages are intended by the release of each study. Read more>>

(An item from the ISHN Member information service)  A letter/article in Issue #11, 2015 of Public Health Nutrition makes a good point in response to an earlier article suggesting that BMI should be replaced as a measure of obesity by the time it takes a child to run 500 meters. The argument is made well by differentiating "fitness" from "fatness". The physical fitness to run that distance is quite a different construct than a simplistic height/weight ration such as BMI. Further, there are more sophisticated measures of body fat (waist circumference, waist to to height ratio and abdominal fat etc) that can replace BMI if needed. However it is this simple clarification of fitness and fatness that may be even more important to consider, especially in the light of increasing evidence that physical activity alone has little impact on body weight. Increasingly, researchers are turning to diet/healthy eating and accompanying mental states (boredom, loneliness,k stress) as the dominant factors. Read more>>

(An item from the ISHN Member information service)  The use of ecological analysis of the over-lapping and inter-acting influences of individual, family, neighbourhood, school and larger community on behaviour and health status is now well-accepted in health promotion research. The ISHN has a version of this thinking that we developed with several researchers. However, it is very difficult to sort out the relative impact of these various layers. Indeed, the more "proximal" and "distal" influences are likely to vary for different individuals, at different times in their lives and events. An article in Issue #11, 2015 of Public Health Nutrition describes the relative contributions of these layers of the Social Ecological Model (SEM) when examining childhood obesity. A randomized telephone survey conducted in 2009–2010 collected information on parental perceptions of their neighbourhoods, and household, parent and child demographic characteristics. Parents provided measured height and weight data for their children. Geocoded data were used to calculate proximity of a child’s residence to food and physical activity outlets. Multiple logistic regression models were estimated to determine the joint contribution of elements within each layer of the SEM as well as the relative contribution of each layer. Layers of the SEM representing parental perceptions of their neighbourhoods, parent demographics and neighbourhood characteristics made the strongest contributions to predicting whether a child was overweight or obese. Layers of the SEM representing food and physical activity environments made smaller, but still significant, contributions to predicting children’s weight status. Read more>>

(An item from the ISHN Member information service) An article in Issue #4, 2015 of The Journal of Primary Prevention describes how adding a food co-op component to a healthy nutrition and physical activity program in schools serving disadvantaged communities can be effective. "The purpose of this study was to conduct a pilot feasibility evaluation of Brighter Bites, a school-based food co-op to provide access to fresh F&V and nutrition education to low-income children and their families. Brighter Bites is a 16-week school-based food co-op consisting of: (1) Weekly distribution of 50–60 servings of fresh F&V; (2) Weekly bilingual parent handouts and recipe demonstrations; and (3) implementing CATCH, a coordinated school health program in schools. Process data using parent surveys, teacher surveys, attendance logs, and produce cost data were used to determine feasibility and acceptability of program. Participants received on average 61 servings of F&V weekly for 16 weeks at the cost of $4.31/family/week. Results showed significant increases in child reported self-efficacy, outcome expectations and attitudes towards consuming F&V (p < 0.05). We found significant increases in child exposure to F&V and child preference of various F&V from baseline to post-intervention (p < 0.05). Parent surveys showed significant improvements in mealtime practices at home: decrease in children eating while watching TV, increase in eating dinner with the family, less fast food, less sugary drinks with meals, more children asking for F&V as snacks. Process data showed 98 % retention rate and high parent acceptability of program components. Brighter Bites is a promising strategy to increase F&V access and education in low-income populations using existing infrastructure of schools and food banks." Read more>>

(An item from the ISHN Member information service)  A special issue (#5-6, 2015) of The Journal of Early Adolescence uses different measures to understand the early adolescents’ experience in schools. The introduction noted that "We are particularly interested in measures with direct application—providing actionable data to teachers, principals, parents, school counselors, or the students themselves, in ways that promote social-emotional and academic learning. In this introduction, we highlight the ways in which articles in this special issue offer rigorous, relevant, and feasible approaches to this measurement work". The next two articles examined the non-classroom settings within the school, hallways, cafeterias and school yards and measured items such as the density of student gatherings, verbal noise and staff perceptions, all of which were found to be significant. In the schoolyard, the researcher suggested a much greater focus on non-social students who were excluded from activities. My only question, a serious one, was whether the study included the bathrooms in the schools. Note: In the ISHN complex, ecological and systems-based model depicting the school environment, we do depict these various sub-settings within the school. Read more>>

(An item from the ISHN Member information service) An article in the August 2015 Issue of the Journal of Adolescent Health correlates the real and perceived crime rates in neighbourhoods with adolescent activity behaviours and weight status. "Socioeconomically and racially/ethnically diverse adolescents (N = 2,455, 53.4% female) from 20 urban, public middle and high schools in Minneapolis/St. Paul, Minnesota responded to a classroom survey in the Eating and Activity in Teens 2010 study. BMI was measured by research staff. Participants' mean age was 14.6 (standard deviation = 2.0); 82.7% represented racial/ethnic groups other than non-Hispanic white. Linear regressions examined associations between crime perceived by adolescents and crime reported to police and the outcomes of interest (BMI z-scores, physical activity, and screen time). Models were stratified by gender and adjusted for age, race/ethnicity, socioeconomic status, and school. BMI was positively associated with perceived crime among girls and boys and with reported crime in girls. For girls, there was an association between higher perceived crime and increased screen time; for boys, between higher reported property crime and reduced physical activity. Perceived crime was associated with reported crime, both property and personal, in both genders." Should we worry less about fast food outlets and more about safe streets? Read more>>

(An item from the ISHN Member information service)  Asset based youth development approaches are well-recognized in the research and program literature. More recently, attention has been paid to the accumulation of adverse life experiences in childhood and adolescence. It looks like the weight of negative experiences is as powerful as the support of multiple positive factors or assets. An article in Volume 43, 2015 of Journal of Adolescence discusses cumulative experiences with life adversity with a view to iIdentifying critical levels for targeting prevention efforts. The authors note that "This paper aims to assess the role of individual types and cumulative life adversity for understanding depressive symptomatology and aggressive behavior. Data were collected in 2011 as part of the Teen Life Online and in Schools Study from 916 ethnically-diverse students from 12 middle, K–8, 6–12 and high schools in the Midwest United States. Youth reported an average of 4.1 non-victimization adversities and chronic stressors in their lifetimes. There was a linear relationship between number of adversities and depression and aggression scores. Youth reporting the highest number of adversities (7 or more) had significantly higher depression and aggression scores than youth reporting any other number of adversities suggesting exposure at this level is a critical tipping point for mental health concerns. Findings underscore an urgent need to support youth as they attempt to negotiate, manage, and cope with adversity in their social worlds. Read more>>

(An item from the ISHN Member information service)  We have been discussing the value of integrating various health, social and other services to support students in this blog. This week we identified three aspects of the approach recommended by the UCLA school mental health program which focuses on removing barriers to student learning. These include: a policy-oriented overview (Transforming Student and Learning Supports: Developing a Unified, Comprehensive, and Equitable System) an analysis of implementation issues (Processes/Lessons Learned in Facilitating Systemic Transformation towards integrated student services) and a model school board policy (Board Policy for a Unified and Comprehensive System of Learning Supports/Integrated Services) Go to the weekly report for all three items at: http://www.schoolhealthinsider.org/page/Aug+3-9%2C+2015

(An item from the ISHN Member information service)   A register-based study of 90,000 girls and their parents in Norway was used to examine the demographic, socioeconomic and behavioural correlates of HPV vaccination of preadolescent girls in a publicly funded, school-based vaccination programme. "Data for all Norwegian girls born 1997–1999, eligible for routine school-based HPV vaccination in 2009–2011 (n = 90,842), and their registered mother and father, were merged from national registries. Correlates of girl vaccination status were analysed by unadjusted and multivariable logistic regression. In total, 78.2% of the girls received the first dose of the HPV vaccine, 74.6% received three doses, and 94.8% received the MMR vaccine. Correlates associated with initiation of HPV vaccination included parental age, income and education, maternal occupational status and cervical screening attendance, and girl receipt of the MMR vaccine. Rates of completion of HPV vaccination among initiators were high, and disparities in completion were negligible. " The authors conclude that "Routine school-based vaccination generally provides equitable delivery, yet some disparities exist. Information campaigns designed to reach the sub-groups with relatively low vaccine uptake could reduce disparities." The Norwegian vaccination programme is administered by the municipality health services, who are obliged by law to provide the included vaccines to all children. HPV vaccination was included in the programme in 2009. The vaccine is usually given by the school nurse during school hours. Among other vaccines, the childhood immunisation programme also offers vaccination against MMR (measles, mumps and rubella combined) in the sixth grade. Vaccination is optional, and the vaccine and their parents/guardians have to consent to vaccination. Written consent is not required, but is encouraged for vaccination of school children." Read More>>