Digital game-based learning environments (DGBLEs) are increasingly used in mathematics education, highlighting the need to better understand their role in supporting students’ learning, emotional experiences, and self-regulated learning (SRL). This scoping review maps and synthesizes the existing literature on DGBLEs designed for school-aged learners, with a focus on mathematics achievement, academic emotions (including math anxiety), and SRL processes. A comprehensive search of multiple databases identified 192 studies that met inclusion criteria. Of the 185 studies examining mathematics achievement, 127 (68.6%) reported positive findings, while 45 (24.3%) reported mixed or partial findings. A substantial body of research also examined academic emotions. Among the 97 studies directly examining academic emotions, 25 examined negative emotions either exclusively (n = 12) or alongside positive emotions (n = 13), with findings generally indicating reductions in negative emotional experiences, including math anxiety. In contrast, relatively few studies directly examined SRL (n = 34), with self-efficacy representing the most frequently examined SRL-related outcome. Across studies, evidence suggests that DGBLEs may support SRL processes, particularly when scaffolded through structured prompts and feedback. As a scoping review, these findings represent a synthesis of trends across heterogeneous studies rather than causal effects. Overall, this review highlights the potential of DGBLEs to support both cognitive and affective aspects of mathematics learning, while identifying key gaps in the measurement of SRL and emotional processes. Findings underscore the need for more rigorous, theory-driven, and multimodal research to better understand how achievement, emotion, and SRL interact in digital learning environments.
Background: The prevalence of overweight and obesity in Chinese school-aged children has continued to rise, posing significant health risks. Rational nutrition knowledge and dietary behaviors are important for obesity prevention and control. The ‘Know Your Food’ campaign aimed to promote nutritious diets and empower informed food choices among Chinese children and young people. This study aims to assess both the implementation and effectiveness of the campaign in primary school settings. Methods: The monitoring framework was designed using the Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) framework and consisted of a series of social media advocacy and school-based nutrition sessions. A monitoring system based on the RE-AIM model was developed to assess the impact of the campaign. Observational data on reach, effectiveness, adoption, implementation, and maintenance were collected through media tracking, self-reported questionnaires, and focus group discussions. Results: Between 13 May and 15 June 2022, the campaign gained 77.13 million views and 291,029 interactions from social media. The campaign garnered positive feedback as it reached a wide audience through traditional media, social media and school sessions. 94.7% of the respondents were willing to share campaign information. After the session, more than two thirds of the students reported behavior change, with 70.0% reporting eating five vegetables a day, 67.7% reporting drinking fewer sugary drinks, 74.0% reporting replacing snacks with fruits/nuts, 76.9% reporting doing exercises, and 78.0% reporting getting sufficient sleep. Conclusions: The ‘Know Your Food’ campaign was able to reach and engage the target audience, increasing nutrition knowledge, and influencing behavior change within the short observation window. The findings exemplify the implementation and effectiveness of this campaign and highlight the importance of using a comprehensive assessment framework to assess such nutrition campaigns.
Early childhood dental caries (ECC) remains one of the most prevalent and preventable chronic diseases affecting young children globally, yet behavioral and contextual determinants of its onset during the first 1000 days of life remain poorly understood and infrequently modeled in Latin American populations. This study presents a novel application of the PRECEDE diagnostic framework to conceptualize Early Childhood Dental Caries during the first 1000 days (1000ECDC) as a behaviorally rooted, socio-ecologically conditioned health problem. Drawing on a formative longitudinal pilot study (n = 10 mother–infant dyads, Caracas, Venezuela) and a complementary narrative literature review, we develop the first PRECEDE-based conceptual model linking maternal prenatal and postnatal behaviors to dental caries risk in a Latin American context. The model identifies dietary and feeding behaviors, oral health care practices, and healthcare service utilization as primary behavioral risk factors, modulated by predisposing factors (low oral health knowledge, limited self-efficacy, cultural norms), enabling factors (socioeconomic constraints, fragmented health systems), and reinforcing factors (social norms, family influence). Exploratory pilot findings indicated that more than 60% of children had advanced dental caries lesions at 24-month follow-up, consistent with regional estimates and underscoring the urgency of early intervention. This model provides practitioners and policymakers with a structured, evidence-informed diagnostic tool to guide the design of early-life oral health promotion programs, with particular relevance for low-resource Latin American settings. Future validation through expert consensus and prospective studies is warranted.
Background: Bullying victimization among adolescents is common and has been consistently associated with higher risks of anxiety and depressive symptoms among adolescents exposed to bullying. Breakfast consumption may function as a daily regulatory resource that supports emotional regulation and coping; however, whether breakfast consumption patterns moderate the associations between bullying victimization and mental health outcomes among adolescents remains unclear. This study examined the associations among bullying victimization, breakfast consumption, and anxiety and depressive symptoms among adolescents and tested the moderating role of breakfast consumption. Methods: Using a multistage stratified cluster sampling design, 67,683 adolescents were recruited from 234 schools across 13 cities in Heilongjiang Province, China. Standardized anonymous questionnaires assessed adolescents’ experiences of bullying victimization, breakfast consumption, anxiety and depressive symptoms, and relevant covariates. Multivariable mixed-effects logistic regression models were applied to estimate the associations between bullying victimization and mental health outcomes among adolescents. Linear trend tests and interaction terms between breakfast frequency and bullying frequency were used to examine moderating effects. Results: Except for verbal victimization (items 1 and 6), among adolescents exposed to most forms of bullying victimization, those reporting higher breakfast frequency had lower risks of anxiety and depressive symptoms (all trend p < 0.05). Among adolescents exposed to relational, physical, and cyber victimization, breakfast frequency moderated the associations between bullying frequency and anxiety and depressive symptoms (all p for interaction < 0.05), with sex-stratified sensitivity analyses yielding consistent results. Among adolescents who consumed breakfast daily, greater breakfast diversity (≥3 vs. 1–2 food groups) was associated with lower risks of anxiety and depressive symptoms. Specifically, among adolescents who experienced physical victimization “sometimes,” those consuming breakfast with ≥3 food groups had a 29% lower risk of anxiety symptoms (ROR = 0.71, 95% CI: 0.48–0.98) and a 30% lower risk of depressive symptoms (ROR = 0.70, 95% CI: 0.46–0.97) than those consuming 1–2 food groups. Among adolescents exposed to cyber victimization, those consuming breakfast with ≥3 food groups had a 32% lower risk of depressive symptoms at the “sometimes” frequency (ROR = 0.68, 95% CI: 0.45–0.98) and had a 32% lower risk of anxiety symptoms (ROR = 0.68, 95% CI: 0.42–0.96) and a 35% lower risk of depressive symptoms (ROR = 0.65, 95% CI: 0.40–0.95) at the “often” frequency than those consuming 1–2 food groups. Conclusions: Among adolescents exposed to bullying victimization—particularly relational, physical, and cyber victimization—those reporting higher breakfast frequency had lower risks of anxiety and depressive symptoms than those who skipped breakfast. Greater breakfast diversity was also associated with lower risks, particularly among adolescents exposed to physical and cyber victimization.
Early childhood caries risk is dynamic and can change over relatively short periods, even in the presence of preventive interventions. This study aimed to predict caries risk transitions in preschoolers using longitudinal data from the CAMBRA-kids mobile application. Using machine learning, we identified children whose risk progressed to high or extreme categories over 12 months and clarified the key contributing factors. A Random Forest model was developed using a multidimensional dataset that integrated parent-reported behavioral data and clinical assessments. Model performance was evaluated through ROC and precision–recall (PR) analyses, while SHAP was employed to ensure model interpretability and identify influential variables. Despite improvements in disease indicators and risk factors overall following the intervention, a subset of children transitioned to high or extreme risk. The model demonstrated acceptable discriminative performance with high precision in an imbalanced dataset. Changes in quantitative light-induced fluorescence loss, restored teeth, and red-fluorescent plaque area were identified as key predictors. These findings suggest that caries risk escalation reflects cumulative biological and clinical changes rather than short-term behavioral fluctuations and support the use of longitudinal, explainable machine learning for early risk identification and targeted prevention.
School burnout is a detrimental factor contributing to a decline in students’ well-being. Coping strategies are frequently mentioned among factors associated with school burnout; however, no analyses have yet examined the possible relationship between school burnout and repression–sensitization proneness, understood as a generalized coping tendency oriented toward avoidance of or vigilance for threatening stimuli. It is hypothesized that repression–sensitization proneness functions as a mediator between risk factors and the development of school burnout by influencing the way individuals perceive their school demands and their own well-being. Based on a scoping review, a general description of the concepts of school burnout and repression–sensitization proneness is presented, together with a brief discussion of the role of coping in the development and maintenance of school burnout. The hypothetical role of repression–sensitization proneness in the development and maintenance of school burnout is also discussed. The article proposes directions for future research on repression–sensitization proneness in the context of school burnout, including the assessment of the prevalence of repressive and sensitizing tendencies among students. Several hypotheses for future empirical verification are formulated, along with practical implications for preventive interventions. The article provides a theoretical foundation for future empirical studies and practical preventive programs and contributes to broadening the discussion on students’ mental health at different educational levels in the context of school burnout predictors.
Pediatric phlebotomy is a common invasive procedure frequently associated with pain, anxiety, and fear, which may negatively affect children’s cooperation and overall healthcare experiences. Virtual reality (VR) has emerged as a promising non-pharmacological intervention capable of providing immersive distraction and emotional engagement during painful medical procedures. The aim of this systematic review was to evaluate the effectiveness of immersive VR in reducing pain perception and anxiety-related outcomes among pediatric patients undergoing phlebotomy procedures. This review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The research question was developed using the PICO framework. Randomized controlled trials and comparative controlled studies published between January 2020 and September 2025 were identified through systematic searches of PubMed and the Cochrane Central Register of Controlled Trials (CENTRAL). Studies involving children and adolescents aged 4–17 years undergoing phlebotomy or venipuncture procedures were eligible for inclusion. A total of six studies comprising 557 pediatric participants were included in the review. The VR interventions involved immersive and interactive environments, including educational simulations, animated scenarios, and game-based experiences delivered through head-mounted displays. Four studies reported statistically significant reductions in pain and/or anxiety among participants exposed to VR compared with control groups, whereas two studies found no significant differences. Across the included studies, VR interventions were generally well accepted by children, parents, and healthcare professionals, with only mild and transient adverse effects reported. However, substantial heterogeneity was observed regarding clinical settings, VR technologies, intervention protocols, and outcome assessment methods. The current evidence suggests that immersive VR is a promising adjunctive strategy for reducing pain and anxiety during pediatric phlebotomy procedures. Nevertheless, the available evidence remains limited by methodological heterogeneity and relatively small sample sizes. Future research should focus on larger, well-designed randomized controlled trials using standardized intervention protocols and outcome measures to support evidence-based implementation of VR in pediatric clinical practice.
Background: Bullying in schools has been a major issue among teens in the United States. The effects of bullying could be detrimental to both the mental and physical health of teens. Teens who are bullied may face higher odds of vaping or substance use. The specific aim of this study is to understand the relationship between vaping and being bullied. Method: The study used CDC 2023 YBRS data. The variables included in the study were being bullied, vaping status, grade level, sex, race, and sexual identity. Frequencies, percents, chi-square analysis, and multivariate binary logistic regression were used in the analysis. Results: After controlling for covariates (i.e., grade, sex, race, sexual identity), being bullied was associated with 2.2 times higher odds of vaping (OR, 2.2, 95% CI, 2.0–2.4, p-value ≤ 0.001) among high school students. Conclusions: Based on the findings, being bullied increased the odds of vaping. The higher odds suggest the need for more interventions to address bullying and bring awareness to the risk factors associated with bullying.
Farm-to-school initiatives, including school gardens, are an increasingly popular strategy to increase student access to healthy produce and nutrition education opportunities. While studies show school garden programs and garden-enhanced nutrition education can positively impact student consumption of fruits and vegetables, there is a gap in evaluation tools that can be used by practitioners across varied school sites, grades, and communities, to assess outcomes of their garden programs. This effort piloted the Student Garden Retrospective Survey (SGR) for grades 4+ in four classrooms in two counties in California. The instrument included items to measure program exposure, garden skill experiences, changes in students’ behaviors, preferences, and attitudes, as well as their perceptions of the program. Student and teacher feedback on the evaluation tool was gathered to determine if students understood the questions being asked, were able to complete the survey, and whether the evaluation questions were pertinent to their school gardening experiences. The results demonstrate that the SGR is suitable for evaluating school garden and garden-enhanced nutrition education programming. In the future, the evaluation tool can be used by practitioners to iteratively improve garden-based education to enhance students’ nutrition and health outcomes.
Over the past two decades, the concept of physical literacy (PL) has gained increasing attention across research and policy domains. Grounded in holistic and embodied theoretical frameworks, PL encompasses physical, affective, cognitive, and social dimensions that underpin lifelong engagement in movement. Global policy frameworks, including the World Health Organization’s Global Action Plan on Physical Activity (2018–2030) and UNESCO’s Guidelines for Quality Physical Education, highlight PL as a foundation for health and wellbeing. Despite this recognition, research examining the associations among PL, physical activity (PA), and mental health in Mediterranean contexts remains scarce. This study examined the interrelationships among perceived PL, PA, and MH in a sample of 542 Cypriot children and adolescents aged 6–18 years. Participants completed the Perceived Physical Literacy Instrument (PPLI), the Physical Activity Questionnaire for Older Children (PAQ-C), and the Depression, Anxiety, and Stress Scale (DASS-21). Structural Equation Modelling (SEM) was used to test direct and indirect effects, and multi-group analyses explored measurement and structural invariance across gender and age. Results indicated that higher perceived PL was associated with better MH, both directly and indirectly through increased PA. Boys and younger participants reported higher PA levels, whereas adolescents displayed higher symptoms of depression, anxiety, and stress. However, the structural relationships among PL, PA, and mental health were consistent across genders. The findings highlight the role of PL as a multidimensional determinant of youth wellbeing and underscore the importance of promoting physical literacy aligned behaviours from early childhood within educational and community settings.
Pain in children and adolescents remains an underestimated and undertreated condition, with long-term physical and psychosocial consequences. Non-invasive neuromodulation has emerged as a promising, low-risk approach for managing acute and chronic pain by modulating central and peripheral neural pathways. This systematic review followed PRISMA 2020 guidelines to evaluate the efficacy, safety, and clinical applicability of non-invasive neuromodulation techniques in pediatric pain. Searches were conducted in PubMed, Embase, Scopus, Web of Science, Cochrane CENTRAL, and ScienceDirect for randomized controlled trials (RCTs) published between 2015 and 2025. Six RCTs met the inclusion criteria, encompassing percutaneous electrical nerve field stimulation (PENFS), transcutaneous auricular vagus nerve stimulation (taVNS), transcutaneous electrical acupoint stimulation (TEAS), and transcutaneous electrical nerve stimulation (TENS). Four trials reported significant reductions in pain intensity alongside improvements in functional outcomes and quality of life, particularly in functional abdominal pain and postoperative contexts. Most studies showed low or moderate risk across domains, with appropriate randomization and blinded assessment. No serious adverse events were reported, confirming an excellent safety profile. These findings support non-invasive neuromodulation as a feasible and well-tolerated adjunct to conventional pediatric pain management. Further high-quality trials are warranted to standardize protocols and explore mechanisms of neuroplasticity in the developing nervous system. PROSPERO (CRD420251170866).
Children with special health care needs require health and related services beyond those required by children in general, which may affect their participation and inclusion in school. School nurses play a key role in supporting these children through a range of health-related interventions within the school setting. However, evidence on school nurse–led interventions for this population remains fragmented. This scoping review will follow the JBI methodology and aims to map the nature and extent of interventions developed by school nurses for children with special health care needs in school settings worldwide. The review will provide an overview of current practices and may inform the development of school health policies and evidence-informed nursing interventions. This research is registered on the Open Science Framework platform since 10 June 2024, with data updated on 26 August 2025.
While perfectionism is recognized as a complex personality trait with both adaptive and maladaptive facets in adults, the specific developmental and contextual factors that influence its emergence in children are poorly understood. This study addresses this critical gap by examining associations between children’s perceptions of family climate and emotion regulation strategies. A sample of 191 children (94 boys, Mage = 11.27 years, SD = 0.97) completed standardized measures of perfectionism, family environment, and emotion regulation. Results indicated that both family climate and emotion regulation significantly predict perfectionism in children (R2 = 0.36). Specifically, children’s perceptions of high parental control, a strong achievement family orientation, and reliance on expressive suppression (hiding emotions) emerged as moderate, significant predictors. These findings clarify the developmental factors underlying perfectionism, providing actionable targets—particularly around adaptive parenting and emotion coping—for child and family support programs and preventative interventions focused on promoting long-term well-being.
The development of health literacy skills yields numerous benefits, including reduced premature mortality, better engagement with preventative health services (e.g., immunisations and screening) and medication compliance. Schools are an ideal setting to promote health education. The Personal, Social, Health, and Economic curriculum is essential in equipping children for adulthood, addressing health, relationships, and well-being. In recent years, commendable emphasis has been placed on mental health, healthy relationships, substance use, healthy weight, and physical activity. However, education concerning physical health, including immunisation, within the context of health literacy has not been prioritised. This Viewpoint piece examines several contemporary issues within the realm of health education, including contributions from those with lived experience, and proposes recommendations to complement broader health improvement models
Adolescence is a critical life period connected with the initiation of substance use. Exploring the prevalence of and contributors to adolescents’ smoking, drinking, and drug use is essential for developing effective health education programs. This study aims to detect prevalence rates of adolescent substance use and their association with sociodemographics and a set of psychological, social, and school-related variables. Participants were high school students (9th graders, N = 1590; 694 males, 896 females) in Békés county, Hungary. The lifetime prevalence rates were the following: smoking (47.2%), alternative smoking (49.2%), drinking (85.7%), cannabis use (7.6%), sedative use (7.0%), and designer drug (herbal) use (3.7%), with gender differences (a surplus of girls) found only in smoking and sedative use. Using bivariate logistic regression analyses, depressive and psychosomatic symptoms and internet addiction increased the odds of all types of substance use, life satisfaction, future orientation, and social support from the family, while school achievement and school satisfaction showed odds-reducing effects. In multivariate analyses, the various types of substance use were predicted by different variables, while psychosomatic symptoms, social support from the family, and school achievement seemed to be the most relevant contributors. Health education programs should also incorporate fostering mental health to prevent adolescent substance use.
Schoolbags represent a common source of physical strain for school-aged children and may influence posture during critical years of growth. This systematic review synthesizes evidence published since the previous review (1995–2014), which mainly focused on load thresholds and did not consider postural health as a multidimensional outcome. The review protocol was prospectively registered in PROSPERO (CRD420251080328). PubMed, Web of Science, and Google Scholar were systematically searched up to 11 June 2024. Of 1013 screened articles, 12 studies met the inclusion criteria. Schoolbag weight was the most frequently investigated factor, followed by postural and spinal alterations, particularly scoliosis. Excessive loads were consistently associated with trunk inclination, postural asymmetry, lumbar strain, and musculoskeletal discomfort. Several studies reported demographic differences, with girls showing greater susceptibility to postural deviations and boys carrying heavier loads. Compared with earlier evidence, more recent studies employed improved postural assessment methods and broader outcome frameworks incorporating ergonomic and behavioral factors. Despite methodological heterogeneity, findings support limiting schoolbag weight to 10–15% of body weight. This review highlights the importance of integrating ergonomic design, carrying behaviors, and demographic modifiers into school health guidelines and provides practical recommendations for clinicians, educators, and policymakers.
Families with low income are faced with various intertwined public health issues, including low literacy levels and nutrition insecurity. Although numerous studies have detailed effective methodologies for delivering literacy or nutrition education in silos, there is no protocol for developing, implementing, and evaluating a brief, interdisciplinary literacy and nutrition education program for parent–child dyads. Books & Cooks, a seven-week literacy and nutrition education program aimed at improving families’ literacy and nutrition capacities by providing parents with strategies to assist their child, facilitating interactive education lessons, and providing take-home reflection activities, was piloted during the 2023–2024 school year. Results informed the protocol for current and future cohorts in efforts to further enhance outcomes. Family literacy capacity is addressed using evidence-based, grade-appropriate literacy techniques and evaluated using validated and internally developed instruments. Family nutrition capacity is addressed through education and cooking lessons based on the 2020–2025 Dietary Guidelines and MyPlate and evaluated using validated instruments. Results will be analyzed by assessing change from baseline to post-program completion, addressing potential confounding factors, and utilizing randomization. By detailing the development, implementation, and evaluation of this study, we anticipate that this protocol will provide guidance for cross-functional collaborators who seek to address various public health concerns in at-risk populations.
Recent collective stressful events have influenced adolescents’ perceptions of the future; however, their impact on future-thinking and the coping strategies used to manage these challenges remain unclear. This study examines adolescents’ future-related concerns in response to collective stressful events and the strategies they adopt to cope with them. In spring 2024, 12 focus groups were conducted with 97 high school students (46.4% females; Mage = 15.34; SDage = 1.06) in Italy. Participants discussed experienced collective stressful events, their main concerns about the future, and related coping strategies. Data were analyzed using thematic analysis. Students identified four major events: war, climate change, economic crisis, and the COVID-19 pandemic. These events triggered concerns such as ‘uncertainty about future plans and goals,’ ‘limitations on personal freedom,’ ‘deteriorating survival conditions,’ ‘the outbreak of sudden events and natural disasters,’ and ‘job loss and increase in prices.’ Five coping strategies emerged: ‘taking action,’ ‘staying informed,’ ‘avoiding overthinking,’ ‘seeking social support (from family, friends, and teachers),’ and ‘seeking support from institutions.’ Findings highlight adolescents’ future-related concerns and underscore the need for interventions promoting adaptive future-oriented thinking.
Violence in schools is an unfortunate reality that is facing not only South Africa but all countries across the globe. The prevalence, frequency and intensity of violence are comprehensively documented, and there is enough evidence to demonstrate that school-based violence is a major problem in South African schools. What is still not clear are the effects of this violence on learners and educators. As such, the study aimed to explore the effects of school-based violence on learners and educators in South Africa. It is important to fully understand the effects of this phenomenon to devise appropriate strategies for addressing it. Based on a qualitative study conducted at nine high schools in South Africa, data were collected from 47 learners and 30 educators using focus group discussions and analysed using thematic analysis. Measures were implemented to ensure the quality of the data. The study received ethical clearance and adhered to all ethical considerations. The findings indicate that violence has detrimental effects on the victim, the perpetrator, the bystander, the educators, and the teaching and learning environment. Learners who experience bullying reported heightened levels of fear, frustration, and emotional distress, which contribute to negative perceptions of schooling and diminished academic performance. Collectively, these factors shape an overall adverse school experience. The study also found that exposure to school violence undermines educators’ self-confidence and erodes their sense of professional dignity. Furthermore, essential instructional time is lost as teachers are compelled to manage disruptive and violent behaviour, limiting opportunities for effective teaching and learning. The paper concludes that the short-term and long-term effects of school-based violence call for strategies and programmes to be put in place to address the problem of school-based violence.
Background: Adolescence is a critical period for emotional well-being, and individuals with gluten-related disorders (GRDs) may face additional psychological challenges. This study aims to explore the relationship between emotional well-being and GRDs in adolescents. Methods: A cross-sectional study was conducted using data from the DESKcohort project, consisting of a biannual panel survey on health, health behaviours, and associated determinants, collected in secondary education centres. The final analytical sample consisted of 9265 students aged 12 to 18 years. Data were collected from October 2021 to June 2022. The dependent variables relate to emotional well-being and are assessed through a series of mood-related questions. The independent variables included were having GRDs, health behaviours and socioeconomic factors. Poisson regression models with robust variance were used to assess the association between the impact of GRDs and emotional states, providing prevalence ratios with 95% confidence intervals. Results: Prevalence of adolescents with GRD was 1.15%, with a higher rate in girls (1.51%) compared to boys (0.79%) (p < 0.001). While there were no significant emotional differences between adolescents with and without GRDs overall (p > 0.05), Poisson regression models with robust variance showed that those with digestive symptoms had a significantly higher prevalence of emotional distress, most notably in feeling sad or depressed (PR = 2.52; 95% CI: 1.64–3.88) and fatigue (PR = 1.90; 95% CI: 1.51–2.38). Conclusions: The presence of digestive symptoms in adolescents with self-reported GRDs is associated with a higher prevalence of emotional distress. Public health strategies should specifically target this symptomatic subgroup to address their psychological and nutritional needs.
