BACKGROUND:Racially minoritized and economically disadvantaged children are disproportionately affected by asthma and often receive less or lower quality care. This paper describes the implementation of a community health worker (CHW)-delivered program in the School District of Philadelphia, asthma management challenges in under-resourced schools, and provides potential solutions. CONTRIBUTIONS TO PRACTICE:Implementation outcomes for two school-based interventions were evaluated to inform sustainment. Ten school nurses and administrators participated in semi-structured interviews about intervention experience, sustainment, resource gaps, and supports needed to continue the interventions. The research team observed intervention delivery and rated fidelity. Medication management, education, and coordination costs for nurses and CHWs were estimated and annualized over a 180-day school year. Interviews identified five themes: (1) barriers, (2) facilitators, (3) recommendations, (4) successes/impacts, and (5) sustainment. Lesson fidelity was measured across 7 schools and varied across lessons. CHW (≈$3366/school) and nurse costs (≈$1620/school) differed by over $70,000. IMPLICATIONS FOR SCHOOL HEALTH POLICY, PRACTICE, AND EQUITY:Care coordination, community partnerships, and reimbursement for CHW-supported programs in public schools should be instituted to implement and sustain asthma interventions and improve care access for racially minoritized and economically disadvantaged children. CONCLUSIONS:Despite nurses' and/or administrators' satisfaction with the intervention, it was not sustainable without CHWs.
BACKGROUND:Interoceptive awareness (IA), the capacity to perceive and interpret internal bodily signals, is increasingly linked to self-regulation, emotional functioning, and well-being. However, its conceptualisation, measurement, and relevance for school-aged children and youth remain fragmented, particularly within school health research. METHODS:This study employed a systematic integrative review, with study identification and selection reported in line with PRISMA 2020. Thirteen child- and youth-focused empirical studies were synthesized alongside supporting foundational literature using a narrative integrative approach. RESULTS:IA was identified as a multidimensional and developmentally situated construct. Evidence linked it to emotional regulation, social-emotional competence, executive functioning, sensory processing, playfulness, emotional eating, and school-related functioning. However, its adaptive value appears conditional, depending on how bodily awareness is interpreted and integrated with regulatory capacities. Measurement approaches varied, with most studies relying on self-report tools that primarily capture subjective awareness. Direct evidence from educational settings remains limited. IMPLICATIONS FOR SCHOOL HEALTH POLICY, PRACTICE, AND EQUITY:IA may be cautiously integrated into existing school health, social-emotional learning, and well-being frameworks rather than treated as a standalone intervention. CONCLUSION:IA offers a useful but still underdeveloped lens for understanding children's self-regulation and well-being in school health. Further classroom-based, longitudinal, and multimethod research is needed.
BACKGROUND:Classroom activity breaks may increase moderate-to-vigorous physical activity (MVPA); however, few studies have compared teacher and video-delivered approaches under real-world conditions. METHODS:In this cluster randomized trial, 11 elementary schools were assigned to teacher-delivered (PAAC-T; 5 schools, 192 students) or video-delivered (PAAC-V; 6 schools, 276 students) classroom activity breaks across one academic year. Teachers were trained to deliver two 10-min breaks daily. Intervention delivery was tracked via a web-based platform, and classroom MVPA was assessed using accelerometers at baseline and follow-up. RESULTS:Implementation fidelity was low and highly variable, but comparable between PAAC-T (42.3 ± 57.1 activity breaks/teacher/year) and PAAC-V (39.2 ± 33.9; p = 0.96), with teachers delivering ∼50% of the intended daily activity. Classroom MVPA increased significantly in both groups (PAAC-T: 9.8 ± 15.9; PAAC-V: 9.1 ± 15.3 min/day; p < 0.001), with no intervention arm-by-time interaction (p = 0.43). IMPLICATIONS FOR SCHOOL HEALTH POLICY, PRACTICE, AND EQUITY:Classroom physical activity breaks may increase student MVPA, but effectiveness in elementary schools appears to depend on implementation fidelity, administrative support, and equitable system-level infrastructure. CONCLUSIONS:Modest increases in classroom MVPA were observed across both delivery formats, although low and variable implementation fidelity limited conclusions regarding effectiveness and highlighted the need for stronger implementation supports. TRIAL REGISTRATION:NCT03493139.
BACKGROUND:We examined trends in physical activity (PA), sedentary behavior (SB), and weight status among Korean adolescents across the COVID-19 period and assessed subgroup disparities. METHODS:We analyzed nationally representative data from the 2017 to 2024 Korea youth risk behavior web-based survey (N = 417,243; mean age, 15.0 years). PA adherence followed World Health Organization recommendations; SB adherence was defined as ≤ 2 h/day of recreational screen time; and weight status used the 2017 Korean Growth Chart BMI percentiles. Weighted estimates and Joinpoint regression quantified annual percent changes (APCs). RESULTS:Underweight and obesity both increased. Underweight rose particularly among girls (APC, 6.7%), whereas obesity was more prevalent among boys (14.7%; APC, 3.2%) and high school students (13.3%; APC, 3.2%). PA adherence increased over the study period (APC, 4.0%) but remained low, especially in girls (2.4% vs. 8.6% in boys). SB adherence declined from 36.1% in 2017 to 19.2% in 2020 and partially recovered by 2024 (24.5%). IMPLICATIONS FOR SCHOOL HEALTH POLICY, PRACTICE, AND EQUITY:Schools should adopt gender-sensitive strategies to increase daily PA and reduce recreational SB, prioritizing girls and high school students. CONCLUSIONS:From 2017 to 2024, weight polarization worsened among Korean adolescents, underscoring the need for equitable school-based interventions targeting PA, SB, and weight-related disparities.
BACKGROUND:Youth physical activity in the United States remains low, with disparities by socioeconomic status (SES). Physical education (PE) is an effective structural intervention, yet implementation is below recommendations. This study examines whether elementary school SES is associated with the implementation of recommended PE practices. METHODS:Elementary school data from School Health Map were merged with National Center for Education Statistics data to fit four mixed-effects logistic models with SES and locale as fixed effects and state as a random intercept. Outcomes were four recommended PE practices. RESULTS:Schools with lower SES had higher odds of meeting recommended weekly instructional minutes compared to high-SES schools. However, low-SES schools also had higher odds of allowing students to be withheld from PE for disciplinary or academic reasons and lower odds of employing qualified PE teachers. State-level factors appeared to influence physical education minutes, class size, and teacher qualifications. IMPLICATIONS FOR SCHOOL HEALTH POLICY, PRACTICE, AND EQUITY:Addressing disparities in PE practices will require coordinated state, district, and school-level efforts that go beyond weekly instructional time to prevent withholding PE, ensure manageable class sizes, and support qualified teachers. CONCLUSIONS:Low-SES schools met PE minutes more often, but other equity gaps remained.
BACKGROUND:Emerging literature suggests cumulative adverse childhood experiences (ACEs), potentially traumatic experiences before age 18, are associated with poor school outcomes. This scoping review assessed the state of the literature on the association between cumulative ACEs and adolescent school outcomes. METHODS:Following PRISMA-ScR guidelines, four databases were searched. Two independent reviewers screened 7188 titles and abstracts, then 112 articles in full. Twenty-four articles met eligibility criteria. FINDINGS:Findings overwhelmingly supported a negative association between cumulative ACEs and school outcomes. Cumulative ACEs were associated with reduced likelihood of high school completion (n = 8), poor academic performance (n = 7), and school disengagement (n = 8). Nine studies identified mediational pathways between ACEs and school outcomes via biopsychosocial processes, mental/behavioral health, and school processes. IMPLICATIONS FOR SCHOOL HEALTH, POLICY, PRACTICE, AND EQUITY:Findings underscore the importance of early identification strategies and preventive school health approaches that address trauma exposure to improve academic trajectories and reduce downstream educational disengagement. CONCLUSIONS:ACEs are negatively associated with school outcomes. Although additional research is needed, this review indicates that intervening on behavioral health and factors like school engagement, absenteeism, and academic achievement could result in improved school outcomes.
BACKGROUND:We examined patient and visit trends in pediatric emergency department (ED) usage during the school year and summer breaks before, during, and after the COVID-19 pandemic. METHODS:We extracted data on mental health-related visits to the ED of an academic medical center from 2018 to 2023 among youth aged 5-18. Data were visualized, and overall visit frequency was modeled via piecewise linear regression. Odds ratios were estimated for characteristics associated with suicidal ideation and inpatient admission. RESULTS:A total of n = 2536 unique individuals had 3358 ED encounters resulting in a mental health-related diagnosis. Visit frequency was flat from August 2018 to a nadir in August 2020, followed by an increase. Female patients had increased odds of ED visits (OR = 1.45; 95% CI: 1.24-1.69) compared to males. Visits during school breaks were associated with increased odds of inpatient admission compared to visits during school sessions (OR = 1.30; 95% CI: 1.08-1.56). IMPLICATIONS FOR SCHOOL HEALTH POLICY, PRACTICE, AND EQUITY:Schools are an important site for mental health promotion and can collaborate with EDs and community providers to support students before breaks. CONCLUSIONS:Students may experience a decrease in school-related stress during breaks, but a lack of access to school-based mental health support may be one factor related to increased ED visits requiring inpatient admissions.
BACKGROUND:Unmet material needs disrupt student learning and behavior. Some school-based programs address these needs, but we know less about their impact. METHODS:We conducted a scoping review of studies published between 2013 and 2023 in the United States that evaluated school-based strategies to address unmet material needs. FINDINGS:We included 55 studies and identified four intervention types: providing food, delivering healthcare, connecting families to resources, and offering transportation. Researchers have evaluated these interventions for school performance, participation, and safety. Most studies evaluated the effects of providing food on school performance (n = 21) and participation (n = 19), with mixed findings. Several studies evaluated the effects of providing healthcare on school performance (n = 14) and participation (n = 10), with overall supportive findings. There was limited evidence on connecting families to resources (n = 4) or offering transportation (n = 2). Across all interventions, only a few studies (n = 7) evaluated effects on school safety. IMPLICATIONS FOR SCHOOL HEALTH POLICY, PRACTICE, AND EQUITY:School-based healthcare can benefit school performance and participation. CONCLUSION:The field has focused on the effects of providing food and healthcare on school participation and performance. We can gain a more comprehensive understanding of school-based strategies to address unmet material needs by (1) evaluating interventions beyond these two types, and (2) considering additional outcomes such as safety.
BACKGROUND:Sleep difficulties are common in childhood and affect behavior, emotional regulation, and school functioning, yet are often unrecognized by caregivers. METHODS:This population-based, repeated cross-sectional study included 1168 first-grade children (6-7 years) in Évora, Portugal. Sleep was assessed using the Portuguese Children's Sleep Habits Questionnaire (CSHQ-PT) and a structured family questionnaire. Associations with sociodemographic and family factors were examined using multivariable logistic regression; short sleep duration was analyzed using penalized logistic regression. RESULTS:Across cohorts, 46%-49% of children met the criterion for clinically significant sleep disturbance (SDI ≥ 48). Bedtime resistance, daytime sleepiness, and sleep-related anxiety were the most prevalent difficulties. Fewer than 10% of caregivers reported sleep problems, even among affected children. Clinically significant sleep disturbance was associated with caregiver education and later dinner timing, while longer commuting distance was associated with short sleep duration. IMPLICATIONS FOR SCHOOL HEALTH POLICY, PRACTICE, AND EQUITY:Findings support brief sleep screening and family-oriented sleep health guidance at school entry. CONCLUSION:Many children begin primary school with unrecognized sleep difficulties, highlighting the value of integrating sleep health into early school health frameworks.
BACKGROUND:School nurses increasingly support student mental health, yet how perceived role responsibility and self-efficacy shape continuing education needs remains unclear. METHODS:A nationwide cross-sectional online survey was conducted in Taiwan using probability proportional to size sampling. Among 658 selected school nurses, 305 responded (46.4%). A 33-item questionnaire assessed perceived role responsibility, self-efficacy, and continuing education needs across six competency domains. Multivariable linear regression identified predictors. RESULTS:Most nurses lacked prior psychiatric/psychology work experience (74.4%). Perceived role responsibility and self-efficacy were highest for referral/resource mapping and crisis response/safety assessment, and lowest for psychotropic medication management/monitoring. Continuing education needs were high, particularly for crisis response/safety assessment and identification/assessment. Perceived role responsibility was the only significant predictor of continuing education needs, explaining 29.4% of the variance. IMPLICATIONS FOR SCHOOL HEALTH POLICY, PRACTICE, AND EQUITY:Training should prioritize role-focused interventions and standardized protocols for crisis response/safety assessment and identification/assessment, with clear medication-related coordination guidance to reduce role ambiguity. CONCLUSIONS:School nurses' perceived role responsibility drives continuing education needs; training should strengthen role clarity alongside skills.
BACKGROUND:Persistent pain affects approximately one in five children and adolescents globally and is associated with school absenteeism, reduced academic engagement, psychosocial distress, and long-term health consequences. Schools are important settings for developing health beliefs and self-management behaviors, yet educators receive little formal preparation about pain. CONTRIBUTIONS TO PRACTICE:This Practitioner's Perspective describes integration of a brief contemporary pain neuroscience education (CPNE) module into an undergraduate teacher preparation course. Two interactive sessions delivered by a physical therapist introduced pain as a protective nervous system output influenced by biological, psychological, and social factors. Participants demonstrated improved pain knowledge and beliefs, increased confidence discussing pain-related concepts, and greater appreciation for the relevance of pain literacy to educational practice. IMPLICATIONS FOR SCHOOL HEALTH POLICY, PRACTICE, AND EQUITY:Pain literacy may improve educator responses to student pain, reduce stigma, support appropriate participation, and promote equitable school environments. Physical therapists may be well positioned to collaborate with teachers, school nurses, counselors, coaches, and other school-based professionals. CONCLUSIONS:Teacher preparation programs may represent an upstream opportunity to improve pain literacy, support student health and learning, and contribute to the prevention of persistent pain.
BACKGROUND:Youth in the United States face unprecedented levels of emotional distress, highlighting the need for comprehensive school-based approaches to well-being. Mindfulness-based programs (MBPs) are developmentally appropriate strategies for fostering resilience, yet large-scale implementation remains challenging. CONTRIBUTIONS TO PRACTICE:A long-term partnership between a public school district and a community behavioral health agency supported the expansion of mindfulness programming across elementary schools through a facilitator-supported delivery model and intensive instructor preparation. Implementation reached about 90% of elementary schools, demonstrating unusually broad district-level coverage, an underexplored aspect of MBP research. These collaborative efforts reduced the burden on educators while strengthening program consistency and sustainability. IMPLICATIONS FOR SCHOOL HEALTH POLICY, PRACTICE, AND EQUITY:This case highlights the role of collaborative policy alignment, integrated delivery structures, and culturally responsive implementation in expanding equitable access to preventive mental health supports. CONCLUSIONS:This practitioner case demonstrates how relational trust, multi-sector collaboration, and adaptive implementation strategies can support district-scale integration of mindfulness programming within comprehensive school health systems.
BACKGROUND:Life stressors might influence health behaviors, including frequent sugar-sweetened beverage (SSB) consumption. We described associations between life stressors and soda/sports drink (SD) consumption among US high school students. METHODS:We tested associations between life stressors and daily (≥ 1 time/day) and heavy daily (≥ 3 time/day) consumption of soda/SD using the 2023 national Youth Risk Behavior Survey (daily n = 12,308; heavy daily n = 11,980). We calculated prevalence ratios (aPRs) and 95% confidence intervals (CI) adjusted for grade, sex, weight perception, and race and ethnicity. Not experiencing the stressor was the reference group. RESULTS:Daily consumption was significantly higher among those who experienced unstable housing (aPR = 1.6, 95% CI = 1.2, 2.2), lacking a household adult trying to meet basic needs (aPR = 1.3, 95% CI = 1.1, 1.5), bullying at school (aPR = 1.3, 95% CI = 1.2, 1.4), missing school due to safety concerns (aPR = 1.3, 95% CI = 1.1, 1.5), or feeling unfairly disciplined at school (aPR = 1.2, 95% CI = 1.1, 1.3). Results for heavy daily consumption were similar. IMPLICATIONS FOR SCHOOL HEALTH POLICY, PRACTICE AND EQUITY:Initiatives to reduce soda/SD consumption could benefit students with relatively high consumption prevalence, including those experiencing life stressors. CONCLUSIONS:The prevalence of consuming soda/SD was higher among US high school students who experienced life stressors than those who did not.
BACKGROUND:There is a gap in knowledge regarding self-esteem in US adolescents in the context of depressive symptoms and overweight and/or obesity status. Self-esteem can potentially play a role in the relationship between obesity and depressive symptoms, which are both increasing in prevalence in US adolescents. The aim of this scoping review was to understand the extent of evidence in relation to self-esteem in this context. METHODS:Using the Arksey and O'Malley framework, a total of 717 articles were identified from seven databases, 593 unique studies were screened after duplicates, 86 full text articles were retrieved and assessed for eligibility, and 37 articles were included in the review. Two independent reviewers screened each article, and a third reviewer served as a tiebreaker. FINDINGS:Several factors were associated with self-esteem in this context, including family dynamics, puberty, teasing, sports participation, eating disorders, stressors, and body satisfaction. IMPLICATIONS FOR SCHOOL HEALTH POLICY, PRACTICE, AND EQUITY:School-based screening and interventions can be conducted by school nurses, counselors, physical educators, food services, mental health team members, and other school health professionals. These professionals can also help to create a supportive environment in which bullying is not tolerated, physical activity and sports participation are promoted, and healthy food is provided. CONCLUSIONS:Future research is needed to better understand the link between self-esteem and depressive symptoms and weight status. When caring for children with obesity or overweight status and depressive symptoms, school health professionals should assess for low self-esteem, family dynamics, and cohesion.
BACKGROUND:This study is grounded in the Whole School, Whole Community, Whole Child (WSCC) model, which highlights the interconnectedness of student and staff well-being in promoting healthy, safe, and supportive school environments. It explores how school-based trauma influences teachers' well-being and professional identity. METHODS:Utilizing a qualitative, narrative inquiry approach, four K-12 teachers in New York City Title I charter schools participated in three semi-structured interviews and one school-based observation. Data were analyzed thematically and represented through a narrative documentary script. RESULTS:Findings are organized around four narrative threads: (1) trauma's impact on teacher well-being, (2) the emotional burden of unresolved student trauma, (3) post-COVID-19 disruption to school climate, and (4) purpose and teacher leadership as sources of resilience. Participants described trauma exposure as cumulative over time and influential in shaping their professional identities and leadership trajectories. IMPLICATIONS FOR SCHOOL HEALTH POLICY, PRACTICE, AND EQUITY:Trauma-informed professional learning, accessible mental health resources for staff, and opportunities for teacher leadership are essential in building and maintaining safe, equitable, and resilient schools. CONCLUSIONS:Centering teacher narratives reveals how direct and secondary trauma affect educators' health and capacity to sustain supportive learning environments for the students they serve.
BACKGROUND:This study examined trends in physical activity among Baltic adolescents across the intersection of gender and socio-economic status (SES). METHODS:Data were gathered from Health Behavior in School-aged Children (2001-2018) (n = 61,619). No or low moderate-to-vigorous physical activity (MVPA) (≤ 1 day/week of 60 min/day of MVPA), insufficient physical activity (not engaging in 60 min/day of MVPA daily), gender, and SES were self-reported. RESULTS:From 2001 to 2018, girls and adolescents with low and medium SES experienced a higher probability of no or low MVPA and insufficient physical activity than boys and adolescents with high SES, respectively. Compared to boys with high SES, the other gender × SES groups were more likely to experience insufficient physical activity, with differences more consistent among girls. IMPLICATIONS FOR SCHOOL HEALTH POLICY, PRACTICE, AND EQUITY:Actions to promote physical activity should prioritize school-aged girls from disadvantaged socio-economic backgrounds. CONCLUSIONS:Physical activity is unequally distributed among adolescents, with girls and adolescents with lower SES being more likely to have no or low MVPA and insufficient physical activity in the Baltic States. Notable inequalities in physical activity emerged when the intersection of gender and SES was considered simultaneously, especially for no or low MVPA.
