David K. Lohrmann

Condom Availability Programs in Massachusetts High Schools: Relationships With Condom Use and Sexual Behavior

OBJECTIVES This study assessed relationships between condom availability programs accompanied by community discussion and involvement and adolescent sexual practices. METHODS Sexual practice and condom use differences were assessed in a representative sample of 4166 adolescents enrolled in high schools with and without condom availability programs. RESULTS Adolescents in schools where condoms were available were more likely to receive condom use instruction and less likely to report lifetime or recent sexual intercourse. Sexually active adolescents in those schools were twice as likely to use condoms, but less likely to use other contraceptive methods, during their most recent sexual encounter. CONCLUSIONS The strategy of making condoms available, an indication of socioenvironmental support for condom use, may improve HIV prevention practices.

A Complementary Ecological Model of the Coordinated School Health Program

BACKGROUND A complementary ecological model of the coordinated school health program (CSHP) reflecting 20 years of evolved changes is proposed. Ecology refers to the complex interrelationship between intrapersonal factors, interpersonal processes and primary groups, institutional factors, community factors, and public policy. METHODS Public health and child development theories that incorporate the influence of personal and social environments on health behavior, along with models that incorporate the influence of ecology, were consulted. RESULTS Concepts from several models were combined with the 8 components of CSHP to formulate an ecological model involving 6 program and services components in an inner circle surrounded by 4 concentric rings representing the healthy school environment, essential structures of CSHP, local school district governance, and family and community involvement. CONCLUSION This complementary ecological model is intended to serve as an additional conceptual approach to CSHP practice, evaluation, and research, and should prove especially useful to practitioners and researchers who already have a fundamental understanding of CSHP.

Discrepant body mass index: behaviors associated with height and weight misreporting among US adolescents from the National Youth Physical Activity and Nutrition Study.

BACKGROUND The accuracy and reliability of self-reported height and weight among adolescents in the process of calculating BMI is usually subject to bias. The aim of this study was to determine whether over- and under-reporting of self-reported height and weight existed among US high school students by weight category; if so, to examine anthropometric, behavioral, and demographic factors associated with over- and under-reporting. METHODS Data were retrieved from the National Youth Physical Activity and Nutrition Study, 2010, a nationally representative sample (7160 students, grades 9-12). Analysis of variance was performed to determine any significant difference between weight categories in misreporting. Discriminant function analysis and sequential logistic regression were executed to detect behavioral and demographic predictors of reporting accuracy, respectively. RESULTS The mean over-reporting of height and under-reporting of weight were 1.1 cm and 1.020 kg, respectively, which underestimated BMI and BMI percentile by 0.671 and 2.734, respectively. Use of self-reported height and weight for BMI calculation overestimated prevalence of healthy weight by 3.8% and underestimated prevalence of obesity by 4.1%. Underweight students under-reported height and over-reported weight, whereas overweight and obese students over-reported height and under-reported weight. Reporting accuracy of females was significantly higher. Weight loss behaviors, both healthy and unhealthy, were associated with BMI underestimation, whereas fast foods and screen time were associated with overestimation. CONCLUSION Whenever possible, measuring height and weight is essential. However, because many studies must rely on self-reported values alone, additional research should examine the relationships between misreport of anthropometric data and lifestyle features in diverse adolescent samples to better interpret self-reported anthropometric data.

The effect of a designed health education intervention on physical activity knowledge and participation of adults with intellectual disabilities.

Purpose. The purpose of this study was to assess novel methods of health education and promotion to increase physical activity among adults with intellectual disabilities. Design. A pre-post delayed treatment design was employed to assess the effect of the intervention. Setting. The intervention was administered at two agencies that serve adults with intellectual disabilities. Subjects. Forty-two adults ranging in age from 19 to 62 with mild to moderate intellectual disability participated in the study. Participants were equally divided by gender. Intervention. An eight-session intervention employed a combination of video instruction, pictorial memory tools, and interactive class activities as educational methods. Measures. Physical activity knowledge was evaluated using Illingworth, Moore, and McGillivrays Nutrition Activity Knowledge Scale (NAKS) and the Physical Activity Recommendations Assessment (PARA). Average daily minutes of physical activity were measured using dual-axis accelerometers. Analysis. Paired and independent samples t-tests were used to assess the knowledge scales. Wilcoxon signed-rank tests and Mann-Whitney U-tests were used to assess physical activity participation. Results. Overall, there were mean improvements in scores for both the NAKS (p < .05) and the PARA (p < .001) following the intervention. Physical activity also improved, but not significantly. Conclusion. The education and training methods used in this curriculum are promising for future health education programs in this population. Additional interventions may be necessary to improve physical activity participation.

A complementary ecological model of the coordinated school health program.

A complementary ecological model of the coordinated school health program (CSHP) reflecting 20 years of evolved changes is proposed. Ecology refers to the complex interrelationship among intrapersonal factors, interpersonal processes and primary groups, institutional factors, community factors, and public policy. Public health and child development theories that incorporate the influence of personal and social environments on health behavior, along with models that incorporate the influence of ecology, were consulted. Concepts from several models were combined with the eight components of CSHP to formulate an ecological model involving six program and services components in an inner circle surrounded by four concentric rings representing the healthy school environment, essential structures of CSHP, local school district governance, and family and community involvement. This complementary ecological model is intended to serve as an additional conceptual approach to CSHP practice, evaluation, and research, and should prove especially useful to practitioners and researchers who already have a fundamental understanding of CSHP.

Developing a Physical Activity Education Curriculum for Adults With Intellectual Disabilities

Adults with intellectual disabilities have high rates of physical inactivity and related chronic diseases. Researchers have called for an increase in the development and evaluation of health education programs adapted to the unique needs of this population. Formative and process evaluation strategies were applied to develop a physical activity education program. The first phase of formative evaluation included a comprehensive literature review to select educational strategies and curriculum content. The theory of planned behavior was selected as a guiding framework, and meetings with stakeholders were held to assess feasibility. The second phase of formative evaluation included an assessment of materials by an expert panel and the priority population, and pilot testing. Next, field testing was implemented, followed by process evaluation and an assessment of implementation fidelity. The final curriculum was developed as a result of the completion of the aforementioned steps and led to a successful physical activity intervention.

Trends in Body Mass Index and Prevalence of Extreme High Obesity Among Pennsylvania Children and Adolescents, 2007–2011: Promising but Cautionary

OBJECTIVES We determined current trends and patterns in overweight, obesity, and extreme high obesity among Pennsylvania pre-kindergarten (pre-K) to 12th grade students and simulated future trends. METHODS We analyzed body mass index (BMI) of pre-K to 12th grade students from 43 of 67 Pennsylvania counties in 2007 to 2011 to determine trends and to discern transition patterns among BMI status categories for 2009 to 2011. Vinsem simulation, confirmed by Markov chain modeling, generated future prevalence trends. RESULTS Combined rates of overweight, obesity, and extreme high obesity decreased among secondary school students across the 5 years, and among elementary students, first increased and then markedly decreased. BMI status remained constant for approximately 80% of normal and extreme high obese students, but both decreased and increased among students who initially were overweight and obese; the increase in BMI remained significant. CONCLUSIONS Overall trends in child and adolescent BMI status seemed positive. BMI transition patterns indicated that although overweight and obesity prevalence leveled off, extreme high obesity, especially among elementary students, is projected to increase substantially over time. If current transition patterns continue, the prevalence of overweight, obesity, and extreme high obesity among Pennsylvania students in 2031 is projected to be 16.0%, 6.6%, and 23.2%, respectively.

Use of data mining to reveal body mass index (BMI): patterns among Pennsylvania schoolchildren, pre-k to grade 12.

BACKGROUND Health eTools for Schools was developed to assist school nurses with routine entries, including height and weight, on student health records, thus providing a readily accessible data base. Data-mining techniques were applied to this database to determine if clinically significant results could be generated. METHODS Body mass index (BMI) data collected and entered in eTools by school nurses from 657,068 students attending 1156 schools in 49 of 67 Pennsylvania counties during 2005-2009 were analyzed. Students in each BMI category were sorted; regression was used to model mean and percentage trends. A chi-square test of individually matched BMI percentages was computed and migration across normal, overweight, and obese states determined. RESULTS The highest percentage of obese students occured in middle school. The mean trends for obesity and overweight had increasing slopes of 0.189 and 0.227, respectively; with regression slope for overweight >59%. Within groups, substantial percentages of individually matched BMIs changed significantly (p < .0001) over 2 years, migrating between normal weight, overweight, and obese. A comparison of 2009 measured BMI for grades 9-12 from eTools with 2009 Pennsylvania Youth Risk Behavior Survey self-reported BMI yielded substantial diferences. CONCLUSION A pattern of increasing BMI for elementary students with a corresponding decrease among middle and high school students emerged. The means trends for both overweight and obesity were greater in 2009 than in 2005, increasing steadily to 2008 and slightly declining to 2009. The dominant overall pattern flows from overweight to obese. If continued unabated, percentage of students who are obese will dominate over time.

Lessons Learned From the Whole Child and Coordinated School Health Approaches

BACKGROUND The new Whole School, Whole Community, Whole Child (WSCC) model, designed to depict links between health and learning, is founded on concepts of coordinated school health (CSH) and a whole child approach to education. METHODS The existing literature, including scientific articles and key publications from national agencies and organizations, was reviewed and synthesized to describe (1) the historical context for CSH and a whole child approach, and (2) lessons learned from the implementation and evaluation of these approaches. RESULTS The literature revealed that interventions conducted in the context of CSH can improve health-related and academic outcomes, as well as policies, programs, or partnerships. Several structural elements and processes have proved useful for implementing CSH and a whole child approach in schools, including use of school health coordinators, school-level and district-level councils or teams; systematic assessment and planning; strong leadership and administrative support, particularly from school principals; integration of health-related goals into school improvement plans; and strong community collaborations. CONCLUSIONS Lessons learned from years of experience with CSH and the whole child approaches have applicability for developing a better understanding of the WSCC model as well as maximizing and documenting its potential for impacting both health and education outcomes.

Prevention of dengue Fever: an exploratory school-community intervention involving students empowered as change agents(*).

BACKGROUND Dengue fever and dengue hemorrhagic fever (DF/DHF) are epidemic and endemic in tropical and subtropical countries including Sri Lanka. Numerous structural and community interventions have been shown to be effective in interrupting the life cycle of mosquitoes that transmit DF/DHF; however, these interventions are not always implemented intensely and/or consistently enough to control the mosquito populations and suppress the disease. Following a planned and systematic training and mobilizing program, in conjunction with a public information campaign, seventh-, eighth-, and ninth-grade students in 2 schools performed multiple mosquito control and education interventions in their communities once a week for 8 weeks. METHODS Five actions identified in previous literature and executed by students were tracked and secondary entomology data were obtained from public health surveillance systems. The Z-test for determining differences between proportions was utilized to determine significant changes between pre- and post-entomological survey findings in 2 intervention areas, 1 rural and 1 urban. Pre- and post-incidence rates from the intervention areas and comparable control areas were compared. RESULTS In intervention areas, all proportions of larval indexes were found to be significantly lower following the intervention. Surveillance data showed a 73% reduction in case load for the urban area and a 61% reduction in the rural area during the year following intervention. CONCLUSION If properly involved and guided, school children can be an asset to mosquito-borne disease control; the education sector could be an important partner in DF/DHF control.