Karen E. Johnson

Relationships between physical activity and depressive symptoms among middle and older adolescents: A review of the research literature

PURPOSE The purpose of the review was to describe current knowledge regarding relationships between physical activity (PA) and depressive symptoms among adolescents. CONCLUSIONS Inverse relationships were found between PA, particularly sports participation, and depressive symptoms. Limitations of the current research are discussed, including measurement issues. A major gap exists regarding research with youth at high risk for depressive symptoms and low levels of PA, including older, low-income, minority females. Future research should focus on high-risk populations such as youth attending alternative high schools. PRACTICE IMPLICATIONS Nurses should consider promoting PA among middle and older adolescents as a way to prevent depressive symptoms and consider integrating PA into care plans for those experiencing depressive symptoms.

Health behaviors and mental health of students attending alternative high schools: A review of the research literature

PURPOSE The purpose of this review is to describe current knowledge about health-risk behaviors and mental health among alternative high school students. CONCLUSIONS Substance use, diet and/or physical activity, sexual-risk behaviors, mental health, and violence were reviewed. Students were described as marginalized youth facing significant social environmental challenges. Findings from 43 studies published from 1997-2010 suggested a high prevalence of health-risk behaviors among alternative high school students. Very few studies were conducted by nurse researchers. Suggestions for future research include addressing social environmental factors, resiliency, and emotional/mental health outcomes. PRACTICE IMPLICATIONS Alternative high schools offer a venue to conduct research and implement nursing interventions with high-risk, yet resilient, youth.

Sport participation during adolescence and suicide ideation and attempts

Abstract Background: Most research regarding sport participation and suicide risk found protective relationships. However, all studies in this area were based on cross-sectional designs. Objective: To fill a gap in research by exploring associations between sport involvement and suicide ideation and attempts (suicidality) based on a 5-year longitudinal, population-based study. Study group: Participants (n=739) completed surveys in middle school and high school. Methods: Logistic regression analysis compared suicidality during high school across four groups: youth who participated in sport in both middle and high school, youth who participated only in middle school or only in high school, and youth who did not participate in sport during adolescence. Results: Compared to non-participants, youth involved in sport in both middle and high school had lower odds of suicidal ideation during high school. Youth who discontinued sport after middle school had higher odds of attempting suicide during high school than non-participants. Conclusions: Remaining involved in sport throughout adolescence can offer mental health benefits. Future research should identify mechanisms that account for protective relationships between involvement in sport throughout adolescence and suicidality, and identify factors that explain deleterious relationships for youth who discontinue sport early in adolescence.

A Systematic Review of Interventions to Reduce Stress in Adolescence

Adolescence can be a stressful developmental phase, placing youth at risk for negative health outcomes. Evidence-based interventions are crucial to helping adolescents manage stress; yet, most of the literature on adolescent stress is observational and descriptive. We systematically reviewed the literature on stress management interventions for adolescents and found there is evidence to support the effectiveness of interventions that aim to develop cognitive skills among adolescents; however, most studies had small samples and relied on different operational definitions of outcomes. Few included biological indicators of stress. Further study is needed to develop interventions to enhance adolescents’ capacity to manage stress.

Relationships between Sports Team Participation and Health-Risk Behaviors among Alternative High School Students.

Background Evidence suggests that sports team participation differentially relates to health-risk behaviors. Few studies have explored relationships among high-risk youth. Purpose To examine associations between weekly sports team participation and health-risk behaviors (substance use, sexual risk-taking, violence involvement) among alternative high school (AHS) students. Methods Data for this repeated cross-sectional analysis came from the 2001, 2004, 2007, and 2010 Minnesota Student Surveys (n = 2847 to 4596). Logistic regression was used to examine relationships between sports team participation and 14 outcomes. Interaction terms tested whether associations varied by survey year, gender, and/or race/ethnicity. Results For males, sports team participation protected against most substance use outcomes and was associated with higher condom use. Female sports participants were less likely than nonparticipants to have ever had sex. For both genders, sports team participation was positively associated with gun carrying. No differences by race/ethnicity or year were found. Discussion Further research is needed with AHS students who play sports to understand mixed findings from the current study and how to promote healthy behaviors through sports. Translation to Health Education Practice Health education professionals are in ideal positions to work with school administrators and researchers to facilitate scientific inquiry and translate it into practice.

Comparison of Health-Risk Behaviors Among Students Attending Alternative and Traditional High Schools in Minnesota

Previous research, over a decade old, suggests students attending alternative high schools (AHS) engage in high levels of health-risk behaviors. Data from the 2007 Minnesota Student Survey for students attending AHS (n = 2,847) and traditional high schools (THS; n = 87,468) were used for this cross-sectional analysis to compare prevalence estimates, adjusted for age, race/ethnicity, and free and reduced lunch, for 28 health-risk behaviors. Students attending AHS were significantly more likely than students attending THS to report engaging in all behaviors related to unintentional injury and violence, tobacco use, alcohol and other drug use, and sexual activity, and were significantly less likely to report participating in physical activity, including sports teams. Students attending AHS continue to engage in high levels of health-risk behaviors as compared to their peers in THS. Updated national prevalence data were needed, as well as studies examining the role of protective factors in the lives of students attending AHS.

What big size you have! Using effect sizes to determine the impact of public health nursing interventions

BACKGROUND The Omaha System is a standardized interface terminology that is used extensively by public health nurses in community settings to document interventions and client outcomes. Researchers using Omaha System data to analyze the effectiveness of interventions have typically calculated p-values to determine whether significant client changes occurred between admission and discharge. However, p-values are highly dependent on sample size, making it difficult to distinguish statistically significant changes from clinically meaningful changes. Effect sizes can help identify practical differences but have not yet been applied to Omaha System data. METHODS We compared p-values and effect sizes (Cohens d) for mean differences between admission and discharge for 13 client problems documented in the electronic health records of 1,016 young low-income parents. Client problems were documented anywhere from 6 (Health Care Supervision) to 906 (Caretaking/parenting) times. RESULTS On a scale from 1 to 5, the mean change needed to yield a large effect size (Cohens d ≥ 0.80) was approximately 0.60 (range = 0.50 - 1.03) regardless of p-value or sample size (i.e., the number of times a client problem was documented in the electronic health record). CONCLUSIONS Researchers using the Omaha System should report effect sizes to help readers determine which differences are practical and meaningful. Such disclosures will allow for increased recognition of effective interventions.

A Systematic Review of Consent Procedures, Participation Rates, and Main Findings of Health-Related Research in Alternative High Schools from 2010 to 2015.

There is a well-established link between educational attainment and health. Alternative high schools (AHSs) serve students who are at risk for school dropout. Health-related research conducted in AHSs has been sparse. Achieving high participation rates is critical to producing generalizable results and can be challenging in research with adolescents for reasons such as using active consent. These challenges become greater when working with vulnerable populations of adolescents. In this systematic review, we examined health-related studies conducted in AHSs between 2010 and 2015. Results indicated that (1) health-related research in AHSs has increased over the past 5 years, (2) AHS students continue to experience significant disparities, (3) active consent is commonly used with AHS students, (4) 42% of studies reported participation rates or provided enough information to calculate participation rates, and (5) school nurses are missing from health-related research conducted in AHSs. Implications for future research and school nursing are discussed.

Gender and Ethnic Differences in Health-Promoting Behaviors of Rural Adolescents.

Although much is known about health-risk behaviors of adolescents, less is known about their health-promoting behaviors. The purpose of this analysis was to compare health-promoting behaviors in adolescents in Grades 9–12 by gender and ethnicity and explore how these behaviors changed over time. Data were collected from 878 rural adolescents (47.5% Hispanic; mean age at baseline 14.7 years). Males from all ethnic groups scored significantly higher than all females on physical activity; non-Hispanic Black males and females scored significantly higher than other ethnic groups on safety behaviors. Hispanic and non-Hispanic White females scored higher than males in these ethnic groups on stress management. Nutrition, physical activity, and safety behaviors decreased significantly for most participants from Grade 9 to 12 whereas stress management remained relatively stable. Findings are similar to those from nationally representative samples that analyzed cross-sectional data and have implications for school nursing interventions to improve health-promoting behaviors in rural adolescents.

Health-Risk Behaviors Among High School Athletes and Preventive Services Provided During Sports Physicals

INTRODUCTION Preparticipation examinations (PPEs), or sports physicals, present opportunities for health care providers to identify and discuss common adolescent health-risk behaviors. We sought to examine the prevalence of health-risk behaviors among high school athletes and the proportion of providers who address these behaviors during PPEs. METHOD For this descriptive study we used data from two statewide surveys: a survey of adolescents (n = 46,492) and a survey of nurse practitioners and physicians (n = 561). RESULTS The most prevalent risk behaviors reported by student athletes were low levels of physical activity (70%), bullying perpetration (41%), and alcohol use (41%). Most providers (≥75%) addressed many common risk behaviors during PPEs but fewer addressed bullying, violence, and prescription drug use. Topics discussed differed by provider type and patient population. DISCUSSION Many providers addressed critical threats to adolescent health during PPEs, but findings suggest potential disconnects between topics addressed during PPEs and behaviors of athletes.