Publications by authors named "Leah Robin"

37 Publications

Vital Signs: Prevalence of Multiple Forms of Violence and Increased Health Risk Behaviors and Conditions Among Youths - United States, 2019.

MMWR Morb Mortal Wkly Rep 2021 Feb 5;70(5):167-173. Epub 2021 Feb 5.

Introduction: Experiencing violence, especially multiple types of violence, can have a negative impact on youths' development. These experiences increase the risk for future violence and other health problems associated with the leading causes of morbidity and mortality among adolescents and adults.

Methods: Data from the 2019 national Youth Risk Behavior Survey were used to determine the prevalence of high school students' self-reported experiences with physical fighting, being threatened with a weapon, physical dating violence, sexual violence, and bullying. Logistic regression models adjusting for sex, grade, and race/ethnicity were used to test the strength of associations between experiencing multiple forms of violence and 16 self-reported health risk behaviors and conditions.

Results: Approximately one half of students (44.3%) experienced at least one type of violence; more than one in seven (15.6%) experienced two or more types during the preceding 12 months. Experiencing multiple types of violence was significantly more prevalent among females than among males and among students identifying as gay, lesbian, or bisexual or not sure of their sexual identity than among heterosexual students. Experiencing violence was significantly associated with higher prevalence of all examined health risks and conditions. Relative to youths with no violence experiences, adjusted health risk and condition prevalence estimates were up to seven times higher among those experiencing two types of violence and up to 21 times higher among those experiencing three or more types of violence.

Conclusions And Implications For Public Health Practice: Many youths experience multiple types of violence, with potentially lifelong health impacts. Violence is preventable using proven approaches that address individual, family, and environmental risks. Prioritizing violence prevention is strategic to promoting adolescent and adult health.
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http://dx.doi.org/10.15585/mmwr.mm7005a4DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7861486PMC
February 2021

Vital Signs: Prevalence of Multiple Forms of Violence and Increased Health Risk Behaviors and Conditions Among Youths - United States, 2019.

MMWR Morb Mortal Wkly Rep 2021 Feb 5;70(5):167-173. Epub 2021 Feb 5.

Introduction: Experiencing violence, especially multiple types of violence, can have a negative impact on youths' development. These experiences increase the risk for future violence and other health problems associated with the leading causes of morbidity and mortality among adolescents and adults.

Methods: Data from the 2019 national Youth Risk Behavior Survey were used to determine the prevalence of high school students' self-reported experiences with physical fighting, being threatened with a weapon, physical dating violence, sexual violence, and bullying. Logistic regression models adjusting for sex, grade, and race/ethnicity were used to test the strength of associations between experiencing multiple forms of violence and 16 self-reported health risk behaviors and conditions.

Results: Approximately one half of students (44.3%) experienced at least one type of violence; more than one in seven (15.6%) experienced two or more types during the preceding 12 months. Experiencing multiple types of violence was significantly more prevalent among females than among males and among students identifying as gay, lesbian, or bisexual or not sure of their sexual identity than among heterosexual students. Experiencing violence was significantly associated with higher prevalence of all examined health risks and conditions. Relative to youths with no violence experiences, adjusted health risk and condition prevalence estimates were up to seven times higher among those experiencing two types of violence and up to 21 times higher among those experiencing three or more types of violence.

Conclusions And Implications For Public Health Practice: Many youths experience multiple types of violence, with potentially lifelong health impacts. Violence is preventable using proven approaches that address individual, family, and environmental risks. Prioritizing violence prevention is strategic to promoting adolescent and adult health.
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http://dx.doi.org/10.15585/mmwr.mm7005a4DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7861486PMC
February 2021

Vital Signs: Prevalence of Multiple Forms of Violence and Increased Health Risk Behaviors and Conditions Among Youths - United States, 2019.

MMWR Morb Mortal Wkly Rep 2021 Feb 5;70(5):167-173. Epub 2021 Feb 5.

Introduction: Experiencing violence, especially multiple types of violence, can have a negative impact on youths' development. These experiences increase the risk for future violence and other health problems associated with the leading causes of morbidity and mortality among adolescents and adults.

Methods: Data from the 2019 national Youth Risk Behavior Survey were used to determine the prevalence of high school students' self-reported experiences with physical fighting, being threatened with a weapon, physical dating violence, sexual violence, and bullying. Logistic regression models adjusting for sex, grade, and race/ethnicity were used to test the strength of associations between experiencing multiple forms of violence and 16 self-reported health risk behaviors and conditions.

Results: Approximately one half of students (44.3%) experienced at least one type of violence; more than one in seven (15.6%) experienced two or more types during the preceding 12 months. Experiencing multiple types of violence was significantly more prevalent among females than among males and among students identifying as gay, lesbian, or bisexual or not sure of their sexual identity than among heterosexual students. Experiencing violence was significantly associated with higher prevalence of all examined health risks and conditions. Relative to youths with no violence experiences, adjusted health risk and condition prevalence estimates were up to seven times higher among those experiencing two types of violence and up to 21 times higher among those experiencing three or more types of violence.

Conclusions And Implications For Public Health Practice: Many youths experience multiple types of violence, with potentially lifelong health impacts. Violence is preventable using proven approaches that address individual, family, and environmental risks. Prioritizing violence prevention is strategic to promoting adolescent and adult health.
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http://dx.doi.org/10.15585/mmwr.mm7005a4DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7861486PMC
February 2021

Early adolescent gender diversity and mental health in the Adolescent Brain Cognitive Development study.

J Child Psychol Psychiatry 2021 Feb 28;62(2):171-179. Epub 2020 May 28.

Division of Adolescent and School Health, Centers for Disease Control and Prevention, Atlanta, GA, USA.

Background: There are known associations between mental health symptoms and transgender identity among adults. Whether this relationship extends to early adolescents and to gender domains other than identity is unclear. This study measured dimensions of gender in a large, diverse, sample of youth, and examined associations between diverse gender experiences and mental health.

Methods: The ABCD study is an ongoing, longitudinal, US cohort study. Baseline data (release 2.0) include 11,873 youth age 9/10 (48% female); and the 4,951 1-year follow-up visits (age 10/11; 48% female) completed prior to data release. A novel gender survey at the 1-year visit assessed felt-gender, gender noncontentedness, and gender nonconformity using a 5-point scale. Mental health measures included youth- and parent-reports.

Results: Roughly half a percent of 9/10-year-olds (n = 58) responded 'yes' or 'maybe' when asked, 'Are you transgender' at baseline. Recurrent thoughts of death were more prevalent among these youth compared to the rest of the cohort (19.6% vs. 6.4%, χ  = 16.0, p < .001). At the 1-year visit, when asked about the three dimensions of gender on a 5-point scale, 33.2% (n = 1,605) provided responses that were not exclusively and totally aligned with one gender. Significant relationships were observed between mental health symptoms and gender diversity for all dimensions assessed.

Conclusions: Similar to adult studies, early adolescents identifying as transgender reported increased mental health symptoms. Results also point to considerable diversity in other dimensions of gender (felt-gender, gender noncontentedness, gender nonconformity) among 10/11-year-olds, and find this diversity to be related to critical mental health symptoms. These findings add to our limited understanding of the relationship between dimensions of gender and wellness for youth.
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http://dx.doi.org/10.1111/jcpp.13248DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7704539PMC
February 2021

Violence Victimization, Substance Use Disparities, and Gender-Nonconforming Youth.

Am J Prev Med 2020 05 5;58(5):e159-e169. Epub 2020 Mar 5.

Division of Adolescent and School Health, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia.

Introduction: Exposure to violence victimization may help explain disparities of substance use among gender-nonconforming youth (i.e., those whose gender expression differs from societal expectations).

Methods: In 2015, three large urban school districts (2 in California and 1 in Florida) conducted a Youth Risk Behavior Survey that included the assessment of gender expression among a racially/ethnically diverse population-based sample of 6,082 high school students. Five categories of violence victimization were assessed (felt unsafe at school, threatened or injured with a weapon at school, bullied at school, electronically bullied, and forced sexual intercourse). In 2019, the effect of violence victimization on substance use disparities was examined by calculating sex-stratified prevalence ratios by gender nonconformity, adjusted for sexual identity, race/ethnicity, and grade (adjusted prevalence ratio 1 [APR1]), and comparing these with prevalence ratios adjusted for those variables plus violence victimization (adjusted prevalence ratio 2 [APR2]).

Results: Among female students, only being threatened or injured with a weapon was significantly (p<0.05) associated with gender nonconformity and there were no substance use disparities by gender nonconformity. Among male students, every category of violence victimization was more prevalent among gender-nonconforming than among gender-conforming students and most substance use categories demonstrated significant gender nonconformity disparities. After controlling for violence victimization, these disparities decreased but remained statistically significant for the use of cocaine (APR1=2.84 vs APR2=1.99), methamphetamine (APR1=4.47 vs APR2=2.86), heroin (APR1=4.55 vs APR2=2.96), and injection drug use (APR1=7.90 vs APR2=4.72).

Conclusions: School-based substance use prevention programs may benefit from strategies that support gender diversity and reduce violence victimizations experienced by gender-nonconforming students, by providing a safe and supportive school environment.
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http://dx.doi.org/10.1016/j.amepre.2019.12.021DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7885263PMC
May 2020

Get Yourself Tested Goes to High School: Adapted Sexually Transmitted Disease Prevention Campaign and Associated Student Use of Clinic Sexually Transmitted Disease Testing Services.

Sex Transm Dis 2019 06;46(6):383-388

Division of Health, Research, Informatics, and Technology, ICF, Atlanta GA.

Background: In an attempt to increase high school students' sexually transmitted disease (STD) testing rates, the Centers for Disease Control and Prevention's Division of Adolescent and School Health partnered with ICF and Chicago Public Schools to adapt and implement the "GYT: Get Yourself Tested" health marketing campaign for a high school.

Methods: Clinic record data and student retrospective self-report surveys (n = 193) tested for differences between the GYT intervention school and a comparison school on a number of outcomes, including human immunodeficiency virus and STD testing.

Results: Clinic record data showed that testing increased significantly more for the intervention than the comparison school during the GYT implementation period (B, 2.9; SE, 1.1, P < 0.05). Furthermore, the odds of being tested at the referral clinic were more than 4 times (odds ratio, 4.4) as high for students in the campaign school than for those in the comparison school (95% confidence interval, 2.3-8.2). Survey data did not show increased self-reported testing but, more students in the GYT school (92.7%) were aware of where to receive free, low-cost, or affordable human immunodeficiency virus and STD testing than students in the comparison school (76.0%; P < 0.01). Among sexually experienced students (n = 142), significantly more from the campaign school reported that they intended to test for STDs in the next 3 months (48.4% strongly agree and 33.2% agree) compared with those at the comparison school (27.4% strongly agree and 32.9% agree; P < 0.05).

Conclusions: Our pilot suggests that a student-led GYT campaign in high schools may successfully increase STD testing of students. Although some of the findings from this pilot evaluation are promising, they are limited, and broader implementation and evaluation is needed. Future evaluation efforts can include more rigorous study designs, multiple schools or districts, longer campaign and evaluation across an entire school or calendar year, or in combination with other school-based testing strategies like a mass school-based screening event.
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http://dx.doi.org/10.1097/OLQ.0000000000000983DOI Listing
June 2019

Nonconforming Gender Expression, Mental Distress, and Substance Abuse in Adolescents-Reply.

JAMA Pediatr 2019 04;173(4):400-401

Division of Adolescent and School Health, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia.

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http://dx.doi.org/10.1001/jamapediatrics.2019.0018DOI Listing
April 2019

Practices That Support and Sustain Health in Schools: An Analysis of SHPPS Data.

J Sch Health 2019 04 19;89(4):279-299. Epub 2019 Feb 19.

Division of Adolescent and School Health, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, 4770 Buford Highway NE (Mailstop F-78), Atlanta, GA 30329.

Background: The Whole School, Whole Community, Whole Child (WSCC) model provides an organizing framework for schools to develop and implement school health policies, practices, and programs. The purpose of this study was to examine the presence of practices that support school health for each component of the WSCC model in US schools.

Methods: Data from the School Health Policies and Practices Study 2014 were analyzed to determine the percentage of schools with practices in place that support school health for WSCC components.

Results: Less than 27% of schools had a school health council that addressed any specific WSCC component, but more than 50% had a coordinator for all but one component. The use of other practices that support school health varied widely across the WSCC components. For example, more than 80% of schools reported family engagement for health education and nutrition environment and services, but less than 50% reported family engagement for other components.

Conclusions: These results indicate that many US schools are using practices that support school health and align with WSCC components, but improvement is needed. These results also highlight discrepancies in the types of practices being used.
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http://dx.doi.org/10.1111/josh.12742DOI Listing
April 2019

Practices That Support and Sustain Health in Schools: An Analysis of SHPPS Data.

J Sch Health 2019 04 19;89(4):279-299. Epub 2019 Feb 19.

Division of Adolescent and School Health, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, 4770 Buford Highway NE (Mailstop F-78), Atlanta, GA 30329.

Background: The Whole School, Whole Community, Whole Child (WSCC) model provides an organizing framework for schools to develop and implement school health policies, practices, and programs. The purpose of this study was to examine the presence of practices that support school health for each component of the WSCC model in US schools.

Methods: Data from the School Health Policies and Practices Study 2014 were analyzed to determine the percentage of schools with practices in place that support school health for WSCC components.

Results: Less than 27% of schools had a school health council that addressed any specific WSCC component, but more than 50% had a coordinator for all but one component. The use of other practices that support school health varied widely across the WSCC components. For example, more than 80% of schools reported family engagement for health education and nutrition environment and services, but less than 50% reported family engagement for other components.

Conclusions: These results indicate that many US schools are using practices that support school health and align with WSCC components, but improvement is needed. These results also highlight discrepancies in the types of practices being used.
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http://dx.doi.org/10.1111/josh.12742DOI Listing
April 2019

Practices That Support and Sustain Health in Schools: An Analysis of SHPPS Data.

J Sch Health 2019 04 19;89(4):279-299. Epub 2019 Feb 19.

Division of Adolescent and School Health, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, 4770 Buford Highway NE (Mailstop F-78), Atlanta, GA 30329.

Background: The Whole School, Whole Community, Whole Child (WSCC) model provides an organizing framework for schools to develop and implement school health policies, practices, and programs. The purpose of this study was to examine the presence of practices that support school health for each component of the WSCC model in US schools.

Methods: Data from the School Health Policies and Practices Study 2014 were analyzed to determine the percentage of schools with practices in place that support school health for WSCC components.

Results: Less than 27% of schools had a school health council that addressed any specific WSCC component, but more than 50% had a coordinator for all but one component. The use of other practices that support school health varied widely across the WSCC components. For example, more than 80% of schools reported family engagement for health education and nutrition environment and services, but less than 50% reported family engagement for other components.

Conclusions: These results indicate that many US schools are using practices that support school health and align with WSCC components, but improvement is needed. These results also highlight discrepancies in the types of practices being used.
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http://dx.doi.org/10.1111/josh.12742DOI Listing
April 2019

Nonconforming Gender Expression and Associated Mental Distress and Substance Use Among High School Students.

JAMA Pediatr 2018 11;172(11):1020-1028

Division of Adolescent and School Health, National Center for HIV/AIDS, Viral Hepatitis, Sexually Transmitted Disease (STD), and Tuberculosis (TB) Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia.

Importance: The cultural roles and expectations attributed to individuals based on their sex often shape health behaviors and outcomes. Gender nonconformity (GNC) (ie, gender expression that differs from societal expectations for feminine or masculine appearance and behavior) is an underresearched area of adolescent health that is often linked to negative health outcomes.

Objective: To examine the associations of GNC with mental distress and substance use among high school students.

Design, Setting, And Participants: Cross-sectional study based on data from the Youth Risk Behavior Survey (YRBS) conducted in 2015. The setting was 3 large urban US school districts (2 in California and 1 in Florida). Participants were a racially/ethnically diverse population-based sample of 6082 high school students representative of all public school students in grades 9 through 12 attending these 3 school districts.

Main Outcomes And Measures: Sex-stratified adjusted prevalence ratios (APRs) (adjusted for race/ethnicity, grade, and sexual identity) for high gender-nonconforming students (very/mostly/somewhat feminine male students or very/mostly/somewhat masculine female students) and moderate gender-nonconforming students (equally feminine and masculine students) relative to a referent group of low gender-nonconforming students (very/mostly/somewhat masculine male students or very/mostly/somewhat feminine female students).

Results: Among 6082 high school students, 881 (15.9%) were white, 891 (19.1%) black, 3163 (55.1%) Hispanic, and 1008 (9.9%) other race/ethnicity. Among female students (2919 [50.0% of the study population]), moderate GNC was significantly associated with feeling sad and hopeless (APR, 1.22; 95% CI, 1.05-1.41), seriously considering attempting suicide (APR, 1.41; 95% CI, 1.14-1.74), and making a suicide plan (APR, 1.52; 95% CI, 1.22-1.89); however, substance use was not associated with GNC. Among male students (3139 [50.0% of the study population]), moderate GNC was associated with feeling sad and hopeless (APR, 1.55; 95% CI, 1.25-1.92); high GNC was associated with seriously considering attempting suicide (APR, 1.72; 95% CI, 1.16-2.56), making a suicide plan (APR, 1.79; 95% CI, 1.17-2.73), and attempting suicide (APR, 2.78; 95% CI, 1.75-4.40), as well as nonmedical use of prescription drugs (APR, 1.81; 95% CI, 1.23-2.67), cocaine use (APR, 2.84; 95% CI, 1.80-4.47), methamphetamine use (APR, 4.52; 95% CI, 2.68-7.61), heroin use (APR, 4.59; 95% CI, 2.48-8.47), and injection drug use (APR, 8.05; 95% CI, 4.41-14.70).

Conclusions And Relevance: This study suggests mental distress is associated with GNC among female and male students. Substance use also appeared to be strongly associated with GNC among male students. These findings underscore and suggest the importance of implementing school-based programs to prevent substance use and promote student mental health that are inclusive of gender diversity in students.
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http://dx.doi.org/10.1001/jamapediatrics.2018.2140DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6248138PMC
November 2018

Sexual Risk Behavior Differences Among Sexual Minority High School Students - United States, 2015 and 2017.

MMWR Morb Mortal Wkly Rep 2018 Sep 14;67(36):1007-1011. Epub 2018 Sep 14.

Sexual minority youths (i.e., those identifying as gay, lesbian, bisexual, or another nonheterosexual identity or reporting same-sex attraction or sexual partners) are at higher risk than youths who are not sexual minority youth (nonsexual minority youth) for negative health behaviors and outcomes, including human immunodeficiency virus (HIV) infection, other sexually transmitted diseases (STDs), pregnancy (1),* and related sexual risk behaviors (2). Less is known about sexual risk behavior differences between sexual minority youth subgroups. This is the first analysis of subgroup differences among sexual minority youths using nationally representative Youth Risk Behavior Survey (YRBS) data. CDC analyzed pooled data from the 2015 and 2017 cycles of the national YRBS, a cross-sectional, school-based survey assessing health behaviors among U.S. students in grades 9-12. Analyses examined differences in eight sexual risk behaviors between subgroups of sexual minority youths and nonsexual minority youths, as well as within sexual minority youths. Logistic regression models controlling for race/ethnicity and grade found that bisexual females and "not sure" males reported higher prevalences for many behaviors than did heterosexual students. For behavior-based subgroups, the largest number of differences were seen between students who had sexual contact with both sexes compared with students with only opposite-sex sexual contact. Findings highlight subgroup differences within sexual minority youths that could inform interventions to promote healthy behavior.
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http://dx.doi.org/10.15585/mmwr.mm6736a3DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6146951PMC
September 2018

Social Stress and Substance Use Disparities by Sexual Orientation Among High School Students.

Am J Prev Med 2017 Oct 18;53(4):547-558. Epub 2017 Aug 18.

Division of Adolescent and School Health, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia.

Introduction: Sexual minority youth often experience increased social stress due to prejudice, discrimination, harassment, and victimization. Increased stress may help explain the disproportionate use of substances like tobacco, alcohol, marijuana, and other illicit drug use by sexual minority youth. This study examined the effect of social stress on substance use disparities by sexual orientation among U.S. high school students.

Methods: In 2016, data from the national 2015 Youth Risk Behavior Survey, conducted among a nationally representative sample of 15,624 U.S. high school students, were analyzed to examine the effect of school-related (threatened/injured at school, bullied at school, bullied electronically, felt unsafe at school) and non-school-related (forced sexual intercourse, early sexual debut) social stress on substance use disparities by sexual orientation, by comparing unadjusted prevalence ratios (PRs) and adjusted (for social stressors, age, sex, and race/ethnicity) prevalence ratios (APRs).

Results: Unadjusted PRs reflected significantly (p<0.05 or 95% CI did not include 1.0) greater substance use among students who identified as lesbian/gay or bisexual than students who identified as heterosexual. APRs for injection drug use decreased substantially among lesbian/gay (PR=12.02 vs APR=2.14) and bisexual (PR=2.62 vs APR=1.18) students; the APR for bisexual students became nonsignificant. In addition, APRs among both lesbian/gay and bisexual students decreased substantially and were no longer statistically significant for cocaine, methamphetamine, and heroin use.

Conclusions: School-based substance use prevention programs might appropriately include strategies to reduce social stress, including policies and practices designed to provide a safe school environment and improved access to social and mental health services.
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http://dx.doi.org/10.1016/j.amepre.2017.06.011DOI Listing
October 2017

Harassment and Mental Distress Among Adolescent Female Students by Sexual Identity and BMI or Perceived Weight Status.

Obesity (Silver Spring) 2017 08 11;25(8):1421-1427. Epub 2017 May 11.

Division of Adolescent and School Health, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, USA.

Objective: Sexual minority girls (lesbian/bisexual) and girls with overweight/obesity experience high rates of discrimination and mental distress. This study explored whether BMI or perceived weight status might compound sexual minority girls' risk for harassment and mental distress.

Methods: Data on female students from the national 2015 Youth Risk Behavior Survey (n = 7,006) were analyzed. Logistic regression was used to examine differences in bullying, harassment, and mental distress across sexual identity/BMI groups: heterosexual/normal-weight, heterosexual/overweight, sexual minority/normal-weight, and sexual minority/overweight. Procedures were repeated with four analogous groups created from sexual identity and perceived weight.

Results: Across sexual identity/BMI groups, being overweight increased heterosexual females' odds of being bullied or experiencing suicidal thoughts and behaviors. Regardless of weight status, sexual minority females had greater odds for each outcome than heterosexual females. Sexual minority females who perceived themselves as overweight had greater odds of suicidality than all other sexual minority/perceived weight groups.

Conclusions: Double jeopardy may exist for sexual minority female students who perceive themselves as overweight. Professional development with school staff on how to create a positive climate for sexual minorities and those with overweight/obesity and addressing positive identity and body image within school-based suicide prevention efforts may be important to the well-being of adolescent girls.
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http://dx.doi.org/10.1002/oby.21850DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5572140PMC
August 2017

Effect of Forced Sexual Intercourse on Associations Between Early Sexual Debut and Other Health Risk Behaviors Among US High School Students.

J Sch Health 2017 06;87(6):435-447

School-Based Surveillance Branch, Division of Adolescent and School Health, US Centers for Disease Control and Prevention, 1600 Clifton Road, N.E. Mailstop E-75, Atlanta, GA 30329.

Background: Previous research on associations between early sexual debut and other health risk behaviors has not examined the effect of forced sexual intercourse on those associations.

Methods: We analyzed data from a nationally representative sample of 19,240 high school students in the United States, age ≥16 years, to describe the effect of forced sexual intercourse on associations between early sexual debut and other health risk behaviors using adjusted prevalence ratios (APR).

Results: Early sexual debut and forced sexual intercourse were simultaneously and independently associated with sexual risk-taking, violence-related behaviors, and substance use. For example, even after controlling for forced sexual intercourse and race/ethnicity, students who experienced their first sexual intercourse before age 13 years were more likely than students who initiated sexual intercourse at age ≥16 years to have had ≥4 sexual partners during their lifetime (girls, APR = 4.55; boys, APR = 5.82) and to have not used a condom at last sexual intercourse (girls, APR = 1.74; boys, APR = 1.47).

Conclusions: Associations between early sexual debut and other health risk behaviors occur independently of forced sexual intercourse. School-based sexual health education programs might appropriately include strategies that encourage delay of initiation of sexual intercourse, and coordinate with violence and substance use prevention programs.
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http://dx.doi.org/10.1111/josh.12512DOI Listing
June 2017

Effect of Forced Sexual Intercourse on Associations Between Early Sexual Debut and Other Health Risk Behaviors Among US High School Students.

J Sch Health 2017 06;87(6):435-447

School-Based Surveillance Branch, Division of Adolescent and School Health, US Centers for Disease Control and Prevention, 1600 Clifton Road, N.E. Mailstop E-75, Atlanta, GA 30329.

Background: Previous research on associations between early sexual debut and other health risk behaviors has not examined the effect of forced sexual intercourse on those associations.

Methods: We analyzed data from a nationally representative sample of 19,240 high school students in the United States, age ≥16 years, to describe the effect of forced sexual intercourse on associations between early sexual debut and other health risk behaviors using adjusted prevalence ratios (APR).

Results: Early sexual debut and forced sexual intercourse were simultaneously and independently associated with sexual risk-taking, violence-related behaviors, and substance use. For example, even after controlling for forced sexual intercourse and race/ethnicity, students who experienced their first sexual intercourse before age 13 years were more likely than students who initiated sexual intercourse at age ≥16 years to have had ≥4 sexual partners during their lifetime (girls, APR = 4.55; boys, APR = 5.82) and to have not used a condom at last sexual intercourse (girls, APR = 1.74; boys, APR = 1.47).

Conclusions: Associations between early sexual debut and other health risk behaviors occur independently of forced sexual intercourse. School-based sexual health education programs might appropriately include strategies that encourage delay of initiation of sexual intercourse, and coordinate with violence and substance use prevention programs.
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http://dx.doi.org/10.1111/josh.12512DOI Listing
June 2017

Barriers and Facilitators to Sustaining School Health Teams in Coordinated School Health Programs.

Health Promot Pract 2017 05 19;18(3):418-427. Epub 2016 Apr 19.

2 Centers for Disease Control and Prevention, Atlanta, GA, USA.

Coordinated school health (CSH) programs address multiple factors related to students' overall health, thereby increasing their physical and mental readiness to learn. A formative evaluation of three school districts in 2010-2011 examined strategies for sustaining the school health teams (SHTs) that lead CSH efforts. Qualitative data from 39 interviews and 13 focus groups revealed facilitators and barriers for sustaining SHTs. Quantitative data from 68 questionnaires completed by SHT members and school principals examined factors associated with having more active SHTs and district and school characteristics SHT members believed to be important to their schools' efforts to implement CSH. Facilitators of sustaining SHTs included administrative support, staff engagement in the SHT, and shared goals and responsibility. Barriers to sustaining SHTs included limited time and competing priorities, budget and funding constraints, and staff turnover. Findings provide valuable insight into challenges and potential solutions for improving the sustainability of SHTs to enable them to better support CSH efforts.
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http://dx.doi.org/10.1177/1524839916638817DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7909475PMC
May 2017

Communicating with School Staff About Sexual Identity, Health and Safety: An Exploratory Study of the Experiences and Preferences of Black and Latino Teen Young Men Who Have Sex with Men.

LGBT Health 2015 Sep;2(3):258-64

Purpose: This exploratory study examined the experiences of black and Latino teen young men who have sex with men (YMSM) and their preferences for communication with school staff about matters related to sexual orientation.

Methods: Participants for this study were recruited in three urban centers in the United States and by multiple community-based organizations serving black and Latino YMSM. Eligible youth were male, black and Latino, ages 13–19, enrolled in 90 days of school in the previous 18 months, and reported attraction to or sexual behavior with other males, or identified as gay or bisexual. Participants completed web-based questionnaires (n=415) and/or in-depth interviews (n=32).

Results: Questionnaire participants reported willingness to talk to at least one school staff member about: safety, dating and relationships, and feeling attracted to other guys (63.4%, 58.4%, and 55.9%, respectively). About one-third of the sample reported they would not talk with any school staff about these topics. Exploratory analyses revealed youth who experienced feeling unsafe at school and who had higher levels of trust in the information provided by school staff were more likely to be willing to talk with school staff about safety issues, dating, or same sex attraction (adjusted odds ratio [AOR]=2.80 and AOR=4.85, respectively). Interview participants reported being most willing to talk to staff who were able and willing to help them, who would keep discussions confidential, and who expressed genuine care. Preferences for confiding in school staff perceived to be lesbian, gay, bisexual, and transgender (LGBT) and having similar racial/ethnic background were also noted.

Conclusion: Findings suggest school staff can serve as points of contact for reaching YMSM and professional development and interventions can be tailored to reach YMSM and connect them to services they need. Additional research is needed to understand how to increase YMSM comfort talking with school staff about sexual health or sexual identity concerns.
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http://dx.doi.org/10.1089/lgbt.2014.0087DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4589529PMC
September 2015

Communicating With School Nurses About Sexual Orientation and Sexual Health: Perspectives of Teen Young Men Who Have Sex With Men.

J Sch Nurs 2015 Oct 17;31(5):334-44. Epub 2014 Dec 17.

Centers for Disease Control and Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Division of Adolescent and School Health, Atlanta, GA, USA.

Black and Latino young men who have sex with men (YMSM) are at disproportionate risk for sexually transmitted diseases (STDs), including HIV. This study informs school-centered strategies for connecting YMSM to health services by describing their willingness, perceived safety, and experiences in talking to school staff about sexual health. Cross-sectional data were collected from Black and Latino YMSM aged 13-19 through web-based questionnaires (N = 415) and interviews (N = 32). School nurses were the staff members youth most often reported willingness to talk to about HIV testing (37.8%), STD testing (37.1%), or condoms (37.3%), but least often reported as safe to talk to about attraction to other guys (11.4%). Interviews revealed youth reluctance to talk with school staff including nurses when uncertain of staff members' perceptions of lesbian, gay, bisexual, transgender, and questioning (LGBTQ) people or perceiving staff to lack knowledge of LGBTQ issues, communities, or resources. Nurses may need additional training to effectively reach Black and Latino YMSM.
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http://dx.doi.org/10.1177/1059840514557160DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4587487PMC
October 2015

Associations of body mass index with sexual risk-taking and injection drug use among US high school students.

J Obes 2014 1;2014:816071. Epub 2014 Jul 1.

Division of Nutrition, Physical Activity, and Obesity, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA 30341, USA.

The purpose of this study was to determine if body mass index (BMI) is associated with behaviors that may increase risk for HIV and other sexually transmitted diseases (STDs) among US high school students. We analyzed nationally representative data from the 2005-2011 national Youth Risk Behavior Surveys (YRBS) to examine associations of BMI categories with sexual risk behaviors and injection drug use among sexually active high school students, using sex-stratified logistic regression models. Controlling for race/ethnicity and grade, among female and male students, both underweight (BMI < 5th percentile) and obesity (BMI ≥ 95th percentile) were associated with decreased odds of being currently sexually active (i.e., having had sexual intercourse during the past 3 months). However, among sexually active female students, obese females were more likely than normal weight females to have had 4 or more sex partners (odds ratio, OR = 1.59), not used a condom at last sexual intercourse (OR = 1.30), and injected illegal drugs (OR = 1.98). Among sexually active male students, overweight (85th percentile ≤ BMI < 95th percentile) was associated with not using a condom at last sexual intercourse (OR = 1.19) and obesity was associated with injection drug use (OR = 1.42). Among sexually active students, overweight and obesity may be indicators of increased risk for HIV and other STDs.
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http://dx.doi.org/10.1155/2014/816071DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4106110PMC
May 2016

Indicators of asthma control among students in a rural, school-based asthma management program.

J Asthma 2014 Oct 22;51(8):876-85. Epub 2014 May 22.

Division of Adolescent and School Health, Centers for Disease Control and Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention , Atlanta, GA , USA .

Objective: The evaluation sought to determine if a comprehensive, school-based asthma management program in a small, rural school district helped students improve asthma control.

Methods: To determine if students in the asthma program demonstrated better asthma control than students in a comparison school district, the evaluation team used a quasi-experimental, cross-sectional design and administered questionnaires assessing asthma control (which included FEV1 measurement) to 456 students with asthma in the intervention and comparison districts. Data were analyzed for differences in asthma control between students in the two districts. To determine if students in the intervention experienced increased asthma control between baseline and follow-up, the evaluation team used a one-group retrospective design. Program records for 323 students were analyzed for differences in percent of predicted forced expiratory volume in one second (FEV1) between baseline and follow-up.

Results: Students with asthma in the intervention district exhibited significantly better asthma control than students with asthma in the comparison district. Percent of predicted FEV1 did not change significantly between baseline and follow-up for the intervention participants; however, post hoc analyses revealed students with poorly controlled asthma at baseline had significantly higher FEV1 scores at follow-up, and students with well-controlled asthma at baseline had significantly lower FEV1 scores at follow-up.

Conclusions: Findings suggest that the comprehensive school-based program led to improvements in asthma control for students with poorly controlled asthma at baseline, and school-based programs need mechanisms for tracking students with initially well-controlled asthma to ensure they maintain control.
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http://dx.doi.org/10.3109/02770903.2014.913620DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4587486PMC
October 2014

Indicators of asthma control among students in a rural, school-based asthma management program.

J Asthma 2014 Oct 22;51(8):876-85. Epub 2014 May 22.

Division of Adolescent and School Health, Centers for Disease Control and Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention , Atlanta, GA , USA .

Objective: The evaluation sought to determine if a comprehensive, school-based asthma management program in a small, rural school district helped students improve asthma control.

Methods: To determine if students in the asthma program demonstrated better asthma control than students in a comparison school district, the evaluation team used a quasi-experimental, cross-sectional design and administered questionnaires assessing asthma control (which included FEV1 measurement) to 456 students with asthma in the intervention and comparison districts. Data were analyzed for differences in asthma control between students in the two districts. To determine if students in the intervention experienced increased asthma control between baseline and follow-up, the evaluation team used a one-group retrospective design. Program records for 323 students were analyzed for differences in percent of predicted forced expiratory volume in one second (FEV1) between baseline and follow-up.

Results: Students with asthma in the intervention district exhibited significantly better asthma control than students with asthma in the comparison district. Percent of predicted FEV1 did not change significantly between baseline and follow-up for the intervention participants; however, post hoc analyses revealed students with poorly controlled asthma at baseline had significantly higher FEV1 scores at follow-up, and students with well-controlled asthma at baseline had significantly lower FEV1 scores at follow-up.

Conclusions: Findings suggest that the comprehensive school-based program led to improvements in asthma control for students with poorly controlled asthma at baseline, and school-based programs need mechanisms for tracking students with initially well-controlled asthma to ensure they maintain control.
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http://dx.doi.org/10.3109/02770903.2014.913620DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4587486PMC
October 2014

Youth violence and connectedness in adolescence: what are the implications for later sexually transmitted infections?

J Adolesc Health 2014 Mar 19;54(3):312-318.e1. Epub 2013 Nov 19.

National Center for HIV/AIDS, Viral Hepatitis, STD and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia.

Purpose: To examine associations between (1) youth violence victimization and perpetration and later sexually transmitted infections (STI) and (2) parent-family and school connectedness and later STI, and to explore the moderating role of connectedness on the associations between youth violence victimization and perpetration and later STI.

Methods: We used data from Waves I and IV of the National Longitudinal Study of Adolescent Health, which provided a baseline weighted sample of 14,800 respondents. We used logistic regression to examine associations between youth violence and connectedness with self-reported ever STI diagnosis, including gonorrhea, chlamydia, syphilis, genital herpes, genital warts or human papillomavirus, or human immunodeficiency virus. If participants reported having an STI at Wave I they were excluded from the analysis.

Results: Controlling for biological sex, race/ethnicity, age, parent's highest education level, and parent's marital status, both youth violence victimization and perpetration were associated with an increased risk of later STI (adjusted odds ratio [AOR], 1.27, 95% confidence interval [CI], 1.07-1.52; and AOR, 1.21, 95% CI, 1.04-1.41, respectively). Parent-family and school connectedness in adolescence were associated with a decreased risk for later STI (AOR, .96, 95% CI, .95-.98; and AOR, .97, 95% CI, .95-.99, respectively); however, connectedness did not moderate the associations between nonsexual violence involvement and later STI.

Conclusions: These results indicate that youth violence victimization and perpetration may be risk factors for STI later in life. Conversely, parent-family and school connectedness in adolescence appear to protect against subsequent STI. The findings suggest that provider efforts to address youth violence and connectedness in adolescence can promote positive sexual health outcomes in adulthood.
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http://dx.doi.org/10.1016/j.jadohealth.2013.09.008DOI Listing
March 2014

Sexual risk avoidance and sexual risk reduction interventions for middle school youth: a randomized controlled trial.

J Adolesc Health 2012 Mar 7;50(3):279-88. Epub 2011 Oct 7.

Center for Health Promotion and Prevention Research, University of Texas Health Science Center, 7000 Fannin Street, Houston, TX 77030, USA.

Purpose: To evaluate the efficacy of two, theory-based, multimedia, middle school sexual education programs in delaying sexual initiation.

Methods: Three-armed, randomized controlled trial comprising 15 urban middle schools; 1,258 predominantly African American and Hispanic seventh grade students followed into ninth grade. Both programs included group and individualized, computer-based activities addressing psychosocial variables. The risk avoidance (RA) program met federal abstinence education guidelines; the risk reduction (RR) program emphasized abstinence and included computer-based condom skills-training. The primary outcome assessed program impact on delayed sexual initiation; secondary outcomes assessed other sexual behaviors and psychosocial outcomes.

Results: Participants were 59.8% females (mean age: 12.6 years). Relative to controls, the RR program delayed any type of sexual initiation (oral, vaginal, or anal sex) in the overall sample (adjusted odds ratio [AOR]: .65, 95% CI: .54-.77), among females (AOR: .43, 95% CI: .31-.60), and among African Americans (AOR: .38, 95% CI: .18-.79). RR students also reduced unprotected sex at last intercourse (AOR: .67, 95% CI: .47-.96), frequency of anal sex in the past 3 months (AOR: .53, 95% CI: .33-.84), and unprotected vaginal sex (AOR: .59, 95% CI: .36-.95). The RA program delayed any sexual initiation among Hispanics (AOR: .40, 95% CI: .19-.86), reduced unprotected sex at last intercourse (AOR: .70, 95% CI: .52-.93), but increased the number of recent vaginal sex partners (AOR: 1.69, 95% CI: 1.01-2.82). Both programs positively affected psychosocial outcomes.

Conclusions: The RR program positively affected sexually inexperienced and experienced youth, whereas the RA program delayed initiation among Hispanics and had mixed effects among sexually experienced youth.
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http://dx.doi.org/10.1016/j.jadohealth.2011.07.010DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4882098PMC
March 2012

Results of evaluability assessments of local wellness policies in 6 US school districts.

J Sch Health 2011 Aug;81(8):502-11

Centers for Disease Control and Prevention, Division of Adolescent and School Health, Atlanta, GA 30341, USA.

Background: A US federal mandate that school districts devise and implement local wellness policies (LWPs) has potential widespread impact on the nutritional content of foods and beverages available in schools and on the amount of physical activity that students engage in; however, evidence concerning the mandate's effectiveness is limited. This study describes the content of LWPs of 6 US school districts and steps taken toward their implementation and evaluation.

Methods: During visits to 6 school districts, we interviewed 88 school and community representatives about the content of their district's LWPs and how the LWPs were being implemented and evaluated.

Results: The 6 LWPs were consistent with the federal mandate, although they varied in content and degree of specificity, and none had been fully implemented. All 6 districts were pursuing strategies to ensure that foods and beverages available at school met nutrition standards but did not offer nutrition education to all K-12 students. All 6 districts offered students only limited opportunities for physical activity, and all 6 collected data to monitor process and outcomes of their LWPs.

Conclusions: Partial implementation of LWPs in the districts we visited resulted in significant improvement in the nutritional quality of foods available at district schools, but only slight improvement in students' opportunities for school-based physical activity. We provide recommendations for school districts on implementation and evaluation. Future research is needed to determine the impact of these LWPs on students' health.
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http://dx.doi.org/10.1111/j.1746-1561.2011.00620.xDOI Listing
August 2011

What works? Process evaluation of a school-based fruit and vegetable distribution program in Mississippi.

J Sch Health 2011 Apr;81(4):202-11

Department of Research, ETR Associates, 4 Carbonero Way, Scotts Valley, CA 95066, USA.

Background: During the 2004-2005 school year, the Mississippi Department of Education, Office of Child Nutrition, initiated a pilot program to distribute free fruit and vegetable snacks to students during the school day. This article describes the first-year implementation of the Mississippi Fruit and Vegetable Pilot Program.

Methods: The process evaluation addressed where, when, and how produce was distributed; what was distributed; challenges and successes; and recommended modifications. Five of the 25 program schools were selected to participate in the evaluation; selection was based on grade levels served and demographic characteristics. Data were collected from program staff (N = 11) and administrators (N = 6) via interviews and logs; student (N = 42) and parent (N = 19) focus groups; student questionnaires (N = 660); and school staff questionnaires (N = 207).

Results: Distributing fresh fruit and vegetable snacks at school was well received by staff and students. Most schools distributed the fresh fruit and vegetable snacks at morning break in classrooms or a central courtyard. Twenty-two types of fresh fruit, 4 types of dried fruit, and 7 types of vegetables were served to students during the program year. Commonly distributed fruit included apples, oranges, pears, bananas, and tangerines. Carrots were the staple vegetable, followed by celery. Key challenges included getting students to try new foods and receiving the produce in a timely manner without spoiling. Main successes included seeing students try new fruit and vegetable snacks, having the program run smoothly, and teacher support.

Conclusions: The program fit well within the school structure and could be an effective component of a multifaceted approach to enhancing child nutrition.
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http://dx.doi.org/10.1111/j.1746-1561.2010.00580.xDOI Listing
April 2011

The association between school-based physical activity, including physical education, and academic performance: a systematic review of the literature.

Prev Med 2011 Jun 1;52 Suppl 1:S10-20. Epub 2011 Feb 1.

Centers for Disease Control and Prevention, 4770 Buford Highway, NE MS: K-33, Atlanta, GA 30341, USA.

Objective: The purpose of this review is to synthesize the scientific literature that has examined the association between school-based physical activity (including physical education) and academic performance (including indicators of cognitive skills and attitudes, academic behaviors, and academic achievement).

Method: Relevant research was identified through a search of nine electronic databases using both physical activity and academic-related search terms. Forty-three articles (reporting a total of 50 unique studies) met the inclusion criteria and were read, abstracted, and coded for this synthesis. Findings of the 50 studies were then summarized.

Results: Across all the studies, there were a total of 251 associations between physical activity and academic performance, representing measures of academic achievement, academic behavior, and cognitive skills and attitudes. Slightly more than half (50.5%) of all associations examined were positive, 48% were not significant, and 1.5% were negative. Examination of the findings by each physical activity context provides insights regarding specific relationships.

Conclusion: Results suggest physical activity is either positively related to academic performance or that there is not a demonstrated relationship between physical activity and academic performance. Results have important implications for both policy and schools.
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http://dx.doi.org/10.1016/j.ypmed.2011.01.027DOI Listing
June 2011

Follow-up of an elementary school intervention for asthma management: do gains last into middle school?

J Asthma 2010 Jun;47(5):587-93

Albuquerque Health/Mental Health Services, Albuquerque, New Mexico, USA.

Objective: Albuquerque Public Schools (APS), in collaboration with the Centers for Disease Control and Prevention, conducted an evaluation to examine whether students who were exposed to the APS asthma program in elementary school retained benefits into middle school.

Methods: APS middle school students who participated in the APS asthma program in elementary school, including the Open Airways for Schools (OAS) education curriculum, responded to a follow-up questionnaire (N = 121) and participated in student focus groups (N = 40). Asthma management self-efficacy scores from the follow-up questionnaire were compared to scores obtained before and after the OAS education component. Additional items assessed students' asthma symptoms, management skills, avoidance of asthma triggers, and school impact.

Results: Although asthma management self-efficacy scores declined in middle school among students exposed to the asthma program in elementary school, they remained significantly higher than scores obtained during elementary school prior to the OAS intervention.

Conclusion: The results indicate that although students benefited from the asthma program delivered in elementary school, they need booster sessions and continued school support in middle school.
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http://dx.doi.org/10.3109/02770901003713987DOI Listing
June 2010

Distributing free fresh fruit and vegetables at school: results of a pilot outcome evaluation.

Public Health Rep 2009 Sep-Oct;124(5):660-9

ETR Associates, 4 Carbonero Way, Scotts Valley, CA 95066, USA.

Objectives: Consumption of fruit and vegetables among children is generally below recommended levels. This evaluation addressed two questions: (1) To what extent did children's attitudes toward, familiarity with, and preferences for fruit and vegetables change during the school year? and (2) To what extent did children's consumption of fruit and vegetables change during the school year?

Methods: During the 2004-2005 school year, the Mississippi Department of Education, Child Nutrition Programs initiated a pilot program to distribute free fruit and vegetables to students (kindergarten through 12th grade) during the school day. Data were collected in 2004-2005 within a one-group pretest/posttest design using a self-report questionnaire (n=725) and 24-hour dietary recalls (n=207) with a sample of students from five schools in Mississippi. Data were analyzed in 2006-2007.

Results: Results showed greater familiarity with fruit and vegetables at all grade levels (p<0.05) and increased preferences for fruit among eighth- and 10th-grade students (p<0.01). Eighth-grade students also reported more positive attitudes toward eating fruit and vegetables (p<0.01), increased perceived self-efficacy to eat more fruit (p<0.01), and increased willingness to try new fruit. Finally, results showed increased consumption of fruit, but not vegetables, among eighth- and 10th-grade students (p<0.001).

Conclusions: Distributing free fruit and vegetables at school may be a viable component of a more comprehensive approach for improving students' nutrition attitudes and behaviors. More program emphasis is needed on ways to promote vegetable consumption.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2728658PMC
http://dx.doi.org/10.1177/003335490912400508DOI Listing
October 2009