Turning Vicious Cycles Into Virtuous Ones: the Potential for Schools to Improve the Life Course

Wong, Mitchell D.; Quartz, Karen Hunter; Saunders, Marisa; Meza, Ben P.L.; Childress, Saltanat; Seeman, Teresa E.; Dudovitz, Rebecca

doi:10.1542/peds.2021-053509m

Cited by 9 publications

(3 citation statements)

References 80 publications

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“…Adolescent health behaviors and mental health are closely tied to educational outcomes and peer network formation in a reinforcing feedback loop. Wong et al pointed out how this can lead to school disengagement and dropout, but also how supportive school climates can promote prosocial behaviors that are fundamentally important for health both in adolescence and later in life.…”

Section: Shifting Our Mental Modelsmentioning

confidence: 99%

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Vicious and Virtuous Cycles in Health

Chokshi

2023

JAMA Health Forum

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Section: Shifting Our Mental Modelsmentioning

confidence: 99%

“…Wong et al 7 pointed out how this can lead to school disengagement and dropout, but also how supportive school climates can promote prosocial behaviors that are fundamentally important for health both in adolescence and later in life.…”

Section: Shifting Our Mental Modelsmentioning

confidence: 99%

Vicious and Virtuous Cycles in Health

Chokshi

2023

JAMA Health Forum

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“…Traditional school-based substance use prevention strategies rarely target a school's social and academic environment, despite recognition that school environments are consistently related to substance use. 32,[46][47][48] The appeal of targeting the larger school environment for substance use prevention is twofold. First, this approach may be more successful and can simultaneously influence multiple education and health outcomes.…”

Section: Figurementioning

confidence: 99%

Outcome of the AVID College Preparatory Program on Adolescent Health: A Randomized Trial

Dudovitz¹,

Dosanjh

Phillips³

et al. 2022

Pediatrics

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BACKGROUND AND OBJECTIVES: Academic tracking is a widespread practice, separating students by prior academic performance. Clustering lower performing students together may unintentionally reinforce risky peer social networks, school disengagement, and risky behaviors. If so, mixing lower performing with high performing youth (“untracking”) may be protective, leading to better adolescent health. METHODS: Advancement via Individual Determination (AVID), a nationally-disseminated college preparatory program, supports placing middle-performing students in rigorous college-preparatory classes alongside high-performing peers. We conducted the first randomized, controlled trial of AVID in the United States, randomizing 270 students within 5 large public high schools to receive AVID (AVID group) versus usual school programming (control group). Participants completed surveys at the transition to high school (end of eighth grade/ beginning of ninth grade) and the end of ninth grade. Intent-to-treat analyses tested whether AVID resulted in healthier social networks (primary outcome), health behaviors, and psychosocial wellbeing. RESULTS: At follow-up, AVID students had lower odds of using any substance (odds ratio [OR] 0.66, 95% confidence interval [CI] 0.48–0.89) and associating with a substance-using peer (OR 0.74, 95% CI 0.45–0.98), and higher odds of associating with a peer engaged in school (OR 1.73, 95% CI 1.11–2.70). Male AVID students had lower stress and higher self-efficacy, grit, and school engagement than control students (P < .05 for all). No adverse health effects among high-performing peers were observed. CONCLUSIONS: AVID positively impacts social networks, health behaviors, and psychosocial outcomes suggesting academic untracking may have substantial beneficial spillover effects on adolescent health.

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A Nature-Based Intervention and Mental Health of Schoolchildren

Loose,

Fuoco,

Malboeuf-Hurtubise

et al. 2024

JAMA Netw Open

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ImportanceNature-based therapeutic or preventive interventions for mental health are increasingly popular, but their effectiveness for improving mental health is not well documented.ObjectiveTo investigate the effectiveness of the Open Sky School Program (École à Ciel Ouvert), a 12-week nature-based intervention for elementary schoolchildren in grades 5 and 6, for reducing mental health symptoms.Design, Setting, and ParticipantsThis 2-arm, cluster randomized clinical trial was conducted from February 27 to June 16, 2023, in French-language elementary schools in Quebec, Canada, with green space within 1 km. Participants were teachers and students in grades 5 and 6.InterventionIn the intervention group, for 2 hours per week for 12 weeks, classes were taught outdoors in a nearby park or wooded area. Teachers were encouraged to engage students in basic subjects and in 10 or more mental health activities (mindfulness, philosophy, and/or art therapy). Control group schools conducted classes as usual.Main Outcomes and MeasuresThe primary outcome was change in student mental health (internalizing and externalizing symptoms, social problems) based on teacher- and student-reported 30-item Social Behavior Questionnaire (SBQ) scores (3-point scale) from baseline to the immediate postintervention follow-up, assessed in per-protocol and intent-to-treat mixed-model analyses. Secondary outcomes were student self-reported changes in depressive symptoms, positive or negative affect, pro-environmental efforts and/or attitudes, and nature connectedness.ResultsA total of 33 schools participated (53 teachers, 1015 students), including 16 schools (25 teachers, 515 students) in the intervention group and 17 schools (28 teachers, 500 students) in the control group. Student mean (SD) age was 10.9 (0.75) years; 507 (50.7%) were girls. Per-protocol and intent-to-treat mixed-model analyses showed no differences in mental health symptom change between groups; for example, the adjusted mean difference in SBQ scores between the intervention and control groups for externalizing symptoms was −0.04 (95% CI, −0.13 to 0.04) in the intent-to-treat analysis and −0.06 (95% CI, −0.16 to 0.04) in the per-protocol analysis. Post hoc analyses revealed low mental health symptoms at baseline, with low variability. Slightly greater reductions in symptoms were observed in the intervention group, but only for children with higher mental health symptoms at baseline (P &lt; .05 for interaction). For example, for children with internalizing symptoms 1 SD above the mean at baseline, internalizing symptoms decreased by 0.38 SD (mean change, −0.15; P &lt; .001) in the intervention group vs the control group.Conclusions and RelevanceIn this large cluster randomized clinical trial in daily-life elementary school settings, 12 weeks of classes in green space for 2 hours per week did not reduce mental health symptoms in students aged 10 to 12 years in either the per-protocol or the intent-to-treat analysis. However, this low-cost, safe outdoor intervention may provide unmeasured or longer-term benefits for children with higher risk of mental health symptoms.Trial RegistrationClinicalTrials.gov Identifier: NCT05662436

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Turning Vicious Cycles Into Virtuous Ones: the Potential for Schools to Improve the Life Course

Cited by 9 publications

References 80 publications

Vicious and Virtuous Cycles in Health

Vicious and Virtuous Cycles in Health

Outcome of the AVID College Preparatory Program on Adolescent Health: A Randomized Trial

A Nature-Based Intervention and Mental Health of Schoolchildren

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