Natural disasters can have a devastating impact on the social and emotional well-being of children and adolescents (Garrett et al., 2007; Kataoka, Rowan, & Hoagwood, 2009; Walsh, 2007). Exposure to disasters puts young people at risk for a number of stressors such as displacement from their homes, loss of friends, family, home and community (Abigail Gewirtz, Forgatch, & Wieling, 2008; La Greca & Silverman, 2010). They are also at a higher risk for future mental health issues related to the event including anxiety and depressive disorders (Jaycox; et al., 2010; Sapienza & Masten, 2011). While there are many interventions that address mental health symptoms, there is a gap in widely accessible prevention programming for mitigation of future mental health issues for young people affected by a disaster (Silverman et al., 2008). To address the gap in services this dissertation sought to examine the efficacy of an intervention, the Journey of Hope (JoH), an eight-session school based model designed to be delivered to the aggregate of children and adolescents affected by disasters. This three article dissertation presents the JoH through: (1) a conceptual description of the intervention; (2) a quasi-experimental waitlist control study and; (3) a qualitative case study. Findings from the quantitative and qualitative studies indicate that after participation in the JoH, participants had an increase in protective factors such as positive coping skills, pro-social behaviors, and affect regulation. The qualitative case study also indicated that children learned about disaster related issues such as grief, anger, and peer victimization. Future research should examine the longitudinal impact of the intervention through larger samples, different geographical and cultural contexts, and with sensitive measurement instruments. / text

BACKGROUND: In America, stroke is the fifth leading cause of death taking more than 130,000 people every year. Early recognition is imperative as survival increases with prompt intervention. Unfortunately, many Americans including children do not know the acute signs and symptoms of stroke, especially those in high-risk communities. Due to the significance surrounding the public health burden of stroke, the purpose of this project is to evaluate a time efficient, mobile device supported stroke education program for fifth graders and their parents who live in a multi-ethnic community. DESIGN: This DNP project implemented a prospective descriptive study. SETTING: The study took place at a local public elementary school in Phoenix, Arizona within a multiethnic community with predominately Hispanic children. DATA COLLECTION: The data was collected in the form of pre and post-tests from the fifth-grade students. Surveys were also given to parents and the teacher. RESULTS: Results from 19 students indicated fifth graders can learn about stroke, recognize the early warning signs, and seek help fast. Data from parental surveys indicated students talked to their parents about what they learned and shared the stroke phone app with them. The study also found a positive teacher perception of incorporating technology-supported stroke lesson into fifth-grade curriculum. CONCLUSION: This study found increasing stroke knowledge among fifth graders using a novel mobile technology supported school-based intervention is possible and, in fact, found students shared the information and stroke application with their parents and families at home. Findings also support the need for continual research on educating today’s youth, targeting high-risk populations, and further fine-tuning this sustainable stroke knowledge program for middle schools across Arizona.

Childhood is a critical time point in determining adult health. Healthy habits that are formed during childhood can not only prevent medical conditions and illnesses in adulthood, but also allow a child to learn, grow, and become a healthy adult. The importance of healthy childhood habits has been discussed in U.S. Health Department of Health and Human Services' Healthy People 2020 initiative and numerous scientific studies regarding the importance of promoting child health and physical activity at an early age to ensure that these habits continue into adulthood. The purpose of this retrospective, qualitative study is to analyze the effectiveness of CYCLE Kids, a school-based bicycling and nutrition curriculum, in promoting physical activity and healthy behaviors in children. The CYCLE Kids program is implemented as eight physical education classes for students in the fourth and fifth grade. It was evaluated using self-reported pre- and post- curriculum assessments to determine if students showed measurable behavioral changes or knowledge gains. The assessments also contained open-ended questions to further understand the students' point of view on what they were learning and what they enjoyed most. For the evaluation, the assessment questions were divided into bicycle skills and safety, bicycling frequency and physical activity, and nutrition and physical fitness. The study sample included 1,575 children ages 8-12 years (mean 10.2 years) from public schools in Cambridge and Somerville, Massachusetts. The demographics of the students were 30% Caucasian, 16% Latino, 19% African American, 10% Asian, and 2% American Indian or Alaskan Native. Teachers and police officers involved in the implementation of the CYCLE Kids program were also surveyed to ascertain perceptions of the strengths and weaknesses of the curriculum, and to discern the perceived benefits of participating in the program. A total of 15 teachers responded to the survey (60%) from partner schools in eight states across the United States where the CYCLE Kids curriculum is being taught. Results from the student assessments indicate that students showed the most knowledge gain in bicycle and safety skills, with a 39% increase in the proportion of students who reported knowing how to use hand signals when riding a bicycle by program completion. This trend remained prominent in students' post-assessment open-ended responses where bicycle skills and safety made up more than three-quarters (78%) of the responses to the two most important things learned in the program. Bicycling frequency and physical activity showed moderate increases; an increase by 4% (from 76% at baseline to 80% after the unit) in the proportion of students who own a bicycle at home, an increase by 7% (from 39% to 46%) in the proportion of student who rode their bikes weekly, and an increase by 10% increase (from 68% to 78%) in the proportion of students who were exercising and playing sports more often. In the nutrition and physical fitness category, children showed only minor improvement with the greatest gains in this category for knowing how to take their heart rate and wanting to learn more about healthy eating. Teachers perceived that the CYCLE Kids program increased a student's self-confidence, helped students overcome fears, and got students excited about riding a bicycle. Additionally, all but one teacher who participated in the survey reported perceived behavioral changes in their students. Teachers also noted several implementation obstacles to the curriculum delivery including not having enough classroom time to fully teach the lessons, the difficulty of doing textbook lessons in the gymnasium, and the logistics of moving the bicycles from storage to riding areas. Overall, the student and teacher feedback indicated that the CYCLE Kids program increases bicycle knowledge and safety skills in addition to increasing self-confidence of participants. Teaching children to safely and properly ride a bike develops a life skill that they can carry far into the future. However, it is unclear if participation in the CYCLE Kids program prompts students to be more physically active. A long-term study analyzing students' behaviors and physical activity levels several years after program participating in the program is warranted. Ongoing work will revise several of the CYCLE Kids curriculum components and address implementation logistics uncovered by this evaluation.

Childhood anxiety disorders are highly prevalent, cause significant distress and functional impairment, are risk factors for depression, suicidal ideation and attempts, substance abuse and smoking, yet often go unrecognized and untreated. As a result, effective prevention and early intervention have become policy and research priorities. This study evaluated the effectiveness of a universal school-based cognitive behavioural intervention in decreasing anxiety symptoms experienced by early adolescents during the transition from elementary to middle or secondary school. The role of gender, coping style, geographic location, and timing of the intervention were also assessed. Participants were 722 grade 7 and 8 students (11 – 14 years) from 41 classrooms in 20 randomly selected public schools in British Columbia. Schools were randomly assigned to either the FRIENDS for Youth program provided within regular classrooms, one hour weekly for 10 weeks or to a waitlist control group. Self-reported anxiety, depression and coping, and parent and teacher assessed difficulties were assessed at pre-, post, and six month follow-up. Results were examined universally and for children who scored above the clinical cut-off for anxiety at pre-test. Results indicate students, including those “at risk”, who participated in the FRIENDS for Youth program had lower anxiety than those in the control group at 6-month follow-up. Gender differences in self-reported anxiety as well as in response to the intervention were found, with girls, including those “at risk” reporting higher anxiety scores than boys, and intervention group girls reporting significantly lower anxiety scores at post-intervention and at 6-month follow-up compared to the control group. Teachers assessed girls as having lower difficulties scores than boys, and intervention group girls reporting significantly lower difficulties scores at post-intervention than the control group. Grade 7 elementary students had significantly lower anxiety scores than middle school students and grade 7 students in the intervention group had significantly lower anxiety scores at post-intervention than the control group. Overall, intervention effects on anxiety were small. For “at risk” participants and for girls, however, the intervention was effective. Results demonstrated a prevention effect with significantly fewer “at risk” students at 6-month follow-up in the intervention group than the control group.

Childhood anxiety disorders are highly prevalent, cause significant distress and functional impairment, are risk factors for depression, suicidal ideation and attempts, substance abuse and smoking, yet often go unrecognized and untreated. As a result, effective prevention and early intervention have become policy and research priorities. This study evaluated the effectiveness of a universal school-based cognitive behavioural intervention in decreasing anxiety symptoms experienced by early adolescents during the transition from elementary to middle or secondary school. The role of gender, coping style, geographic location, and timing of the intervention were also assessed. Participants were 722 grade 7 and 8 students (11 – 14 years) from 41 classrooms in 20 randomly selected public schools in British Columbia. Schools were randomly assigned to either the FRIENDS for Youth program provided within regular classrooms, one hour weekly for 10 weeks or to a waitlist control group. Self-reported anxiety, depression and coping, and parent and teacher assessed difficulties were assessed at pre-, post, and six month follow-up. Results were examined universally and for children who scored above the clinical cut-off for anxiety at pre-test. Results indicate students, including those “at risk”, who participated in the FRIENDS for Youth program had lower anxiety than those in the control group at 6-month follow-up. Gender differences in self-reported anxiety as well as in response to the intervention were found, with girls, including those “at risk” reporting higher anxiety scores than boys, and intervention group girls reporting significantly lower anxiety scores at post-intervention and at 6-month follow-up compared to the control group. Teachers assessed girls as having lower difficulties scores than boys, and intervention group girls reporting significantly lower difficulties scores at post-intervention than the control group. Grade 7 elementary students had significantly lower anxiety scores than middle school students and grade 7 students in the intervention group had significantly lower anxiety scores at post-intervention than the control group. Overall, intervention effects on anxiety were small. For “at risk” participants and for girls, however, the intervention was effective. Results demonstrated a prevention effect with significantly fewer “at risk” students at 6-month follow-up in the intervention group than the control group.

Childhood anxiety disorders are highly prevalent, cause significant distress and functional impairment, are risk factors for depression, suicidal ideation and attempts, substance abuse and smoking, yet often go unrecognized and untreated. As a result, effective prevention and early intervention have become policy and research priorities. This study evaluated the effectiveness of a universal school-based cognitive behavioural intervention in decreasing anxiety symptoms experienced by early adolescents during the transition from elementary to middle or secondary school. The role of gender, coping style, geographic location, and timing of the intervention were also assessed. Participants were 722 grade 7 and 8 students (11 – 14 years) from 41 classrooms in 20 randomly selected public schools in British Columbia. Schools were randomly assigned to either the FRIENDS for Youth program provided within regular classrooms, one hour weekly for 10 weeks or to a waitlist control group. Self-reported anxiety, depression and coping, and parent and teacher assessed difficulties were assessed at pre-, post, and six month follow-up. Results were examined universally and for children who scored above the clinical cut-off for anxiety at pre-test. Results indicate students, including those “at risk”, who participated in the FRIENDS for Youth program had lower anxiety than those in the control group at 6-month follow-up. Gender differences in self-reported anxiety as well as in response to the intervention were found, with girls, including those “at risk” reporting higher anxiety scores than boys, and intervention group girls reporting significantly lower anxiety scores at post-intervention and at 6-month follow-up compared to the control group. Teachers assessed girls as having lower difficulties scores than boys, and intervention group girls reporting significantly lower difficulties scores at post-intervention than the control group. Grade 7 elementary students had significantly lower anxiety scores than middle school students and grade 7 students in the intervention group had significantly lower anxiety scores at post-intervention than the control group. Overall, intervention effects on anxiety were small. For “at risk” participants and for girls, however, the intervention was effective. Results demonstrated a prevention effect with significantly fewer “at risk” students at 6-month follow-up in the intervention group than the control group. / Graduate and Postdoctoral Studies / Graduate

Childhood obesity has become epidemic in the United States. One of the best places to combat this problem is within the school system. The purpose of this study was to examine changes in exercise self-efficacy, science interest, and science knowledge of children who participated in a school-based anatomy and healthy lifestyle intervention called Anatomy Academy. In this pilot study, 212 study participants were recruited from 5th and 6th grade children enrolled in one of three charter schools who participated in our 7-week intervention, Anatomy Academy. Children completed four questionnaires pre and post intervention: (1) a science knowledge questionnaire, (2) a science interest questionnaire, (3) an exercise self-efficacy questionnaire, and (4) a demographic questionnaire. A statistically significant difference was found in participants’ pre and post test scores on the science knowledge questionnaire. Anatomy Academy was well received by children, parents, and faculty and provides helpful curriculum for science and physical education classes.

This study addressed obesity of youth in a predominantly African-American school and was concerned with the implementation of a CVD intervention program, Project Health Curriculum, for high school students, focusing on early health promotion and support to children at risk of developing adult diseases. A health promotion program was implemented at a high school in Canton, Mississippi, to equip students with information to help reduce risk behaviors that could lead to health problems. This intervention was conducted in the health and physical education classes. Students were given the opportunity to report their knowledge and behaviors by participating in a pretest. A posttest was completed after the health promotion intervention. A Wilcoxon Signed Ranked test was computed to analyze the differences between the pretest and posttest scores of the students on the Project Health Student Survey (PHSS) to determine if the intervention program impacted their attitudes, practices, and knowledge regarding their risk behaviors and practices. The posttest served as the student outcome measure and indicator of the effectiveness and perceived usefulness in modifying student risk behaviors when compared to the pretest scores. Changes in student behaviors were found in several of the categories examined. The results of the study indicated that a carefully designed prevention/intervention program within the school curriculum can positively impact student behavioral practices to improve students’ quality of life. As the State of Mississippi deals with the epidemic of obesity and the prevalence of CVD, preventing these diseases from increasing is a priority. Strategies and programs for weight maintenance, weight reduction, and health promotion must become a public health and education priority, especially among the youth.

The purpose of this study was to examine a sample of students who participated in a student assistance program in Southwest Virginia. Using existing data from a school system in Southwest Virginia, this sample was observed to measure changes in student academic performance. The sample was also examined to determine the extent to which they instituted positive behaviors such as school attendance and reduction of disciplinary actions taken. In addition, this study assessed differences in demographic characteristics among student participants. Also studied was the extent to which gender differences related to academic performance and behavior. Significant changes in students’ academic performance, attendance and disciplinary measures were established in the present study. Negative associations were established for those participating in the student assistance program and grade point average. Positive associations were found for those participating in SAP and attendance and disciplinary measures. No significant differences were yielded in the comparison of gender to academic performance and behavior. SAP coordinators recorded that the majority of participants did improve since referral to program and most completed or currently remained in the student assistance program. However, a small percentage of students actually entered treatment programs following recommendations made to parents from the student assistance program committee. This research assessed only the demographic and individual characteristics: gender, gifted or special education status, ethnicity and age. Therefore, other demographics such as socio economic status may offer additional explanation into academic and behavior outcomes of students involved in student assistance programs. / Ph. D.

Les manifestations de stress semblent de plus en plus présentes chez nos jeunes. C’est pourquoi des interventions pouvant amener une réduction de stress sont pertinentes à intégrer dans nos écoles. Parallèlement, toujours avec le souci d’aider les jeunes dans leur réussite éducative, des interventions favorisant l’apprentissage et les performances académiques sont tout aussi importantes à intégrer dans nos réseaux éducatifs. L’activité physique et la méditation de pleine conscience semblent être des activités prometteuses à ces égards. L’objectif de cette recherche est de déterminer auprès de jeunes l’effet immédiat sur les performances cognitives et le stress perçu des interventions suivantes : 1- Quinze minutes d’activité physique; 2- Quinze minutes de méditation de pleine conscience; 3- Quinze minutes d’activité physique et de méditation de pleine conscience; 4- Quinze minutes d’écoute passive d’un documentaire. Pour ce faire, 82 participants ont été recrutés dans une école primaire de la région de Sherbrooke. Chaque participant a effectué chacune de ces conditions à une seule reprise. Pour mesurer les performances cognitives, les tests de Stroop et du Tracé ont été utilisés alors que le stress perçu a été mesuré à l’aide d’une échelle visuelle analogique. Une amélioration significative des performances cognitives a été remarquée pour les jeunes ayant performé sous la médiane lors de la condition témoin. De plus, toutes les interventions, y compris l’intervention témoin, ont engendré une réduction significative du stress perçu et aucune différence significative entre les interventions n’a été observée. Ces résultats soutiennent l’utilisation des interventions d’activité physique et de méditation de pleine conscience dans les écoles primaires. De plus, cette recherche répond à plusieurs critiques effectuées dans la littérature scientifique. En effet, les interventions comprenant de la pleine conscience ont été dans le cadre de cette étude standardisées et elles sont complètement reproductibles. Les participants ont aussi indiqué leur niveau d’appréciation ainsi que la fréquence à laquelle ils désireraient pratiquer de la méditation de pleine conscience. Finalement, ce projet de recherche innove en mesurant des effets immédiats chez les jeunes de l’intervention de méditation de pleine conscience en plus de combiner la pratique d’activité physique et celle de la méditation de pleine conscience.