Asthma Symptoms Impair Sleep Quality and School Performance in Children

The negative effects of poorly controlled asthma symptoms on sleep quality and academic performance in urban schoolchildren has been confirmed in a new study.

“While it has been recognized that missed sleep and school absences are important indicators of asthma morbidity in children, our study is the first to explore the associations between asthma, sleep quality, and academic performance in real time, prospectively, using both objective and subjective measures,” said principal investigator Daphne Koinis-Mitchell, PhD, Associate Professor of Psychiatry & Human Behavior (Research) and Associate Professor of Pediatrics (Research) at Brown University’s Alpert Medical School in Providence, Rhode Island. “In our sample of urban schoolchildren (aged 7 to 9), we found that compromised lung function corresponded with both poor sleep efficiency and impaired academic performance.”

The results of the study will be presented at the American Thoracic Society’s 2013 International Conference.

The study included data on 170 parent-child dyads from urban and African-American, Latino, and non-Latino white backgrounds who reside in Greater Providence, RI. These data are part of a larger 5-year study of asthma and allergic rhinitis symptoms, sleep quality and academic performance (which will include 450 urban children with persistent asthma and healthy controls) funded by The Eunice Kennedy Shriver National Institute of Child Health and Human Development. Project NAPS (Nocturnal Asthma and Performance in School) is administered through Rhode Island Hospital at The Bradley Hasbro Research Center.
Asthma symptoms were assessed over three 30-day monitoring periods across the school year by spirometry, which measures the amount and speed of exhaled air, and with diaries maintained by children and their caregivers. Sleep quality was assessed with actigraphy, which measures motor activity that can be used to estimate sleep parameters. Asthma control was assessed with the Asthma Control Test (ACT), a brief questionnaire used to measure asthma control in children. Academic functioning was assessed by teacher report during the same monitoring periods.

Compared with children with well-controlled asthma, those with poorly controlled asthma had lower quality school work and were more careless with their school work, according to teacher reports. Higher self-reported and objectively measured asthma symptom levels were associated with lower quality school work. Poorer sleep quality was also associated with careless school work. Increased sleep onset latency (the amount of time children take to fall asleep) was associated with more difficulty in remaining awake in class.

“Our findings demonstrate the detrimental effects that poorly controlled asthma may have on two crucial behaviors that can enhance overall health and development for elementary school children; sleep and school performance,” said Dr. Koinis-Mitchell. “Urban and ethnic minority children are at an increased risk for high levels of asthma morbidity and frequent health care utilization due to asthma. Given the high level of asthma burden in these groups, and the effects that urban poverty can have on the home environments and the neighborhoods of urban families, it is important to identify modifiable targets for intervention.”

“Family-level interventions aimed at asthma control and improving sleep quality may help to improve academic performance in this vulnerable population,” Dr. Konis-Mitchell continued. “In addition, school-level interventions can involve identifying children with asthma who miss school often, appear sleepy and inattentive during class, or who have difficulty with school work. Working collaboratively with the school system as well as the child and family may ultimately enhance the child’s asthma control.”

Teens exposed to schoolmate's death by suicide much more likely to consider or attempt suicide

Study supports idea of 'suicide contagion,' especially in 12 and 13 year olds

Youth who had a schoolmate die by suicide are significantly more likely to consider or attempt suicide, according to a study in published in CMAJ (Canadian Medical Association Journal). This effect can last 2 years or more, which has implications for strategies following schoolmate suicides.

"We found that exposure to suicide predicts suicidality," writes senior author Dr. Ian Colman, Canada Research Chair in Mental Health Epidemiology and Assistant Professor, University of Ottawa, with lead author Sonja Swanson, from Harvard School of Public Health, Boston. "This was true for all age groups, although exposure to suicide increased the risk most dramatically in the youngest age group, when baseline suicidality was relatively low."

The concept that exposure to suicide can create suicidal thoughts or actions is called "suicide contagion."

Researchers looked at data from Statistics Canada's National Longitudinal Survey of Children and Youth on 22 064 children aged 12–17 years from across the country. They found that the suicide of a schoolmate magnifies the risk of suicidality for a young person, regardless of whether the young person personally knew the deceased. This risk was particularly strong among 12 to 13 year olds, who were 5 times more likely to have suicidal thoughts (suicide ideation) after exposure to a schoolmate's suicide than those who had had no exposure (15% v. 3%). In this age group, 7.5% attempted suicide after a schoolmate's suicide compared with 1.7% without exposure.

"Suicidality is of utmost public health concern, both as a predictor of suicide and because of its own burden on individuals and society," write the authors.

The apparent "suicide contagion" effect was less pronounced in older children, although 14 to 15 year olds exposed to suicide were still almost 3 times more likely to have suicidal thoughts, and 16 to 17 year olds were twice as likely.

"Perhaps any exposure to a peer's suicide is relevant, regardless of the proximity to the decedent," they write. "It may be best for postvention strategies to include all students rather than target close friends."

By ages 16-17 years, 24% of teens — 1 in 4 — had a schoolmate die by suicide, and 20% personally knew someone who died by suicide.

"Given that such exposure is not rare, and appears to be strongly related to suicidality outcomes, further understanding of this association has the potential to help in the prevention of a substantial proportion of adolescent suicidal behaviours," write the authors.

They conclude that broader, longer-lasting strategies are required. "Our findings support school- or community-wide interventions over strategies targeting those who personally knew the decedent, suggests that allocating resources following an event may be especially important during earlier adolescence, and implies that schools and communities should be aware of an increased risk for at least 2 years following a suicide event," the authors conclude.

In a related commentary, Dr. India Bohanna, School of Public Health, James Cook University, Cairns, Queensland, Australia, states that this study "provides convincing evidence that, among young people, exposure to suicide is a risk factor for future suicidal behaviour. This is extremely important because it tells us that everyone who is exposed to suicide should be considered when postvention strategies are developed."

Dr. Bohanna reiterates that strategies to limit the risk of suicide contagion are critical.

"The idea that suicide is contagious has always been controversial for various reasons; however, this important study should put many, if not all, doubts to rest. A unified and concerted effort now needs to be directed toward developing evidence-based postvention strategies. We need to know what works in mitigating the risk of contagion and why."

Beginning Teachers in California Face a Bumpy Path to a Teaching Career

A new study conducted by SRI International, J. Koppich & Associates, and Inverness Research finds that the majority of beginning teachers in California face a bumpy path to a teaching career. The study found that state policies designed to promote and enhance the effectiveness of beginning teachers fail to match employment realities. Most significantly, beginning teachers often do not get the support they critically need to be effective in the classroom.

State policies assume that teachers complete teacher preparation and earn a preliminary credential, take a probationary teaching job, complete a two-year induction program, are evaluated annually, and earn a clear credential and tenure. Unfortunately, most beginning teachers are not allowed to follow this career path.

Instead, most beginning teachers are only offered jobs as temporary teachers, long-term substitutes, or some other non-probationary status teaching position. This may postpone their participation in the state's induction program until it is no longer relevant and delays their path to tenure. Often, teachers who are not on the tenure track are not evaluated, even though they may continue teaching year after year.

The study found teachers classified as temporary throughout the state. While it is hard to determine precise numbers given the state's incomplete records, data reveal that nearly one-quarter of first- to third-year teachers in California work for some part of their careers as temporary teachers or long-term substitutes. As a result, more than half of teachers entering their third year have not earned tenure.

"We were surprised to discover the temporary teacher phenomenon is neither new nor limited to a geographic area or type of school district," said Daniel Humphrey, Ed.D., director of SRI's Center for Education Policy. "We found that temporary teachers may be rehired in the same district year after year, but often are neither supported nor evaluated."

State policies designed for beginning teachers often do not serve them well regardless of their employment status. Beginning teachers' stories are punctuated by district fiscal uncertainty, repeated layoffs, and the most challenging assignments, often in multiple subjects and more than one school.

Julia Koppich, Ph.D., the co-lead author of the report concluded, "Our study results make clear that California beginning teachers' career trajectory is anything but smooth. Many new teachers are required to take a tortured route that often twists or skirts the intent of state policy."

One in ten teens using “study drugs,” but parents aren't paying attention

As high schoolers prepare for final exams, teens nationwide may be tempted to use a “study drug” – a prescription stimulant or amphetamine – to gain an academic edge. But a new University of Michigan poll shows only one in 100 parents of teens 13-17 years old believes that their teen has used a study drug.

Study drugs refer to stimulant medications typically prescribed for the treatment of attention deficit hyperactivity disorder (ADHD); commonly prescribed medicines in this category include Adderall, Concerta, Ritalin, and Vyvanse.

Among parents of teens who have not been prescribed a stimulant medication for ADHD, just 1% said they believe their teen has used a study drug to help study or improve grades, according to the latest University of Michigan Mott Children’s Hospital National Poll on Children’s Health. However, recent national data from Monitoring the Future indicate that 10% of high school sophomores and 12% of high school seniors say they’ve used an amphetamine or stimulant medication not prescribed by their doctor.

Sometimes students without ADHD take someone else’s medication, to try to stay awake and alert and try to improve their scores on exams or assignments. Taking study drugs has not been proven to improve students’ grades, and it can be very dangerous to their health, says Matthew M. Davis, M.D., M.A.P.P., director of the C.S. Mott Children’s Hospital National Poll on Children’s Health.

“Taking these medications when they are not prescribed for you can lead to acute exhaustion, abnormal heart rhythms and even confusion and psychosis if the teens get addicted and go into withdrawal,” says Davis.

“What we found in this poll is a clear mismatch between what parents believe and what their kids are reporting. But even though parents may not be recognizing these behaviors in their own kids, this poll also showed that one-half of the parents say they are very concerned about this abuse in their communities,” Davis says.

White parents were most likely to say they are “very concerned” (54%), compared with black (38%) and Hispanic/Latino (37%) parents.

Despite this concern, only 27 percent of parents polled said they have talked to their teens about using study drugs. Black parents were more likely to have discussed this issue with their teens (41%), compared with white (27%) or Hispanic (17%) parents.

“If we are going to make a dent in this problem, and truly reduce the abuse of these drugs, we need parents, educators, health care professionals and all who interact with teens to be more proactive about discussing the issue,” says Davis.

Over three-quarters of parents polled said they support school policies aimed at stopping abuse of study drugs in middle schools and high schools. Overall, 76% of parents said they believe schools should be required to discuss the dangers of ADHD medication abuse.

Another 79% support a policy to require students with a prescription for ADHD medications to keep their pills in a secure location such as the school nurse’s office—a requirement that would prohibit students from carrying medicines of this nature that could potentially be shared with, or sold to, other students.

“We know teens may be sharing drugs or spreading the word that these medications can give their grades a boost. But the bottom line is that these prescription medications are drugs, and teens who use them without a prescription are taking a serious risk with their health,” Davis says.

Gym class reduces probability of obesity

Little is known about the effect of physical education (PE) on child weight, but a new study from Cornell University finds that increasing the amount of time that elementary schoolchildren spent in gym class reduces the probability of obesity.

The study represents some of the first evidence of a causal effect of PE on youth obesity, and is forthcoming in the Journal of Health Economics.

An early, online version of the study can be viewed at: http://www.sciencedirect.com/science/article/pii/S0167629613000556

The research offers support for the recommendations of organizations such as the Centers for Disease Control, Institute of Medicine, and the American Academy of Pediatrics, all of which have advocated increasing the amount of time that elementary school children spend in gym class, says lead researcher and Cornell professor of policy analysis and management, John Cawley, who conducted the study with Chad Meyerhoefer of Lehigh University (Cornell Ph.D. 2002) and David Frisvold of Emory University.

Treating variation in the amount of time that states mandate schoolchildren spend in PE as natural experiments, the researchers found that an additional 60 minutes per week of PE time (enough to bring states without an explicit requirement up to the amount of PE recommended by the CDC) reduces the probability that a fifth-grader is obese by 4.8 percentage points.

The researchers also detected a gender difference: additional PE time reduces weight for boys but has a negligible effect for girls. One explanation for this difference, says Cawley, is that PE and other types of physical activity are complements for boys (increased PE leads boys to be more active in structured physical activities like organized sports), but substitutes for girls (increased PE leads girls to spend more time watching television).

States' Test Security Policies and Procedures: GAO Report

According to a GAO nationwide survey of state testing directors, all states reported that their policies and procedures included 50 percent or more of the leading practices to prevent test irregularities in the following five areas—security plans, security training, security breaches, test administration and protecting secure materials. Additionally, of the 28 states that administered computer-based assessments, the majority reported including half or more of the leading practices in computer-based testing. However, states varied in the extent to which they incorporated elements of certain categories of leading practices.

For example, 22 states reported having all of the leading practices for security training, but four states reported having none of the practices in this category. Although state officials reported having a variety of security policies and procedures in place, many reported feeling vulnerable to cheating at some point during the testing process.

States reported using various tools, such as statistical analyses of student data, monitoring, and audits of testing procedures, to oversee districts’ implementation of test security policies and procedures, and most states have used this oversight to identify cheating in recent years.

For example, officials in 40 states reported allegations of cheating in the past two school years, and officials in 33 states confirmed at least one instance of cheating. Further, 32 states reported that they canceled, invalidated, or nullified test scores as a result of cheating.

States reported receiving assistance with test security from several sources, with testing contractors being the most frequent source of support. States also identified areas where additional assistance with test security would be useful. In particular, officials from the majority of states reported that it would be very or extremely useful if the Department of Education gathered and disseminated information on best practices in test security.

Home Computers Don't Affect Academic Achievement

Computers are an important part of modern education, yet many
schoolchildren lack access to a computer at home. This study, Experimental
Evidence on the Effects of Home Computers on
Academic Achievement among Schoolchildren tested
whether this lack of access impedes educational achievement.

The approach used was to provides free home computers to randomly
chosen students.

Although computer ownership and use increased
substantially, the authors found no effects on any educational outcomes,
including grades, test scores, credits earned, attendance and
disciplinary actions.

The estimated null effect is consistent with survey evidence showing
no change in homework time or other "intermediate" inputs in education.