Last data update: Dec 02, 2024. (Total: 48272 publications since 2009)
Records 1-30 (of 49 Records) |
Query Trace: Barrios LC[original query] |
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School-level data on COVID-19 cases, quarantines, and student absenteeism during the COVID-19 pandemic: Understanding missingness
Pampati S , Timpe Z , Rasberry C , Waller LA , Lopman B , Stuart EA , Guest JL , Barrios LC , Jones J . Am J Epidemiol 2024 This study aims to understand availability of school-based infectious disease surveillance data (e.g., COVID-19 cases, student absences) based on experiences during the COVID-19 pandemic using a national sample of public K-12 schools (n = 1,602). Based on surveys administered to school administrators throughout the 2021-2022 school year, we found high levels of missingness data for school-level COVID-19 cases, quarantines, and student absenteeism, increasing missingness over time, and variations in missingness by school characteristics (e.g., school size) and protocols (e.g., having a school-based system to report at-home COVID-19 tests). For the same sample of schools, using data requests to health departments, we found similarly high levels of missingness of school-level COVID-19 case data and varying approaches in data collection. Developing nationally standardized case definitions-and systems to surveil or collect and monitor school-based infectious disease outcomes early in a public health emergency-may be helpful in producing actionable data. |
A longitudinal analysis of COVID-19 prevention strategies implemented among US K-12 public schools during the 2021-2022 school year
Conklin S , McConnell L , Murray C , Pampati S , Rasberry CN , Stephens R , Rose I , Barrios LC , Cramer NK , Lee S . Ann Epidemiol 2024 PURPOSE: Examine how school-based COVID-19 prevention strategy implementation varied over time, including by local characteristics. METHODS: School administrators (n=335) from a nationally representative sample of K-12 public schools completed four surveys assessing COVID-19 prevention strategies at two-month intervals between October 2021 and June 2022. We calculated weighted prevalence estimates by survey wave. Generalized estimating equations (GEE) were used to model longitudinal changes in strategy implementation, accounting for school and county covariates. RESULTS: Opening doors/windows, daily cleaning, and diagnostic testing were reported by ≥50% of schools at each survey wave. Several strategies were consistently implemented across the 2021-2022 school year (i.e., daily cleaning, opening doors and windows, diagnostic testing) while other strategies increased initially and then declined (i.e., contact tracing, screening testing, on-campus vaccination) or declined consistently throughout the school year (i.e., mask requirement, classroom distancing, quarantine). Although longitudinal changes in strategy implementation did not vary by school characteristics, strategy implementation varied by urban-rural classification and school level throughout the school year. CONCLUSIONS: Strategies that were consistently implemented throughout the school year were also reported by a majority of schools, speaking toward their feasibility for school-based infection control and prevention and potential utility in future public health emergencies. |
Predictors of willingness to participate in COVID-19 screening testing from a pilot school survey in the United States
Mark-Carew M , Swanson M , Eller B , Cullen T , Valenzuela MO , LaBelle M , Persad N , Barrios LC , Szucs LE . J Sch Health 2023 93 (12) 1061-1069 BACKGROUND: COVID-19 screening testing (ST) can detect asymptomatic or pre-symptomatic cases, allowing for prompt identification of cases and close contacts. This study examined parents' and school staffs' knowledge and attitudes toward to a pilot school-based ST program in a school district in southern Arizona. METHODS: In May 2021, online surveys to parents and school staff were administered to examine attitudes toward ST and impacts of the COVID-19 pandemic. Unweighted percent estimates were calculated, and bivariate differences were examined by demographics. Associations were assessed using chi-square tests and logistic regression. RESULTS: The survey had response rates of 10% (606/6085) and 22% (187/849) among parents and staff, respectively. Approximately one-third of responding parents (35%) would or already allow their child to participate in school-based ST, 37% would not participate; 28% were unsure. Among responding staff, 46% would or already participate in ST, 33% would not; 21% were unsure. The top concern (38%) among responding staff was taking job-related leave if testing positive. CONCLUSION: Schools work to balance the needs of students, families, and staff by implementing supportive and flexible policies and practices founded on buy-in and acceptance from their communities. |
Facilitators and barriers to implementing COVID-19 prevention strategies in K-12 public schools
Rose I , Powell L , King A , Murray CC , Rasberry CN , Pampati S , Barrios LC , Lee S . J Sch Nurs 2023 10598405231191282 To meet the educational needs of students, most schools in the United States (U.S.) reopened for in-person instruction during the 2021-2022 school year implementing a wide range of COVID-19 prevention strategies (e.g., mask requirements). To date, there have been limited studies examining facilitators and barriers to implementing each of the recommended COVID-19 prevention strategies in schools. Twenty-one semistructured interviews were conducted with public school staff from across the U.S. responsible for overseeing prevention strategy implementation. MAXQDA was used for thematic analysis. Findings identified key facilitators including utilizing Centers for Disease Control and Prevention guidance and district policies to guide decision-making at the school level, possessing financial resources to purchase supplies, identifying key staff for implementation, and having school health services infrastructure in place. Key barriers included staff shortages, limited resources, and community opposition. Findings from this study provide important insight into how schools can prepare for future public health emergencies. |
Modifications to student quarantine policies in K-12 schools implementing multiple COVID-19 prevention strategies restores in-person education without increasing SARS-CoV-2 transmission risk, January-March 2021 (preprint)
Dawson P , Worrell MC , Malone S , Fritz SA , McLaughlin HP , Montgomery BK , Boyle M , Gomel A , Hayes S , Maricque B , Lai AM , Neidich JA , Tinker SC , Lee JS , Tong S , Orscheln RC , Charney R , Rebmann T , Mooney J , Rains C , Yoon N , Petit M , Towns K , Goddard C , Schmidt S , Barrios LC , Neatherlin JC , Salzer JS , Newland JG . medRxiv 2022 21 Objective: To determine whether modified K-12 student quarantine policies that allow some students to continue in-person education during their quarantine period increase schoolwide SARS-CoV-2 transmission risk following the increase in cases in winter 2020-2021. Method(s): We conducted a prospective cohort study of COVID-19 cases and exposures among students and staff (n=65,621) in 103 Missouri public schools. Participants were offered free, saliva-based RT-PCR testing. An adjusted Cox regression model compared hazard rates of school-based SARS-CoV-2 infections between schools with a modified versus standard quarantine policy. Result(s): From January-March 2021, a projected 23 (1%) school-based transmission events occurred among 1,636 school close contacts. There was no difference in the adjusted hazard rates of school-based SARS-CoV-2 infections between schools with a modified versus standard quarantine policy (hazard ratio=1.00; 95% confidence interval: 0.97-1.03). Discussion(s): School-based SARS-CoV-2 transmission was rare in 103 K-12 schools implementing multiple COVID-19 prevention strategies. Modified student quarantine policies were not associated with increased school incidence of COVID-19. Modifications to student quarantine policies may be a useful strategy for K-12 schools to safely reduce disruptions to in-person education during times of increased COVID-19 community incidence. Copyright The copyright holder for this preprint is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. This article is a US Government work. It is not subject to copyright under 17 USC 105 and is also made available for use under a CC0 license. |
Disparities in the implementation of school-based mental health supports among K-12 public schools
Moore S , Timpe Z , Rasberry CN , Hertz M , Verlenden J , Spencer P , Murray C , Lee S , Barrios LC , Tripathi T , McConnell L , Iachan R , Pampati S . Psychiatr Serv 2023 75 (1) appips20220558 OBJECTIVE: The authors sought to explore the availability of mental health supports within public schools during the COVID-19 pandemic by using survey data from a nationally representative sample of U.S. K-12 public schools collected in October-November 2021. METHODS: The prevalence of 11 school-based mental health supports was examined within the sample (N=437 schools). Chi-square tests and adjusted logistic regression models were used to identify associations between school-level characteristics and mental health supports. School characteristics included level (elementary, middle, or high school), locale (city, town, suburb, or rural area), poverty level, having a full-time school nurse, and having a school-based health center. RESULTS: Universal mental health programs were more prevalent than more individualized and group-based supports (e.g., therapy groups); however, prevalence of certain mental health supports was low among schools (e.g., only 53% implemented schoolwide trauma-informed practices). Schools having middle to high levels of poverty or located in rural areas or towns and elementary schools and schools without a health infrastructure were less likely to implement mental health supports, even after analyses were adjusted for school-level characteristics. For example, compared with low-poverty schools, mid-poverty schools had lower odds of implementing prosocial skills training for students (adjusted OR [AOR]=0.49, 95% CI=0.27-0.88) and providing confidential mental health screening (AOR=0.42, 95% CI=0.22-0.79). CONCLUSIONS: Implementation levels of school-based mental health supports leave substantial room for improvement, and numerous disparities existed by school characteristics. Higher-poverty areas, schools in rural areas or towns, and elementary schools and schools without a health infrastructure may require assistance in ensuring equitable access to mental health supports. |
Disparities in implementing COVID-19 prevention strategies in public schools, United States, 2021-22 school year
Pampati S , Rasberry CN , Timpe Z , McConnell L , Moore S , Spencer P , Lee S , Murray CC , Adkins SH , Conklin S , Deng X , Iachan R , Tripathi T , Barrios LC . Emerg Infect Dis 2023 29 (5) 937-944 During the COVID-19 pandemic, US schools have been encouraged to take a layered approach to prevention, incorporating multiple strategies to curb transmission of SARS-CoV-2. Using survey data representative of US public K-12 schools (N = 437), we determined prevalence estimates of COVID-19 prevention strategies early in the 2021-22 school year and describe disparities in implementing strategies by school characteristics. Prevalence of prevention strategies ranged from 9.3% (offered COVID-19 screening testing to students and staff) to 95.1% (had a school-based system to report COVID-19 outcomes). Schools with a full-time school nurse or school-based health center had significantly higher odds of implementing several strategies, including those related to COVID-19 vaccination. We identified additional disparities in prevalence of strategies by locale, school level, and poverty. Advancing school health workforce and infrastructure, ensuring schools use available COVID-19 funding effectively, and promoting efforts in schools with the lowest prevalence of infection prevention strategies are needed for pandemic preparedness. |
Ventilation improvements among K-12 public school districts - United States, August-December 2022
Mark-Carew M , Kang G , Pampati S , Mead KR , Martin SB Jr , Barrios LC . MMWR Morb Mortal Wkly Rep 2023 72 (14) 372-376 Improving ventilation has been one of several COVID-19 prevention strategies implemented by kindergarten through grade 12 (K-12) schools to stay open for safe in-person learning. Because transmission of SARS-CoV-2 occurs through inhalation of infectious viral particles, it is important to reduce the concentration of and exposure time to infectious aerosols (1-3). CDC examined reported ventilation improvement strategies among U.S. K-12 public school districts using telephone survey data collected during August-December 2022. Maintaining continuous airflow through school buildings during active hours was the most frequently reported strategy by school districts (50.7%); 33.9% of school districts reported replacement or upgrade of heating, ventilation, and air conditioning (HVAC) systems; 28.0% reported installation or use of in-room air cleaners with high-efficiency particulate air (HEPA) filters; and 8.2% reported installation of ultraviolet (UV) germicidal irradiation (UVGI) devices, which use UV light to kill airborne pathogens, including bacteria and viruses. School districts in National Center for Education Statistics (NCES) city locales, the West U.S. Census Bureau region, and those designated by U.S. Census Bureau Small Area Income Poverty Estimates (SAIPE) as high-poverty districts reported the highest percentages of HVAC system upgrades and HEPA-filtered in-room air cleaner use, although 28%-60% of all responses were unknown or missing. Federal funding remains available to school districts to support ventilation improvements. Public health departments can encourage K-12 school officials to use available funding to improve ventilation and help reduce transmission of respiratory diseases in K-12 settings. |
Evaluation of self-administered antigen testing in a college setting.
Tinker SC , Prince-Guerra JL , Vermandere K , Gettings J , Drenzik C , Voccio G , Parrott T , Drobeniuc J , Hayden T , Briggs S , Heida D , Thornburg N , Barrios LC , Neatherlin JC , Madni S , Rasberry CN , Swanson KD , Tamin A , Harcourt JL , Lester S , Atherton L , Honein MA . Virol J 2022 19 (1) 202 BACKGROUND: The objective of our investigation was to better understand barriers to implementation of self-administered antigen screening testing for SARS-CoV-2 at institutions of higher education (IHE). METHODS: Using the Quidel QuickVue At-Home COVID-19 Test, 1347 IHE students and staff were asked to test twice weekly for seven weeks. We assessed seroconversion using baseline and endline serum specimens. Online surveys assessed acceptability. RESULTS: Participants reported 9971 self-administered antigen test results. Among participants who were not antibody positive at baseline, the median number of tests reported was eight. Among 324 participants seronegative at baseline, with endline antibody results and ≥ 1 self-administered antigen test results, there were five COVID-19 infections; only one was detected by self-administered antigen test (sensitivity = 20%). Acceptability of self-administered antigen tests was high. CONCLUSIONS: Twice-weekly serial self-administered antigen testing in a low prevalence period had low utility in this investigation. Issues of testing fatigue will be important to address in future testing strategies. |
Modifications to student quarantine policies in K-12 schools implementing multiple COVID-19 prevention strategies restores in-person education without increasing SARS-CoV-2 transmission risk, January-March 2021.
Dawson P , Worrell MC , Malone S , Fritz SA , McLaughlin HP , Montgomery BK , Boyle M , Gomel A , Hayes S , Maricque B , Lai AM , Neidich JA , Tinker SC , Lee JS , Tong S , Orscheln RC , Charney R , Rebmann T , Mooney J , Rains C , Yoon N , Petit M , Towns K , Goddard C , Schmidt S , Barrios LC , Neatherlin JC , Salzer JS , Newland JG . PLoS One 2022 17 (10) e0266292 OBJECTIVE: To determine whether modified K-12 student quarantine policies that allow some students to continue in-person education during their quarantine period increase schoolwide SARS-CoV-2 transmission risk following the increase in cases in winter 2020-2021. METHODS: We conducted a prospective cohort study of COVID-19 cases and close contacts among students and staff (n = 65,621) in 103 Missouri public schools. Participants were offered free, saliva-based RT-PCR testing. The projected number of school-based transmission events among untested close contacts was extrapolated from the percentage of events detected among tested asymptomatic close contacts and summed with the number of detected events for a projected total. An adjusted Cox regression model compared hazard rates of school-based SARS-CoV-2 infections between schools with a modified versus standard quarantine policy. RESULTS: From January-March 2021, a projected 23 (1%) school-based transmission events occurred among 1,636 school close contacts. There was no difference in the adjusted hazard rates of school-based SARS-CoV-2 infections between schools with a modified versus standard quarantine policy (hazard ratio = 1.00; 95% confidence interval: 0.97-1.03). DISCUSSION: School-based SARS-CoV-2 transmission was rare in 103 K-12 schools implementing multiple COVID-19 prevention strategies. Modified student quarantine policies were not associated with increased school incidence of COVID-19. Modifications to student quarantine policies may be a useful strategy for K-12 schools to safely reduce disruptions to in-person education during times of increased COVID-19 community incidence. |
An Examination of SARS-CoV-2 Transmission Based on Classroom Distancing in Schools With Other Preventive Measures in Place-Missouri, January-March 2021.
Donovan CV , Worrell MC , Steinberg J , Montgomery BK , Young R , Richardson G , Dawson P , Dinh TH , Botkin N , Fitzpatrick T , Fields A , Rains CM , Fritz S , Malone S , Tong S , Mooney J , Newland JG , Barrios LC , Neatherlin JC , Salzer JS . Public Health Rep 2022 137 (5) 333549221109003 OBJECTIVES: Classroom layout plays a central role in maintaining physical distancing as part of a multicomponent prevention strategy for safe in-person learning during the COVID-19 pandemic. We conducted a school investigation to assess layouts and physical distancing in classroom settings with and without in-school SARS-CoV-2 transmission. METHODS: We assessed, measured, and mapped 90 K-12 (kindergarten through grade 12) classrooms in 3 Missouri public school districts during January-March 2021, prior to widespread prevalence of the Delta variant; distances between students, teachers, and people with COVID-19 and their contacts were analyzed. We used whole-genome sequencing to further evaluate potential transmission events. RESULTS: The investigation evaluated the classrooms of 34 students and staff members who were potentially infectious with COVID-19 in a classroom. Of 42 close contacts (15 tested) who sat within 3 ft of possibly infectious people, 1 (2%) probable transmission event occurred (from a symptomatic student with a longer exposure period [5 days]); of 122 contacts (23 tested) who sat more than 3 ft away from possibly infectious people with shorter exposure periods, no transmission events occurred. CONCLUSIONS: Reduced student physical distancing is one component of mitigation strategies that can allow for increased classroom capacity and support in-person learning. In the pre-Delta variant period, limited physical distancing (<6 ft) among students in K-12 schools was not associated with increased SARS-CoV-2 transmission. |
Ventilation Improvement Strategies Among K-12 Public Schools - The National School COVID-19 Prevention Study, United States, February 14-March 27, 2022.
Pampati S , Rasberry CN , McConnell L , Timpe Z , Lee S , Spencer P , Moore S , Mead KR , Murray CC , Deng X , Iachan R , Tripathi T , Martin SBJr , Barrios LC . MMWR Morb Mortal Wkly Rep 2022 71 (23) 770-775 Effective COVID-19 prevention in kindergarten through grade 12 (K-12) schools requires multicomponent prevention strategies in school buildings and school-based transportation, including improving ventilation (1). Improved ventilation can reduce the concentration of infectious aerosols and duration of potential exposures (2,3), is linked to lower COVID-19 incidence (4), and can offer other health-related benefits (e.g., better measures of respiratory health, such as reduced allergy symptoms) (5). Whereas ambient wind currents effectively dissipate SARS-CoV-2 (the virus that causes COVID-19) outdoors,* ventilation systems provide protective airflow and filtration indoors (6). CDC examined reported ventilation improvement strategies among a nationally representative sample of K-12 public schools in the United States using wave 4 (February 14-March 27, 2022) data from the National School COVID-19 Prevention Study (NSCPS) (420 schools), a web-based survey administered to school-level administrators beginning in summer 2021.(†) The most frequently reported ventilation improvement strategies were lower-cost strategies, including relocating activities outdoors (73.6%), inspecting and validating existing heating, ventilation and air conditioning (HVAC) systems (70.5%), and opening doors (67.3%) or windows (67.2%) when safe to do so. A smaller proportion of schools reported more resource-intensive strategies such as replacing or upgrading HVAC systems (38.5%) or using high-efficiency particulate air (HEPA) filtration systems in classrooms (28.2%) or eating areas (29.8%). Rural and mid-poverty-level schools were less likely to report several resource-intensive strategies. For example, rural schools were less likely to use portable HEPA filtration systems in classrooms (15.6%) than were city (37.7%) and suburban schools (32.9%), and mid-poverty-level schools were less likely than were high-poverty-level schools to have replaced or upgraded HVAC systems (32.4% versus 48.8%). Substantial federal resources to improve ventilation in schools are available.(§) Ensuring their use might reduce SARS-CoV-2 transmission in schools. Focusing support on schools least likely to have resource-intensive ventilation strategies might facilitate equitable implementation of ventilation improvements. |
Dosage in implementation of an effective school-based health program impacts youth health risk behaviors and experiences
Li J , Timpe Z , Suarez NA , Phillips E , Kaczkowski W , Cooper AC , Dittus PJ , Robin L , Barrios LC , Ethier KA . J Adolesc Health 2022 71 (3) 334-343 PURPOSE: This study is part of a larger evaluation of a multilevel, multistrategy federal program to reduce high school students' risk for HIV/sexually transmitted infection and unintended pregnancy. Local education agencies supported schools in implementing three strategies: delivering exemplary sexual health education, increasing student access to quality sexual health services, and enhancing safe and supportive school environments (SSE). We examined how levels of school implementation of these strategies moderated program effects on targeted student outcomes. METHODS: The Youth Risk Behavior Survey was implemented in participating local education agencies in 2015 and 2017 to assess student behaviors and experiences, whereas the School Health Profiles surveys assessed school policies and practices in 2014 and 2016. We used these surveys to measure student-level outcomes and school-level program delivery, respectively, which were analyzed using multilevel modeling in a difference-in-differences framework. RESULTS: Levels of SSE implementation significantly moderated program effects on multiple student outcomes, including ever having sex, having four or more lifetime sexual partners, being sexually active, using hormonal birth control, dual use of a condom and hormonal birth control, ever being forced to have sex, missing school because of safety concerns, and lifetime and current marijuana use. However, we found few moderating effects of exemplary sexual health education and sexual health services dosage. DISCUSSION: We found a significant relationship between incremental increases in implementation of activities to increase the safety and supportiveness of school environments and enhanced program effects in improving multiple student health outcomes. These findings suggest that school implementation of SSE activities contributed to intended program effects. |
Overwhelming support for sexual health education in U.S. schools: A meta-analysis of 23 surveys conducted between 2000 and 2016
Szucs LE , Harper CR , Andrzejewski J , Barrios LC , Robin L , Hunt P . J Adolesc Health 2022 70 (4) 598-606 Purpose: Surveys suggest that the general public (i.e., adults or parents) supports sexual health education in schools. However, the number of schools providing sex education continues to decline in the United States. The purpose of this study is to conduct a meta-analysis of U.S.-based representative surveys to provide a pooled estimate of public support for sexual health education delivered in schools. Methods: A systematic search of three databases (Medline, PsycInfo, and ERIC) was conducted to identify survey measuring adult and parent attitudes toward sexual health education in school between 2000 and 2016. Meta-analyses were conducted in OpenMetaAnalyst via the metaphor package in R using a DerSimonian-Laird random effect models to account for heterogeneity between surveys. Results: A total of 23 citations met study inclusion and exclusion criteria, representing 15 unique probability surveys conducted with the public. Among the included surveys, 14 were nationwide and 11 included parents or an overrepresentation of parents. Across all survey findings, 88.7% (95% confidence interval = 86.2–91.2) of respondents supported sexual health education. Among surveys that only included parents or oversampled for parents, 90.0% (95% confidence interval = 86.5–93.4) supported sexual health education, and among nationally representative surveys, 87.7% (95% confidence interval = 85.1–90.6) of respondents supported sexual health education. Conclusion: These findings demonstrate overwhelming support for sexual health education delivered in schools. Additional research is needed to determine individual differences in support for specific sexual health education topics and skills delivered through classroom-based instruction. © 2021 |
Test-to-Stay Programs in Schools Are Effective but Are They Equitable?
Neatherlin J , Thomas ES , Barrios LC . Pediatrics 2022 149 (5) During the 2020/2021 school year, kindergarten through grade 12 (K-12) schools in under-resourced communities were more likely to close due to the coronavirus disease (COVID-19) pandemic, and students in these schools missed more in-person learning days.1 Evidence collected during this time demonstrated in-person learning for all K-12 students could be conducted safely with layered prevention strategies.2 In August 2021, most U.S. school districts opened with 100% in-person learning. Despite a decrease in cases after the start of fall semester, cases among school-aged populations again increased in December prior to the winter break due to the highly transmissible B.1.1.529 (Omicron) variant.3. |
Acceptance of Saliva-Based Specimen Collection for SARS-CoV-2 Testing Among K-12 Students, Teachers, and Staff.
McLaughlin HP , Worrell MC , Malone S , Dawson P , Maricque B , Halpin JL , Lee S , Fritz SA , Tinker SC , Neidich JA , Towns K , Lee JS , Barrios LC , Neatherlin JC , Newland JG , Salzer JS . Public Health Rep 2022 137 (3) 333549221074395 OBJECTIVE: Saliva specimens collected in school populations may offer a more feasible, noninvasive alternative to nasal swabs for large-scale COVID-19 testing efforts in kindergarten through 12th grade (K-12) schools. We investigated acceptance of saliva-based COVID-19 testing among quarantined K-12 students and their parents, teachers, and staff members who recently experienced a SARS-CoV-2 exposure in school. METHODS: We surveyed 719 participants, in person or by telephone, who agreed to or declined a free saliva-based COVID-19 reverse-transcription polymerase chain reaction test as part of a surveillance investigation about whether they would have consented to testing if offered a nasal swab instead. We conducted this investigation in 6 school districts in Greene County (n = 3) and St. Louis County (n = 3), Missouri, from January 25 through March 23, 2021. RESULTS: More than one-third (160 of 446) of K-12 students (or their parents or guardians), teachers, and staff members who agreed to a saliva-based COVID-19 test indicated they would have declined testing if specimen collection were by nasal swab. When stratified by school level, 51% (67 of 132) of elementary school students or their parents or guardians would not have agreed to testing if a nasal swab was offered. CONCLUSIONS: Some students, especially those in elementary school, preferred saliva-based COVID-19 testing to nasal swab testing. Use of saliva-based testing might increase voluntary participation in screening efforts in K-12 schools to help prevent the spread of SARS-CoV-2. |
Measurement of gender and sexuality in the Adolescent Brain Cognitive Development (ABCD) study
Potter AS , Dube SL , Barrios LC , Bookheimer S , Espinoza A , Feldstein Ewing SW , Freedman EG , Hoffman EA , Ivanova M , Jefferys H , McGlade EC , Tapert SF , Johns MM . Dev Cogn Neurosci 2022 53 101057 The Adolescent Brain Cognitive Development(SM) (ABCD) study is a longitudinal study of adolescent brain development and health that includes over 11,800 youth in the United States. The ABCD study includes broad developmental domains, and gender and sexuality are two of these with noted changes across late childhood and early adolescence. The Gender Identity and Sexual Health (GISH) workgroup recommends measures of gender and sexuality for the ABCD study, prioritizing those that are developmentally sensitive, capture individual differences in the experience of gender and sexuality, and minimize participant burden. This manuscript describes the gender and sexuality measures used in ABCD and provides guidance for researchers using these data. Data showing the utility of these measures and longitudinal trends are presented. Including assessment of gender and sexuality in ABCD allows for characterization of developmental trajectories of gender and sexuality, and the broad scope of ABCD data collection allows examination of identity development in an intersectional manner. |
The CDC's Division of Adolescent and School Health Approach to Sexual Health Education in Schools: 3 Decades in Review
Szucs LE , Barrios LC , Young E , Robin L , Hunt P , Jayne PE . J Sch Health 2021 92 (2) 223-234 BACKGROUND: School health education, including sexual health education, plays a crucial role in shaping adolescents' protective health behaviors, experiences, and outcomes. Adolescents need functional knowledge and skills to practice, adopt, and maintain healthy behaviors for preventing sexually transmitted infections (STIs), including human immunodeficiency virus (HIV), and unintended pregnancy. METHODS: The US Centers for Disease Control and Prevention's Division of Adolescent and School Health (CDC/DASH) has advanced school-based approaches to STI/HIV and pregnancy prevention through surveillance, research and evaluation, and program partnership and collaboration for over 3 decades. RESULTS: CDC/DASH uses systematic and innovative strategies to identify the breadth of adolescent sexual health evidence; characterize key elements of effective educational curricula; and provide practical guidance to support school-based delivery. CDC/DASH's approach to effective health and sexual health education in schools has changed dramatically over the past 30 years and must continue to progress. CONCLUSION: This paper describes how and why that approach has evolved and outlines directions for the future. |
Pediatric COVID-19 Cases in Counties With and Without School Mask Requirements - United States, July 1-September 4, 2021.
Budzyn SE , Panaggio MJ , Parks SE , Papazian M , Magid J , Eng M , Barrios LC . MMWR Morb Mortal Wkly Rep 2021 70 (39) 1377-1378 Consistent and correct mask use is a critical strategy for preventing the transmission of SARS-CoV-2, the virus that causes COVID-19 (1). CDC recommends that schools require universal indoor mask use for students, staff members, and others in kindergarten through grade 12 (K-12) school settings (2). As U.S. schools opened for the 2021-22 school year in the midst of increasing community spread of COVID-19, some states, counties, and school districts implemented mask requirements in schools. To assess the impact of masking in schools on COVID-19 incidence among K-12 students across the United States, CDC assessed differences between county-level pediatric COVID-19 case rates in schools with and without school mask requirements. |
COVID-19-Related School Closures and Learning Modality Changes - United States, August 1-September 17, 2021.
Parks SE , Zviedrite N , Budzyn SE , Panaggio MJ , Raible E , Papazian M , Magid J , Ahmed F , Uzicanin A , Barrios LC . MMWR Morb Mortal Wkly Rep 2021 70 (39) 1374-1376 Beginning in January 2021, the U.S. government prioritized ensuring continuity of learning for all students during the COVID-19 pandemic (1). To estimate the extent of COVID-19-associated school disruptions, CDC and the Johns Hopkins University Applied Physics Laboratory used a Hidden Markov Model (HMM) (2) statistical approach to estimate the most likely actual learning modality based on patterns observed in past data, accounting for conflicting or missing information and systematic Internet searches (3) for COVID-19-related school closures. This information was used to assess how many U.S. schools were open, and in which learning modalities, during August 1-September 17, 2021. Learning modalities included 1) full in-person learning, 2) a hybrid of in-person and remote learning, and 3) full remote learning. |
Point-of-Care Antigen Test for SARS-CoV-2 in Asymptomatic College Students.
Tinker SC , Szablewski CM , Litvintseva AP , Folster J , Shewmaker PL , Medrzycki M , Bowen MD , Bohannon C , Bagarozzi D Jr , Petway M , Rota PA , Kuhnert-Tallman W , Thornburg N , Prince-Guerra JL , Barrios LC , Tamin A , Harcourt JL , Honein MA . Emerg Infect Dis 2021 27 (10) 2662-2665 We used the BinaxNOW COVID-19 Ag Card to screen 1,540 asymptomatic college students for severe acute respiratory syndrome coronavirus 2 in a low-prevalence setting. Compared with reverse transcription PCR, BinaxNOW showed 20% overall sensitivity; among participants with culturable virus, sensitivity was 60%. BinaxNOW provides point-of-care screening but misses many infections. |
Effects of condom use on HIV transmission among adolescent sexual minority males in the United States: a mixed epidemiology and epidemic modeling study
Katz DA , Hamilton DT , Rosenthal EM , Wang LY , Dunville RL , Aslam M , Barrios LC , Zlotorzynska M , Sanchez TH , Sullivan PS , Rosenberg ES , Goodreau SM . Sex Transm Dis 2021 48 (12) 973-980 PURPOSE: We examined condom use patterns and potential population-level effects of a hypothetical condom intervention on HIV transmission among adolescent sexual minority males (ASMM). METHODS: Using three datasets: national Youth Risk Behavior Survey 2015-2017 (YRBS-National), local YRBS data from 8 jurisdictions with sex of partner questions from 2011-2017 (YRBS-Trends), and American Men's Internet Survey (AMIS) 2014-2017, we assessed associations of condom use with year, age, and race/ethnicity among sexually-active ASMM. Using a stochastic agent-based network epidemic model, structured and parameterized based on the above analyses, we calculated the percent of HIV infections averted over 10 years among ASMM ages 13-18 by an intervention that increased condom use by 37% for 5 years and was delivered to 62% of ASMM at age 14. RESULTS: In YRBS, 51.8% (95% confidence interval [CI] = 41.3-62.3%) and 37.9% (32.7-42.3%) reported condom use at last sexual intercourse in national and trend datasets, respectively. In AMIS, 47.3% (95%CI = 44.6-49.9%) reported condom use at last anal sex with a male partner. Temporal trends were not observed in any dataset (p > 0.1). Condom use varied significantly by age in YRBS-National (p < 0.0001) and YRBS-Trends (p = 0.032) with 13-15-year-olds reporting the lowest use in both; age differences were not significant in AMIS (p = 0.919). Our hypothetical intervention averted a mean of 9.0% (95% simulation interval = -5.4%-21.2%) of infections among ASMM. CONCLUSIONS: Condom use among ASMM is low and appears to have remained stable during 2011-2017. Modeling suggests that condom use increases consistent with previous interventions have potential to avert 1 in 11 new HIV infections among ASMM. |
Pilot Investigation of SARS-CoV-2 Secondary Transmission in Kindergarten Through Grade 12 Schools Implementing Mitigation Strategies - St. Louis County and City of Springfield, Missouri, December 2020.
Dawson P , Worrell MC , Malone S , Tinker SC , Fritz S , Maricque B , Junaidi S , Purnell G , Lai AM , Neidich JA , Lee JS , Orscheln RC , Charney R , Rebmann T , Mooney J , Yoon N , Petit M , Schmidt S , Grabeel J , Neill LA , Barrios LC , Vallabhaneni S , Williams RW , Goddard C , Newland JG , Neatherlin JC , Salzer JS . MMWR Morb Mortal Wkly Rep 2021 70 (12) 449-455 Many kindergarten through grade 12 (K-12) schools offering in-person learning have adopted strategies to limit the spread of SARS-CoV-2, the virus that causes COVID-19 (1). These measures include mandating use of face masks, physical distancing in classrooms, increasing ventilation with outdoor air, identification of close contacts,* and following CDC isolation and quarantine guidance(†) (2). A 2-week pilot investigation was conducted to investigate occurrences of SARS-CoV-2 secondary transmission in K-12 schools in the city of Springfield, Missouri, and in St. Louis County, Missouri, during December 7-18, 2020. Schools in both locations implemented COVID-19 mitigation strategies; however, Springfield implemented a modified quarantine policy permitting student close contacts aged ≤18 years who had school-associated contact with a person with COVID-19 and met masking requirements during their exposure to continue in-person learning.(§) Participating students, teachers, and staff members with COVID-19 (37) from 22 schools and their school-based close contacts (contacts) (156) were interviewed, and contacts were offered SARS-CoV-2 testing. Among 102 school-based contacts who received testing, two (2%) had positive test results indicating probable school-based SARS-CoV-2 secondary transmission. Both contacts were in Springfield and did not meet criteria to participate in the modified quarantine. In Springfield, 42 student contacts were permitted to continue in-person learning under the modified quarantine; among the 30 who were interviewed, 21 were tested, and none received a positive test result. Despite high community transmission, SARS-CoV-2 transmission in schools implementing COVID-19 mitigation strategies was lower than that in the community. Until additional data are available, K-12 schools should continue implementing CDC-recommended mitigation measures (2) and follow CDC isolation and quarantine guidance to minimize secondary transmission in schools offering in-person learning. |
Association of Children's Mode of School Instruction with Child and Parent Experiences and Well-Being During the COVID-19 Pandemic - COVID Experiences Survey, United States, October 8-November 13, 2020.
Verlenden JV , Pampati S , Rasberry CN , Liddon N , Hertz M , Kilmer G , Viox MH , Lee S , Cramer NK , Barrios LC , Ethier KA . MMWR Morb Mortal Wkly Rep 2021 70 (11) 369-376 In March 2020, efforts to slow transmission of SARS-CoV-2, the virus that causes COVID-19, resulted in widespread closures of school buildings, shifts to virtual educational models, modifications to school-based services, and disruptions in the educational experiences of school-aged children. Changes in modes of instruction have presented psychosocial stressors to children and parents that can increase risks to mental health and well-being and might exacerbate educational and health disparities (1,2). CDC examined differences in child and parent experiences and indicators of well-being according to children's mode of school instruction (i.e., in-person only [in-person], virtual-only [virtual], or combined virtual and in-person [combined]) using data from the COVID Experiences nationwide survey. During October 8-November 13, 2020, parents or legal guardians (parents) of children aged 5-12 years were surveyed using the NORC at the University of Chicago AmeriSpeak panel,* a probability-based panel designed to be representative of the U.S. household population. Among 1,290 respondents with a child enrolled in public or private school, 45.7% reported that their child received virtual instruction, 30.9% in-person instruction, and 23.4% combined instruction. For 11 of 17 stress and well-being indicators concerning child mental health and physical activity and parental emotional distress, findings were worse for parents of children receiving virtual or combined instruction than were those for parents of children receiving in-person instruction. Children not receiving in-person instruction and their parents might experience increased risk for negative mental, emotional, or physical health outcomes and might need additional support to mitigate pandemic effects. Community-wide actions to reduce COVID-19 incidence and support mitigation strategies in schools are critically important to support students' return to in-person learning. |
Observed Face Mask Use at Six Universities - United States, September-November 2020.
Barrios LC , Riggs MA , Green RF , Czarnik M , Nett RJ , Staples JE , Welton MD , Muilenburg JL , Zullig KJ , Gibson-Young L , Perkins AV , Prins C , Lauzardo M , Shapiro J , Asimellis G , Kilgore-Bowling G , Ortiz-Jurado K , Gutilla MJ . MMWR Morb Mortal Wkly Rep 2021 70 (6) 208-211 Approximately 41% of adults aged 18-24 years in the United States are enrolled in a college or university (1). Wearing a face mask can reduce transmission of SARS-CoV-2, the virus that causes coronavirus disease 2019 (COVID-19) (2), and many colleges and universities mandate mask use in public locations and outdoors when within six feet of others. Studies based on self-report have described mask use ranging from 69.1% to 86.1% among adults aged 18-29 years (3); however, more objective measures are needed. Direct observation by trained observers is the accepted standard for monitoring behaviors such as hand hygiene (4). In this investigation, direct observation was used to estimate the proportion of persons wearing masks and the proportion of persons wearing masks correctly (i.e., covering the nose and mouth and secured under the chin*) on campus and at nearby off-campus locations at six rural and suburban universities with mask mandates in the southern and western United States. Trained student observers recorded mask use for up to 8 weeks from fixed sites on campus and nearby. Among 17,200 observed persons, 85.5% wore masks, with 89.7% of those persons wearing the mask correctly (overall correct mask use: 76.7%). Among persons observed indoors, 91.7% wore masks correctly. The proportion correctly wearing masks indoors varied by mask type, from 96.8% for N95-type masks and 92.2% for cloth masks to 78.9% for bandanas, scarves, and similar face coverings. Observed indoor mask use was high at these six universities with mask mandates. Colleges and universities can use direct observation findings to tailor training and messaging toward increasing correct mask use. |
Impacts of changing sexual behavior on chlamydia and gonorrhea burden among US high school students, 2007-2017
Goodreau SM , Pollock ED , Wang LY , Aslam MV , Barrios LC , Dunville RL , Rosenthal EM , Hamilton DT , Katz DA , Rosenberg ES . Sex Transm Dis 2021 48 (9) 635-642 BACKGROUND: Rates of adolescent sexual activity have long been declining in the United States. We sought to estimate the number of cases of gonorrhea and chlamydia averted over one decade associated with these declines, and associated costs saved. METHODS: We analyzed data from the CDC's Youth Risk Behavior Survey of US high-school students from 2007-2017 and combined it with epidemiological estimates drawn from the literature to parameterize a dynamic population transmission model. We compared transmissions from observed behavioral trends to a counterfactual scenario that assumed sexual behaviors from 2007 remained constant over 10 years. We calculated outcomes by age and for three racial/ethnic groups (Hispanic, non-Hispanic Black, and non-Hispanic White adolescents) who vary on underlying burden and amount of behavioral change. RESULTS: We estimated 1,118,483 cases of chlamydia and 214,762 cases of gonorrhea were averted (19.5% of burden across all ages). This yielded $474 million (2017 dollars) savings in medical costs over the decade. The largest number of averted cases (767,543) was among Black adolescents, but the largest proportion (28.7%) was among Hispanic adolescents. CONCLUSIONS: Whatever its origins, changing sexual behavior among adolescents results in large estimated reductions in STI burden and medical costs relative to previous cohorts. Although diagnoses among adolescents have not declined at this rate, multiple explanations could make these apparently divergent trends consistent. Efforts to continue supporting effective sex education in and out of school along with STI screening for adolescents should reinforce these gains. |
Data and Policy to Guide Opening Schools Safely to Limit the Spread of SARS-CoV-2 Infection.
Honein MA , Barrios LC , Brooks JT . JAMA 2021 325 (9) 823-824 On March 11, 2020, less than 2 weeks after community transmission of the severe acute respiratory syndrome coronavirus 2 (SARS CoV-2) was identified in the US, the World Health Organization declared that the novel coronavirus (COVID-19) outbreak was a global pandemic. By March 25, 2020, all kindergarten to grade 12 (K-12) public schools in the US had closed for in-person instruction. After initial closures, many schools pivoted to online education for the remainder of the school year. For the fall 2020 school term, there was tremendous geographic and district-to-district variation in mode of K-12 educational delivery. Among 13 597 of 14 944 districts that provided school reopening plans, 24% were fully online, 51% were using a hybrid model, and 17% were fully open for in-person instruction (some districts included options for parents to opt out); 51% of districts had students participating in school sports programs.1 |
Time from Start of Quarantine to SARS-CoV-2 Positive Test Among Quarantined College and University Athletes - 17 States, June-October 2020.
Atherstone C , Peterson ML , Malone M , Honein MA , MacNeil A , O'Neal CS , Paul S , Harmon KG , Goerl K , Wolfe CR , Casani J , Barrios LC . MMWR Morb Mortal Wkly Rep 2021 70 (1) 7-11 To safely resume sports, college and university athletic programs and regional athletic conferences created plans to mitigate transmission of SARS-CoV-2, the virus that causes coronavirus disease 2019 (COVID-19). Mitigation measures included physical distancing, universal masking, and maximizing outdoor activity during training; routine testing; 10-day isolation of persons with COVID-19; and 14-day quarantine of athletes identified as close contacts* of persons with confirmed COVID-19. Regional athletic conferences created testing and quarantine policies based on National Collegiate Athletic Association (NCAA) guidance (1); testing policies varied by conference, school, and sport. To improve compliance with quarantine and reduce the personal and economic burden of quarantine adherence, the quarantine period has been reduced in several countries from 14 days to as few as 5 days with testing (2) or 10 days without testing (3). Data on quarantined athletes participating in NCAA sports were used to characterize COVID-19 exposures and assess the amount of time between quarantine start and first positive SARS-CoV-2 test result. Despite the potential risk for transmission from frequent, close contact associated with athletic activities (4), more athletes reported exposure to COVID-19 at social gatherings (40.7%) and from roommates (31.7%) than they did from exposures associated with athletic activities (12.7%). Among 1,830 quarantined athletes, 458 (25%) received positive reverse transcription-polymerase chain reaction (RT-PCR) test results during the 14-day quarantine, with a mean of 3.8 days from quarantine start (range = 0-14 days) until the positive test result. Among athletes who had not received a positive test result by quarantine day 5, the probability of having a positive test result decreased from 27% after day 5 to <5% after day 10. These findings support new guidance from CDC (5) in which different options are provided to shorten quarantine for persons such as collegiate athletes, especially if doing so will increase compliance, balancing the reduced duration of quarantine against a small but nonzero risk for postquarantine transmission. Improved adherence to mitigation measures (e.g., universal masking, physical distancing, and hand hygiene) at all times could further reduce exposures to SARS-CoV-2 and disruptions to athletic activities because of infections and quarantine (1,6). |
The Role of Testing in Reducing SARS-CoV-2 Transmission on College Campuses.
Barrios LC , Green RF , Honein MA . J Adolesc Health 2021 68 (1) 1-2 As institutions of higher education (IHEs) across the nation opened for in-person, hybrid, or online classes for the fall 2020 term, they used various testing strategies in an effort to prevent or reduce transmission of SARS-CoV-2, the virus that causes COVID-19 [1]. Testing strategies range from testing only those presenting with symptoms to testing all students on arrival on campus (entry testing) to regularly testing three times a week. The U.S. Centers for Disease Control and Prevention (CDC) posted updated guidance on September 30 for testing in IHEs in response to recent outbreaks in the IHE setting. The guidance also provides information on rapid antigen viral tests and expanded considerations for transmission in off-campus settings [2]. |
Adolescent mental health, COVID-19, and the value of school-community partnerships.
Hertz MF , Barrios LC . Inj Prev 2020 27 (1) 85-86 Newly released 2019 Youth Risk Behavior Surveillance System data and the Center for Disease Control and Prevention's (CDC)'2019 Youth Risk Behavior Survey Data Summary and Trends Report show that US adolescents continue to suffer from poor mental health and suicidality at alarming rates. These data alone would be cause for concern, but the COVID-19 pandemic has the potential to further erode adolescent mental health, particularly for those whose mental health was poor prior to the pandemic. Given the status of adolescent mental health prior to COVID-19 and the impact of COVID-19, health professionals and schools must partner together now to mitigate potentially deleterious health, mental health and education impacts for children and adolescents. |
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