BACKGROUND: School health education promotes health knowledge and skills, yet measurement of teens' health skills is limited. We psychometrically assessed the perceptions of skills enhanced through school health education (PSE-SHE) measure. METHODS: Cross-sectional data (n = 471) were collected from teens using Teen and Parent Surveys of Health, conducted through AmeriSpeak Panels. The survey included one 5-item question assessing teens' perceptions of health skills enhanced through school health education-including getting health information and services, and understanding factors influencing health, communication, decision-making, and advocacy. For each PSE-SHE item, a 3-level categorization measure was examined (strongly agree/agree, neither agree nor disagree, and strongly disagree/disagree). Cronbach's alphas and confirmatory factor analysis (CFA) examined PSE-SHE measures' reliability and validity. Structural equation modeling used the CALIS procedure (SAS 9.4). RESULTS: High Cronbach's α = 0.91 was observed for the PSE-SHE measure, indicating internal consistency. Polychoric correlations among PSE-SHE items (0.68-0.81) were found. CFA confirmed substantial factor loadings (0.72-0.84, p < 0.0001) of each item on the latent factor (CFI = 0.98), supporting construct validity. IMPLICATIONS FOR SCHOOL HEALTH POLICY, PRACTICE, AND EQUITY: The reliable and valid PSE-SHE measure may inform skills-focused health education research. CONCLUSIONS: Psychometric results confirm the PSE-SHE measure is valid in capturing perceptions of skills enhanced through school health education.

PURPOSE: This study sought to determine the influence of pandemic-related stress and adverse childhood experiences (ACEs) on adolescent mental health during the COVID-19 pandemic and examine the protective role of school connectedness (SC). METHODS: Cohort data from the two-wave COVID Experiences (CovEx) surveys of US adolescents were analyzed. CovEx surveys were administered online in English to US adolescents aged 13-19 years using the NORC AmeriSpeak and NORC AmeriSpeak Teen panels, probability-based panels designed to be representative of the US household population. Data from Wave 1 (W1, October to November 2020 [N(W1) = 727]) and Wave 2 (W2, April to May 2021, N(W2) = 569) were analyzed. Pairwise deletion was used for missing data. Depressive symptoms were measured using the nine-item Patient Health Questionnaire (PHQ W2), and symptoms of trauma-related disorders were assessed using the six-item Trauma Symptom Checklist for Children (TSCC W2). SC was assessed at W1 and W2 using three items measuring: closeness to people at school; perception of teachers caring; and feeling like a part of school. ACEs since birth were assessed using eight items at W1. Items align with the core ACE constructs included in the Behavioral Risk Factor Surveillance System ACE module and the Youth Risk Behavior Survey. Pandemic-related stress exposure at W1 was measured using the seven-item Pandemic-Related Stress Index (PRSI). Structural equation modeling was used to examine direct and indirect associations. RESULTS: In each model, ACE W1 and PRSI W1 were significantly associated with higher depressive symptoms and symptoms of trauma-related disorders. PRSI W1 partially mediated the association between ACE W1 and symptoms of poor mental health, with higher exposure to ACE W1 associated with higher PRSI W1 scores and higher PRSI W1 scores associated with more symptoms of poor mental health at W2. SC at W1 and W2 each were negatively associated with ACEs W1 and PRSI W1. SC W1 and SC W2 significantly attenuated depressive symptoms and symptoms of trauma-related disorders at W2 and therein partially mediated the relationships between ACEs, PRSI, and symptoms of poor mental health. DISCUSSION: Findings illustrate the interplay between ACE and pandemic-related stress and their association with adolescent mental health and highlight the strength of SC as a protective factor. The results emphasize the importance of incorporating multisystem, trauma-informed approaches and prioritizing connectedness in efforts to address the adolescent mental health crisis.

BACKGROUND: The COVID-19 pandemic and associated changes in school learning model reshaped students' lives and may have impacted sexual behaviors and healthcare access. METHODS: We used a difference-in-differences (DID) approach to compare changes in sexual behaviors, HIV/STI testing, and STI diagnosis rates from 2019 to 2021 between jurisdictions where high school was primarily virtual versus in-person for the 2020-2021 school year. We used behavioral data from local jurisdictions administering Youth Risk Behavior Survey and reported chlamydia and gonorrhea diagnosis rates for 15-19-year-olds in corresponding counties from AtlasPlus. Learning model was defined using the COVID-19 School Data Hub, school/governmental policies, news, or other documentation. We used survey-weighted logistic regression for behavioral outcomes and Poisson regression for diagnosis rates. DID estimates were parameterized as the interaction between year and learning model. RESULTS: Twenty-four local jurisdictions (16 virtual, 8 in-person) were included. Compared to in-person learning, virtual learning was significantly associated with a relative increase in condom use from 2019 to 2021 [DID odds ratio (DID-OR) = 1.42, 95%CI = 1.12-1.79] and relative decreases in STI testing [DID-OR = 0.75, 95%CI = 0.59-0.96], chlamydia diagnoses [DID incidence rate ratio (DID-IRR) = 0.86, 95%CI = 0.84-0.88], and gonorrhea diagnoses [DID-IRR = 0.83, 95%CI = 0.79-0.87]. Learning model was not significantly associated with changes in sexual intercourse ever or in past 3 months, multiple sex partners in past 3 months, alcohol/drug use before last sex, or ever HIV testing. CONCLUSIONS: Efforts are needed to maintain access to sexual health services during and after public health emergencies involving schools and increase STI testing access for students, especially those who attended school virtually.

Relatively little is known about the association between school discipline and student health and well-being. Using CDC's 2023 Youth Risk Behavior Survey, CDC analyzed the prevalence of report of unfair discipline at school and associations with experiences at school, mental health, suicidal thoughts and behaviors, and health risk behaviors among high school students overall and stratified by race and ethnicity. Prevalence estimates, prevalence differences, and prevalence ratios adjusted for race (in overall models), grade, and sex were calculated. Overall, 19.3% of students reported receiving unfair discipline during the previous 12 months; Black or African American students had a higher prevalence (23.1%) compared with Hispanic or Latino students (18.4%) and White students (18.1%). Unfair discipline was reported among a majority of students who describe their sexual identity in some other way (besides gay, heterosexual, lesbian, bisexual, or questioning) for American Indian or Alaska Native (81.7%) and multiracial (57.1%) subgroups. Overall, report of unfair discipline was associated with every health risk behavior and experience examined, including being bullied at school or electronically, skipping school due to feeling unsafe, carrying a weapon at school, prescription opioid misuse, poor mental health, persistent feelings of sadness or hopelessness, seriously considered attempting suicide, and attempted suicide. This pattern of association was similar among most student groups in models stratified by race and ethnicity. This analysis is the first to demonstrate, among a nationally representative sample of high school students, that reports of unfair discipline are associated with various health risk behaviors and experiences. With these findings, public health and education practitioners can create interventions that equitably promote safe, supportive, and inclusive school environments for student health.

Adolescent mental health and suicide risk remain substantial public health concerns. High pre-COVID rates of poor mental health and suicide-related behaviors have continued to rise, highlighting the need to identify factors that might foster positive mental health outcomes and reduce suicide-related behaviors at population levels. Using CDC's 2023 Youth Risk Behavior Survey, CDC analyzed the prevalence of mental health and suicide risk indicators and their associations with individual-, family-, and school- or community-level protective factors. Prevalence estimates were calculated for each of the mental health and suicide risk indicators by demographic characteristic. Prevalence ratios adjusted for sex, sexual identity, grade, and race and ethnicity were calculated to examine the association between protective factors and mental health and suicide risk indicators. Overall, 39.7% of students experienced persistent feelings of sadness and hopelessness, 28.5% experienced poor mental health, 20.4% seriously considered attempting suicide, and 9.5% had attempted suicide. Mental health and suicide risk indicators differed by sex, sexual identity, grade, and race and ethnicity. All protective factors were associated with lower prevalence of one or more risk indicators. Findings from this report can serve as a foundation for the advancement of research on protective factors and for the development and implementation of programs, practices, and policies that protect and promote mental health and emotional well-being among youth.

Wisdom is the hallmark of social judgment, but how people across cultures recognize wisdom remains unclear-distinct philosophical traditions suggest different views of wisdom's cardinal features. We explore perception of wise minds across 16 socio-economically and culturally diverse convenience samples from 12 countries. Participants assessed wisdom exemplars, non-exemplars, and themselves on 19 socio-cognitive characteristics, subsequently rating targets' wisdom, knowledge, and understanding. Analyses reveal two positively related dimensions-Reflective Orientation and Socio-Emotional Awareness. These dimensions are consistent across the studied cultural regions and interact when informing wisdom ratings: wisest targets-as perceived by participants-score high on both dimensions, whereas the least wise are not reflective but moderately socio-emotional. Additionally, individuals view themselves as less reflective but more socio-emotionally aware than most wisdom exemplars. Our findings expand folk psychology and social judgment research beyond the Global North, showing how individuals perceive desirable cognitive and socio-emotional qualities, and contribute to an understanding of mind perception.