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Stigler, M. H., Neusel, E., & Perry, C. L. (2011). School-based programs to prevent and reduce alcohol use among youth. Alcohol research & health : the journal of the National Institute on Alcohol Abuse and Alcoholism.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3860568/
This article about alcohol abuse from The journal of the National Institute on Alcohol Abuse and Alcoholism talks about how school is an important setting for interventions aimed to prevent alcohol abuse. It states that interventions should be theory driven, address social norms around alcohol use, build personal and social skills helping students resist pressure to use alcohol, involve interactive teaching approaches,  and be culturally and developmentally appropriate. This allows teachers to be informed of the proper way to teach to the prevention of alcohol abuse and inform kids of the danger that it can be to yourself and others.

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Abstract

Schools are an important setting for interventions aimed at preventing alcohol use and abuse among adolescents. A range of school-based interventions have been developed to prevent or delay the onset of alcohol use, most of which are targeted to middle-school students. Most of these interventions seek to reduce risk factors for alcohol use at the individual level, whereas other interventions also address social and/or environmental risk factors. Not all interventions that have been developed and implemented have been found to be effective. In-depth analyses have indicated that to be most effective, interventions should be theory driven, address social norms around alcohol use, build personal and social skills helping students resist pressure to use alcohol, involve interactive teaching approaches, use peer leaders, integrate other segments of the population into the program, be delivered over several sessions and years, provide training and support to facilitators, and be culturally and developmentally appropriate. Additional research is needed to develop interventions for elementary-school and high-school students and for special populations.

Keywords: Alcohol and other drug use (AODU), alcohol consumption, alcohol abuse, age of AODU onset, underage drinking, adolescent, risk factors, individual risk factors, social environmental risk factors, elementary school, middle school, high school, school-based prevention, school-based intervention

Because alcohol use typically begins during adolescence ( Office of the Surgeon General 2006) and because no other community institution has as much continuous and intensive contact with underage youth, schools can be an important setting for intervention. This article describes school-based approaches to alcohol prevention, highlighting evidence-based examples of this method of intervention, and suggests directions for future research. This summary primarily is based on several recent reviews focusing on alcohol prevention among underage youth conducted by Foxcroft and colleagues (2002), Komro and Toomey (2002), and-the most comprehensive and critical review of this field to date-Spoth and colleagues ( 2008, 2009). Although these previous reviews addressed interventions in a variety of contexts (e.g., families, schools, and communities), the present article highlights key findings specific to school-based interventions.

Characteristics of School-Based Alcohol Prevention Programs

Rates of initiation of drinking rise rapidly starting at age 10 (i.e., grades 4 and 5) and peak between ages 13 and 14 (i.e., grades 8 and 9). At that point, more than 50 percent of adolescents report ever having consumed alcohol in their lifetime ( Kosterman et al. 2000). Given this natural history of alcohol use in adolescence, most school-based programs have been developed for and delivered in middle schools; programs aimed at elementary schools (especially grades 3 to 5) and high schools are less common ( Spoth et al. 2008, 2009). Of particular concern to contemporary research with underage youth is heavy drinking, including harmful behaviors, such as binge drinking and drunkenness.

The primary goal of school-based alcohol prevention programs is to prevent or delay the onset of alcohol use, although some programs also seek to reduce the overall prevalence of alcohol use. Interventions earlier in life (i.e., during elementary school) target risk factors for later alcohol use (e.g., early aggression) because alcohol use itself is not yet relevant to this age group ( Spoth et al. 2008, 2009). Any reduction in alcohol-related behavior is assumed to lead to subsequent reductions in alcohol-related problems (e.g., injuries or alcohol dependence), although the latter often are not measured in primary prevention studies ( Foxcroft et al. 2002).

School-based alcohol interventions are designed to reduce risk factors for early alcohol use primarily at the individual level (e.g., by enhancing student's knowledge and skills), although the most successful school-based programs address social and environmental risk factors (e.g., alcohol-related norms) as well. Some school-based programs focus on the general population of adolescents (i.e., are universal programs), whereas others target adolescents who are particularly at risk (i.e., are selective or indicated programs). The research literature on the efficacy of school-based alcohol prevention programs is large, encompassing several decades of study ( Foxcroft et al. 2002; Komro and Toomey 2002; Spoth et al. 2008, 2009). The most recent review by Spoth and colleagues ( 2008, 2009) provides several examples of effective school-based programs, which will be discussed in detail below. Not all school-based alcohol prevention programs for youth are effective, however. The review by Foxcroft and colleagues (2002), especially, emphasizes this point with regard to long-term (3 years or more) outcomes of primary prevention efforts such as school-based programs.

Examples of Evidence-Based, School-Based Alcohol Prevention Programs

The review by Spoth and colleagues ( 2008, 2009) provides support for the efficacy of school-based programs, at least in the short term (defined as at least 6 months after the intervention was implemented). This review considered alcohol prevention interventions across three developmental periods (i.e., younger than age 10 years, age 10 to 15 years, and age 16 years or older), aligned with reviews of other etiologic work during the same developmental stages ( Masten et al. 2009; Zucker et al. 2009). Of more than 400 studies that the investigators screened, only 127 interventions could be evaluated for their efficacy according to the inclusion criteria specified by the researchers. Of these 127 studies, 41 showed evidence of a positive effect-that is, they could be classified as "most promising" ( n = 12) or having "mixed or emerging" evidence ( n = 29). A list of the school-based interventions identified as most promising is provided in the .

Table

Children younger than 10 years of age

Linking the Interests of Families and Teachers

Raising Healthy Children

Seattle Social Development Project

Adolescents ages 10 to 15 years

Midwestern Prevention Project/Project STAR

Project Northland

Older participants ages 16 to more than 20 years

Project Toward No Drug Abuse

Two-thirds of the most-promising interventions that were identified by Spoth and colleagues ( 2008, 2009) either were exclusively school based ( n = 2) or included a large school-based component within a multiple-component or multiple-domain intervention ( n = 6). Most-promising interventions were identified for all three age-groups studied. At the elementary-school level, interventions classified as most promising included the following:

At the middle-school level, the most promising interventions included the following:

At the high-school level, only the Project Toward No Drug Abuse ( Sussman et al. 2002) was classified as most promising, although Project Northland also has been implemented and shown to be successful with high-school students ( Perry et al. 2002).

Other school-based programs that may be familiar to readers who conduct research in this area, such as Promoting Alternative Thinking Strategies ( Kam et al. 2004; Riggs et al. 2006), Life Skills Training ( Botvin et al. 1995; Spoth et al. 2005), and Project Alert ( Ellickson and Bell 1990; Ellickson et al. 2003) were identified as either having mixed (e.g., Life Skills Training, Project Alert) or emerging (e.g., Promoting Alternative Thinking Strategies) evidence, along with 26 other interventions ( Spoth et al. 2008, 2009). Seventeen of 29 "mixed or emerging evidence" interventions either were exclusively school based ( n = 11) or included a school-based component ( n = 6). (See the review by Spoth and colleagues [2008, 2009], as well as the original literature cited above for a more detailed description of these interventions.)

Although the review by Spoth and colleagues ( 2008, 2009) offers concrete examples of evidence-based interventions, it does not address why some school-based interventions were effective and others were not. Other recent literature reviews ( Cuijpers 2002; Komro and Toomey 2002) and meta-analyses (e.g., Roona et al. 2003; Tobler et al. 2000) have examined this issue. The findings suggest that the following elements are essential to developing and implementing effective school-based alcohol prevention interventions:

The interventions are theory driven, with a particular focus on the social-influences model, which emphasizes helping students identify and resist social influences (e.g., by peers and media) to use alcohol.

The interventions address social norms around alcohol use, reinforcing that alcohol use is not common or acceptable among youth.

The interventions build personal and social skills that help students resist pressure to use alcohol.

The interventions use interactive teaching techniques (e.g., small-group activities and role plays) to engage students.

The interventions use same-aged students (i.e., peer leaders) to facilitate delivery of the program.

The interventions integrate additional components to connect other segments of the community (e.g., parents) to the program.

The interventions are conducted across multiple sessions and multiple years to ensure that an adequate "dose" of prevention is received by students and schools.

The interventions provide adequate training and support for program facilitators (i.e., teachers, students).

The interventions are both culturally and developmentally appropriate for the students they serve.

Two projects that are examples of programs meeting the criteria noted above are Project Northland ( Perry et al. 1996, 2002) and Communities that Care ( Hawkins et al. 2009). These community-wide programs used evidence-based school curricula, supplemented with parental involvement, peer leadership, and community action to achieve reductions in the onset of alcohol use in early adolescence. Communities that Care is described in more detail in the article by Fagan and colleagues (pp. 167-174, in this issue) that focuses on community-based preventive interventions.

Future Directions for School-Based Alcohol Prevention Interventions

Although the understanding of effective interventions to prevent underage alcohol use has grown substantially over the last few decades, especially for school-based approaches, additional research is warranted to fill remaining gaps in the knowledge base. For example, the existing literature does not include sufficient evidence to support or refute the short- or long-term efficacy of school-based interventions in elementary-or high-school settings and does not fully address interventions for special populations, including culturally specific programming. These points are considered in more detail below as suggestions for future directions for school-based research. Readers are directed to the reviews by Spoth and colleagues ( 2008, 2009) for additional discussion of needed improvements in conducting and reporting this research.

School-Based Interventions for Elementary-School and High-School Settings

As noted above, the majority of school-based alcohol prevention interventions have been conducted in middle schools. By comparison, far fewer interventions have been developed for elementary schools and high schools. In the review by Spoth and colleagues (2008), only one school-based intervention for high-school students could be classified as most promising, and only one could be classified as having mixed or emerging evidence. However, alcohol use is particularly problematic during the high-school years. Nationwide, almost half of high-school seniors report consuming alcohol in the previous month, and one-third were drunk in the last month ( Johnston et al. 2010). Accordingly, sustained intervention throughout high school likely is necessary to maintain any changes in developmental trajectories of alcohol use achieved through interventions delivered in middle school, as was demonstrated by the high-school component of Project Northland ( Perry et al. 2002). Further efforts to curb more problematic patterns of alcohol use, such as binge drinking, also are warranted during this period ( Spoth et al. 2008).

Additional efforts to design, develop, and test school-based interventions for younger age-groups (e.g., "tweens") are needed as well, given that school-based interventions seem to be most efficacious when delivered as a primary prevention program, with the strongest effects found in youth who have not yet begun to experiment with alcohol ( Perry et al. 1996). Early onset of alcohol use during the teen or pre-teen years is of great concern because it can have substantial physical, social, and emotional health consequences for children and adolescents (e.g., Ellickson et al. 2003; Grant and Dawson 1997), including impairment of key brain functions and development ( Squeglia et al. 2009). Of note, a large proportion of young adolescents use or begin to use alcohol before middle school. For example, in Project Northland Chicago, 17 percent of these urban sixth graders had started drinking alcohol before they entered middle school ( Pasch et al. 2009), and the proportion was even higher (i.e., 37 percent) in rural Minnesota, in the original Project Northland; moreover, these students were much less responsive to the intervention than students who had not begun drinking ( Perry et al. 1996). These high rates of early alcohol use make it worthwhile to introduce earlier, universal approaches to alcohol prevention. For example, Spoth and colleagues (2008) suggested intervening in grades 3, 4, and 5; however, none of the existing school-based programs aimed at the later elementary-school years met the criteria for inclusion in their review.

School-Based Interventions for Special Populations

To date, the large majority of school-based interventions have been implemented with primarily White urban and suburban youth. The problem of alcohol use, however, is not limited to these populations. Alcohol use rates among school-going youth often are higher in rural settings, especially rates of binge drinking (i.e., five or more drinks in one sitting in the last 2 weeks) and drunkenness ( Johnston et al. 2010). With respect to ethnic groups, rates of alcohol use among Hispanic eighth graders exceed those of White eighth graders, followed by African Americans ( Johnston et al. 2010). Accordingly, the need for alcohol use prevention interventions tailored for these special populations is great. Although the body of research on this topic is growing, it requires even more attention. As Schinke and colleagues (2000) noted in a Cochrane review, culturally focused interventions may be an especially valuable approach to intervention over the long term. However, additional development and rigorous evaluation of this approach is required ( Foxcroft et al. 2002).

In their review, Spoth and colleagues (2008) identified a few school-based alcohol prevention interventions specifically designed for special populations (e.g., minority youth, rural youth) with promising or emerging evidence. For example, keepin' it REAL is a culturally grounded alcohol prevention program developed for and tested in Mexican and Mexican-American middle-school students ( Hecht et al. 2003; Kulis et al. 2005). Instead of "translating" an existing school-based program originally designed for majority youth for use in this population, Hecht and colleagues (2003) crafted a successful program grounded from the beginning in ethnic norms and values. Their multicultural version, based on Latino, European-American, and African-American norms and values, was especially effective at reducing alcohol use over time ( Kulis et al. 2005). Approaches like these that influence the deeper structure of an intervention might be necessary to effectively meet the needs of special populations as additional efforts are considered and subsequently undertaken to adapt existing evidence-based interventions for use in nonmajority, understudied groups.

Efforts to date to translate or adapt existing evidence-based interventions for special populations and settings have produced mixed results ( Spoth et al. 2008). For example, the adaptation of Project Northland for use with a multiethnic population in Chicago was unsuccessful at changing alcohol use behaviors among those urban middle-school youth ( Komro et al. 2008), even though the adaptation included not only surface-structure changes (e.g., changes in text and graphics) but also the deep-structure changes (e.g., incorporating culturally specific values and norms) alluded to above ( Komro et al. 2004; Resnicow et al. 1999). The original Project Northland in Minnesota had pursued a more proximal approach to intervention, with staff who were housed at the schools and with special emphasis given to school- and after-school-based activities, supplemented with parental involvement ( Perry et al. 1996). The Chicago adaptation, in contrast, placed more emphasis on more distal intervention strategies, using staff who were housed in the community and emphasizing community organization to reduce access to alcohol ( Komro et al. 2008). The results achieved with the two variants of the intervention suggest that in middle-school school students may require a more focused, hands-on approach to alcohol prevention. On the other hand, the Chicago implementation may have been less successful because alcohol use was less of a concern or priority in this population ( Komro et al. 2008). Thus, in the Minnesota sample, alcohol use was the most serious problem found in the region of the State where the intervention was implemented ( Perry et al. 1996), whereas in the Chicago sample other concerns (e.g., regarding other drugs or violence) were more prominent. Therefore, community needs, priorities, and readiness-as well as the question of how these can be shaped successfully-need to be considered carefully as translation research unfolds.

A final program worthy of note is Drug Abuse Resistance Education (D.A.R.E.). Although reviews of this program consistently show that it has little if any impact on alcohol and drug use ( Ennett et al. 1994), it continues to be widely used across the United States. To capitalize on the powerful dissemination mechanism of the D.A.R.E. program, Perry and colleagues (2003) developed and evaluated D.A.R.E. Plus, which was successful in reducing tobacco and alcohol use among boys. These positive outcomes were attributed to the "Plus" components, such as peer leadership, parental education, and neighborhood involvement, because the D.A.R.E. program alone did not demonstrate these outcomes ( Perry et al. 2003).

Conclusion

Alcohol remains the drug of choice among America's adolescents, with rates of current (i.e., past 30-day) use that are more than double those of cigarette smoking and rates of annual use that far exceed the use of marijuana and other illicit drugs ( Johnston et al. 2010). Because alcohol use is more prevalent, and thus more normative, it remains more resistant to change than these other types of drug use. As a consequence, reducing underage alcohol use will require sustained intervention across adolescence, with added attention given to special populations for which effective interventions are not yet available. School-based interventions can be an effective approach to prevention, at least in the short term ( Komro and Toomey 2002; Spoth et al. 2008, 2009). But because alcohol use currently is so normative among both adolescents and adults in the United States, comprehensive interventions that address multiple domains of a young person's social environment-including the family, school, and community-likely will be required to substantially alleviate this problem in the long term. Given the predominance of school in the lives of youth, using schools as a central coordinating institution for primary prevention and linking them to families, worksites, media, and community policies is an efficient public health approach to alcohol use prevention that also can be efficacious.

Footnotes
Financial Disclosure
The authors declare that they have no competing financial interests.

References

Hawkins JD, Catalano RF, Morrison DM, et al. The Seattle Social Development Project: Effects of the first four years on protective factors and problem behaviors. In: McCord J, Tremblay RE, editors. Preventing Antisocial Behavior: Interventions From Birth Through Adolescence. New York: Guilford Press; 1992. pp. 139-162. [Google Scholar]

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School-Based Programs to Prevent and Reduce Alcohol Use among Youth

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Schools are an important setting for interventions aimed at preventing alcohol use and abuse among adolescents. A range of school-based interventions have been developed to prevent or delay the onset of alcohol use, most of which are targeted to middle-school ...

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Harvey, J., Chadi, N., & Canadian Paediatric Society, Adolescent Health Committee (2016). Preventing smoking in children and adolescents: Recommendations for practice and policy. Paediatrics & child health.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4934164/
This journal called Preventing Smoking in children and adolescents from Pediatrics and Child Health  is aimed at informing people of the key responsibilities in preventing tobacco use among youth and their families, and that they  need to know more about effective smoking prevention and cessation strategies. Clinicians need to integrate tobacco counseling into health assessments of teenagers and be aware of the roles that families, communities and governments can play in promoting tobacco-free environments.This gives teachers an idea of the responsibility they have on informing kids of tobacco use and how they need to be informed of all the different types of ways it can affect your health.

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Language: English | French

Abstract

Canada has witnessed a general decrease in smoking prevalence among all age groups in recent years. However, despite large numbers of campaigns and interventions, thousands of young Canadians continue to initiate cigarette smoking every year. The increasing popularity of alternative tobacco products and e-cigarettes is also creating new health challenges. Research has shown that the deleterious effects of nicotine and cigarette smoke are significant and long lasting. Health care professionals have key responsibilities in preventing tobacco use among youth and their families, and need to know more about effective smoking prevention and cessation strategies. Clinicians need to integrate tobacco counselling into health assessments of teenagers and be aware of the roles that families, communities and governments can play in promoting tobacco-free environments. Information, effective strategies and opportunities for health care professionals to intervene and advocate for Canadian adolescents are discussed.

Keywords: Adolescents, Children, Counselling, Nicotine, Prevention, Smoking

Résumé

Ces dernières années, le Canada a connu une diminution générale de la prévalence de tabagisme dans tous les groupes d'âge. Cependant, malgré les multiples campagnes et interventions, des milliers de jeunes Canadiens commencent encore à fumer chaque année. La popularité croissante d'autres produits du tabac et de la cigarette électronique (vapoteuse) engendre d'ailleurs de nouveaux enjeux en matière de santé. D'après les recherches, les effets délétères de la nicotine et de la fumée du tabac sont prononcés et persistants. Les professionnels de la santé ont un rôle essentiel à jouer pour prévenir le tabagisme chez les enfants, les adolescents et leur famille, et ils doivent mieux connaître les stratégies efficaces de prévention du tabagisme et d'abandon du tabac. Les cliniciens doivent intégrer les conseils sur le tabagisme à leur évaluation de santé des jeunes et être conscients du rôle des familles, des communautés et des gouvernements dans la promotion de milieux sans tabac. L'information que les professionnels de la santé doivent connaître, les stratégies efficaces qu'ils peuvent utiliser et les occasions d'intervenir et de défendre les intérêts des adolescents canadiens qu'ils peuvent saisir sont présentées.
Français en page 215
Cigarette smoking remains the number one preventable cause of death worldwide, killing almost six million people each year.( 1) In 2013, 14.6% of Canadians >15 years of age (about 4.2 million people) were active smokers. About 15% of Canadian children are exposed to second-hand smoke in their homes.( 2)

Canadian smoking rates have been steadily decreasing in all age groups since the early 1990s, but now seem to be stabilizing. Therefore, tobacco use and second-hand tobacco smoke exposure are still critical national health concerns. Smoking kills more than 37,000 Canadians each year - six times more than vehicle collisions, suicides, homicides and AIDS combined. Also, with the increasing popularity of electronic (e-)cigarettes, nicotine dependence remains an important and timely topic. For more information, see the CPS statement "E-cigarettes: Are we renormalizing public smoking?": www.cps.ca/en/documents/position/e-cigarettes.

Strategies to prevent smoking initiation in children and adolescents are reviewed in the present position statement, with focus on interventions that can be performed in the health care setting. Approaches to managing smoking cessation in adolescents are discussed in the practice point "Strategies to promote smoking cessation among adolescents", also published in this issue.

IMPORTANCE: PERSONAL AND PUBLIC HEALTH CONCERNS

It is well known that tobacco use increases the risk for contracting a variety of diseases and health conditions, including lung, bladder, colorectal, esophageal, kidney, larynx, mouth, throat and other cancers, respiratory infections, diabetes and coronary heart disease. Risk levels increase steadily with the number of packs of cigarettes smoked,( 3) along with cumulative toxic effects on microvasculature that contribute to hair loss, skin wrinkling and the risk for erectile dysfunction.( 4) The negative effects of tobacco use during pregnancy are discussed in the CPS position statement "Use and misuse of tobacco among Aboriginal peoples": www.cps.ca/documents/position/tobacco-aboriginal-people.

Campaigns to inform the public of these risks, combined with smoking legislation regulating age of access and smoking in public places, have led to a general decrease in smoking prevalence among all age groups in Canada. Despite these efforts, thousands of young Canadians continue to take up smoking every year.

PRODUCTS AND PREVALENCE

The most recent data on tobacco use in Canadian provinces are based on national surveys conducted by Health Canada and Statistics Canada in 2013, which excluded the territories:( 5)

Smoking prevalence increased with age: 2% of youth in grades six to nine were smoking, 11% at 15 to 19 years of age, 18% at 20 to 24 years of age, and 19% at 25 to 34 years of age.

Smoking rates in teens 15 to 19 years of age were two to three times lower than in 1999.

Smoking rates among teens 15 to 19 years of age were highest in Quebec (13.9%) and lowest in Alberta (8.8%).

There were more male than female smokers (13.2% versus 8.1%). Both genders tended to smoke approximately the same number of cigarettes per day.

Six out of ten smokers 15 to 19 years of age were seriously considering quitting in the next six months, and more than one-half (57%) had made an attempt to quit in the previous 12 months. These numbers have been relatively stable over the past 15 years.

It is also known from other sources that sexual minority youth (LGBTQ) and Aboriginal/Indigenous youth have smoking rates that are up to five times higher than other adolescents.( 6, 7)

Other forms of tobacco

While other forms of inhaled tobacco have been present for decades (), the recent increase in popularity of e-cigarettes is rapidly changing the way teenagers interact with tobacco products. The health risks of e-cigarettes compared with traditional cigarettes are not yet clearly known, but the potential for accidental nicotine poisoning in infants and young children is well established.( 8)

Smokeless tobacco is often perceived as being 'safer' or less addictive than cigarettes by teenagers and adults alike, but a growing body of evidence contradicts such beliefs.( 9) Some new forms of smokeless tobacco look like candy or 'breath-strips', making them attractive to children. Some alternative tobacco products actually deliver more nicotine than cigarettes, increasing the potential for addiction and nicotine poisoning. In addition to the health risks associated with tobacco smoking, smokeless tobaccos have a direct effect on the mouth, causing bad breath, dental problems, increased risk of ear, nose and throat cancers (eg, involving the lips, tongue, cheeks and throat) and leukoplakia.( 10)

Alternative tobacco product use varies widely among provinces, ranging from 18% to 35% for cigarillos, 11% to 19% for cigars, 8% to 17% for water pipes and 6% to 11% for chewing tobacco.( 5) The first national data set on e-cigarette use in Canada revealed that in 2013, 20% of youth 15 to 19 years of age had tried e-cigarettes, compared with 20.2% for traditional cigarettes. It is speculated that more teenagers will soon be smoking e-cigarettes than traditional cigarettes, a particularly worrisome possibility considering current gaps in municipal, provincial/territorial and federal regulation for e-cigarette use and promotion.( 11)

FACTORS CONTRIBUTING TO SMOKING INITIATION

Many factors contribute to smoking initiation in teenagers but the two leading contributors are access to tobacco and individual attitudes and beliefs about smoking, which often arise from the environment.

Access to tobacco

Current Canadian data reveal that although most smokers in grades six to nine obtain their cigarettes within their social network,( 5) over one-quarter (28%) still buy their cigarettes at a store, despite legislation fixing the legal age to purchase cigarettes at either 18 or 19 years, depending on the province.

A higher proportion of youth smokers 15 to 18 years of age buy their cigarettes in stores themselves, while almost one-half (44%) receive them for free from family, friends or other people. Of note, a substantial percentage in this age group (16%) report getting their cigarettes from 'other' sources, which include cigarettes purchased from friends and contraband suppliers. In fact, in the 2006/2007 Youth Smoking Survey, 13% of daily smokers reported that their main source of cigarettes was contraband. Contraband sources account for 18% of cigarettes smoked daily by teens in Canada, with figures exceeding 25% in Quebec and Ontario.( 12) In one Health Canada analysis, contraband cigarettes were shown to contain ingredients and a nicotine content similar to legal cigarettes.( 13) Of particular concern is that contraband cigarettes are purchased at a lower cost (ie, minus the tax), rendering them more affordable for youth with limited financial means, and undermining legal controls, which are a proven method for reducing adolescent smoking.

Environmental risk factors

The two strongest factors associated with smoking initiation in children and adolescents are parental smoking and parental nicotine dependence.( 14) Certain attitudes and beliefs related to cigarette smoking are also important predictors of smoking initiation,( 15- 22) along with independent factors listed in .

IMPACTS OF TEEN SMOKING

Nicotine addiction

Nicotine is a highly addictive substance and youth are particularly vulnerable to becoming addicts compared with adults. In fact, studies have shown that teenagers develop nicotine addiction at much lower levels of consumption than adults, making smoking cessation potentially more difficult for this population.( 15) Many adolescents develop a higher tolerance to nicotine and experience withdrawal symptoms (signalling dependence) after only days or weeks of exposure.( 23)

Early nicotine dependence is an important factor in determining which individuals become regular smokers after experimentation.( 24) Interestingly, while some studies have demonstrated that adolescents usually experience less severe withdrawal symptoms than adults,( 25) withdrawal symptoms can appear sooner, sometimes after smoking only a few cigarettes. Also, data from a 12-year Canadian longitudinal cohort investigation suggest that:( 26)

One-fifth of young adolescents who smoke weekly experience symptoms of nicotine dependence.

Craving, which is often the first symptom of nicotine dependence, can emerge three months to four months after taking the first puff of cigarette smoke.

About 18 months after smoking their first whole cigarette, one-quarter of young smokers have lost confidence in their ability to quit.

NICOTINE'S EFFECT ON THE ADOLESCENT BRAIN

Several studies looking at the impacts of early smoking initiation on the developing teenage brain have shown that nicotine induces persistent changes in neural connectivity in several brain areas, including the nucleus accumbens, the medial prefrontal cortex and the amygdala, all of which are involved with emotion regulation.( 27) Adolescent smokers appear to be more sensitive to the rewarding effects of nicotine. They are also vulnerable to nicotine-elicited changes on synaptic interconnections, leading to higher risks for addiction and affective disorders in adulthood.( 28)

Chronic nicotine use in adolescence has also been shown to induce epigenetic changes that sensitize the brain to other drugs and increase the risks for future substance use.( 29) Important individual differences appear to exist, such that some adolescents are at higher risk than others for smoking initiation, maintenance and nicotine-related neurological effects.( 30) Studies conducted in animals suggest that nicotine consumption in adolescence increases impulsivity and decreases attention performance in the long term.( 31) Many questions remain unanswered but health care providers should inform young smokers that the effects of nicotine on the adolescent brain are deleterious and long-lasting.

CHRONIC ILLNESSES

Youth with a chronic illness often smoke despite their greater vulnerability to the adverse health effects of smoking. It is well known that smoking carries important and specific health risks, not only for young people with respiratory disorders such as asthma and cystic fibrosis, but also those with conditions such as sickle cell disease, cancer, diabetes mellitus and juvenile arthritis. summarizes disease-specific health risks and can be used to guide counselling in youth with these conditions.

TABLE 3

Chronic illness

Potential disease-specific health consequences

Asthma

Increased frequency and severity of exacerbations, medication use, hospitalization and risk of respiratory arrest

Cystic fibrosis

Increased frequency and severity of bacterial lung infections and hospitalization; accelerated decline in lung function and lower nutritional status

Juvenile idiopathic arthritis

Greater disease severity, higher risks for cardiovascu- lar disease and premature death, and exacerbation of osteopenia

Cancer

Greater risks from several cancer treatments, for respiratory infections when immunosuppressed, and exacerbated mucositis

Sickle cell disease

Increased risk of acute chest syndrome and possible increased risk of stroke

Diabetes mellitus

Accelerated cardiovascular and peripheral vascular disease, including atherosclerosis, retinopathy and nephropathy. Smoking increases the morbidity and mortality of type 1 diabetes by 50% to 75%.

INTERVENTIONS THAT WORK

Smoking prevention in the primary care setting

Health care encounters in paediatric offices should include a screen for sources of tobacco exposure for every child seen. There is adequate evidence to recommend that primary care clinicians provide interventions, including education and brief counselling, to prevent initiation of tobacco use in school-age children and adolescents.( 14, 32) Counselling interventions can take many forms, including:

Face-to-face encounters

Phone interactions with a health care provider

Providing printed materials in person, by mail, or by e-mail

Guidance to computer applications or Internet sources that are known to be effective

Counselling can help counter or address an adolescent's attitudes, beliefs and knowledge about smoking and its consequences, especially when they are mistaken or influenced by social or environmental factors, such as tobacco marketing. Counselling can also strengthen the development of social competence and social skills, thus helping youth to decline cigarettes.

GUIDANCE FOR PARENTS AND FAMILIES

Smoking and exposure to second-hand smoke are harmful at all stages of life, starting before birth. Some health effects can last a lifetime, and parents and caregivers should be made aware of health risks and ways to reduce or avoid them. Guidance for parents and families must be personalized to age and context and provide messaging that is specifically meaningful for them. For prevention to be successful, the health care provider's focus should be family-centred. Rather than concentrating on preventing smoking initiation in a child or youth, consider informing parents about the positive effects of smoking cessation during pregnancy and the first years of their child's life.( 16) lists key elements to be included in a brief counselling intervention conducted with parents and youth. Emphasize the immediate negative effects of smoking when counselling children and adolescents, because long-term consequences tend to be less meaningful for younger age groups.

TABLE 4

Parents

Risks associated with second-hand smoke on children and other household members:

Prematurity

Stillbirth

Sudden infant death syndrome (SIDS)

Effects on fetal brain development

Asthma, colds, pneumonia and ear infections (even when parents do not smoke indoors)

Acquired heart disease

Becoming smokers (even when parents tell children not to start)

Long-term health risks:

School age (5 to 11 years)

Negative effects and consequences of smoking:

Yellow teeth

Harder to keep up during active games or sports

Smoking just a few times can get your body hooked so that it is harder to stop

Cigarettes are expensive. Smokers spend money on cigarettes that they could use for more fun things

Tobacco companies use ads to trick you into thinking that smoking is cool and safe

Smoking has long-term effects on health, including several types of cancer and heart attacks

It is illegal to buy cigarettes when you are underage

Adolescents

Immediate effects of smoking

Cosmetic effects (smell, bad breath, yellow teeth, early wrinkles)

Poorer endurance and athletic performance

Hacking coughs, more colds and pneumonias

You can get addicted to tobacco after smoking as few as 100 cigarettes

Cigarette smoking is expensive. The cost of buying one pack a day for a year could buy a used car (between $1500 and $3500)

When you smoke you might be 'under the influence' of marketing from tobacco companies

Long-term health consequences:

Selected long-term health risks listed for parents (above)

Alternative forms of tobacco (eg, snuff, e-cigarettes) may not be safer than cigarettes

Smoking exposes friends and family (including babies) to harm from second-hand smoke

According to one Cochrane review published in 2015, there is evidence of moderate quality that family-based interventions have a positive impact on preventing smoking in children and adolescents.( 33) Authoritative parenting, where parents show a strong interest in caring for their adolescent combined with rule-setting, is a key feature of effective interventions with this age group.

SCHOOLS AND COMMUNITIES

Another Cochrane review published in 2013 examined the effectiveness of school-based programs in smoking prevention.( 34) The study demonstrated that school-based interventions were effective in reducing long-term smoking rates including, notably, an average 12% reduction in students who start to smoke compared with control groups. The most effective interventions targeted both social competence and social skills development (social influences). Studies that looked at information-only strategies, multimodal interventions (ie, combining initiatives within and beyond school) or that target only social influences, did not show significant results.

One overview of community-based interventions to prevent smoking in young people concluded that the evidence supporting their effectiveness in reducing teen smoking initiation was weak. Nevertheless, there also appeared to be a significant positive short- and long-term impact on teen smoking initiation in a number of studies.( 35)

GOVERNMENTS

There is growing evidence to support the effectiveness of government legislation and initiatives to prevent smoking initiation in young people.( 15) In Canada, the Tobacco Act, passed in 1997, and its amendment, Bill C-32, passed in 2009, provide the basis for federal tobacco regulations.( 36) Provincial/territorial regulatory laws and municipal regulations are also in force. Consensus is growing that some of the most effective measures to reduce teenage smoking rates are already mandated in Canada. They include:

High taxation rates: Making tobacco products less affordable by raising taxes on tobacco products.( 37)

Labelling disincentives: Using explicit photos and smoking-associated health warnings on all tobacco products, packages and labelling.( 38)

Restricted marketing and sales: Banning point-of-sale displays, advertising to minors and the sponsorship of public events by tobacco companies.

Smoke-free spaces: Smoking bans in public places such as schools, child care centres, workplaces, hospitals, restaurants, hotels and parks, as well as in public transportation and cars transporting minors.( 39)

Increasing evidence also supports the effectiveness of mass media campaigns by governmental and nongovernmental agencies, including signage, advertising, social media and the Internet.( 40) For optimal effectiveness, studies show that population-based interventions should be culturally appropriate and designed to appeal to minority groups, particularly Aboriginal youth( 41) and the LGBTQ community, both of whom have higher than average smoking rates.( 42)

RECOMMENDATIONS

To help prevent smoking initiation in young people, health care providers should:

Ask children, youth and families about tobacco use and exposure and provide age-appropriate information and counselling to prevent initiation as part of routine health care.

Use the '5A's' method to counsel smoking cessation. For details, see the practice point "Strategies to promote smoking cessation among adolescents", published in this issue.

Stay aware of research on pharmaceutical cessation interventions for teens and adults and prescribe effective medications as indicated, in combination with counselling.

Advocate for medical schools and residency programs to address smoking prevention and cessation as a part of their core curriculums.

Schools and communities should:

Legislate bans on smoking for all school and public properties and enforce such laws among school personnel and public sector workers.

Educate students and families on the negative health consequences of tobacco use as part of elementary and high school curriculums, and in tandem with public programming.

Offer regular programs to screen and counsel for smoking cessation.

All levels of government should:

Continue to adopt and enforce laws and regulations that limit tobacco access for minors, including e-cigarettes and alternative tobacco products.

Legislate a universal ban on smoking in cars where youth younger than 18 years of age are passengers.

Continue to regulate tobacco advertising and packaging, and specifically control newer tobacco products aimed at minors.

Implement strict penalties for any establishment or individual selling contraband cigarettes.

Make all tobacco products less affordable by taxing them prohibitively.

Provide confidential access to and coverage for smoking cessation therapies, including medications under provincial/territorial health plans.

Fund and encourage research on the effects of tobacco use in youth and into smoking prevention and cessation interventions that work.

Acknowledgments

This position statement has been reviewed by the Community Paediatrics, Drug Therapy and Hazardous Substances, and First Nations, Inuit and Métis Health Committees of the Canadian Paediatric Society.

Footnotes
CPS ADOLESCENT HEALTH COMMITTEE
Members: Giuseppina Di Meglio MD, Johanne Harvey MD (past member), Natasha Johnson MD, Margo Lane MD (Chair), Karen Leis MD (Board Representative), Mark Norris MD, Gillian Thompson NP-Paediatrics

Liaison: Christina Grant MD, CPS Adolescent Health Section

Principal authors: Johanne Harvey MD, Nicholas Chadi MD

The recommendations in this statement do not indicate an exclusive course of treatment or procedure to be followed. Variations, taking into account individual circumstances, may be appropriate. All Canadian Paediatric Society position statements and practice points are reviewed on a regular basis. Retired statements are removed from the website. Please consult the Position Statements section of the CPS website ( www.cps.ca) for the full-text, current version.

REFERENCES

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Preventing smoking in children and adolescents: Recommendations for practice and policy

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Language: English | French Canada has witnessed a general decrease in smoking prevalence among all age groups in recent years. However, despite large numbers of campaigns and interventions, thousands of young Canadians continue to initiate cigarette smoking every year. The increasing popularity of alternative tobacco products and e-cigarettes is also creating new health challenges.

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Melinda Smith, M.A., Lawrence Robinson, and Jeanne Segal, Ph.D. (2019). Child Abuse and Neglect. HelpGuide.
https://www.helpguide.org/articles/abuse/child-abuse-and-neglect.htm
This article is about the difference between myths and facts on ways to look for signs of child abuse. it explains ways to recognize the different types of abuse such as emotional abuse, child neglect, physical abuse, and sexual abuse. This is a good article for teachers for them to learn about the warning signs and for how to be aware of them. It also explains ways in how to help a child dealing with this.

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What is child abuse and neglect?

Child abuse isn't just about black eyes. While physical abuse is shocking due to the marks it leaves, not all signs of child abuse are as obvious. Ignoring a child's needs, putting them in unsupervised, dangerous situations, exposing them to sexual situations, or making them feel worthless or stupid are also forms of child abuse and neglect-and they can leave deep, lasting scars on kids.

Regardless of the type of abuse, the result is serious emotional harm. But there is help available. If you suspect a child is suffering from abuse or neglect, it's important to speak out. By catching the problem as early as possible, both the child and the abuser can get the help they need.

To start, it's important to separate the myths from the facts about child abuse and neglect:

Myths and facts about child abuse and neglect

Effects of child abuse and neglect

All types of abuse and neglect leave lasting scars. Some of these scars might be physical, but emotional scarring has long lasting effects throughout life, damaging a child's sense of self, their future relationships, and ability to function at home, work and school.

The effects of abuse and neglect on a child include:

Lack of trust and relationship difficulties. If you can't trust your parents, who can you trust? Without this base, it is very difficult to learn to trust people or know who is trustworthy. This can lead to difficulty maintaining relationships in adulthood. It can also lead to unhealthy relationships because the adult doesn't know what a good relationship is.

Core feelings of being "worthless." If you've been told over and over again as a child that you are stupid or no good, it is very difficult to overcome these core feelings. As they grow up, abused kids may neglect their education or settle for low-paying jobs because they don't believe they are worth more. Sexual abuse survivors, with the stigma and shame surrounding the abuse, often struggle with a feeling of being damaged.

Trouble regulating emotions. Abused children cannot express emotions safely. As a result, the emotions get stuffed down, coming out in unexpected ways. Adult survivors of child abuse can struggle with unexplained anxiety, depression, or anger. They may turn to alcohol or drugs to numb out the painful feelings.

Recognizing the different types of child abuse

Abusive behavior comes in many forms, but the common denominator is the emotional effect on the child. Whether the abuse is a slap, a harsh comment, stony silence, or not knowing if there will be dinner on the table, the end result is a child that feels unsafe, uncared for, and alone.

Emotional abuse

Contrary to some people's beliefs, words can hurt and emotional abuse can severely damage a child's mental health or social development. Examples of emotional abuse include:

Constant belittling, shaming, and humiliating.

Calling names and making negative comparisons to others.

Telling a child they're "no good," "worthless," "bad," or "a mistake."

Frequent yelling, threatening, or bullying.

Ignoring or rejecting a child as punishment, giving them the silent treatment.

Limiting physical contact with a child-no hugs, kisses, or other signs of affection.

Exposing a child to violence against others, whether it is against the other parent, a sibling, or even a pet.

Child neglect

Neglect-a very common type of child abuse-is a pattern of failing to provide for a child's basic needs, which include adequate food, clothing, hygiene, or supervision.

Child neglect is not always easy to spot. Sometimes, a parent might become physically or mentally unable to care for a child, such as in cases of serious illness or injury, or untreated depression or anxiety. Other times, alcohol or drug abuse may seriously impair judgment and the ability to keep a child safe.
[Read: Alcoholism and Alcohol Abuse]
Physical abuse

This involves physical harm or injury to the child. It may be the result of a deliberate attempt to hurt the child or excessive physical punishment. Many physically abusive parents insist that their actions are simply forms of discipline-ways to make children learn to behave. But there is a big difference between using physical punishment to discipline and physical abuse.

With physical abuse, the following elements are present:

Unpredictability. The child never knows what is going to set the parent off. There are no clear boundaries or rules. The child is constantly walking on eggshells, never sure what behavior will trigger a physical assault.

Lashing out in anger. Abusive parents act out of anger and the desire to assert control, not the motivation to lovingly teach the child. The angrier the parent, the more intense the abuse.

Using fear to control behavior. Abusive parents may believe that their children need to fear them in order to behave, so they use physical abuse to "keep their child in line." However, what children are really learning is how to avoid being hit, not how to behave or grow as individuals.

Sexual abuse

Child sexual abuse is an especially complicated form of abuse because of its layers of guilt and shame. It's important to recognize that sexual abuse doesn't always involve body contact. Exposing a child to sexual situations or material is sexually abusive, whether or not touching is involved.
[Read: Recovering from Rape and Sexual Trauma]

Sexually abused children are often tormented by shame and guilt. They may feel that they are responsible for the abuse or somehow brought it upon themselves. This can lead to self-loathing and sexual and relationship problems as they grow older.

The shame of sexual abuse makes it very difficult for children to come forward. They may worry that others won't believe them, will be angry with them, or that it will split their family apart. Because of these difficulties, false accusations of sexual abuse are not common, so if a child confides in you, take them seriously.

Warning signs of child abuse and neglect

The warning signs that a child is being abused or neglected can vary according to the type of abuse inflicted.

Warning signs of emotional abuse

The child may:

Be excessively withdrawn, fearful, or anxious about doing something wrong.

Show extremes in behavior (extremely compliant, demanding, passive, aggressive).

Not seem to be attached to the parent or caregiver.

Act either inappropriately adult (taking care of other children) or inappropriately infantile (thumb-sucking, throwing tantrums).

Warning signs of physical abuse

The child may:

Have frequent injuries or unexplained bruises, welts, or cuts. Their injuries may appear to have a pattern such as marks from a hand or belt.

Be always watchful and "on alert," as if waiting for something bad to happen.

Shy away from touch, flinch at sudden movements, or seem afraid to go home.

Wear inappropriate clothing to cover up injuries, such as long-sleeved shirts on hot days.

Warning signs of child neglect

The child may:

Wear ill-fitting, filthy, or inappropriate clothing for the weather.

Have consistently bad hygiene (unbathed, matted and unwashed hair, noticeable body odor).

Have untreated illnesses and physical injuries.

Be frequently unsupervised or left alone or allowed to play in unsafe situations.

Be frequently late or missing from school.

Warning signs of sexual abuse in children

The child may:

Have trouble walking or sitting.

Display knowledge of sexual acts inappropriate for their age, or even exhibit seductive behavior.

Make strong efforts to avoid a specific person, without an obvious reason.

Not want to change clothes in front of others or participate in physical activities.

Have an STD or pregnancy, especially if they're under the age of 14.

Try to run away from home.

Risk factors for child abuse and neglect

While abuse and neglect occurs in all types of families, children are at a much greater risk in certain situations.

Domestic violence. Even if the abused parent does their best to protect their children, domestic violence is still extremely damaging. Getting out is the best way to help your children.
[Read: Domestic Violence and Abuse]
Alcohol and drug abuse. Parents who are drunk or high may be unable to care for their children, make good parenting decisions, or control often-dangerous impulses. Substance abuse can also lead to physical abuse.

Untreated mental illness. Parents who are suffering from depression, an anxiety disorder, bipolar disorder, or another mental illness may have trouble taking care of themselves, much less their children. A mentally ill or traumatized parent may be distant and withdrawn from their children, or quick to anger without understanding why. Treatment for the caregiver means better care for the children.

Lack of parenting skills. Some caregivers never learned the skills necessary for good parenting. Teen parents, for example, might have unrealistic expectations about how much care babies and small children need. Or parents who were themselves victims of child abuse may only know how to raise their children the way they were raised. Parenting classes, therapy, and caregiver support groups are great resources for learning better parenting skills.

Stress and lack of support. Parenting can be a very time-intensive, stressful job, especially if you're raising children without support from family and friends, or you're dealing with relationship problems or financial difficulties. Caring for a child with a disability, special needs, or difficult behaviors is also a challenge. It's important to get the support you need, so you are emotionally and physically able to support your child.

Recognizing abusive behavior in yourself

Raising children is one of life's greatest challenges and can trigger anger and frustration in the most even-tempered parent or guardian. If you grew up in a household where screaming and shouting or violence was the norm, you may not know any other way to raise your kids.

Recognizing that you have a problem is the biggest step to getting help. The following are warning signs that you may be crossing the line into abuse:

You can't stop your anger. What starts as a swat on the backside may turn into multiple hits getting harder and harder. You may shake your child more and more and finally throw them down. You find yourself screaming louder and louder and can't stop yourself.
[Read: Anger Management]
You feel emotionally disconnected from your child. You may feel so overwhelmed that you don't want anything to do with your child. You just want to be left alone and for your child to be quiet.

Meeting the daily needs of your child seems impossible. While everyone struggles with balancing dressing, feeding, and getting kids to school or other activities, if you continually can't manage to do it, it's a sign that something might be wrong.

Other people have expressed concern. It may be easy to bristle at other people expressing concern. However, consider carefully what they have to say. Are the words coming from someone you normally respect and trust?

Breaking the cycle of abuse

If you have a history of child abuse, having your own children can trigger strong memories and feelings that you may have repressed. You may be shocked and overwhelmed by your anger, and feel like you can't control it. But you can learn new ways to manage your emotions and break your old patterns.

Remember, you are the most important person in your child's world - and you don't have to go it alone. Help and support are available:

Learn what is age appropriate and what is not. Having realistic expectations of what children can handle at certain ages will help you avoid frustration and anger at normal child behavior. For example, newborns are not going to sleep through the night without a peep, and toddlers are not going to be able to sit quietly for extended periods of time.

Develop new parenting skills. Start by learning appropriate discipline techniques and how to set clear boundaries for your children. Parenting classes, books, and seminars offer this information. You can also turn to other parents for tips and advice.

Take care of yourself. If you are not getting enough rest and support or you're feeling overwhelmed, you are much more likely to succumb to anger. Sleep deprivation, common in parents of young children, adds to moodiness and irritability-exactly what you are trying to avoid.

Learn to control your emotions. If you were abused or neglected as a child, you may have an especially difficult time getting in touch with your range of emotions. You may have had to deny or repress them as a child, and now they spill out without your control. HelpGuide's free Emotional Intelligence Toolkit can help.

Get professional help. Breaking the cycle of abuse can be very difficult if the patterns are strongly entrenched. If you can't seem to stop yourself no matter how hard you try, it's time to get help, whether in the form of therapy, parenting classes, or other interventions. Your children will thank you for it.

How to help an abused or neglected child

What should you do if you suspect that a child is being abused? Or if a child confides in you? It's normal to feel a little overwhelmed and confused. Child abuse is a difficult subject that can be hard to accept and even harder to talk about-for both you and the child. When talking with an abused child, the best way to encourage them is to show calm reassurance and unconditional support. If you're having trouble finding the words, let your actions speak for you.

Avoid denial and remain calm. A common reaction to news as unpleasant and shocking as child abuse is denial. However, if you display denial to a child, or show shock or disgust at what they are saying, the child may be afraid to continue and will shut down. As hard as it may be, remain as calm and reassuring as you can.

Don't interrogate. Let the child explain to you in their own words what happened, but don't interrogate the child or ask leading questions. This may confuse and fluster the child and make it harder for them to continue their story.

Reassure the child that they did nothing wrong. It takes a lot for a child to come forward about abuse. Reassure them that you take what they said seriously, and that it is not their fault.

Safety comes first. If you feel that your safety or the safety of the child would be threatened if you tried to intervene, leave it to the professionals. You may be able to provide more support later.

Reporting child abuse or neglect

If you suspect that a child is undergoing abuse, it's critical to report it-and to continue reporting each separate incidence if it continues to recur. Each report you make is a snapshot of what's going on in the family. The more information you can provide, the better the chance of the child getting the help they deserve. Of course, it's normal to have some reservations or worries about reporting child abuse.

Overcoming worries about reporting child abuse or neglect

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Do you know what the warning signs of child abuse are? Learn how to recognize, prevent and report child abuse.

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Mary L. Gavin (2018, June)  Motivating Kids to Be Active Kids Health from Nemours
https://kidshealth.org/en/parents/active-kids.html
This article about Physical activity from Active Kids Health Magazine by Nemours  is about the benefits of keeping children active. It suggests ways to keep them interested and engaged as well as age appropriate activities for them to participate in. This gives teachers ideas on ways that they can keep their students active.

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Keeping Kids Active

Anyone who's seen kids on a playground knows that most are naturally physically active and love to move around. But what might not be apparent is that climbing to the top of a slide or swinging from the monkey bars can help lead kids to a lifetime of being active.

As they get older, it can be a challenge for kids to get enough daily activity. This can be due to:

increasing demands at school

a feeling among some kids that they aren't good at sports

a lack of active role models

busy working families

And even if kids have the time and the desire to be active, parents may not feel comfortable letting them freely roam the neighborhood as kids did generations ago. So their opportunities to be active might be limited.

In spite of these barriers, parents can teach a love of physical activity and help kids fit it into their everyday lives. Doing so can set healthy patterns that will last into adulthood.

Benefits of Being Active

When kids are active, their bodies can do the things they want and need them to do. Why? Because regular exercise provides these benefits:

strong muscles and bones

healthy weight

decreased risk of developing type 2 diabetes

better sleep

a better outlook on life

Physically active kids also are more likely to be motivated, focused, and successful in school. And mastering physical skills builds confidence at every age.

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What Motivates Kids?

So there's a lot to gain from regular physical activity, but how do you encourage kids to do it? The three keys are:

1. Choosing the right activities for a child's age: If you don't, the child may be bored or frustrated.

2. Giving kids plenty of opportunity to be active: Kids need parents to make activity easy by providing equipment, signing them up for classes or sports teams, and taking them to playgrounds and other active spots.

3. Keeping the focus on fun: Kids won't do something they don't enjoy.

When kids enjoy an activity, they want to do more of it. Practicing a skill - whether it's swimming or riding a tricycle - improves their abilities and helps them feel accomplished, especially when the effort is noticed and praised. These good feelings often make kids want to continue the activity and even try others.

Age-Appropriate Activities

The best way for kids to get physical activity is by incorporating physical activity into their daily routine. Toddlers and preschoolers should play actively several times a day. Children 6 to 17 years should do 60 minutes or more physical activity daily. This can include free play at home, active time at school, and participation in classes or organized sports.

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Age-Based Advice:

Preschoolers: Preschoolers need play and exercise that helps them continue to develop important motor skills - kicking or throwing a ball, playing tag or follow the leader, hopping on one foot, riding a trike or bike with training wheels, or running obstacle courses.

Although some sports leagues may be open to kids as young as 4, organized team sports are not recommended until they're a little older. Preschoolers can't understand complex rules and often lack the attention span, skills, and coordination needed to play sports. Instead of playing on a team, they can work on fundamental skills.

School-age: With school-age kids spending more time in front of screens, the challenge for parents is to help them find physical activities they enjoy and feel successful doing. These can range from traditional sports like baseball and basketball to martial arts, biking, hiking, and playing outside.

As kids learn basic skills and simple rules in the early school-age years, there might only be a few athletic standouts. As kids get older, differences in ability and personality become more apparent. Commitment and interest level often go along with ability, which is why it's important to find an activity that's right for your child. Schedules start getting busy during these years, but don't forget to set aside some time for free play.

Teens: Teens have many choices when it comes to being active - from school sports to after-school interests, such as yoga or skateboarding. It's a good idea to have an exercise plan since it often has to be sandwiched between school and other commitments.

Do what you can to make it easy for your teen to exercise by providing transportation and the necessary gear or equipment (including workout clothes). In some cases, the right clothes and shoes might help a shy teen feel comfortable biking or going to the gym.

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Kids' Fitness Personalities

In addition to a child's age, it's important to consider his or her fitness personality. Personality traits, genetics, and athletic ability combine to influence kids' attitudes toward participation in sports and other physical activities, particularly as they get older.

Which of these three types best describes your child?

1. The nonathlete: This child may lack athletic ability, interest in physical activity, or both.

2. The casual athlete: This child is interested in being active but isn't a star player and is at risk of getting discouraged in a competitive athletic environment.

3. The athlete: This child has athletic ability, is committed to a sport or activity, and likely to ramp up practice time and intensity of competition.

If you understand the concepts of temperament and fitness types, you'll be better able to help your kids find the right activities and get enough exercise - and find enjoyment in physical activity. Some kids want to pursue excellence in a sport, while others may be perfectly happy and fit as casual participants.

The athlete, for instance, will want to be on the basketball team, while the casual athlete may just enjoy shooting hoops at the playground or in the driveway. The nonathlete is likely to need a parent's help and encouragement to get and stay physically active. That's why it's important to encourage kids to remain active even through they aren't top performers.

Whatever their fitness personality, all kids can be physically fit. A parent's positive attitude will help a child who's reluctant to exercise.

Be active yourself and support your kids' interests. If you start this early enough, they'll come to regard activity as a normal - and fun - part of your family's everyday routine.

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Anyone who's seen kids on a playground knows that most are naturally physically active and love to move around. But what might not be apparent is that climbing to the top of a slide or swinging from the monkey bars can help lead kids to a lifetime of being active.

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(2020) Fire Safety for Kids Guide Safety.com
https://www.safety.com/kids-fire-safety/
This article is about at home Fire Safety and ways to keep children and the family safe. It talks about how to plan and implement a fire escape plan as well as many ways to help prevent a fire from happening. As a teacher this is important because not only do you need to inform students on what to do if there is a fire in the school but inform them on how to stay safe if there was a fire in their home or somewhere else.

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Roughly seven people die every day in the U.S. as a result of home fires. Kids under the age of five have a much higher risk of dying in a residential fire compared to children in other age groups, according to the U.S. Fire Administration. In fact, among the thousands of children killed or injured in home fires each year, more than 40 percent are under five years of age.

Young kids aren't as capable of exiting a home or understanding the dangers of fire risks, so parents must take extra precautions to reduce fire risk in the home, including installing fire safety equipment and preparing comprehensive safety and evacuation plans to ensure children escape safely.

Install and test smoke alarms

Three out of five home fire deaths in 2010-2014 occurred in homes with no smoke alarms or no working smoke alarms. And while you can take steps to reduce fire hazards, there's little that can be done to predict and prevent a random wiring malfunction that could lead to a devastating fire. Smoke alarms serve as a first alert, letting your family know there's imminent danger and providing a few moments warning for you to enact your fire safety plan.

If you don't have smoke alarms installed, your local fire department may offer them free or at a reduced cost. You can also opt for wireless alarm systems that are interconnected, sounding all the alarms in the home for better notification of a problem in one area of the home. Those extra few seconds can be enough to save the lives of your young kids.
Follow these recommendations from the U.S. Fire Administration to install or update your home smoke alarms:

Install a smoke alarm on every floor of your home, even the basement.

Install a smoke alarm outside every sleeping area. Ideally, install smoke alarms in every sleeping area, too.

Replace smoke alarms after 10 years.

Also, be sure to test your smoke alarms at least twice annually-some experts advise testing monthly. You should also change the batteries every six months, at minimum, to ensure proper functioning.

Reduce fire threats in the home

It takes about two minutes for a small flame to turn into a life threatening fire and just five minutes for a fire to engulf an entire home, according to Ready.gov. Putting in place fire prevention measures to avoid a home fire altogether is the best fire safety practice.

While prevention isn't a 100 percent guarantee, there are many precautions you can take in your home to reduce fire hazards and keep your kids safe. Follow these recommendations to address common household fire hazards and protect your family from a home fire catching in your home:

Don't overload electric outlets, extension cords or wall sockets. Stringing multiple extension cords together in order to plug several appliances into the same outlet is a bad idea.

Reduce clutter. This is especially important in the kitchen, where dish towels, sponges, paper towels, and other items can catch fire if placed too close to a hot stove. But it's also important in all areas of your home - blankets and clothing piled up against a heat run, for instance, can also pose a fire hazard. As a rule, keep combustible materials at least three feet from the stove burners, and never leave cooking unattended.

Don't leave burning candles unattended. A candle can fall for a multitude of reasons, lighting carpets, curtains or furniture ablaze. This can also happen if a candle is allowed to burn down too low, causing its glass container to break and freeing the flame.

Hide all matches and lighters out of reach of young children. Even responsible children can accidentally light a fire if they encounter a lighter or match and try it out of curiosity. It's best to place these items well out of reach of kids.

Always have multiple working fire extinguishers conveniently located in your home. You should always have a fire extinguisher in the kitchen, for instance, as it's a common location for fires to occur from cooking and other hazards.

Replace circuit breakers with arc-fault circuit interrupters. These gadgets pick up on electrical arcs, usually caused by poor insulation or loose wires or connections, and halt them before they lead to fires.

Replace electrical outlets. Faulty electrical outlets can be a source of home fires, too. If plugs seem to be loose or fall out, the blades inside may have loosened. Loose blades create excessive heat, which can lead to fires.

Give your clothes dryer proper maintenance. Cleaning the lint catcher thoroughly with every load is just the starting point. Over time, lint and other particles can build up in the vent system or dryer cabinet (where the heating element is located) and potentially cause fires. Having your dryer cabinet professionally cleaned every two years can also reduce potential fire risks.

Keep an eye on garage safety. Heated garages pose another threat to your home's safety. If your garage contains a workshop, where even a thin layer of sawdust is present, and a heating appliance - whether a portable kerosene heater, wood stove, coal stove or anything else - there's a fire risk. Sawdust is easily combustible, so employ a heavy-duty vacuum like a Shop Vac to remove as much sawdust as possible.

Don't use really old appliances. A great find in your parent's attic might seem like a money-saver, but old appliances weren't manufactured up to par with modern safety standards. That means a vintage record player is only a nostalgic piece of art if it's unplugged. Otherwise, it's a fire hazard.

Only use portable space heaters certified by the Underwriters Laboratory (UL). It's best not to use portable space heaters at all. But if you must, ensure that it's a certified appliance and keep any combustible objects and materials at least three feet from the appliance. Only use K-1 type kerosene in a kerosene heater, and check with your local authorities to find out if it's legal to use them in your area.

Don't smoke inside, and never smoke indoors where portable oxygen is used. Portable oxygen is 100 percent pure oxygen, making it extremely flammable - in fact, it's explosive and makes fire burn hotter and faster. The air we breathe contains only about 20 percent oxygen. This deadly combination has caused many unfortunate deaths and devastating burns.

Use proper heat sources and conduct regular maintenance. Wood stoves, coal stoves, oil furnaces and any other heat source should be regularly inspected, cleaned and maintained. This reduces the likelihood of dangerous chimney fires. Never use a cooking stove as a heat source in the home.

Create a home fire escape safety plan

Upwards of 75% of U.S. homes do not have a fire escape plan that they practice regularly. Creating a fire escape plan and practicing it with your kids is critical to protecting your family's safety in a fire emergency. Kids as young as age three can typically follow a fire escape plan, according to FEMA. Every child is different, so base your plans on your child's individual abilities. For children younger than three or those not able to adequately follow detailed instructions, you'll need a more comprehensive escape plan.
In addition, FEMA recommends the following steps:

Keep all exits clear of toys and debris.

Draw a diagram of your home and plan two escape routes.

Practice, practice, practice.

Keep children's doors closed. This slows the time it takes for smoke from hallway fires to enter the room, leaving more time for firefighters to rescue young kids.

Have a safe meeting place outside the home. It should be far enough away from the structure that you will be safe if the building collapses, but close enough that your kids can get there easily.

Ready.gov also offers some advice on preparing for a fire before it happens:

Always have two routes of escape from every room. In addition to the door, find an alternate escape route, such as a window that leads to a neighboring roof or a window with a collapsible ladder for escaping from upper-story windows.

Test windows to ensure screens can be removed easily and windows aren't stuck shut from multiple layers of paint or swollen wood frames.

When you practice fire escape plans, do it in the dark or with your eyes closed. Have kids do the same to ensure they can navigate the way out safely and quickly.

During your fire escape practice, use multiple scenarios and practice rescuing infants via multiple methods.

Consider installing an automatic fire sprinkler system in your home, especially if you have an infant or toddler. These devices detect fires and activate sprinklers, which can help douse flames and provide a few extra critical minutes or seconds to evacuate the home.

Tips to teach your kids about fire safety

There are a few things that are critically important to teach young kids about fire safety, in addition to planning and practicing a fire escape route:

The Stop, Drop and Roll technique - Stop moving, lie down and roll if clothing catches fire.

Crawl through rooms and hallways to avoid smoke inhalation.

Touch doors before opening - if the door is hot, don't open it.

Never re-enter the building for any reason once safely outside.

Fire is a tool, not a toy.

Never pick up matches or lighters if found. Instead, tell an adult right away.

Never leave children unattended around any fire hazard, including cooking stoves, candles, portable heaters, or any other heat source. Teach toddlers and young kids to stay at least three feet away from any common heat source or hazard in your home.

KeepKidsFireSafe.org offers an abundance of resources and materials to teach kids about fire safety, including coloring pages, perfect for toddlers who don't yet have a firm grasp of language communication.

Fire safety for kids: Local fire department resources

Your local fire department may also offer child safety kits, including window decals to alert first responders to the rooms in which your kids may be sleeping. This lets them quickly locate and retrieve your child from a burning building, drastically increasing their chances of survival.

Take a tour of your local fire station to familiarize your kids with fire fighters in uniform. Teach them that fire fighters are friendly heroes - this prevents them from shying away or even running away from fire fighters in hazardous situations. Those extra few minutes - or even seconds - could save your child's life.

Most fire departments offer families assistance creating fire safety plans free of charge. Invite your local fire station to your home to help you devise the most efficient escape routes. They will also check your smoke alarms and fire extinguishers, and can even point out fire hazards in your home that you weren't aware of.

To find a fire department near you, use The National Fire Department Census Database to search by city or address. You'll find all fire departments registered with the USFA, along with addresses and basic information on each department.

What to do during a home fire

Heat and smoke are actually more dangerous than the flames in a home fire. Inhaling hot air can burn the lungs, and smoke inhalation can cause lung damage or asphyxiation. People are three times more likely to die from asphyxiation than burns in a home fire. During a fire, carbon monoxide is released, a poisonous gas that can also lead to death.

The first course of action in a home fire is to attempt to escape. Heavy smoke and poisonous gases accumulate first near the ceiling. Teach toddlers to crouch low or crawl through rooms and hallways under the smoke to reduce exposure as much as possible. If you're navigating your escape route with a baby, hold the infant securely under your body with one arm. This provides a shield for your baby if something should fall on top of you, and also keeps your infant as low as possible to the ground to avoid smoke and gas inhalation.

If you're unable to evacuate the home because fire has taken over all available exit routes, stay put. Cover cracks around doors with cloth or tape to keep as much smoke and gas out as possible. Equip babies' and kids' bedrooms with bright flashlights. If you and your baby or toddler are trapped, use the flashlight to alert rescue crews to your location through the windows. Teach kids to do the same in case they become trapped alone.

BabyCenter.com recommends teaching toddlers to lie on the floor next to their beds if trapped in their rooms. If possible, teach your toddler to lie on the floor while shining the flashlight towards the window. This keeps your kids as low to the ground as possible, where the least amount of smoke and gas has collected, while still alerting rescuers to his location. Firefighters are trained to look next to a child's bed first upon entering a room, ensuring that they will find your child quickly - providing a few more valuable seconds to get your toddler outside safely.

If your kids' clothing has caught fire and they aren't able to stop, drop and roll, quench the flames with blankets or towels. If possible, immediately treat the burns with cool water for three to five minutes and cover with a clean, dry cloth until help arrives.

Help your kids cope after a home fire

Babies are often too young to recall a home fire, but younger kids are cognizant enough that a devastating fire can cause significant emotional problems after the event. Kids must cope with the loss of their familiar home and their most prized possessions, and in the worst cases, possibly the death of a sibling, parent, or another loved one.

Young children have a difficult time fully grasping the concept that things can be replaced, but people cannot. Toddlers may experience fear, confusion and insecurity in the days, weeks and even months after a home fire.
Children may also exhibit other common after-effects of fires and disasters like:

Anxiety, clinging or dependency, and new separation anxiety

Sleep disturbances, nightmares, sudden fear of the dark

Anger, acting out and tantrums

Unexplained aches and pains

Bedwetting and other atypical behavior, regression

Even if your child wasn't present when the fire occurred, sudden uprooting of the living environment and the loss of favorite blankets or stuffed animals can cause confusion and distress. You may want to consult a professional psychologist to help your child navigate his grief, but there are ways you can help your kids cope as well.
Take these cues to help your kids cope with the after-effects of a home fire:

Involve your child in a disaster recovery plan

Give your child a chance to share or express feelings

Validate your child's concerns

Answer all questions

If your kids can't express their feelings in words, let them draw a picture

Establish a new routine as soon as possible

Provide ample hugs and affection, especially physical affection

Praise your child's positive behaviors

Keep your child informed by sharing details about upcoming changes - but not enough to create more fear or insecurity

No one wants to have a home fire, no matter how small. House fires can have devastating physical and emotional consequences, and the effects on young kids can be especially difficult to overcome in the aftermath.

The best way to keep your kids safe is to prevent home fires from happening in the first place. Even if it seems like you're being overly cautious, every precautionary step you take could be the one that saves your child's life. No precaution is too insignificant when it comes to fire safety.

By teaching your kids about fire safety, formulating and practicing a fire escape plan, following fire prevention practices and preparing your children for the proper actions during a fire, you're doing everything you can to keep them safe from a home fire.

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Fire Safety for Kids Guide: How to Keep Babies, Toddlers and Young Children Safe from Home Fires | Safety.com

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Roughly seven people die every day in the U.S. as a result of home fires. Kids under the age of five have a much higher risk of dying in a residential fire compared to children in other age groups, according to the U.S. Fire Administration.

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Helping Children Deal with Grief. Child Mind Institute.
https://childmind.org/article/helping-children-deal-grief/
This article is about how children deal with grief and that they can all deal with it in a different way. It explains ways on how to help that child and different signs they might be showing with their emotions. This is helpful to teachers in the way they can can learn signals of children that may be dealing with loss and ways that they can help them.

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Most young children are aware of death, even if they don't understand it. Death is a common theme in cartoons and television, and some of your child's friends may have already lost a loved one. But experiencing grief firsthand is a different and often confusing process for kids. As a parent, you can't protect a child from the pain of loss, but you can help them feel safe. And by allowing and encouraging them to express their feelings, you can help your child build healthy coping skills that will serve them well in the future.

Kids grieve differently

After losing a loved one, a child may go from crying one minute to playing the next. Their changeable moods do not mean that they aren't sad or that they've finished grieving; children cope differently than adults, and playing can be a defense mechanism to prevent a child from becoming overwhelmed. It is also normal to feel depressed, guilty, anxious, or angry at the person who has died or at someone else entirely.

Very young children may regress and start wetting the bed again or slip back into baby talk.

Encourage a grieving child to express feelings

It's good for kids to express whatever emotions they are feeling. There are many good children's books about death, and reading these books together can be a great way to start a conversation with your child. Since many children aren't able to express their emotions through words, other helpful outlets include drawing pictures, building a scrapbook, looking at photo albums, or telling stories.

Be developmentally appropriate

It is hard to know how a child will react to death or even if they can grasp the concept. Don't volunteer too much information, as this may be overwhelming. Instead, try to answer their questions. Very young children often don't realize that death is permanent, and they may think that a dead loved one will come back if they do their chores and eat their vegetables. As psychiatrist Gail Saltz, MD, explains, "Children understand that death is bad, and they don't like separation, but the concept of 'forever' is just not present."

Older, school-age children understand the permanence of death, but they may still have many questions. Do your best to answer honestly and clearly. It's okay if you can't answer everything; being available to your child is what matters.

When discussing death, never use euphemisms. Kids are extremely literal, and hearing that a loved one "went to sleep" can be scary. Besides making your child afraid of bedtime, euphemisms interfere with their opportunity to develop healthy coping skills that they will need in the future.

Whether or not to attend the funeral is a personal decision that depends entirely on you and your child. Funerals can be helpful in providing closure, but some children simply aren't ready for such an intense experience. Never force a child to attend a funeral. If your child wants to go, make sure that you prepare them for what they will see. Explain that funerals are very sad occasions, and some people will probably be crying. If there will be a casket, you should prepare them for that, too.

Keep in mind that even the best-prepared child might get upset, and their behavior can be unpredictable. "Kids will not behave in a way that you might want or expect," Dr. Saltz notes. "If you decide that a funeral is not the best way, there are other ways to have a goodbye." Planting a tree, sharing stories, or releasing balloons can all be good alternatives for providing closure to a child.

Discussing an afterlife

The idea of an afterlife can be very helpful to a grieving child, observes Dr. Saltz. If you have religious beliefs about the afterlife, now is the time to share them. But even if you aren't religious, you can still comfort your child with the concept that a person continues to live on in the hearts and minds of others. You can also build a scrapbook or plant something that represents the person you have lost.

Don't ignore your own grief

Children will often imitate the grieving behavior of their parents. It is important to show your emotions as it reassures children that feeling sad or upset is okay. However, reacting explosively or uncontrollably teaches your child unhealthy ways of dealing with grief.

Children find great comfort in routines, so if you need some time alone, try to find relatives or friends who can help keep your child's life as normal as possible Although it is important to grieve over the death of a loved one, it is also important for your child to understand that life does go on.

Some specific situations

For many children, the death of a pet will be their first exposure to death. The bonds that children build with their pets are very strong, and the death of a family pet can be intensely upsetting. Don't minimize its importance or immediately replace the dead pet with a new animal. Instead, give your child time to grieve for their dog or cat. This is an opportunity to teach them about death and how to deal with grieving in a healthy and emotionally supportive way.

The death of a grandparent is also a common experience for young children, and it may bring up many questions, such as, "Will my mom be next?" It is important to tell your child that you will probably live for a long time.

After the death of a parent, children will naturally worry about the death of the remaining parent or other caretakers. Reassure a child that they are loved and will always be cared for. It is a good idea to rely on family members during this time to help provide additional nurturing and care. Dr. Saltz also recommends therapy in the case of a significant death, such as the death of a parent or sibling. "Therapy provides another outlet for talking when a child may feel like they can't talk with other family members because they are grieving as well."

Treating serious problems

If you notice that your child seems unusually upset and unable to cope with grief and loss, they may have something called adjustment disorder. Adjustment disorder is a serious and distressing condition that some children develop after experiencing a painful or disruptive event. It is a good idea to consult your child's doctor if you feel that your child isn't recovering from a loss in a healthy way.

How can I help a child grieve the loss of a parent?

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Helping Children Deal With Grief - Child Mind Institute

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Tips for families dealing with grief, from what parents should say to how they can help kids express their emotions in a healthy way.

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(September 20, 2019) Healthier Eating at School. U.S department of Health and Human Services.
https://www.cdc.gov/healthyschools/features/eating_healthier.htm
This article is about how kids can develop healthier eating habits if the schools provide them. it is important to give students enough time to eat during the day as well as inform them of healthy nutrition. This is helpful for teachers so that they can be a good role model for students as well as inform and encourage them of healthy eating habits.

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Centers for Disease Control and Prevention

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It’s National School Lunch Week. Learn what schools can do to promote healthy eating. #CDCHealthySchools #NSLW22

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Katie Kindelan (October 10, 2019). Mental Health on Campus: College Students Launch a Side Hustle to help other students' Mental Health. ABC News.
https://www.goodmorningamerica.com/wellness/story/mental-health-campus-college-students-launch-side-hustle-62822012
This article is about how many students can be dealing with different types of mental health such as anxiety and depression. This can help teachers to be aware of students dealing with this and how little things such as self-care boxes can really help. This article mainly talks about college students but students at any age can be dealing with emotional problems.

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College students launch a side hustle to help other students' mental health

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Four students at Marquette University have launched a business called ConfIdence that delivers self-care boxes to college students across the U.S.