Building Strong Children

By Andree EntezariMay 10th, 2019in SHIELD Updates
By Erin D. Maughan

The number of students with chronic and complex health conditions significantly affects a teacher’s ability to teach and meet the needs of the whole child—especially combined with the impact of societal issues such as poverty, violence, and the growing population of families who speak a language other than English at home. Education in America is free, but healthcare is not. This fact presents a unique divide among schools and even within classrooms, where some students have parents who have good healthcare coverage and seek medical attention regularly, while others come from families who are limited to emergency room visits for chronic illnesses or only see a healthcare professional in life-threatening situations.

School nurses can help bridge this divide. Often, they are the only healthcare professional that students see regularly. So when a class includes Paul (who has missed multiple days of school, seems distracted when he does attend, and often has a deep, penetrating cough), Keisha (who stays in her seat during class but always seems drowsy), Aidan (whose disruptive behavior makes instruction difficult), and Anni (who is struggling to learn English), the school nurse should be one of the first resources their teacher turns to.

Unfortunately, not every school has a nurse. Only about 50 percent of schools have a full-time registered nurse for at least 30 hours per week, and 18 percent do not have a nurse at all.1

While the National Association of School Nurses (NASN) recommends that every student have access to a school nurse every day, the presence of a nurse in school depends on state nurse practice acts and regulations. NASN recommends that the severity of a student population’s health needs should factor into how many school nurses should staff a school. Home and family factors, such as poverty and home languages other than English, should also factor into determining adequate nurse staffing.2

Currently, more than 61,000 school nurses work in K–12 schools.3 According to the National Center for Education Statistics, there are 52 million students in our nation’s public schools. Studies indicate that as many as 27 percent of American children have chronic health conditions (such as asthma, diabetes, severe food allergies, and seizure disorders), which school nurses are trained to help manage.4

With so many students in need of medical care in school—whether that care is related to a chronic illness or an emergency situation—and so few nurses in schools to help them, policymakers, educators, and the general public must understand all that school nurses do so they can advocate for having one in every public school.

Meeting Students’ Needs

Building Strong ChildrenIt would seem that teacher preparation programs would be the perfect place for educators to learn how school nurses enable teachers to focus on instruction. Yet few education courses cover what, exactly, school nurses do.

A skilled school nurse can be a lifesaver (both literally and figuratively) for teachers. School nurses have medical training to deal with the physical and mental illnesses of students as well as the entire school population. To help ensure school nurses have the skills needed to address current health concerns, NASN recommends that a school nurse have a minimum of a bachelor’s degree in nursing as well as a registered nurse (RN) license. A bachelor’s program in nursing covers the leadership skills of community and public health nursing, whereas shorter programs, such as associate degree RN programs or licensed practical/vocational nurse (LPN/LVN) programs, may mention these areas but do not emphasize them. Such skills are critical for school nurses to obtain so they can meet their students’ complex health needs. It may be appropriate for aides and LPNs/LVNs to perform certain healthcare-related tasks, but only when an RN is providing proper oversight.

Of course, school nurses’ primary purpose is to keep students healthy and safe so they are ready to learn. School nurses do this in several different ways. These include working with students to manage chronic health conditions (e.g., observing them use an inhaler during an asthma attack or helping them check their blood sugar), identifying students who might have an undiagnosed health condition that is impeding their well-being and ability to learn, and reinforcing current medical and legislative policies that affect student health (e.g., allowing students to carry their inhalers and including a school nurse on appropriate individualized student educational team meetings).

School nurses make sure students know how to manage their conditions by taking their medication or adhering to other treatments. Technological innovations and medical advancements happen quickly, and school nurses work hard to stay up to date. In so doing, they act as the bridge between the school and a student’s healthcare provider to ensure a student’s needs are met.

Some children who have complex medical issues require treatments ranging from catheters to gastrointestinal tubes. School nurses work with teachers and other school staff so that everyone on the educational team understands how best to support students’ needs. They also work hard to connect families struggling with poverty or serious health issues to community resources such as health insurance, food pantries, language assistance programs, and transportation services, as well as offsite healthcare providers.

As a school nurse for several years, I found home and family factors underlying many children’s health concerns. For example, learning that a student did not have electricity and heat at home helped me understand his poor health and helped his teachers understand his academic struggles. By connecting his family to social service agencies in the community, progress was made in helping the student feel well enough to focus on learning. As is so often the case, school nurses do more than hand out Band-Aids and ice packs and check for lice!

School nurses spend much of their time ensuring that all students in the school are ready to learn, and they help to identify those who may be at risk of not progressing academically. To that end, school nurses conduct vision and hearing screenings and follow up with families to ensure students receive eyeglasses or other treatments. If a family member or a teacher is concerned about a student, a school nurse can provide individual screenings and follow-up as well.

In addition, discussions about a student with the school nurse might result in some suggestions that a non–medically trained professional might not provide. For instance, if a student is frequently asking to use the toilet and has shown recent weight loss, a school nurse might suggest that the student see a healthcare provider, as these can be signs of diabetes.

School nurses also serve as health leaders in a school by ensuring that current, evidence-based practices are in place so that the school environment supports students—for example, eliminating environmental asthma triggers such as idling cars or buses near school buildings and playing fields to ensure students with asthma can participate in physical activity.*

School nurses can provide general evidence-based health education, specific trainings, or health promotion activities for students and school staff on a variety of topics. For example, school nurses may train school staff on what to do in a medical emergency or provide outreach to parents when there is an increase in a specific illness among students, to help minimize its further spread.

Monitoring the health of a school community by collecting data is another key practice of school nursing. It was actually a school nurse who identified the first case of H1N1 (swine flu), whose spread reached pandemic proportions in 2009,5 and school nurses have identified measles, pertussis, tuberculosis, and other communicable disease outbreaks in their school communities by virtue of tracking symptoms and immunity. Electronic school health records facilitate their ability to analyze data quickly,6 and to work with local health departments to stop outbreaks and prevent them in the future through improved prevention methods.

School nurses also provide valuable information to school leaders regarding major concerns that can affect a student’s ability to attend school and learn. Unlike the administrators or staff who take the calls reporting a student’s absence, school nurses have an overarching view of the school community’s physical health and can address the underlying physical, social, and mental health causes of absenteeism.

A Return on Investment

Building Strong ChildrenI loved being a school nurse, but, covering multiple schools, I often felt stretched thin. After seeing the overwhelming health needs students had, I decided to earn a doctoral degree in nursing, hoping to make a greater impact. I soon realized there was a dearth of research on the positive impact of school nurses, so I focused on marshalling the evidence to support the benefits of school nursing. However, measuring the effects of school nursing is complex because school nurses are part of a larger team. Also, the standard “random control trial” does not work well in many situations; we do not want to withhold health interventions from students in the name of seeing what works.

This is not to say no evidence exists. Many researchers have shown that when school nurses intervene, they can help decrease rates of student absenteeism and early dismissals of students due to health concerns.7 Often, student absences are related to unknown or poorly controlled chronic conditions that school nurses can assess; then they can help students and their families better manage these conditions, leading to improved attendance.8

Research shows that school immunization rates are higher when a school nurse is present to follow up with parent concerns and help connect families to healthcare providers.9 In addition, school nurses have been found to help students stop smoking, lose weight, avoid pregnancy, and improve their mental health, all factors that influence student learning.10 Besides helping to keep students in school, school nurses may decrease a school’s liability, as researchers have found that when school nurses provide medication to students, fewer medication errors occur.11

My current role as the director of research at NASN is to gather research on school nursing and ensure that school nurses follow evidence-based practices. One of my greatest pleasures is helping school nurses collect and use their school’s data to illustrate the importance of what they do and how it affects student health.

Generally, people agree that having a school nurse is good for a school. Yet, in a time of tightening budgets and increased class sizes, districts often choose to disinvest in school nursing. But researchers have found that having a school nurse actually results in returns on the investment—not only in dollars saved but in time spent on instruction.

One study that investigated the amount of time principals and other staff focused on health concerns instead of instruction found that when there was a school nurse in the building, the principal saved nearly one hour and clerical staff about 46 minutes that they otherwise would have spent on student health. Teachers were also able to devote more time to instruction when a school nurse was present. Using these data, the study’s authors calculated the savings per school to be $133,174.89, which translates to a $1.84 return on investment for every dollar invested.12

Another analysis, this one from school nurses in the Massachusetts Essential School Health Services program, found that for every dollar spent on school nurses, society gains $2.20.13 It is important to note that this analysis only measured program benefits as savings in the costs of medical procedures, parents’ lost productivity (when they take their students out of school for treatment or come to school to give them medication), and teachers’ lost productivity (when they have to deal with students’ health issues instead of teaching). This study did not look at emergency room visits, hospitalizations, or 911 calls, nor did it factor in school nurses’ prevention and promotion efforts to help individual students better manage their conditions and improve their health.

Return-on-investment studies that have focused on prevention often show higher returns on investment. For example, Trust for America’s Health found that for every dollar spent to support community prevention programs that address smoking and promote exercise, $5.60 would be saved after five years.14 In Canada, every dollar spent on measles, mumps, and rubella immunizations saves $16,15 and every dollar spent on mental health and addictions saves $7 in healthcare costs and $30 in lost productivity and social costs.16 Prevention and promotion efforts that focus on children save all of society millions of dollars but require an initial investment.

Given that education dollars always seem to be tight, school districts have found innovative funding streams for school nursing. Some school districts partner with local public health departments to share the cost of nurses, while others have partnered with local healthcare systems or community agencies.†

With the emphasis on decreasing hospital admissions and increasing hospital and community partnerships, hospitals have also become involved in funding or providing school nurses.

Although each state’s Medicaid laws are different, school districts or other health entities employing school nurses can bill Medicaid for reimbursement of particular procedures performed in schools. As a result, some school districts have been able to hire additional school nurses with these reimbursed funds.

Investing in school nurses helps students stay healthy and ensures they’re ready to learn so they can graduate and become productive citizens. As Frederick Douglass once said, “It is easier to build strong children than to repair broken men.” With nurses in schools, educators, families, and school nurses can work together to build strong children.

Erin D. Maughan is the director of research for the National Association of School Nurses. Previously, she was an associate professor in the College of Nursing at Brigham Young University. A former school nurse, she has also worked as a school nurse consultant for the Utah Department of Health.

*For more on common environmental problems in the school setting, see “First, Do No Harm” in the Winter 2011–2012 issue of American Educator. (back to the article)

†School districts that have partnered with local health departments include Austin Independent School District (link is external), Akron Public Schools (link is external), Dayton Public Schools (link is external), and Provo City School District (link is external). (back to the article)

1. Centers for Disease Control and Prevention, Results from the School Health Policies and Practices Study 2014 (Washington, DC: Department of Health and Human Services, 2015), 75.

2. National Association of School Nurses, School Nurse Workload: Staffing for Safe Care (Silver Spring, MD: National Association of School Nurses, 2015).

3. Health Resources and Services Administration, The U.S. Nursing Workforce: Trends in Supply and Education (Washington, DC: Department of Health and Human Services, 2013), 16.

4. Robert Wood Johnson Foundation, Chronic Care: Making the Case for Ongoing Care (Princeton, NJ: Robert Wood Johnson Foundation, 2010), 12.

5. “Swine-Origin Influenza A (H1N1) Virus Infections in a School—New York City, April 2009,” Morbidity and Mortality Weekly Report, April 30, 2009.

6. National Association of School Nurses, School Nurse Role in Electronic School Health Records (Silver Spring, MD: National Association of School Nurses, 2014).

7. Nina Jean Hill and Marianne Hollis, “Teacher Time Spent on Student Health Issues and School Nurse Presence,” Journal of School Nursing 28 (2012): 181–186; Nicole Pennington and Elizabeth Delaney, “The Number of Students Sent Home by School Nurses Compared to Unlicensed Personnel,” Journal of School Nursing 24 (2008): 290–297; and Susan K. Telljohann, Joseph A. Dake, and James H. Price, “Effect of Full-Time versus Part-Time School Nurses on Attendance of Elementary Students with Asthma,” Journal of School Nursing 20 (2004): 331–334.

8. Michelle L. Moricca, Merry A. Grasska, Marcia BMarthaler, et al., “School Asthma Screening and Case Management: Attendance and Learning Outcomes,” Journal of School Nursing 29 (2013): 104–112.

9. Daniel A. Salmon, Lawrence H. Moulton, Saad B. Omer, et al., “Knowledge, Attitudes, and Beliefs of School Nurses and Personnel and Associations with Nonmedical Immunization Exemptions,” Pediatrics 113, no. 6 (2004): e552–e559.

10. National Association of School Nurses, Role of the School Nurse (Silver Spring, MD: National Association of School Nurses, 2011).

11. “Fewer School Nurses Leads to Greater Medication Errors,”, May 7, 2012,
leads-to-greater-medication-errors (link is external).

12. Mary J. Baisch, Sally P. Lundeen, and M. Kathleen Murphy, “Evidence-Based Research on the Value of School Nurses in an Urban School System,” Journal of School Health 81 (2011): 74–80.

13. Li Yan Wang, Mary Vernon-Smiley, Mary Ann Gapinski, et al., “Cost-Benefit Study of School Nursing Services,” JAMA Pediatrics 168 (2014): 642–648.

14. Jeffrey Levi, Laura M. Segal, and Chrissie Juliano, Prevention for a Healthier America: Investments in Disease Prevention Yield Significant Savings, Stronger Communities (Washington, DC: Trust for America’s Health, 2009).

15. Public Health Agency of Canada, Canadian Immunization Guide, Part 1 (Ottawa: Public Health Agency of Canada, 2014), 7.

16. Ontario Ministry of Health and Long-Term Care, Every Door Is the Right Door: Towards a 10-Year Mental Health and Addictions Strategy; A Discussion Paper (Toronto: Ministry of Health and Long-Term Care, 2009), 16.

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5 Ways to Become an Outstanding Nurse Leader

Health Leaders
By Jennifer Thew RN     May 03, 2019

It's Nurses Week—a time to pause and celebrate all that nurses do. And, as the healthcare industry shares its gratitude this week for nurses, it must not forget to include nurse leaders when giving thanks. Because it's not easy being a nurse leader.

"As nurse leaders, we help create circles of care, safety, reliability, quality, and trust for the patients and communities. We are guardians at the gate of all of these things," Cole Edmonson, DNP, RN, NEA-BC, FAAN, chief clinical officer at AMN Healthcare, Inc., said during the AONE 2019 Keynote introduction.

"Leadership in healthcare is not an easy path and, in order to do it well, we have to take time to develop ourselves and those around us," Edmonson said.

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While much has changed since the time of Florence Nightingale, the original nurse leader,  the qualities that make a nurse leader great have not.

"We must be willing to be brave, courageous, authentic, vulnerable, and practice forgiveness to create the future," Edmonson said.

AONE 2019's opening keynote presentation, "Get Out of Line: Step Up, Stand Out & Succeed" by Sarah Robb O'Hagan, founder of EXTREMEYOU and former executive at companies such as Nike, Gatorade, and Virgin Atlantic, covered how to develop some of the qualities Edmonson mentioned.

Below are five ways O'Hagan said nurse leaders can propel themselves toward personal and professional success.

1. Get Out of Line
"[Get out of line] means stepping up, standing out, kicking butt, and stepping out of the line of others around you to take risks and create new value for your organization," O'Hagan said. "Often it can be uncomfortable. Many of us choose not to do that because we don't want to take a risk and fail."

During the keynote, O'Hagan shared a personal story when she took a risk and it paid off. On her first day in a marketing position at Virgin Atlantic airlines—after moving from New Zealand to New York for the job—she was informed that the person who hired her was no longer with the company. Fortunately, she still had a job but secretly wondered if the "last in, first out" philosophy would be implemented. As she noticed the chaos that had developed in the department, she made a bold move by drafting a marketing plan and slipping it under the marketing president's door.

"That could have gone one of two ways, but what ended up happening is I got a promotion," she said.

While O'Hagan was new to the company, she had enough career and marketing knowledge to fill in the leadership gap that occurred when the hiring manager left the company.

The lesson here: Embrace your knowledge and experience and don't be afraid to share solutions with others.

"If you recognize those moments where your experiences [can fill a gap you see] in front of you and you're solving a problem for someone else, it can be incredibly, incredibly successful" she said. "I always say to everyone, scan for opportunities around you."

2. Make Failure Your Fuel
With the rare exception, nobody likes to fail. According to O'Hagan, fear of failure is increasing.

"For about the past 50 years, every generation from the boomers to Gen X to the millennials to Gen Z has statistically become more scared of failing. We do not like taking risks," she said.

But willingness to fail, and to learn from it, is necessary for personal and professional development.

"We have a generation that is scared of failure and, therefore, somewhat risk averse. [If] people are going to develop the best sides of themselves, they actually need to take risks every now and then," she said. "If you don't experience different environments, different types of work, you don't know where you are going to shine, and you want to learn where are you at your very best."

Nurse leaders should keep this in mind especially when working with younger generations of nurses."Talk to the younger people on your team because [a willingness to fail] is actually the most important thing," she said. "When we start our careers, in the world we live in today, there's this feeling that I have to look perfect on Instagram. I have to have a perfect resume on LinkedIn. And, guess what, you actually have to fail."

3. Play Your Specialist Game
O'Hagan asked the AONE attendees: Where do you excel? What excites you? She said once nurse leaders answer those questions, they should embrace their strengths because that will help build a foundation of success.

"Once you know you at your very best, if you find yourself playing in an organization that really wants that out of you, you will be more confident, and you will be more involved," O'Hagan said.

4. Bring Out the Extreme in Others
For nurse leaders, bringing out the best in others is the key to developing an outstanding and engaged nursing staff.

"If we're doing a good job of knowing who we are at our core as leaders, then the most important thing is how you bring out the best in others, so they can play to their full potential," O'Hagan said.

Leaders can encourage staff to reflect on their positive attributes and exceptional skills. Then the leaders should commit to helping the nurses develop those skills at their organization. O'Hagan said committing to diversity in age, ethnicity, gender, and skill can also contribute to an organization's success.

"Diversify those different styles and points of view and the team because that is when you will perform at your best. I do think it's important to partner with those that are least like you," she said.

5. Break Yourself to Make Yourself
"Get yourself out of your comfort zone," O'Hagan said. "It may be at work, it may be in your personal life, but take on a new adventure. Just get out of your comfort zone so that you're being exposed to new and different things."

By being uncomfortable, says O'Hagan, leaders can challenge their most stubborn beliefs.

"Often those beliefs are things that we think we're not good at and we're not giving ourselves enough of a chance," she said.

For example, O'Hagan says she labeled herself as terrible at finance. But when working at Gatorade, she realized she didn't have the option of not feeling comfortable with the subject.

"I took myself back to what I call 'remedial education' and did a finance for executives course and discovered at the age of 38 that I absolutely loved it," she said. "And, because I now had real-world experience that I could apply to what I was learning, it suddenly made sense. I'm never going to be a powerful finance person but at least I now feel confident in that fundamental."

"Sign up for an initiative or a project with other people. It might be that you are needing to transfer to a different kind of hospital or somewhere else [in your current organization]. You have to get out of the places of comfort if you're really going to allow yourself to blossom and find new areas of growth."
Jennifer Thew, RN, is the senior nursing editor at HealthLeaders.

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Articles: An alarming number of children in America can’t afford food

Experts say many people that are ‘food insecure’ work low-paid jobs, yet still don’t qualify as SNAP recipients
By: Jeanette Settembre
Published: May 2, 2019 4:53 p.m. ET

Millions of Americans don’t have enough money to buy healthy food –– and kids are most at risk.

A staggering 97% of counties in the U.S. are home to people who can’t afford or don’t have access to healthy food, according to a study released Wednesday by Feeding America, a Chicago-based nonprofit organization that has a network of more than 200 food banks nationwide.

Out of America’s 3,142 counties, the rates of food insecurity range from 3% in Steele County, N.D., to as much as 36% in Jefferson County, Miss., the report found. And children are suffering the most: One in six kids (or 12.5 million children) are considered to be food insecure, and an estimated 750,000 live in New York City and Los Angeles.

These families are more likely to live in disadvantaged urban areas and also southern U.S. states –– areas with “food deserts” that don’t have easy access to healthy food. Experts say many families that are “food insecure” often work low-paid jobs to pay for rent and utilities, and other expenses like school supplies for their children. They may have little left over for healthy food, but may not always qualify for SNAP (Supplemental Nutrition Assistance Program), formerly known as food stamps.

Approximately 12.5 million children in the U.S. are considered ‘food insecure,’ and an estimated 750,000 of them live in New York City and Los Angeles.

Mississippi is the state with the highest rate of food insecurity (19.2%) or the state with the least access to food; followed by Arkansas with 17.3%; Louisiana with 16.5%; Alabama with 16.3%; Oklahoma with 15.8%; New Mexico with 15.5%; Texas with 14.9%; and Georgia with 14.4%.

The national cost on average of a meal was $3.02 in 2017, down from $3.06 in 2016, according to the study. That said, 43% of counties in the U.S. have meal costs that are higher than the national average, with some costing nearly double. The average cost of a meal on the West Coast is $3.27 and $3.32 in the Northeast.

The South is where 87% of people live in food deserts. These are areas that typically have low-income residents and where many of those who are food insecure live, according to the most recent study. Without access to healthy food, people tend to eat cheaper, less nutritious meals that can negatively impact health leading to illnesses like diabetes, the authors explained.

Of those people living in counties where healthy food is scarce, 29% are not eligible for most federal nutrition assistance programs. To be eligible for SNAP benefits, a household’s gross monthly income must be at or below 130% of the federal poverty level. So for a three person family, that would be $2,213 a month, or around $26,600 a year.

Without access to healthy food, people tend to eat cheaper, less nutritious meals that can negatively impact health leading to illnesses like diabetes.

SNAP benefits can buy any food product aside from beer, wine, liquor, cigarettes, tobacco or any nonfood items like vitamins and medicines, which are exempt. The benefits are strictly for food meant to be eaten or prepared at home –– so items that are prepared in store and hot foods aren’t included, though items like fresh fruit, and snacks like pretzels and ice cream are covered at some convenient stores.

The number of authorized SNAP retailers increased by 4% between 2013 and 2017, and more than 80% of SNAP benefits are spent at big-box stores and supermarkets, according to the Center on Budget and Policy Priorities.

For the first time, the U.S. Department of Agriculture gave retailers the green-light to allow people to use SNAP benefits to shop for food online. SNAP participants can spend their benefits at any retailer that accepts electronic benefit transfer (EBT) cards.

Last month, the USDA announced a two-year pilot program, now live in New York state, at grocery retailers Walmart, Amazon and ShopRite. The pilot program will eventually expand into other parts of New York along with Iowa, Alabama, Maryland, Nebraska, New Jersey, Oregon and Washington.

People who receive SNAP will be able to order groceries from Walmart WMT, -0.68% online to get in-store pick up or delivery. And AmazonFresh AMZN, -1.62% and Prime Pantry is not charging a membership fee for SNAP recipients, the company said in a blog post. To access the portal, users can create an Amazon account or sign in and type in their SNAP EBT card number. Only New York cards are accepted at this time.

In counties where healthy food is scarce, 29% are not eligible for most federal nutrition assistance programs like SNAP, formerly known as food stamps.

However, some worker advocates have criticized Walmart and Amazon’s move to cater to more SNAP recipients. The new access to online shopping will allow these companies to tap into the SNAP market profiting off of lower-income families, many of whom work at their stores.

For SNAP parents who are stuck in low-paid jobs and their children, that’s something of a Catch 22.

Walmart is the No. 1 employer of SNAP recipients in Arizona, Kansas, Ohio, Washington and Pennsylvania, and thousands of low-wage Amazon employees are on food stamps, according to an April 2018 report from Amazon raised its minimum wage to $15 an hour for all U.S. employees in November 2018 after criticism over low pay and poor working conditions.

Amazon disputes those findings. “We encourage anyone to compare our median pay and benefits to other retailers,” Lori Torgerson, a spokeswoman for Amazon told MarketWatch in an email. “Amazon increased our starting minimum wage for all full-time associates to $15 per hour.”

“This compensation is in addition to our benefits package that includes comprehensive health, vision and dental insurance, retirement, generous parental leave and training for in-demand jobs through our Career Choice program,” she added.

Amazon could not confirm whether there are fewer Amazon employees receiving SNAP benefits since it upped its minimum wage last year.

The new access to online shopping will allow Amazon and Walmart to tap into more low-income families that use SNAP, many of whom work at their stores.

Walmart, the world’s largest retailer, pays entry-level workers $11 an hour. When asked for comment regarding criticism about providing a new online service for SNAP recipients instead of paying low wage workers more, a spokeswoman for Walmart said: “We think services like grocery pick-up should be available to everyone, regardless of income or individual circumstances. It’s pretty shocking to hear that someone would disagree with that.”

Catering to SNAP participants is not a new strategy: Major retailers like Walmart, Sam’s Club, Costco COST, -0.96% and brands like Kroger KR, -0.82% Kmart and Albertson’s have allowed SNAP recipients to buy goods with their EBT cards for years.

“This move was an inevitable extension of the SNAP market,” Michele Simon, a public health attorney and author of “Food Stamps: Follow the Money,” told MarketWatch. “There’s a lot of money here. If retailers can encourage more SNAP spending they’re going to look for ways to do that.”

But since Congress does not require data collection on SNAP product purchases, it’s unclear what kinds of foods are being bought and exactly how much retailers are making off the $63 million SNAP market.

Trying to get government data on the nation’s food assistance program has been an eight year quest for South Dakota’s Argus Leader, leading to an ongoing Supreme Court case hearing with supermarket trade association arguing against the release of information.

“We don’t even know how these taxpayer dollars are being spent,” Simon said. “Is this really the best thing for public health? Or is it making it easier for people to buy soda, chips and junk and food?”

Article: School Grades Trigger Family Violence

By Melissa Bright
April 30, 2019

In elementary school, I was typically excited for report cards to come out. I knew my grades were good–which would earn me a reward from my parents–and any notes about my behavior would be neutral at worst. I didn’t realize that for some of my peers, bringing this piece of paper home would be a completely different experience.

Fast-forward a few decades, and I’ve started to learn how my peers’ experiences may have differed. A colleague of mine, a pediatrician, explained to me that he and many of his peers, as well as many K-12 teachers, believe that for some children, report cards result in punishment so severe that it turns into physical abuse. It turns out that this idea has been around for some time. I doubted my colleague. But he was right.

To test his theory, my colleague and I, along with the rest of our research team, conducted a study of all calls to a statewide child abuse hotline for a single academic year. We then narrowed the data to just calls for children aged 5-11 years and calls that were later investigated and verified physical abuse. Next, our team integrated the dates of report card release (typically 4 per year) for each school district. We found that there was more than a two-fold increase in the risk of a child physical abuse report on a Saturday when report cards were released on a Friday.

Our study has inspired several new questions around the timing of report cards and physical abuse.

That is all we can say definitely from the study. We cannot say why this link appears on a Friday but not on other days and we cannot say why there is a link. But we do have some thoughts based on the current scientific literature and anecdotal cases from expert clinicians. We believe that we observed a link between school report cards and physical abuse because these report cards were poor. Parents responded to these report cards with corporal punishment, and this corporal punishment crossed the line to physical abuse.

Corporal punishment is broadly defined as using physical force to correct or control a child’s behavior. Corporal punishment is legal in the US, common practice among parents of young children, and effective at stopping unwanted behavior in the short-term (e.g., eliminating a behavior for 10 minutes or less). The practical line between corporal punishment and physical abuse is gray and the legal line differs between states. As a result, corporal punishment can quickly turn to physical abuse.

Corporal punishment is associated with poor academic achievement, emotional and behavioral problems, and conduct disorders. It is not effective at changing behavior long-term, including improving academic performance or reducing poor behavior in school. Numerous expert psychologists and pediatricians have written extensively on the evidence against using corporal punishment.

Our study has inspired several new questions around the timing of report cards and physical abuse. In a series of studies, our next steps will be to measure these assumed middle steps–bad report cards beget corporal punishment which leads to abuse – and to gain systematic feedback from experts in the field. We are anxious to hear from teachers, pediatricians, administrators, parents, and children about their experiences about report cards. Understanding the details of the problem, and then generating ideas for tackling it are key to developing prevention strategies.

Leadership Program: Summer Leadership Institute for School and Public Health Nurses

By Andree EntezariApril 11th, 2019in SHIELD Updates




Boston University School of Public Health’s Population Health Exchange (PHX) and the School Health Institute for Education and Leadership Development (SHIELD) are collaborating to offer our second annual Leadership Program for School and Public Health Nurses beginning in June, continuing through the year*, and culminating with an advanced leadership  program the following summer.
Course topics are tailored to learners and may include:

  • Developing Your Leadership Strengths
  • Communicating for Impact
  • Using the Power of Data to Tell a Story (Story Mapping)
  • Community Assessments w/ an Emphasis on Equity

*The team will meet for four additional workshops and a culminating event over the course of the year
In addition to providing deep learning opportunities in leadership, this program provides the skills needed to assess for, and effectively communicate about, a community health disparity to initiate change.

Audience: School and Public Health Nurses

Fee: $1,000 for summer workshop;$2500 for full year **NEW! Due to a generous private scholarship donation, we are able to offer a 40% discount to the first 20 registrants. $600 for summer workshop;

$1500 for full year

Location: Boston University, Charles River Campus

Housing (optional): Shared apartment style suites (private bedrooms, kitchen living rooms) are available on campus for $72/day (see attached brochure).

Course limited to 30 participants.

Continuing Nursing Education Provider Unit, Boston University School of Medicine is accredited as a provider of continuing nursing education by the American Nurses Credentialing Center's Commission on Accreditation

SHIELD is a DESE approved provider of Professional Development

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Event: Exploring Our Role in Creating a More Just World for Youth

By Andree EntezariApril 1st, 2019in SHIELD Updates

Professionals, volunteers, activists, and community members that work or interact with youth are invited to come together to explore and grow their role in creating a just world for youth. This conference will offer various workshops that use positive youth development approaches to improve health. This conference is intentionally being held for an adult audience.

Event: ‘Nurses Are with You at Every Step of Life’

By Andree EntezariApril 1st, 2019in SHIELD Updates

Posted: March 28th, 2019

As the largest group within the healthcare profession, nurses operate as the primary link between the healthcare system and the patients and communities they serve. From traditional RNs to advanced practice registered nurses, the role of nurses has expanded due to an aging population and an evolving healthcare system, both in the United States and abroad. They are involved in every aspect of patient care as they work to preserve and promote health across all patient populations.

On Tuesday, April 2, the School of Public Health will hold the Dean’s Symposium, “Nursing and the Health of Populations,” to examine the current state of nursing science and practice, and explore how nurses can continue to impact global population health. The event will feature a keynote speech by Barbara Stillwell, executive director of Nursing Now and a veteran leader in international health workforce issues and health worker migration. Stillwell is heralded for introducing the nurse practitioner role in general practice in the UK.

The symposium will also feature a panel of nursing experts in clinical, administrative, academic, and policy roles, including Jacqueline Fawcett (SON’64), professor of nursing at the College of Nursing and Health Science at University of Massachusetts Boston; Karen Daley (SPH’88), former president of the American Nurses Association; Kelley Brittain, associate professor at Michigan State University College of Nursing; Kate Lorig (SON’64), professor emerita of immunology and rheumatology at Stanford University; and Deborah Washington, director of diversity for patient care services at Massachusetts General Hospital. The panel discussion will be moderated by Maureen Bisognano, president emerita and senior fellow of the Institute for Healthcare Improvement.

Ahead of the event, Stilwell and Bisognano spoke about the expanding role of nurses and the impact of their work on global population health.

In which way has the role of nurses in the healthcare system changed most significantly in the past 10 years, and what are the best skills to have as a nurse?

BISOGNANO: I’ve met a nurse in Sweden who partnered with a young man to teach him self-care in doing hemodialysis and together, they developed a new way of co-producing care that results in better health for chronic dialysis patients across the county of Jonkoping. This nurse has joined with the patient to spread this model across Sweden, and now around the world. Seeing them teaching a nephrologist in Texas this new way really demonstrates the shift in hierarchy and bureaucracy when nurses take the lead in design.

The skills of nurses are so well recognized. Nurses demonstrate the three skills I consider most critical to our mission today. I value IQ and nursing research is adding to our clinical knowledge every day. Nursing education is adapting to include all new methods of building clinical and scientific skills for students and continuing learners. And nurses show EQemotional quotientand empathy. Every day, I meet patients and family members who tell me that nurses’ empathy meant so much at a critical time in their lives. And nurses are always champions of CQcuriosity quotient. Nurses have taken a challenge I gave several years ago, and have spread a campaign to ask patients not only “what’s the matter?” but also, “what matters to you?” The campaign has spread to over 35 countries and impacts thousands of organizations, patients, and families, and interestingly, has a positive impact on joy within the nursing workforce.

STILWELL: Many ofour Nursing Now groups, now in over 80 countries, are keen to try developing Advanced Nursing Practice in a number of care settings. I think this reflects the way that healthcare is changing overall, with a much greater use of technology and sophisticated medicines shifting the pattern of caregiving so that nurses take on more responsibility for leading and coordinating the overall care of a patient.

While we all appreciate the great strides in medicine that keep us alive longer and cure our ills, we still need to understand what is happening to us, and nurses can provide that bridgenot separately from other providers, but as the advocate and interpreter for the patient. Nurses and midwives are with you at every step of life: midwives see you into the world and nurses care for you as you leave it.

Nursing care is cost-effectiveso investing in nursing is smart. A nursing workforce has great clinical skills, as well as the ability to practice the art of nursingbringing it all together with the patient at the center. This is where the IQ, EQ and CQs all come in so powerfully. They create the influential leaders who listen to the team, digest the information, feedback what they hear and plan a pathway of care with the patient.

How has information and communication technology transformed nursing practices and improved patient outcomes?

BISOGNANO: Nurses in Sao Paulo, Brazil have worked with technical experts to design new artificial intelligence and machine learning systems to improve patient flow and to reduce complications. The impact of new technologies, designed with nurses, is making a huge difference in care and caring.

STILWELL: The potential to use technology to get just-in-time advice is huge. It is possible to take X-rays and get them read, take pictures of injuries and skin conditions and send them for specialist opinion, or ask for help. This can transform care with nurses taking the lead backed up by a team at a distance.

And we now have the possibility of collecting and using big data to show the patterns of nursing care. Nursing Now is working with the University of Edinburgh on innovative ways that we can support nurses to collect data and use it in dialogue with policy makers to improve decision-making.

There is currently a global shortage of nurses. How can the industry retain and attract more people to this profession?

BISOGNANO: This is the first time in history we have had five distinct generations in the nursing workforce. We need more nurses entering the workforce and need new ways to engage nurses to stay. I believe we need new ways to lead that recognize the assets and drivers of each generation, including ways to demonstrate regularly the meaning and impact of this work to the nurses providing the care. Young nurses need a mentor who will work with them to build a plan to develop new skills, every year. They have a strong expectation that each year will bring opportunities for new ways to work. I think each nurse needs several “stay interviews” each year rather than an “exit interview” as they seek new opportunities.

STILWELL: Nursing remains a gendered professionpredominantly women, with men often not viewing it as a profession for them. In many countries, this gender effect lowers the status of nurses and nursing. Nursing Now carried out a global survey recently with questions about women nurses and leadership. Survey respondents were asked to rank the top five out of twelve items they felt would interest them in staying in the profession in a higher-level nursing job. The following items were ranked most often in the top five requests: having equipment and resources to perform the job (47%), leadership training (45.3%), good and fair salary (45%), having clear decision-making guidelines (38%), and decision-making support from senior management (35%). These are great signposts for us as we try to recruit and retain nursesthey are not rocket science, but surprisingly often overlooked.

What can be done to increase diversity and inclusion in nursing?

BISOGNANO: Recruiting a more diverse nursing workforce will require us to expand the public image of who is a nurse. We can use many ways to send this message, including sharing stories  on social media and including examples in films and books. We’ll need to focus recruitment in the field, where these people live today. I visited recently the Frontier Nursing University in Kentucky, and was amazed at how effective this university is in recruiting nursing and midwifery students from very rural parts of the country, and in using electronic education to keep these students connected to their home sites. We can have a diverse group of young nurses visiting schools, as they are doing in England, to change the face of nursing for the young. It’s a vital need for us to expand the diversity of our teams.

STILWELL: In some places, we need to be careful to recruit nurses from the populations that are under-represented, by going into schools and colleges and having nursing schools in places that are easy for students to access. As we get better with distance education, it will be possible to create more innovative ways of education delivery that will open opportunities for those who might not be able to otherwise access education.

Jillian McKoy

Link to BUSPH Post:


Webinar: Trauma Informed Care

By Andree EntezariMarch 8th, 2019in SHIELD Updates

We are very excited to invite you to our two part series on Trauma-Informed Care to Support Health and Well-Being for Community Health Workers.

Part 1 of the webinar series will be held on Tuesday, April 16, from 12:00-1:00pm ET.  It answers the question: How common are trauma experiences and how do they effect the lives of those they touch?  At the end of the webinar, participants will be able to:


  • Describe the “dose effect” findings of the ACES study. 
  • Identify 3 neurobiological effects of toxic stress and trauma can affect the lives of children and adults. 
  • Identify 3 of the long-term consequences of unaddressed trauma.

Part 2 of the webinar series will be held on Tuesday, April 23, from 12:00-1:00pm ET. It answers the question: What can you do to help adult survivors avoid the long term consequences of trauma? At the end of the webinar, participants will be able to:


  • Describe the ways in which trauma manifests in adult as adaptations for survival.
  • describe the 3 brief interventions that they can use to support individuals to support healing from trauma and build resilience. 
  • Participants will be able to identify 3 signs of burnout/vicarious trauma in themselves and others.

The webinar subject matter expert is Kristal Cleaver, LICSW, Director of Community Education, Clinical & Support Options, Inc. Kristal Cleaver is a Licensed Independent Clinical Social Worker who has had the privilege of watching resilience in action in lives of the children and adults she has worked with over the last 15 years. Throughout her career Kristal has strived to integrate a trauma informed philosophy into her work. In her current role as CSO’s Director of Community Education she trains and consults with schools, government agencies, and non-profits to help them establish trauma awareness and responsiveness within their organizations.

NEPHTC looks forward to welcoming you online.

Register for both webinars here

Event: Empower~Innovate~Cultivate~Change

By Andree EntezariFebruary 26th, 2019in SHIELD Updates

Join us for nurses week!

Indulge yourself mind, body and spirit.  Let us pamper you with breakfast and lunch, motivational speakers, experiential Yoga sets to reset your nervous system. Raffles and shopping too.  Top it off with contact hours to complete the day.  Let us fill your cup.

Only $99 for the general public.

New This Year!
T-shirts - order your BMC Integrative Nursing t-shirt. They are blue, shortsleeve and cost $20.  You can pre-order on the website and pick it up at the conference.

Poster Session Submit a poster on your institution's latest integrative nursing techniques.  For more information, click here

Presented by:
Boston Medical Center Integrative Nursing Council

Sponsored by:
Sponsored by the Anna Ross Committee of the Massachusetts Memorial Hospital Nurses’ Alumnae, Inc. and the Boston Medical Center Nursing Department.

Julianne Benvie, RN, BSN
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Erin Taylor, DNP, MSN, RN, CNOR
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Vicky Dennis,
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Rebecca Love, RN, BS, MSN
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Jeff Jones
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Margaret “Peg” Baim, MS,
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Leslie Salmon Jones
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The application to award contact hours has been submitted to Boston Medical Center. Boston Medical Center is an approved provider of continuing nursing education by American Nurses Association, Massachusetts, an accredited approver by the American Nurses Credentialing Center’s Commission on Accreditation.
This program is supported by the Anna Ross Committee of the Massachusetts Memorial Hospital Nurses’ Alumnae, Inc. Faculty and planners have no vested interests, and there are no conflicts of interest. There will be no discussion of off label uses of drugs.

Research: US Teens Anxiety and Depression

By Andree EntezariFebruary 26th, 2019in SHIELD Updates

For boys and girls, day-to-day experiences and future aspirations vary in key ways

Date: February 20th, 2019

(Getty Images)

Anxiety and depression top list of problems teens see among their peersAnxiety and depression are on the riseamong America’s youth and, whether they personally suffer from these conditions or not, seven-in-ten teens today see them as major problems among their peers. Concern about mental health cuts across gender, racial and socio-economic lines, with roughly equal shares of teens across demographic groups saying it is a significant issue in their community.

Fewer teens, though still substantial shares, voice concern over bullying, drug addiction and alcohol consumption. More than four-in-ten say these are major problems affecting people their age in the area where they live, according to a Pew Research Center survey of U.S. teens ages 13 to 17.

When it comes to the pressures teens face, academics tops the list: 61% of teens say they feel a lot of pressure to get good grades. By comparison, about three-in-ten say they feel a lot of pressure to look good (29%) and to fit in socially (28%), while roughly one-in-five feel similarly pressured to be involved in extracurricular activities and to be good at sports (21% each). And while about half of teens see drug addiction and alcohol consumption as major problems among people their age, fewer than one-in-ten say they personally feel a lot of pressure to use drugs (4%) or to drink alcohol (6%).

The pressure teens feel to do well in school is tied at least in part to their post-graduation goals. About six-in-ten teens (59%) say they plan to attend a four-year college after they finish high school, and these teens are more likely than those who have other plans to say they face a lot of pressure to get good grades.

Boys’ and girls’ goals and experiences differ in some key waysGirls are more likely than boys to say they plan to attend a four-year college (68% vs. 51%, respectively), and they’re also more likely to say they worry a lot about getting into the school of their choice (37% vs. 26%). Current patterns in college enrollment among 18- to 20-year-olds who are no longer in high school reflect these gender dynamics. In 2017, 64% of women in this age group who were no longer in high school were enrolled in college (including two- and four-year colleges), compared with 55% of their male counterparts.

Boys are more likely than girls to prioritize having a lot of money as adultsIn many ways, however, the long-term goals of boys and girls don’t differ significantly. About nine-in-ten or more in each group say having a job or career they enjoy would be extremely or very important to them as an adult (97% of girls and 93% of boys say this). And similar shares of girls and boys see getting married (45% and 50%, respectively) and having children (41% and 39%) as priorities for them, personally, when they grow up. Still, boys are considerably more likely than girls to say having a lot of money would be extremely or very important to them (61% vs. 41%).

While boys and girls face many of the same pressures – for example, they’re about equally likely to say they feel pressure to get good grades – their daily experiences differ in other ways. Girls are more likely than boys to say they face a lot of pressure to look good: About a third of girls (35%) say this is the case, compared with 23% of boys. And a larger share of girls than boys say they often feel tense or nervous about their day (36% vs. 23%, respectively, say they feel this way every day or almost every day). At the same time, girls are more likely to say they regularly get excited about something they study at school: 33% of girls say this happens every day or almost every day, versus 21% of boys. And while small shares of girls (7%) and boys (5%) say they get in trouble at school daily or almost daily, girls are more likely than boys to say this never happens to them (48% vs. 33%).

Teens in higher-income households are more likely to say they plan to go to college, less worried about family financesIn addition to these gender differences, the survey also finds some differences in the experiences and aspirations of teens across income groups. About seven-in-ten teens in households with annual incomes of $75,000 or more (72%) say they plan to attend a four-year college after they finish high school; 52% of those in households with incomes between $30,000 and $74,999 and 42% in households with incomes below $30,000 say the same. Among teens who plan to attend a four-year college, those in households with incomes below $75,000 express far more concern than those with higher incomes about being able to afford college.

Mental health concerns cross income boundaries, but teen pregnancy is seen as a much bigger problem by teens from lower-income householdsAnd while a relatively small share of teens overall say they face a lot of pressure to help their family financially, teens in lower-income households are more likely to say they face at least somepressure in this regard.

There are also differences by household income in the problems teens say exist in their communities. Teens in lower-income households are more likely to say teen pregnancy is a major problem among people their age in the area where they live: 55% of teens in households with incomes below $30,000 say this, versus 38% of those in the middle-income group and an even smaller share (22%) of those in households with incomes of $75,000 or more. Compared with teens in the higher-income group, those in households with incomes below $30,000 are also more likely to cite bullying, drug addiction, poverty and gangs as major problems.

A note on racial and ethnic differences among teens

The survey suggests that, in some ways, the attitudes and experiences of teens may vary along racial and ethnic lines. However, because of small sample sizes and a reduction in precision due to weighting, estimates are not presented by racial or ethnic groups.

Teens in lower-income households also have different assessments of the amount of time they spend with their parents. Four-in-ten teens in households with incomes below $30,000 say they spend too little time with their parents, compared with about one-in-five teens in households with higher incomes.

These are among the key findings of a survey of 920 U.S. teens ages 13 to 17 conducted online Sept. 17-Nov. 25, 2018.1 Throughout the report, “teens” refers to those ages 13 to 17.

A majority of teens say they plan to attend a four-year college after high school

Girls are more likely than boys to say they plan to go to collegeAbout six-in-ten teens (59%) say they plan to attend a four-year college after they finish high school; 12% plan to attend a two-year college, 5% plan to work full time, 4% plan to enroll in a technical or vocational school and 3% plan to join the military. Another 13% of teens say they are not sure what they’ll do after high school.

Girls are more likely than boys to say they plan to attend a four-year college after finishing high school: 68% of girls say this, compared with about half of boys (51%). Differences in the shares of boys and girls who say they plan to attend a two-year college, enroll in a technical or vocational school, work full time or join the military after high school are small or not significant.

Among teens with at least one parent with a bachelor’s degree or higher, as well as those in households with annual incomes of $75,000 or more, about seven-in-ten say they plan to attend a four-year college after high school. By comparison, about half of teens whose parents don’t have a bachelor’s degree or with household incomes below $75,000 say the same.

Some 65% of teens who say they plan to attend a four-year college after high school say they worry at least some about being able to afford college. Similarly, 70% express at least some concern about getting into the college of their choice.

Perhaps not surprisingly, concerns about affording college are more prevalent among teens in lower-income households. Among teens who say they plan to attend a four-year college, about three-quarters (76%) in households with incomes below $75,00o say they worry at least some about being able to afford it, compared with 55% of those in households with incomes or $75,000 or more.

Having a job or career they enjoy is at the top of teens’ long-term goals

Most teens say having a job or career they enjoy would be extremely important to them as adultsLooking ahead, virtually all teens say they aspire to having a job or career they enjoy: 63% say this would be extremely important to them, personally, as adults, and another 32% say it would be very important. Most teens also say helping other people who are in need would be extremely (42%) or very (39%) important to them when they grow up.

Teens give lower priority to marriage and kids. About half (47%) say getting married would be extremely or very important to them as adults, and 39% say the same about having children.

When it comes to fortune and fame, 51% of teens say having a lot of money would be extremely or very important to them, while relatively few (11%) say the same about becoming famous.

For the most part, boys and girls have similar aspirations. Roughly equal shares of boys and girls say getting married, having kids, and having a job or career they enjoy would be extremely or very important to them as adults. But boys (61%) are far more likely than girls (41%) to say having a lot of money when they grow up would be extremely or very important to them.

Teens in lower-income households are less likely than higher-income teens to prioritize marriage or childrenTeens’ aspirations are also fairly consistent across income levels, with similar shares in each income group saying having a job or career they enjoy, helping others in need, having a lot of money and becoming famous would be extremely or very important to them as adults.

However, teens in households with incomes below $30,000 are less likely than those in households with higher incomes to prioritize marriage and children. Some 56% of teens in households with incomes of $75,000 or more and 46% in households with incomes between $30,000 and $74,999 say getting married would be extremely or very important to them when they grow up, compared with 31% of those in the lower-income group. And while about four-in-ten in the higher- and middle-income groups (43% each) say having children would be extremely or very important to them, 27% of those in the lower-income group say the same.

Academics are at forefront of the pressures teen face

About six-in-ten teens say they feel a lot of pressure to get good gradesMost teens (61%) say they personally feel a lot of pressure to get good grades, and another 27% say they feel some pressure to do so.

Compared with getting good grades, about half as many say they feel a lot of pressure to look good (29%) and to fit in socially (28%). Roughly one-in-five say they face a lot of pressure to be involved in extracurricular activities and to be good at sports (21% each), while smaller shares say they feel a lot of pressure to help their family financially (13%), to participate in religious activities (8%), to be sexually active (8%), to drink alcohol (6%) or to use drugs (4%).

Boys and girls, as well as teens across income groups, generally feel similar levels of pressure in each of these realms, but there are some exceptions. Girls are more likely than boys to say they feel a lot of pressure to look good (35% vs. 23%). And teens in the lower- and middle-income groups are more likely than those in higher-income households to say they feel at least some pressure to help their family financially (42% and 38%, respectively, vs. 28%).

In some ways, teens’ day-to-day experiences vary by gender and income

About three-in-ten teens feel tense or nervous, wish they had more good friends almost dailyWhen asked how often they have certain experiences or feelings, four-in-ten teens say they feel bored every day or almost every day, while about three-in-ten say they feel tense or nervous about their day (29%) or wish they had more good friends (29%) with the same frequency. Roughly a quarter of teens say they get excited by something they study in school (26%), come across people who try to put them down (24%) or worry about their family having enough money for basic expenses (23%) every or almost every day.

Smaller shares say they regularly feel targeted by law enforcement (7%) or get in trouble at school (6%). In fact, 54% of teens say they never feel targeted by law enforcement, and 40% say they never get in trouble at school.

Concerns about their family having enough money for basic expenses differ greatly by income: 36% of teens in the lower-income group and 29% of those in the middle-income group say they worry about this daily or almost daily, whereas 13% of teens in higher-income households say the same.

Gender differences are also apparent, particularly when it comes to experiences in school. Girls are more likely than boys to say they get excited every or almost every day by something they study in school (33% vs. 21%), and they’re less likely to get in trouble at school. About half of girls (48%) say they never get in trouble at school, compared with 33% of boys. In addition, higher shares of girls than boys say they feel tense or nervous about their day on a daily or almost daily basis (36% vs. 23%).

Parents are more likely to say they don’t spend enough time with their teens than teens are to say the same about their parents

Four-in-ten teens in lower-income households say they spend too little time with their parentsWhen it comes to the amount of time they spend with each other, parents and teens diverge in their assessments, with parents far more likely to say it’s not enough. Among parents who live with their teens, 45% say they spend too little time with their teenage children; a quarter of teens say the same about the time they spend with their parents.2 Most teens (65%) say they spend the right amount of time with their parents, while 9% say they spend too much time.

Teens from lower-income households are the most likely to say they spend too little time with their parents: Four-in-ten teens in households with annual incomes below $30,000 say this, compared with roughly one-in-five in households with higher incomes. These same income differences are not evident among parents, however. Similar shares of parents across income levels say they spend too little time with their teenage children.

Among parents who live with their teens, fathers are more likely than mothers to say they spend too little time with their teenage children (53% vs. 39%).

Majority of teens say they get a hug or kiss from their parents almost daily

About three-in-ten teens say they get help from parents with schoolwork almost every dayWhen asked about interactions with their parents, about six-in-ten teens (59%) say they get a hug or kiss from their parents every day or almost every day. Roughly three-in-ten (31%) say they get help or advice from their parents with homework or school projects on a daily or almost daily basis, and 19% say they regularly get into arguments with their parents.

Girls and boys are about equally likely to say they get a hug or kiss from their parents every day or almost every day, as are teens from different socio-economic backgrounds.

The share of teens who say their parents help them with homework or school projects every day or almost every day is considerably lower than it was two decades ago. A Public Agenda survey conducted in 1996 found that, at that time, about half of teens (48%) reported daily or almost daily involvement from parents in their schoolwork.3


This report is a collaborative effort based on the input and analysis of the following individuals. Find related reports online at

Kim Parker, Director, Social Trends Research
Juliana Horowitz, Associate Director, Research
Nikki Graf, Research Associate
Ruth Igielnik, Senior Researcher
Anna Brown, Research Analyst
Anthony Cilluffo, Research Assistant
Deja Thomas, Research Assistant
Claudia Deane, Vice President, Research
Jessica Pumphrey, Communications Associate
Michael Keegan, Information Graphics Designer
David Kent, Copy Editor
Travis Mitchell, Digital Producer

In addition, the project benefited greatly from the guidance of the Pew Research Center methodology team: Courtney Kennedy, Andrew Mercer, Nick Bertoni, Nick Hatley and Arnold Lau, and from feedback provided by the following Pew Research Center researchers: Philip Schwadel, Aaron Smith and Monica Anderson; and Amanda Lenhart, Deputy Director, Better Life Lab, New America.


Teens survey methodology

The teens survey was conducted using the NORC AmeriSpeak panel. AmeriSpeak is a nationally representative, probability-based panel of the U.S. household population. Randomly selected U.S. households are sampled with a known, nonzero probability of selection from the NORC National Frame, and then contacted by U.S. mail and telephone. A subsample of nonresponding households is selected to receive additional, in-person follow-up from field interviewers. More details about the NORC AmeriSpeak panel methodology are available here.

This particular survey featured interviews with 920 teens ages 13 to 17. Interviews were conducted online and by telephone from Sept. 17 to Nov. 25, 2018. Of the 920 teens, 389 were sampled directly from NORC’s AmeriSpeak Teen Panel. These are teens living in empaneled households who have already agreed to participate in surveys and for whom parental consent has already been obtained. The remaining 531 teens came from a sample of AmeriSpeak households known to have at least one child ages 12 to 17. In these households, sampled adults were screened to confirm that they were the parent or guardian of a teen ages 13 to 17 and were asked to solicit the participation of their teen. Interviews are conducted in both English and Spanish.

The teens survey had a survey completion rate of 55% (920 completed interviews out of 1,683 screened eligible panelists for whom parental consent was granted). After accounting for nonresponse to the panel recruitment surveys, attrition, and nonresponse to the parental screener, the weighted cumulative response rate for the teens survey is 5%.

The AmeriSpeak teen sample was weighted in a multistep process that began with the panel base sampling weights that reflect each household’s probability of selection and the fact that some households are subsampled for in-person nonresponse follow-up. These household-level weights were then further adjusted for nonresponse and unknown eligibility. These household-level weights were passed on to all eligible adults in each participating household and further adjusted to correct for within-household nonresponse, and calibrated to match the U.S. Census Bureau’s Current Population Survey (CPS) on age, sex, education, race/Hispanic ethnicity, housing tenure, telephone status and census division to create the final panel weights.

Empaneled teens already belonging to the AmeriSpeak Teen Panel received the same weight as their parent. For the 389 who completed the survey, a nonresponse ratio adjustment was performed using the teen’s age, gender, race/ethnicity, and their parents’ highest level of education.

For parents who completed the screener and consented to their child’s participation, a ratio adjustment was performed using the parents’ age, gender, race/ethnicity, and education to correct for nonresponse and non-consent. This weight was then passed on to the eligible teen. For the 531 non-empaneled teens recruited through their parents, a final ratio adjustment based on their parents’ age, gender, race/ethnicity and education was performed.

Finally, the empaneled and non-empaneled teens were combined, and the data were raked to match the 2018 CPS March supplement with respect to age, gender, race/Hispanic ethnicity, census division, parents’ highest level of education and household size.

Sampling errors and statistical-significance tests take into account the effect of weighting. The following table shows the unweighted sample sizes and the error attributable to sampling that would be expected at the 95% level of confidence for different groups in the survey:

In addition to sampling error, one should bear in mind that question wording and practical difficulties in conducting surveys can introduce error or bias into the findings of opinion polls.

Sample sizes and sampling errors for other subgroups are available upon request.

© Pew Research Center, 2019

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