Purpose-The purpose of this study is to investigate parent reports of the diabetes care support their children receive in school, their concerns about diabetes management in school, and their knowledge of federal laws that protect children with diabetes. In addition, the study explores ethnic and socioeconomic status differences in diabetes management in school.Methods-An ethnically heterogeneous sample of 309 parents of children with diabetes was recruited from a community-based and a university-based diabetes outpatient clinic. Parents completed a survey assessing supports their child's school provides for diabetes care, worries about diabetes care in school, and awareness of federal laws that pertain to children with diabetes.Results-Many children did not have a written care plan or a nurse at school, but significantly more white children had these supports than Hispanic or black children. Most children were not allowed to check blood glucose levels or administer insulin in class. Most parents were worried about hyperglycemia and hypoglycemia in school, and most were not at all or only a little confident in the school's ability to care for diabetes. Most parents were not aware of federal laws, but high-income and white parents were more likely to be aware.Conclusions-According to parents in the current study, children receive inadequate diabetes management support in schools. Minority children are less likely to receive supports than white children. Parents are worried about diabetes management in school, but most do not have the knowledge of federal laws necessary to protect their children.Diabetes mellitus is one of the most common chronic conditions of childhood. 1 Type 1 diabetes is the most common diagnosis, with 1 in every 400 to 600 individuals younger than 20 years affected. 2 Recent studies suggest that the incidence of type 1 diabetes may be increasing in the United States and worldwide. 3,4 Although type 2 diabetes is less common among school-age children than type 1 diabetes, the incidence of type 2 diabetes has increased in the past several years in concordance with the unprecedented rates of obesity among youth. 5 The increasing prevalence of type 2 diabetes among overweight children and adolescents is especially dramatic among minorities. 4,6 In total, an estimated 18 700 children younger than 20 years are newly diagnosed with diabetes mellitus each year in the United States. 4 Diabetes self-care is complex and requires significant lifestyle adaptations that can be difficult for all people with diabetes; however, these changes are especially complicated for children and adolescents. Frequent monitoring of blood glucose levels is required, and constant access to glucose meters is a necessity. Food intake, particularly carbohydrates, must be carefully Balancing the array of diabetes self-care behaviors can be frustrating. 7 For children and adolescents, who spend approximately half of their waking hours at school, these frustrations can be compounded by difficulties getting the support...

Despite contrasting views, parents and staff agreed with the need for comprehensive school-based obesity prevention efforts emphasizing parent and teacher collaboration to promote healthy school and home environments.

Objective: We examined the association between parent and child fruit and vegetable (F&V) intake, physical activity (PA), and Body Mass Index (BMI) in an ethnic minority and low-income sample. Methods: The study sample consisted of 86 children ages 5-7 years (80% Hispanic) and their parents. Three parent health variables (healthy weight, recommended F&V servings per day, and recommended weekly PA) were used to create a healthy role model index. Associations between the parent index and corresponding child health behaviors and weight were examined. Results: Most parents (53.5%) were not healthy role models, 30.2% were limited healthy role models, 16.3% were good role models, and none were excellent role models; most parents and children did not meet guidelines for healthy weight, F&V intake, and PA. Parents who scored higher on the index were more likely to have children with higher levels of F&V. Furthermore, parents who had a healthy weight were 3.7 times more likely to have a child who had a healthy weight. Additionally, parents who were consuming the recommended servings of F&V per day were 10 times more likely to have children who were also consuming the recommended servings of F&V per day compared to parents who were not consuming the recommended servings of F&V per day. Conclusions and Implications: These findings suggest the important role of parental modeling of healthy behaviors to their young children among minority/low-income families. Parents may serve as an important mechanism of change for children's health status by increasing their own healthy lifestyle behaviors.

Little is known about how the adoption of evidence-based physical activity (PA) curricula by out-of-school time (OST) programs affects children's physical fitness, and there are no clear guidelines of what constitutes reasonable gains given the types of PA instruction currently offered in these programs. Using a three-wave, quasi-experimental, naturalistic observation design, this study evaluated the implementation of an evidence-based PA instruction curriculum (Sports, Play, and Active Recreation for Kids [SPARK]) and examined whether the potential health benefits of evidence-based PA instruction can be replicated in this context when compared to OST programs that do not use evidence-based PA curricula. Quality of PA instruction and SPARK implementation fidelity were also assessed. Results indicated that children in the non-evidence-based/standard PA instruction programs engaged in higher levels of moderate-to-vigorous PA (MVPA) and showed greater improvements in fitness levels over time. The findings from this chapter suggest that while it is generally accepted that evidence-based approaches yield higher levels of PA when implemented by researchers under controlled conditions, findings are inconsistent when evidence-based PA instruction is implemented in the field, under presumably less controlled conditions. It appears that when it comes to PA instruction in afterschool, either less structured activities or well-implemented evidence-based practices could be the key to promoting higher PA levels and greater health and fitness for school-aged children.

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