Heat Waves, Pandemics and Learning: Is it Time to Finally Tackle the School Ventilation Problem?

Most of us can remember stewing in the incredible heat and humidity of those stuffy, aroma-filled egg-crate elementary school classrooms. Years ago, teachers tried to pretend that the heat was not unbearable and let you sweat your way through periodic heat wave days. Window blinds were lowered, lights were dimmed and it was hard to keep from falling to sleep on your arms glued by perspiration to those wooden desktops.

Most teachers finally gave-in, installing rotating fans, and allowing you to bring cups and containers with water. My late mother believed in attending school under any circumstances recommended running cold water over your wrists.  Educators knew that June heat makes learning next-to-impossible on certain days, but no one studied its actual effects on learning, until quite recently.

Heat exposure in schools, it turns out, does adversely affect student learning and school air conditioning does make a difference. That’s the key finding of a May 2020 American study published by four recognized experts in quantitative analysis in the education field.

Utilizing student fixed effects models and a sample of 10 million students in Grades 10 and 11 who retook the PSATs (Preliminary Scholastic Assessment Test), the U.S. researchers found that hotter days reduce scores, with extreme heat being particularly damaging to performance.  In short, excessive heat disrupts learning time.

Air conditioning schools can have a positive effect on student learning, the study shows. School-level air conditioning penetration, in effect, offsets the heat’s effects on students. “Without air conditioning, a 1℉ hotter school year reduces the year’s learning by 1 per cent,” the researchers found. Hot school days also tend to have proportionately more adverse effects on minority students, accounting for some 5 per cent of the so-called “racial achievement gap.”

The Pandemic has cost us most of two years of schooling as school systems pivoted to home learning, hybrid models, back and forth, interrupting months of in-person schooling. Health risk reduction strategies are now part of school district facilities planning and maintenance practices. Reopening schools forced education authorities to become more aware of, and responsive to, the critical need to ensure healthy school buildings.

One of the best COVID-19 strategies, produced in June 2020 by the Harvard T.H. Chan School of Public Health, identified the five critical elements of an effective plan: (1) Healthy Classrooms, (2) Healthy Buildings, (3) Healthy Policies, (4) Healthy Schedules, and (5) Healthy Activities. “Breathing clean air in the school building” was deemed essential to the health and safety of students, teachers, and staff during COVID-19 and in post-pandemic times.

Improving air ventilation was at the centre of the proposed plan of action for Healthy Buildings. School authorities were advised to consider a coordinated and flexible approach tailored to the specific conditions in each school site. Increasing outdoor air ventilation was considered a minimum expectation, and the recommended remedial actions included air quality and filtration assessments, portable air cleaners, filtering of indoor air, and the installation of advanced air quality systems, including central or designated zone air conditioning.

The impact of students’ and teachers’ physical environments on educational outcomes is understudied and deserves far more attention. Excessive heat best exemplified during heat waves does directly interfere with learning. Disparities in physical environments, such as improper or intermittent air ventilation, also seem to contribute to inequality when it comes to serving disadvantaged or racialized communities.

The Pandemic was a wake-up call for educators alerting us to the critical role played by air flows and aerosols in the transmission of deadly viruses. Growing awareness of climate change and global warming has also heightened our sensitivity to rising temperatures and the incidence of heat waves. Median climate change scenarios predict average U.S, warming at 5 ℉ from 2010 to 2050.

Based upon existing estimates of global warming across Canada, we can project, by 2050, how much more heat-disrupted learning we can expect relative to today. It’s safe to predict that there will be more school days in the high 30s with sweltering Humidex readings. Given those climate change prospects and what COVID taught us, investing in improved school ventilation, including air conditioning, looks more like a sensible, longer-term capital improvement in K-12 education.

Putting up with oppressive heat and making-do with existing air ventilation is becoming less defensible in COVID times.  How can students perform up to their potential in steamy classrooms with little or no air ventilation? What is the impact on student attention and learning as measured in test results? Will the COVID-19 pandemic be the deal-breaker in addressing the chronic and unaddressed problem?

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Coronavirus and School Closures: Should Schools be Closed and, if so, When?*

The global footprint of coronavirus – COVID-19 – is expanding and national governments as well as regional school districts are making the difficult decision to shutdown the schools. On March 11, 2020, the World Health Organization officially declared it a “pandemic” and all of Canada’s education ministers participated in a teleconference to discuss the situation and potential policy responses, specifically following the annual March break for students and teachers.

Political leaders at the highest levels, working closely with public health authorities, are weighing their emergency measures options to combat the pandemic, ranging from school closures to mass quarantines. Closing schools may be politically expedient, but its effectiveness in curbing transmission is far from clear.

School closures have already interrupted the public education of some 300 million students across the globe. The first nation to close schools was Hong Kong, back in January, then Japan on February 27, and now many more jurisdictions have followed suit, including Italy, South Korea, Iran, France, Pakistan, New Delhi, the New York City region and northern Washington State.

Deciding to close schools in the case of COVID-19 is particularly challenging for one major reason. In the initial wave, the novel coronavirus, unlike HIN1 in 2009, had not affected children at high rates. Out of 44,672 initial confirmed cases in China, fewer than 2 per cent occurred in children under 19 years of age, and no deaths were recorded among those younger than 10 years old. That may be a low estimate because the attack rate for children, at a later stage in Shenzhen, was 13 per cent.

Closing schools, in some previous epidemics, has proven helpful in reducing transmission of seasonal flu among children. One 2013 British Medical Journal report, based upon a systematic review of epidemiological studies, concluded that school closures contained rates of transmission, even in the absence of other intentions. Yet determining “the optimal school closure strategy” remained “unclear” because of the wide variation in its forms of implementation.

Tracking the impact of school closures has proven tricky for researchers.  Some closures were limited to individual schools and, in other cases, whole school systems. Closing before the peak of the outbreak or well into the outbreak suggests that decisions are being made as either a precaution or a reaction to rising student influenza-related absenteeism. In some cases, schools close so children can receive antiviral medicines or vaccines, or in conjunction with a strategy of “social distancing.”  Such wide variations in implementation strategies makes it a challenge in determining which change actually affected transmission.

The body of research on school closure impacts during epidemics is surprisingly large, encompassing the 1918 Spanish flu epidemic, the 2002-03 SARS pandemic, and the 2009 HINI flu outbreak.

Yet the results of those school closures have been mixed. Closing schools for more than two weeks has been linked to lower transmission rates in Hong Kong (seasonal and pandemic flus) and in England (H1N1), but not so in Peru (pandemic) or the United States (during seasonal flu epidemics).

The 2008 Hong Kong outbreak, the 1957 epidemic experience of France, and the 1918 pandemic records in some U.S. cities demonstrate that shutting schools can have no discernible impact, especially if decisions come too late in the cycle of the outbreak. Relying upon older parents or grandparents to be caregivers during closures may actually increase mortality rates among more susceptible populations.

Public heath experts caution educational leaders and school principals against basing decisions on the North American H1N1 experience. “The sensitivity of the 2009 pandemic to school closures probably relates to the high attack rates in children compared with adults,” the BMJ study pointed out. “Outbreaks in which children are less affected” such as COVID-19, “might be less sensitive to school closure.”

Closing schools also has broader socio-economic impacts and unrecognized health effects. There are trade-offs in being overly cautious by closing schools, including potential lengthy disruptions in student learning and compelling parents to stay home from work. Students from lower socio-economic neighbourhoods would also be deprived of school meal programs and cost-free supervised athletics activities.

The most authoritative study of school closure impacts, in the August 2009 issue of The Lancet, actually assesses broader community impacts. If all U.K. schools closed, some 30 per cent of health and social care workers would be taken out of commission, compounding adverse effects on the financial health and viability of communities.

School authorities would be well-advised to consider the potential duration of closures in their emergency response plans.  While it is probably wise to err on the side of caution with school-age children, the longer the closure lasts, the more problematic it becomes, especially in the absence of e-learning bridge programs.

Closing schools for more than two weeks to combat COVID-19, as in the case of Hong Kong, could have a detrimental effect upon the school schedule, year-end-examinations, and the conventional grade- promotion system. It’s possible, perhaps likely, that students will be seriously set back by missing so much instructional time.

Implementing “e-learning plans,” including digital and distance learning, is recommended by the U.S. Center for Disease Control and Prevention (CDC), but there’s a major problem with that constructive proposal in its guide for school administrators. It’s feasible in e-learning ready school systems like those in Hong Kong, United Arab Emirates, and the State of Ohio, but not yet in our provincial school systems.

Few Canadian school districts are prepared or trained to implement e-learning days system-wide, and they have, with few exceptions, resisted piloting e-leaning modules during winter season storm days.  Scrambling to implement hastily prepared distance learning or online courses will not prove effective at all. Nor are schools fully equipped to administer year-end assessments online or to report the results electronically to students and parents.

Closing schools may be expedient in assuring the concerned public that actions are being taken to control the spread of the contagion. This is especially so now that managing the fears and anxieties of children and families is emerging as a priority during the COVID-19 pandemic.

Given the lower attack rates for children and the weight of research evidence, it’s much harder to make the call to dismiss classes and suspend school for what may well be an indeterminate period of time.

 Should schools be closed to contain and reduce the transmission of the 2019-20 coronavirus?  What does past experience closing schools during epidemics tell us?  Should schools be closed early in the cycle as a precaution or in reaction to escalating attack rates among children and their teachers? How prepared are school districts to implement e-learning as a bridge in the teaching-learning process?  If schools do close, the question is — for how long given the unpredictability of the spreading contagion?  

*An earlier version of this commentary appeared in The National Post, March 11, 2020. 

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Flu Season and Coronavirus: Were Schools Fully Prepared for the Latest Twist?*

Students are now coming down with seasonal colds and the flu.  What was predicted to be a normal flu season in schools turned ou out to be highly unpredictable with the arrival of a ghost menace – the fear of coronavirus, now labelled COVID-19.  Public anxieties were fed by a popular media inundated with frightening stories about the spectre of coronavirus, rivaling that associated with the outbreak of SARS in 2002-2003. The latest scare also sparked a disturbing undercurrent of suspicion, with racist undertones, directed at Canadians of Chinese ancestry.

The common flu remains a bigger threat than coronavirus but you would never know it from the media coverage.  Some 25,854 confirmed cases of the regular flu have been reported since late August 2019, and, so far, the coronavirus, has only infected a dozen Canadians. Some 12,200 Canadians are hospitalized for influenza each year and about 1,000 die across Canada. In 2002-2003, for comparison purposes, 44 people died of SARS in Canada.

Normally calm Public Health authorities are now forecasting an uptick in cases throughout February into March. Teachers and principals will be on the front lines because schools are well-known breeding grounds for germs and infections.

This flu season it is going to be worse because, according to the Public Health Agency of Canada (PHAC), the country is seeing an unusually high number of Influenza B cases, which tend to cause more severe illness in children. Of the 33,615 reported Canadian influenza cases (up until February 8, 2020), 11,905 were classified as Type B, with 57 per cent of those patients under 20 years-of-age. Reported Influenza B cases were also more common in the Maritime provinces of Nova Scotia and New Brunswick.

Face masks are disappearing from pharmacy shelves as people are either wearing them outside or hoarding them in the event of a global pandemic. Nova Scotia’s Chief Medical Officer of Health Robert Strang claims that the masks are not guaranteed to offer protection and may encourage people to touch their faces, actually spreading the germs.

The global outbreak is Chinese in origin and that most regrettably still carries insidious connotations. It may have originated in Wuhan in China’s Hubei Province, where some 57 million citizens were placed in a state of lockdown and isolation, but exaggerated fears and anxieties have spread worldwide. The two-week ordeal of international tourists trapped on the quarantined and virus-ravaged Diamond Princess cruise ship anchored in Yokohama, Japan, further fed public anxieties.

Combating and surviving the flu season in school used to be so much easier. Counselling students and teachers to stay home, drink fluids, and get rest used to suffice in weathering the seasonal onslaught. Most of us fooled ourselves into thinking that miracle cures for the cold and flu like Cold-FX were actually working and toughed it out with Tylenol, Hall’s cough drops, and, on a bad day, toilet tissue kleenex.

Today’s principals, teachers, and students come to school prepared with new weapons in the ongoing war against contagion. Wiping down desks with disinfectants and packing little bottles of Purex in pockets and purses is now standard practice. A few even don surgical masks to keep colds in, or ward them off, walking to and from school.

Fear and panic are running high in Ontario and British Columbia school districts where many of the students are Chinese Canadians or recent arrivals of Chinese descent. Vocal and active parents are clamouring for schools to increase screening of Chinese students suspected of being carriers and sending home children whose families have recently returned from China.

Coronavirus-induced tensions are most acute in York Region, north of Toronto, particularly in Richmond Hill and Markham, where 40 per cent of the population is of Chinese origin. A coronavirus-inspired petition targeting Chinese families launched in late January in York Region, north of Toronto, was quickly endorsed by parents in 145 local schools and generated some 10,000 signatures. In the York Region District Board of Education, Board Chair Juanita Nathan and Education Director Louise Sirisko, were compelled to send out a memorandum to all schools in direct response to the level of concern and anxiety being felt by families of Chinese heritage.

While the province of Nova Scotia is home to some 3,500 Chinese-born students, the only public display of concern was by Max Chen, a second-year Chinese student at Cape Breton University. After searching in vain for surgical masks to send home, he voiced his concern that the province’s public health officials were unprepared to deal with a potential outbreak at the university.

Public health officials, educators and academics are fearful of schools and universities becoming swept-up in an us-versus-them cycle of racism directed at those who look different. Spreading of misinformation and ignoring facts from public health agencies is symptomatic of deeper, sublimated problems.

A leading SARS impact researcher, York University’s Harris Ali, who studied the stigmatization of the Chinese population in Canada, put it best. Gaslighting the Chinese as carriers of the contagion, he claims “feeds into already pre-existing underlying biases or prejudices.”

Global pandemics turn flu season into a mass psychological experience that can overshadow the actual health risks of transmission. Calming and dispelling exaggerated fears as well as sanitizing desks have now become the essential skills in a 21st-century educator’s repertoire. That may be a clear indicator of the high anxiety temper of our times.

Why was the current flu season so unpredictable in our schools?  Were Canadian public health authorities ready for the surge in Influenza B, the strain most commonly infecting young people of school age?  Are principals and teachers fully prepare to deal with students showing signs of coronavirus?  What are the challenges posed by containing the spread of viruses while ensuring that students and families of Chinese ancestry are not unfairly targeted in the broader community? 

*An earlier version of this commentary was published in The Chronicle Herald, February 15, 2020.

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School Water Fountains: How Serious is the Lead Risk in our School and Day Care Drinking Water?*

“DO NOT USE” signs plastered all over school drinking fountains have a way of getting the chilling message across. For the past thirty years, those signs have appeared, periodically, on fountains in thousands of Canadian K-12 schools. Most of us walk by, unaware – until recently — of a simmering public health crisis.

What was a largely dormant issue has come back with a vengeance.  The November 4, 2019 release of the findings of the massive year-long Canadian investigation, spearheaded by the Institute for Investigative Journalism, has raised new concerns over exposure to lead in home tap water and school/daycare drinking water supplies.

The “Tainted Water” series of news reports were alarming because many in education had assumed it was behind us. The benchmarks changed in March of 2019 when federal health authorities reduced the acceptable levels of lead from 10 parts per billion (ppb) to 5 ppb. Out of 12,000 tests conducted since 2004, in 11 different Canadian cities, one-third – 33 per cent—exceed the new health. safety standard. The latest investigation, based upon some 260 water tests conducted in 32 cities and towns and validated in accredited labs showed that 39 per cent of samples, or two out of five, exceeded the 5 ppb guideline for healthy water.

The current health alarm is serious, but needs to be considered in proper North American context.  Three to four million American children were found to have toxic levels of lead in their blood back in the 1980s. Levels of contamination were far higher in those days. The U.S. EPA reported that thirty-three of the 47 states testing drinking water had levels exceeding the then acceptable standard of 20 ppb.  Back then, most people, including young children, were exposed to multiple environmental sources, including paint on old housing walls, drinking water, ambient air, dust, soil, and food, particularly canned goods.

The 1988 U.S. Lead Contamination Control Act imposed strict new regulations on American schools requiring them to clean up their act by testing drinking water, abandoning lead-lined water coolers, and remedying any contamination found in taps and water intake pipes. It faced stiff legal challenges and a great deal of non-compliance and was eventually struck down in 1996 by a federal appeals court.

The first real school drinking water scare did produce a ripple effect and reactive responses which reverberated in school districts, from province-to-province, across Canada. What survived was a 1991 EPA established standard that required periodic tests for lead and copper levels in public water systems virtually excluding schools and day cares drawing water from their own wells. While the limit was reduced to 15 ppb, it applied to municipal water feeds rather than internal sources of contamination. In the case of schools, most of the lead still originates in lead pipes, water-cooler linings, and in led metal fountains and taps.

Medical science has advanced significantly over the past three decades, but implementation of health regulations lags, especially when it comes to testing for lead contaminants in schools and daycares. Coast-to-coast, the Canadian investigators identified a patchwork of lead regulations, weak oversight, laxity in conducting tests, and the relative absence of regular testing of homes, schools or daycares drawing water from wells.

When Health Canada cut the acceptable level of lead levels in half, it sent provincial and school district authorities scrambling, particularly outside the major metropolitan centres,  The new regulation came with warnings that, even at concentrations as low as 5 ppb, high levels of exposure can damage the prefrontal cortex, cause prenatal growth abnormalities, and contribute to anti-social behaviour and child behavioural problems. It has also been identified as a risk factor for hypertension, chronic kidney disease and tremors in adults.

Thousands of Canadian children in schools and daycares are at risk of ingesting lead in drinking water and most were totally unaware of that until the release of the latest journalistic expose. Provincial authorities, with the possible exception of Ontario and British Columbia, are playing catch-up, compared to a number of American states more proactive in testing and public disclosure.

The EPA promotes its “3Ts” approach – Training, Testing and Taking Action, complete with home and school water quality testing kits.  Since August 2016, New York State has required all school districts and boards to “test all potable water outlets for lead contamination, to remediate contamination where found, and to notify parents of children and the public of the results.”

The 2016 public health crisis in Flint, Michigan, intimately connected with the toxicity of water did not seem to register up here in Canada. Periodic warnings were issued to no avail by provincial public servants, according to newly-released government documents obtained through formal freedom-of-information requests.

Cleaning-up school drinking water standards is back as a top education priority. Whether it will last in a system best by competing immediate demands for reduced class sizes, more resource supports, and improved working conditions remains to be seen. Deferred maintenance has a way of coming back to bite school systems.

*An earlier version of this commentary was published in The Chronicle Herald, November 16, 2019 

Why is lead still in school and daycare drinking water, thirty years after the initial revelations?  Was the 2019 lead in the water scare the result of Health Canada’s decision to dramatically reduce the acceptable standards? How effectively did school and day care authorities respond?  Without a nation-wide investigative report, how much would we have known about the extent of the problem? 

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Childhood Disease Outbreaks: What’s the School System’s Responsibility in Child Immunization?

Measles outbreaks in the spring of 2019 in the American Pacific Northwest and British Columbia were part of a global revival of an infectious disease that had already affected thousands in Asia, Africa and Eastern Europe. In the wake of that outbreak, the BC Ministry of Health under Adrian Dix acted to require all parents to provide local public health units with their child’s immunization record before beginning school in September 2019. Twelve measles cases in Saint John, New Brunswick, in June 2019, prompted the Chief Medical Officer of Health Dr. Jennifer Russell to intervene to protect as many as 2,000 people exposed to the disease, ordering up 20,000 more doses of MMR vaccine, protection against measles, mumps and rubella.

Lagging childhood immunization rates are emerging as a major public health concern.  Periodic outbreaks of measles and mumps have alerted the public to the fact that childhood diseases, once virtually eradicated by vaccines, are reappearing in and around schools.

Vaccines remain one of the safest and most effective tools we have to protect ourselves, our families and our communities from infectious diseases. Those are not my words, but those of the Public Health Agency of Canada. The current reality is that we are not meeting our national immunization goals and too many children as well as adults remain unprotected and liable to experience illnesses from vaccine-preventable diseases that can cause serious health complications, some of which carry a risk of death.

Each year in April Health Canada raises the alarm during National Immunization Awareness Week and education programs are announced in an attempt to raise vaccination rates. Our Chief Medical Officer of Health, Dr. Robert Strang, makes regular appeals, most recently in August of 2019, to encourage parents to keep their children’s immunization records up-to- date.

The current strategy is not working in Nova Scotia where only 71 per cent of 7- year-olds are immunized for measles and mumps, some 15 per cent lower than the national provincial average and ranking last among the provinces. In New Brunswick, where it’s considered a “crisis,” the measles and mumps coverage rate at age 7 is 92.3 per cent.

While provincial health and school authorities in New Brunswick, British Columbia and Ontario are tackling it head on, Alberta and Nova Scotia are still vacillating on how to improve its abysmal childhood immunization rates. While Health Minister Randy Delorey dithered, PC Leader Tim Houston introduced a private member’s bill to try to force the government’s hand.

Sparked by the spring 2019 measles scare in the Saint John region, New Brunswick Education Minister Dominic Cardy has championed legislation that would make vaccinations mandatory for children without medical exemptions in provincial schools and day cares.

Taking a proactive approach to combating the resurgence of childhood diseases is becoming common right across Canada. Three years ago, Ontario introduced stricter childhood vaccination regulations and in British Columbia legislation requires the reporting of immunization records. Ontario has far higher rates of reported childhood immunization at age 7 than Nova Scotia. Yet, since 2016, that province has required student vaccinations be up to date unless a parent or guardian can provide medical, religious or philosophical reasons why their child has not received a vaccine. Even when exemptions are granted, families are required to watch a 30-minute video on the importance of vaccines and then sign a document saying they viewed the presentation.

Public health authorities hold sway in Nova Scotia, unlike in New Brunswick, where a proactive Education Minister is leading the charge to meet childhood immunization targets so schools do not become sources of contagion.

Nova Scotia Health Minister Delorey may be deterred by fears of stirring-up the radical anti-vaxxers and setting back the cause. He should be taking his cue from New Brunswick’s courageous Education Minister. Confronting a posse of opponents, Cardy called out the group as conspiracy theorists who “influence, mislead and deceive” parents into thinking their children are at risk if they are vaccinated.

Prominent among the N.B. protesters were former Halifax chiropractor Dena Churchill who recently lost her licence to practice because of her anti-vax campaigning, and California pediatrician Dr. Bob Sears, a well-known anti-vax advocate funded by Vaccine Choice Canada.

Vaccine adverse reactions do happen, but, on balance, immunizing children prevents far worse harms caused by the unchecked spread of childhood infectious diseases. School attendance is compulsory and, in that context, so should immunization aimed at safeguarding children’s health.

Minister Cardy stood his ground defending his legislative changes aimed at achieving the goal of 95 per cent coverage. Growing anti-vaccination sentiment, he claimed, was being fed by social media, and threatened to discourage parents from vaccinating their children, reducing immunization rates below a critical threshold that allows a community to resist an outbreak.

Playing nice does not seem to be working at raising childhood immunization rates. Scare stories spread by anti-vaxxers should not go unchallenged. Claims that vaccines are harmful, in Cardy’s words, are “not supported in fact.” “If you believe in evidence-based decision-making, you have to look at the evidence and the evidence is incontrovertible.”

Childhood diseases such as measles, mumps, diphtheria, pertussis, and rubella can do great harm if left unchecked by regular vaccination. With childhood infectious diseases making a comeback, is now the time to be vacillating on child immunization? Does the school system have some responsibility to ensure that immunization rates are high enough to prevent mass outbreaks in the community?  Should it all fall on provincial and local health authorities? 

• An earlier version of this research commentary appeared in The Chronicle Herald, October 31, 2019.

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Vaping and Teen E-Cigarette Addiction: Will Conventional Harm Reduction Programs Work?

The prevalence and use of electronic cigarettes has increased rapidly over the past decade, particularly among youth.  The extraordinary growth of e-cigarettes has also raised significant public health concerns about the emergence of a new generation of teens with nicotine dependency.  Changes in the design and marketing of vaporizers with the introduction in 2015 of more stylish, sleekly-designed, discreet high-tech devices, known as JUUL, have proven irresistible to teens and become the latest ‘nightmare’ for today’s high school principals and teachers.

School authorities in Canada as well as the United States are coming rather late to the challenge of combating vaping and its associated health risks.  Advance promotion of e-cigarettes as a smoking cessation device may have contributed to the initial ambivalent, almost helter-skelter, response.  A May 2019 Ontario Tobacco Research Unit report confirms that schools were caught off-guard by the surge of vaping among never-smokers and responded with interventions once used to combat smoking or imported from the United States, where the craze is far more advanced among youth.

Five years after the arrival of JUUL, public concern has reached a panic stage with the spread of fear over a recent spate of lung-disease cases involving teen users of e-cigarettes. Breathing in flavoured aerosol that contains nicotine was already a worry of doctors, parents and schools.  Over the past few months, some 380 people in 36 different American states have been struck by a mysterious lung infection linked to chemicals inhaled through e-cigarettes, and seven of those affected died.  Shortly after Health Canada issued a September 6, 2019 advisory, a London, Ontario, hospital disclosed that a local high school student suffering from vaping-related illness had been placed on life support before recovering and being sent home. It could become worse in mid-December 2019 when the sale of vaping liquids containing cannabis compounds becomes legal in Canada.

Schools are on the front lines of the current teen health scare. Since entering the Canadian retail market in 2009, e-cigarettes have morphed from a smoking-cessation aid to a full-blown health concern among today’s youth. Ten years ago, Health Canada greeted e-cigarettes with an advisory warning of the dangers of the new nicotine delivery devices, expressing concern over the lack of scientific research to support claims that they were safe for adults and teens. More recently, Canadian health authorities monitoring the spread of e-cigarette use have been echoing the U.S. National Academies of Science, Engineering and Medicine research finding that ” e-cigarettes are not without biological effects on humans” and, rather than aiding in cessation, can lead to further dependency.

Vaping devices and products containing nicotine are now flooding the Canadian market and readily available in local convenience stores and gas stations. Since September 1918, JUUL, the San Francisco-based company that controls over 50 per cent of the market, has been selling its sleek devices that look like a computer flash drive and are re-chargable at a USB port. They have proven more popular that the Imperial Tobacco brand Vype, released Canada in the Spring of 2018, and Japan Tobacco‘s Logic brand released in early 2019.

First introduced by Juul Labs in mid-2015 as a smoking-cessation device, JUUL became the so-called “iPhone of e-cigarettes.” The extraordinary sales growth of the product was driven by a variety of effective, wide-ranging and engaging campaigns reaching youth through social media, particularly on You Tube, Twitter, and Instagram. Five million Canadians, mostly aged 15 to 34, had tried e-cigarettes by 2017 and 300,000 reported using it every day. One more recent study, published in the British Medical Journal, reported that the proportion of Canadian teens (aged 16 to 19) vaping rose from 8.4 per cent in 2017 to 14.8 per cent in 2018, a 74 per cent increase. 

The Ontario Tobacco Research Unit conducted an environmental scan of current harm reduction programs and quickly recognized that there were, as of the Spring of 2019, no studies of the effectiveness of such interventions. Most intervention programs were public education and school-based efforts, typically aimed at teaching children and youth about the dangers of vaping in the hope of reducing or eliminating the practice. Three of the programs reviewed were E-Cigarettes: What You Need to Know (Grades 6 -12, Scholastic), CATCH My Breath (Ages 11-18, CATCH), and School E-Cigarette Toolkit (Grades 6-12, Minnesota Department of Health).  The report also examined interventions outside of schools, including community-based initiatives, public health efforts, health-care programs, and public policy strategies such as advertising and promotion restrictions, age restrictions, labelling and health warnings, flavouring restrictions, and safety requirements.

Most of the actual school-based interventions were embedded in existing tobacco control programs and sought to counter the marketing messages of companies claiming it is a safe, smoking cessation activity. The Ontario Tobacco Research Unit recognized the scattered approach being taken and recommended considering interventions that proved successful at reducing rates of regular cigarette smoking among youth. They also identified the need for a more coordinated and planned anti-vaping strategy.

Vaping has overtaken smoking as the favoured health-risk behaviour of high school students.  Some 15.8 per cent of Ontario Grade 9 students vaped in 2017, and only 6.2 per cent smoked cigarettes. As many as one out of every three high schoolers may now be regular users of vaporizers with nicotine-laced fluids. The recent health scares may have jolted users and curbed the growth in usage, but it remains the biggest, mostly unaddressed health issue in our high schools.

Why have health agencies and school authorities been so slow off-the-mark in combating the spread of vaping among adolescents? What more can be done to regulate and curtail the marketing of e-cigarettes among the youth market segment?  Where are the research initiatives aimed at identifying the real health risks for teens of vaping nicotine and cannabis products?  Should vaping cessation programs simply mimic smoking control strategies and programs?  What can be done to develop more effective student-centered vaping cessation programs? 

 

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Playground Safety Policy: Why are School Districts restricting Children’s Outdoor Play?

Hundreds of children in “Canada’s Ocean Playground” (aka Nova Scotia) entering school for the first time  in September 2018 will be prevented from using the playground equipment in their own schoolyards.  In Atlantic Canada’s largest school district, Halifax Regional Centre for Education (HRCE), parents were only alerted to the new rules affecting children under 5 years in June 2018 newsletters that advised them about “risk management advice” about the use of playground equipment during the school day. The news provoked quite a reaction and prompted Halifax playground expert Alex Smith to post a stinging July 2018 critique headed “Look- Don’t Play” on his widely-read PlayGroundology Blog.

The Halifax school district, like many across Nova Scotia, used the Canadian Safety Association (CSA) standards for outdoor play as a rationale for barring all Junior Primary and Senior Primary (not only ages 3-4 children , but also those age 5), from using the school playground equipment.  School administration had been alerted to the potential problem back in the fall of 2017 at the time of the announcement of an expanded provincial Pre-Primary program. Instead of introducing kids to the joys of outdoor play, principals and teachers will be occupied trying to keep them off the equipment.

Nova Scotia is not alone in ‘bubble-wrapping kids’ on school playgrounds. It is just far more widespread because most of the province’s schools are only equipped with older, off-the shelf, equipment with CSA safety restrictions. Instead of phasing-in the introduction of Pre-Primary programs with playground upgrades, the N.S. Education Department has plowed full steam ahead without considering the importance of providing purpose-built kindergarten play areas.

Vocal critics of school and recreation officials who restrict child’s play are quick to cite plenty of other Canadian examples. Back in November 2011, a Toronto principal at Earl Beatty Elementary School  sparked a loud parent outcry when she banned balls from school grounds. One Canadian neighbourhood, Artisan Gardens on Vancouver Island, achieved international infamy in a June 2018 Guardian feature claiming that the local council had “declared war on fun” by passing a bylaw banning all outside play from the street, prohibiting children from chalk drawing. bike riding, and street hockey.

Such stories make for attention-grabbing headlines, but they tend to miss the significance of the changing dynamics of play in Canada and elsewhere. Protecting kids at all times has been the dominant practice, but fresh thinking is emerging on the importance of “free play” in child development. Alex Smith of PlayGroundology is in the forefront of the growing movement to replace “fixed equipment play” with “adventure sites” and “loose parts play.” While aware that child safety is a priority, the “free play” advocates point to evidence-based research showing the critical need for kids to learn how to manage risk and to develop personal resilience.

School superintendents advocating for the retention and revitalization of recess can be allies in the cause of ensuring kids have regular play time.  Some school district officials, however, seem to thrive on “over-programming kids” and see recess as another time to be planned and regulated. Typical of the current crop of North American senior administrators is Michael J. Hynes, Ed.D., Superintendent of Schools for the Patchogue-Medford School District (Long Island, NY). Providing a decent school recess, in his view, is just another solution to the “mental health issues” affecting many of today’s schoolchildren. Makes you wonder how ‘liberated’ kids would be on those playgrounds.

Larger Canadian school districts in Ontario have managed to avoid the CSA playground standards debacle.  The five-year Ontario implementation  plan for Full Day Junior Kindergarten, starting in 2010-11, included funding to redevelop playgrounds for children ages 3.8 to 5 years. In the case of the York Region District School Board, outdoor learning spaces in their 160 elementary schools were gradually converted, school-by-school into natural “outdoor learning spaces” with fewer and fewer high risk climbing structures. Outdoor creative play and natural settings were recreated, often in fenced-in junior playground areas. In Canada’s largest school district, the Toronto District School Board (TDSB), targeted funding allowed for similar changes, over 5-years, in some 400 schools.

Converting all elementary school playgrounds can be prohibitively expensive for school districts without the resources of these Ontario boards. Instead of investing heavily in the latest “creative play equipment and facilities,” playground experts like Alex Smith recommend taking a scaled-down, more affordable approach. Many of Halifax’s after school Excel programs adopted loose parts play following a presentation on risk and play by the UK children’s play advocate Tim Gill three years ago.  His message to school officials everywhere: “Loose parts play is doable from a budget, training and implementation perspective. What an opportunity!” 

What message are we sending to children entering school when they are barred from using playground equipment?  Should expanding early learning programs be planned with a program philosophy integrating indoor and outdoor play?  Is there a risk that we are robbing today’s kids of their childhood by over-protecting them in schools? When does ‘bubble-wrapping’ children become a problem? 

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Vaping in Schools: Is ‘Juuling’ a Passing High School Craze or a Worrisome Trend?

Smoking in and around high schools has become ‘cool, once again. Over the past year, vaping has overtaken cigarette smoking as the surreptitious habit of choice among teens as well as undergraduate university students. While smoking e-cigarettes is officially outlawed on school property, that has not stopped a dramatic rise in the popularity of vaping among high schoolers. In the case of Ontario, a 2017 provincial survey revealed that more students in Grades 7 to 12 self-reported vaping (18 per cent) than smoking tobacco cigarettes (12 per cent).

The latest vape innovation, the Juul, now dominates the United States teen market and is beginning to spread into Canada. Inhaling multi-flavoured vapors with nicotine is now much harder for school administrators and teachers to detect. The small, sleek device, or juul, which can be easily mistaken for a portable USB drive has cornered the market for e-cigarettes and vaping products, particularly in affluent school districts where students can afford the latest gadgets and stimulants. Concealing bulging vaporizers was tough, but these low-profile, sleek designs allow students to easily conceal their habit and to escape detection not only in in the usual spots (bathrooms, back hallways, and under stairwells), but even in classrooms.

Like most teen crazes, vaping and ‘julling’ caught on far faster than school officials realized and became well established before authorities saw the scale of the problem. School principals are scrambling to contain the practice and trying to stamp it out.  “I think it’s everywhere, and my school is no different, ” Connecticut principal Francis Thompson recently told Education Week. Then he added, “I think it’s the next health epidemic..”

Vaping with the stealth devices, while less prevalent, is reportedly rising in and around Canadian high schools. “Everybody’s doing it, ” a Grade 9 student in Windsor-Essex County told Windsor CBC News in early April 2018.  Teens in Ottawa high schools featured in a May 2018 Canadian Press news story confirmed that it was now “cool” to smoke again, albeit with vaporizers and in well-known hiding spots. In Sydney, Cape Breton, students at Sydney Academy were well-aware of students vaping in class undetected, and fellow students suspended for smoking who were actually vaping on school grounds.

The new federal legislation, the Tobacco and Vaping Products Act, passed in May 2015, may help to clarify the legal position of school principals trying to cope with the latest craze. Bill S-5 (2018) may improve the quality and regulation of  vaping products and it does restrict use to adults. Federal regulations, expected within six months, will reduce the number of flavours used in e-cigarettes, banning those designed to mimic ‘confectionary,’ cannabis, or energy drinks, and designed to hook young people on these devices.

Defenders of e-cigarettes continue to maintain that they are a safer alternative to tar-producing tobacco cigarettes. Tobacco experts at Public Health England tend to support such claims, as confirmed in a February 2018 UK government report. Whether vaping is effective in promoting smoking cessation is far from clear in studies to date.

School policies banning smoking have been updated to include vaping, but the new stealth devices are making it harder than ever to enforce, especially when the juul looks so much like a USB stick and can be easily concealed by student users. The latest fear expressed by school principals and teachers is the prospect of vaporizers being used to deliver cannabis, circumventing school detection and regulations. When cannabis is legalized across Canada, October 17, 2018, we shall see whether it further complicates the job of policing and eliminating vaping on school grounds.

Why is vaping replacing tobacco smoking as the nicotine product of choice in and around schools?  Will the American juul craze become more widely accepted and entrenched among teens here in Canada? Should we be focusing so much on stamping out vaping or on convincing students to stop smoking, whatever the substance? Will the legalization of marijuana only compound this problem for teachers and school administrators? 

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Teen Mental Health Programs: What Works — and Why — in Schools?

Seeing some 400 teachers and school service providers flooding into the Halifax West High School auditorium on July 20, 2017 was an eye-opening experience. In the middle of the summer, they committed time to a two-day conference focusing on child and teen mental health. Led by Dr. Stan Kutcher, the Mental Health Academy was filling a real need in the school system.

With the news full of stories warning of a “mental health crisis,” teachers in the K-12 system are feeling anxious and more conscious than ever of their role in the front lines of education.  What Dr. Kutcher’s Academy offered was something of a tranquilizer because he not only rejects the “crisis” narrative, but urges classroom practitioners to develop “mental health literacy” so they can “talk smart” with students and their parents.

The fifth edition of the Mental Health Academy, initiated in 2006 by Dr. Kutcher, studiously avoided adding further to the noise and sought to advance teacher education in mental health using evidence-based research and programs.  Stress can be good and bad, Kutcher reminded us, and we need to be able to distinguish among the three types of stress responses identified by the Harvard Center for the Developing Child: positive (daily), tolerable (regularly) and toxic (extremely rare).  Instead of pathologizing “stress” as “anxiety,” what children and youth need most is “inoculation” to help build a more robust stress immune system.

While the incidence of teen mental health problems is not appreciably different than it was fifty years ago, we are far better equipped to respond to the challenges in and around schools. The MH Academy amply demonstrated how much more we know today about adolescent brain development, school staff self-care, anxiety, depression, eating disorders, substance addictions, and teen suicide.  Educating teachers about that research is the real purpose of the Academy.

Mental health disorders are serious and teachers are well-positioned to assist in early identification. About 1 in 5 people may experience a mental disorder during adolescence. If left unrecognized and untreated, they can lead to substantial negative outcomes in physical and mental health, academic and vocational achievement, interpersonal relationships, and other important life experiences. Despite this tremendous burden of mental health disability, youth requiring proper care still do not receive it from childhood through to adulthood.  Lack of knowledge, presence of stigma, and limited access to care all serve as barriers to addressing mental disorders and alleviating the daily challenges.

Promoting Mental Health Literacy (MHL) is Dr. Kutcher’s mission because it is an essential component of improving individual and population health and mental health outcomes. As most mental disorders can be identified by age 25, schools provide the ideal location in which to implement interventions that can be demonstrated to improve mental health and life outcomes.  Good MHL programs tend to exhibit four components: : understanding how to obtain and maintain good mental health; understanding mental disorders and their treatments; decreasing stigma; and enhancing help seeking efficacy (knowing when, where, and how to obtain proper care.

A recent Canadian study of some 10,000 educators, cited by  IWK Health researcher Dr. Yifeng Wei at the Academy, found that over 90 per cent of teachers lacked adequate preparation for responding to mental health issues.  That is startling when one considers the fact that the survey uncovered some 200 different mental health programs being implemented in over 1,000 Canadian schools.

Systematic evidence-based reviews of the most popular mental health programs are not that encouraging.  Four such programs, including two based upon “mindfulness, “Learning to Breathe,” and “Mind Up,” analyzed using the GRADE System, were found to be mostly ineffective and judged not ready for widespread implementation in schools. “Good intentions,” Dr. Wei stated,” do not translate into beneficial outcomes for children and teens.”

One curriculum resource, the Mental Health and High School Curriculum Guide, researched and developed by Kutcher and his research team at Dalhousie’s Medical School, shows more promising results. It’s not a “packaged program,” but rather a full curriculum taught by the usual classroom teachers in Canadian secondary schools. Survey data collected before, immediately after, and 2 months after implementation of The Guide showed that students’ knowledge improved significantly when the program was delivered by their regular teachers.  Embedding a classroom resource, delivered by usual classroom teachers in usual school settings is proving to be far better than utilizing any number of the commercially-marketed mental health programs.

What’s contributing to the widespread public perception that we are experiencing a “mental health crisis” in and around our schools?  Why are classroom teachers so motivated and committed to responding to mental health issues?  Why are education authorities and school districts so quick to snap up the latest program in mental health, student behaviour modification, and suicide prevention?  What’s the secret of the recent success of the the Canadian Teen Mental Health Curriculum Guide? 

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Child Mental Health and the Schools: Wherein Lies the “Crisis”?

The public cries of “crisis” are in the air, especially when it comes to child/teen mental health in the schools. Britain’s government-appointed Mental Health Champion, Natasha Devon, rang the latest alarm bell in The Telegram (April 29, 2016) claiming that the “child mental health crisis is spinning out of control.” In issuing her “Mental Health Manifesto” for Britain’s schoolchildren, Devon frequently cites a scary figure to buttress her public claims — the statistic that “rates of depression and anxiety among teenagers have increased by 70 per cent in the past 25 years.”

Not everyone accepts her public pronouncements at face value — and a few are looking more deeply into the nature, definition, and prevalence of the so-called “child public health crisis.” Devon’s further claim that it constitutes an “epidemic” has sparked even more skepticism. Is this the proverbial twenty-first century equivalent of “crying wolf” or just a manifestation of our contemporary tendency to ‘pathologize’ social-psychological trends?

One of Canada’s leading teen mental health experts, Dr. Stan Kutcher, devotes his life to educating teachers, students and families about mental health disorders, but he is very skeptical about overblown claims. When asked about the purported “crisis” at St. Francis Xavier University a few weeks ago, he startled a local newspaper reporter with this statement: “there is no mental health crisis for crying out loud.”

Dr. Kutcher was not minimizing  the severity of the problem, but rather questioning the veracity of some of the recent public claims. “We have the same proportion of mental illness in our society now that we had 40, 50, 60 years ago,” he explained. “There is no epidemic of illness, there is better recognition of illness, which is good but what we’re seeing now is an epidemic of ‘I think I have a mental disorder when I’m just really feeling unhappy,’ and that is a direct reflection of poor mental health literacy.”

Like many health professionals, Dr. Kutcher sees the popular media as contributing to the public misunderstanding about the nature and prevalence of mental disorders. He’s critical of those who exaggerate the “crisis” and equally concerned about others too quick to dismiss
it as a ‘teenage fad.’“Now the depression happens in adolescents and depression is a serious disease and if you have depression you need the proper treatment for depression, but feeling unhappy, that’s not depression,” he said.“So I think a lot of people have become confused with all the talk about mental health and mental illness without the literacy to understand what they’re talking about.”

Stress and distress is not all bad, according to Kutcher. “People do have daily distress, that is normal, ubiquitous, necessary and good for you,” he said.“And all of us are going to have a mental health problem like the loss of a loved one, moving to a new city, losing your job – those are substantive challenges in our lives and we need extra help for that. But those two things aren’t mental illnesses and they don’t need to be medicalized, they don’t need medications, they don’t need specialized psychotherapy, they don’t need access to the mental health care system.They can be dealt with, the first one, mental distress, by yourself with your friends. The second one with special support, sometimes counselors, sometimes your clergy, whoever.”

As the Sun Life Chair of Teen Mental Health at Dalhousie University Medical School, Kutcher’s assessment carries considerable weight and he makes the critical distinctions that the popular media tend to completely miss: “Mental illnesses are different; they need specialized treatment like a treatment for any illness. But one of the challenges we have is that socially we’re tending to confuse mental distress and mental health problems with mental illness. So, because I feel unhappy today I feel like I should have therapy, because I take umbrage at what you said to me I have an anxiety disorder, that’s not true at all.”

Dr. Kutcher seems to dispute the whole approach taken by Britain’s Mental Health czarina and ‘body health’ counsellor, Natasha Devon. While Devon and her Self-Esteem Team (SET) target standardized tests and exams as “stress-inducers,” Kutcher and other specialists, including Dr. Michael Ungar, see value in competitive activities in developing “resilience” in teens.  Dr. Kutcher puts it this way: “We have to be very careful to differentiate the slings and arrows of outrageous fortune in real life which we have to learn to deal with and overcome, and for which we don’t need treatment, and those things which actually require treatment.”

Mental health disorders are serious and providing more accessible, effective and sustainable services should be a top public policy priority, inside and outside of schools. “Teenage angst,” as Ella Whelan recently pointed out, “is not a serious mental health issue.” It is important to carefully consider all public claims for their veracity and to be skeptical of mental health charities seeking to “normalize mental illness.” We must also recognize that “not all of the kids are all right.” Nor are mental health services accessible or available when and where they are needed in and around the schools. Therein lies the real problem.

What ‘s driving the public call to address the “child mental health crisis” in schools? Are school authorities and educators equipped to make the critical distinction between normal ‘mental health stresses’ and serious disorders requiring treatment?  Is there a danger that those ringing the alarm bells are ‘pathologizing’ teenage anxieties and stress?  Is it possible to identify and support those in serious personal crisis while recognizing that competition and stress develops ‘resilience’ and is part of healthy preparation for life? 

 

 

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