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School Health Programs

Improving the Health of Our Nation's Youth
At A Glance 2011

School Health Programs, Improving the Health of Our Nation's Youth

Schools: The Right Place for a Healthy Start

Establishing healthy behaviors during childhood and maintaining them is easier and more effective than trying to change unhealthy behaviors during adulthood. Schools play a critical role in promoting the health and safety of young people and helping them establish lifelong healthy behaviors.

Each day, the nation's 132,700 schools provide

  • An opportunity for 55 million students to learn about health and develop the skills that promote healthy behaviors.

  • A place for students to develop healthy behaviors such as eating healthy foods and participating in physical activity.

Risk Behaviors Are Established Early in Life

Six types of health risk behaviors contribute to the leading causes of death, disability, and social problems in the United States: (1) tobacco use; (2) unhealthy eating; (3) inadequate physical activity; (4) alcohol and other drug use; (5) sexual behaviors that may result in HIV infection, other sexually transmitted diseases (STDs), and unintended pregnancy; and (6) behaviors that contribute to unintentional injury and violence. These behaviors are often established during childhood or adolescence, persist into adulthood, and are preventable.

School health programs should focus on those health risk behaviors and other key health issues, such as asthma and mental health, that most affect the overall health and well-being of students.

Effective School Health Programs Reduce Risk Behaviors and Improve Learning

Research has shown that school health programs can reduce the prevalence of health risk behaviors among young people and have a positive effect on academic performance. The following findings demonstrate the effectiveness of school health programs:

  • A multicomponent, school-based physical activity and nutrition program slowed the increase in rates of obesity and overweight among low-income Hispanic elementary students in El Paso, Texas. Specifically, the increase in rates among students in schools with the program (girls [2%], boys [1%]) was less than the increase among students in schools without the program (girls [13%], boys [9%]).

  • Schools that participated in a 2-year intervention designed to improve school nutrition in elementary schools in Philadelphia, Pennsylvania, reported a 50% reduction in overweight among students. At the end of the intervention, 7.5% of students in participating schools were overweight, compared with 14.9% in nonparticipating schools.

  • A youth antismoking campaign in North Carolina increased the percentage of school districts in the state that adopted 100% tobacco-free school policies from 5% in 2000 to 75% in 2007. Building on that momentum, the state legislature bolstered the campaign by passing legislation in 2007 that mandated statewide compliance. By July 2008, all of North Carolina's 115 school districts were 100% tobacco free.

Health Risks Faced by Young People

  • 1 in 5 high school students in the United States is a current smoker.
  • 78% of high school students do not eat the recommended 5 servings of fruits and vegetables a day. Only 1 in 3 participates in daily physical education classes.
  • 1 in 3 children and adolescents is overweight or obese.
  • 3 in 10 young women become pregnant at least once before age 20.
  • About 18% of new diagnoses of HIV infection are among young people aged 13−24 years. Teenagers and young adults also have the highest rates of STDs of any age group.
  • Young people miss nearly 13 million school days a year because of asthma.
  • Each year, 30% of deaths among young people aged 10–24 years are due to motor-vehicle crashes.
  • About 22% of young people aged 13–18 years experience mental health disorders that can cause severe impairment during their lifetime.
  • High school girls in South Carolina who participated in a multicomponent, school-based physical activity program increased the amount of time they spent in regular, vigorous physical activity compared with girls who did not participate in the program. The program included tailored physical and health education classes, role modeling by faculty and staff, increased communication about physical activity, promotion of physical activity by the school nurse, and family- and community-based activities.

  • Results of an evaluation of a school-based HIV, STD, and unintended pregnancy prevention program for high school students showed a savings of $2.65 in total medical and social costs for every $1 invested in the program. These costs were based on the estimated cases of HIV, chlamydia, gonorrhea, and pelvic inflammatory disease prevented and the number of pregnancies prevented as a result of positive behaviors adopted by students.

  • A review of 48 studies found that sexual health education programs resulted in a delay in first sexual intercourse, a decrease in the number of sex partners, and an increase in condom or contraceptive use. None of the programs increased the likelihood of having sex.

CDC’s Response: Advance and Support School Health Programs

Coordinated School Health

Schools by themselves cannot solve the nation's most serious health and social problems. However, schools have a critical role to play in partnership with community agencies and organizations to improve the health and well-being of young people. One approach recommended by CDC is coordinated school health (CSH). CSH brings together school administrators, teachers, other staff, students, families, and community members to assess health needs; set priorities; and plan, implement, and evaluate school health activities.

CSH typically integrates health promotion efforts across eight interrelated components that already exist to some extent in most schools. These components include

  • Health education.
  • Physical education.
  • Health services.
  • Nutrition services.
  • Counseling, social, and psychological services.
  • Healthy and safe school environments.
  • Staff wellness.
  • Family/community involvement.

CDC has consistently used the CSH model as an organizing framework for its school health guidelines, surveillance systems, recommendations for promising practices, and research application tools. Many states and cities have embraced this model to guide their school health efforts.

CDC's Leadership

CDC funds education and health agencies in 22 states and 1 tribal government to help schools implement CSH, with an emphasis on promoting physical activity, healthy eating, and a tobacco-free lifestyle. CDC also funds 49 state education agencies (including the District of Columbia), 1 tribal government, 6 territorial education agencies, and 16 large urban school districts for school-based HIV prevention. In addition, 10 large urban school districts receive CDC support for school-based asthma management programs.

To help states, districts, and schools improve school health programs, CDC has developed science-based guidelines, strategies, and tools and identified priority actions that states can take to support CSH locally. Specifically, CDC supports the efforts of state, territorial, and local agencies to implement science-based, cost-effective programs through the following activities:

  • Monitoring health risk behaviors and school health policies and practices through the Youth Risk Behavior Surveillance System (YRBSS), the School Health Profiles, and the School Health Policies and Practices Study (SHPPS).

    • The YRBSS consists of national, state, and large urban school district surveys of representative samples of high school students. Conducted every 2 years, these surveys monitor health risk behaviors among young people so that health and education agencies can more effectively tailor and improve programs.

    • The School Health Profiles, a biennial survey conducted by state and local education and health agencies, provides data on school health policies and practices in states and large urban school districts.

    • SHPPS is the most comprehensive study of U.S. school health policies and practices. Conducted every 6 years, SHPPS assesses the characteristics of school health policies and practices at state, district, school, and classroom levels nationwide across all eight CSH components.

  • Analyzing research findings to develop guidelines for addressing priority health risk behaviors among students and creating tools to help schools implement these guidelines. Examples include the following:

    • Guidelines for School Health Programs to Prevent Tobacco Use and Addiction was developed in collaboration with tobacco-use prevention experts across the nation and identifies the most effective policies and practices schools can implement to prevent tobacco use and addiction among young people and create a tobacco-free environment in which students can learn.

    • School Health Index (SHI): A Self-Assessment and Planning Guide helps schools implement evidence-based policies and practices that promote safe and healthy behaviors. SHI provides stakeholders (e.g., teachers, parents, students, community members) with the tools and resources needed to assess health policies and programs and develop improvement plans based on assessment results.

    • Physical Education Curriculum Analysis Tool (PECAT) helps school districts conduct a clear, complete, and consistent analysis of their physical education curricula to see how closely they align with national standards. Results from the analysis can help school districts provide quality physical education in schools.

  • Expanding knowledge of how to address youth health risks through research on determinants of health risk behaviors and evaluations of innovative, school-based approaches to promoting health.

  • Supporting the efforts of 23 national nongovernmental organizations to build the capacity of states, territories, tribal governments, and cities to implement effective school health programs. Some of these organizations also are funded to help community-based organizations implement science-based programs to help youth in high-risk situations (such as those in juvenile justice facilities or not enrolled in school) avoid critical health risks such as HIV infection.

Map showing CDC funding for fiscal year 2011, text description below

[A text description of this map is also available.]

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Success Stories

Arizona: Pilot Program Leads to New Statewide Physical Education Standards

In 2007, results from the Youth Risk Behavior Survey indicated that 12% of high school students in Arizona were obese, 68% did not get the recommended amount of physical activity, and 73% did not attend physical education (PE) classes daily. At the time, Arizona's standards for PE classes were not consistent with national standards. Arizona had no requirement for PE as a stand-alone class, and the state did not allocate funding for PE.

In 2006, the Arizona legislature mandated a Physical Education Pilot Program to collect data on the effectiveness of PE classes. During the 2007–2008 school year, four elementary schools participated in the program. The schools were required to implement PE curricula that were aligned with CDC guidance, including 150 minutes of PE per week. At least 50% of students' time had to be spent in moderate or vigorous physical activity, and schools had to have at least one certified PE teacher for every 500 students.

The program was evaluated by a physical activity, nutrition, and tobacco (PANT) coordinator funded by CDC's Division of Adolescent and School Health and an external team from Arizona State University. The evaluation included a survey of barriers to physical activity and the use of pedometers and observation to measure the physical activity patterns of students.

The evaluation showed that

  • Physical activity levels increased by 17% during the school day and 6% outside school.
  • School absences decreased by 13%.
  • Standardized test scores remained stable, even with more time spent in PE during the school day.

The PANT coordinator promoted the program to state leaders, and in 2009, the Arizona legislature called for PE standards to be revised for the first time since 1997. The new standards are aligned with national standards and will improve the quality of PE for Arizona students. Revisions include the addition of defined concepts that guide teachers on what students should learn and be able to demonstrate by the end of the class, as well as an emphasis on personalized fitness and behavior outcomes.

CDC funding helped to train more than 300 health and PE teachers across the state to help implement the new standards, which went into effect during the 2010–2011 school year.

New Mexico: Strengthening Health Education Through Graduation Requirements

More than half of the states have recognized the importance of teaching health education (HE) in middle or high school and have implemented an HE requirement for graduation. In 2009, New Mexico did not have a state-level HE requirement for graduation. At the district level, only 34 of 89 school districts were teaching HE as a stand-alone class. School districts integrated HE into a variety of other classes, did not require an HE class to graduate, or did not require that the class be taught by a state-licensed health educator.

Although legislative efforts in 2009 did not result in HE being mandated as a graduation requirement in New Mexico, the Senate Education Committee recommended further study to determine the level of need and public support for this change. The New Mexico Public Education Department (NMPED) convened a workgroup that included representatives from the NMPED (including a CDC-supported coordinator for the HIV Prevention Education Program), the state health department, higher education institutions, community groups, and the legislative education study committee, as well as school superintendents and educators.

The workgroup researched best practices for delivering HE and conducted extensive surveys to determine support for making HE a graduation requirement. Finding strong evidence and support for including a stand-alone HE class in the state's graduation requirements, the workgroup presented that recommendation to the Senate Education Committee.

In 2010, New Mexico passed a new law that will go into effect during the 2012–2013 school year. The law will

  • Require a class in HE for graduation from a public school.
  • Allow school districts to determine if the class will be taught in middle school or high school.
  • Require that HE be taught in a stand-alone class by a licensed health educator.

Requiring HE as a graduation requirement is a major step toward ensuring that New Mexico's youth receive

  • Evidence-based health information to guide their decision-making.
  • More opportunities to learn about and practice healthy life style habits, including healthy eating and physical activity, which can lower the risk of becoming obese.
  • More skills-based instruction focused on reducing health risk behaviors, including sexual risk behaviors.

A CDC-supported program coordinator is helping to train curriculum directors, school administrators, and health educators to implement the new requirement. The coordinator also will review school districts' implementation plans to ensure compliance with state HE standards. The NMPED will use CDC's School Health Profiles, a survey that can be used to assess school health policies and practices, to monitor the effect of the new requirement.

Connecticut: Using School Food Policies to Promote Healthy Eating

Children who are overweight are more likely than children of normal weight to be overweight or obese as adults. Most U.S. children eat a large portion of their daily food intake at school. Competitive food sources such as à la carte items, vending machines, and school stores compete with federally regulated school meals, often offering less healthy foods and beverages.

In Connecticut, about 1 in 4 high school students is overweight or obese, which increases the risk of developing diabetes, heart disease, and other health problems.

In 2006, the state enacted legislation supporting the development of coordinated school health (CSH) initiatives and nutrition standards for foods and beverages sold at school. School districts that participate in the state's Healthy Food Certification program receive monetary incentives to implement these standards.

In 2007, the state education department released its Guidelines for a Coordinated Approach to School Health, building directly on CDC's CSH model. To help strengthen school food policies, the guidelines provide specific strategies for

  • Making nutritious, affordable, and appealing meals available to students.
  • Creating an environment that promotes healthy eating.
  • Providing classroom instruction to help students improve their health and reduce risk behaviors.

As a result of Connecticut's commitment to CSH and school nutrition standards,

  • Nearly 68% of its school districts participate in the Healthy Food Certification program.
  • During 2006–2010, the state reduced the percentage of secondary schools that allow students to buy soda or fruit drinks (other than 100% juice) from 40% to 3%, according to results from CDC's School Health Profiles survey.
  • Only 21% of secondary schools sold less nutritious foods and beverages anywhere outside the school food service program.

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