Cost-Effectiveness of a School-Based Emotional Health Screening Program

Background:  School-based screening for health conditions can help extend the reach of health services to underserved populations. Screening for mental health conditions is growing in acceptability, but evidence of cost-effectiveness is lacking. This study assessed costs and effectiveness associated with the Developmental Pathways Screening Program, in which students undergo universal classroom emotional health screening and those who have positive screens are provided with on-site clinical evaluation and referral.
Methods:  Costs are enumerated for screening and clinical evaluation in terms of labor and overhead and summarized as cost per enrolled student, per positive screen, and per referral. Cost-effectiveness is summarized as cost per student successfully linked to services. School demographics are used to generate a predictive formula for estimating the proportion of students likely to screen positive in a particular school, which can be used to estimate program cost.
Results:  Screening costs ranged from $8.88 to $13.64 per enrolled student, depending on the prevalence of positive screens in a school. Of students referred for services, 72% were linked to supportive services within 6 weeks. Cost-effectiveness was estimated to be $416.90 per successful linkage when 5% screened positive and $106.09 when 20% screened positive. A formula to estimate the proportion of students screening positive proved accurate to within 5%.
Conclusion:  Information concerning costs and effectiveness of school-based emotional health screening programs can guide school districts in making decisions concerning resource allocation.     

Health services: results from the School Health Policies and Programs Study 2006

Background: The specific health services provided to students at school and the model for delivering these services vary across districts and schools. This article describes the characteristics of school health services in the United States, including state‐ and district‐level policies and school practices. Methods: The Centers for Disease Control and Prevention conducts the School Health Policies and Programs Study (SHPPS) every 6 years. In 2006, computer‐assisted telephone interviews or self‐administered mail questionnaires were completed by state education agency personnel in all 50 states plus the District of Columbia and among a nationally representative sample of school districts (n = 449). Computer‐assisted personal interviews were conducted with personnel in a nationally representative sample of elementary, middle, and high schools (n = 1029). Results: Most US schools provided basic health services to students, but relatively few provided prevention services or more specialized health services. Although state‐ and district‐level policies requiring school nurses or specifying maximum nurse‐to‐student ratios were relatively rare, 86.3% of schools had at least a part‐time school nurse, and 52.4% of these schools, or 45.1% of all schools, had a nurse‐to‐student ratio of at least 1:750. Conclusions: SHPPS 2006 suggests that the breadth of school health services can and should be improved, but school districts need policy, legislative, and fiscal support to make this happen. Increasing the percentage of schools with sufficient school nurses is a critical step toward enabling schools to provide more services, but schools also need to enhance collaboration and linkages with community resources if schools are to be able to meet both the health and academic needs of students.     

Examining the Consulting Physician Model to Enhance the School Nurse Role for Children With Asthma

BACKGROUND:  The Centers for Disease Control and Prevention's Strategies for Addressing Asthma Within a Coordinated School Health Program recommends a consulting physician for schools to help manage asthma. The literature examines the effects when a school nurse is present, but the addition of a consulting physician is not well understood. The purpose of this study is to assess the effect of having a consulting physician on school absenteeism and children sent home due to health reasons for children with asthma and all children pooled together.
METHODS:  A 2-year preimplementation group cohort and 1-year implementation group cohort of grades K-6 in an urban school district were used to determine the impact of a consulting physician on school absenteeism for children with asthma and all children pooled together.
RESULTS:  A consulting physician was significantly associated with reduced missed school days for children with asthma and all children as a group. All children pooled together were 44% more likely (OR = 1.44, 95% CI = 1.31-1.58) to be sent home without the consulting physician. There was a reduction from 13.8% to 12.6% of sent home events in children with asthma.
CONCLUSIONS:  Having consulting physicians in school districts appears to be associated with fewer days of school absence. The results provide additional evidence and suggest that more research is required to determine if this association is valid and to better understand the cause of such an association.     

Mental health and social services: results from the School Health Policies and Programs Study 2006

BACKGROUND: Schools are in a unique position not only to identify mental health problems among children and adolescents but also to provide links to appropriate services. This article describes the characteristics of school mental health and social services in the United States, including state- and district-level policies and school practices. METHODS: The Centers for Disease Control and Prevention conducts the School Health Policies and Programs Study (SHPPS) every 6 years. In 2006, computer-assisted telephone interviews or self-administered mail questionnaires were completed by state education agency personnel in all 50 states and the District of Columbia and among a nationally representative sample of school districts (n=445). Computer-assisted personal interviews were conducted with personnel in a nationally representative sample of elementary, middle, and high schools (n=873). RESULTS: Although states and districts generally had not adopted policies stating that schools will have mental health and social services staff, 77.9% of schools had at least a part-time counselor who provided services to students. Fewer schools had school psychologists or social workers. Consequently, counseling services were more common in schools than were psychological or social services. Few schools delivered mental health and social services through school-based health centers. Arrangements with providers not located on school property were more common. CONCLUSIONS: SHPPS 2006 reveals that linkages with the community need to continue and grow to meet the mental health needs of students. Efforts must be made to build systematic state agendas for school-based mental health, emphasizing a shared responsibility among families, schools, and other community systems.     

Adolescent Behavioral, Affective, and Cognitive Engagement in School: Relationship to Dropout

BACKGROUND: High school dropout represents an important public health issue. This study assessed the 3 distinct dimensions of student engagement in high school and examined the relationships between the nature and course of such experiences and later dropout.
METHODS: We administered questionnaires to 13,330 students (44.7% boys) from 69 high schools in the province of Quebec (Canada). During 3 consecutive high school years, students reported their behavioral, emotional, and cognitive engagement to school. Information on later dropout status was obtained through official records.
RESULTS: Although many adolescents remained highly engaged in high school, one third reported changes, especially decreases in rule compliance, interest in school, and willingness to learn. Students reporting low engagement or important decrements in behavioral investment from the beginning of high school presented higher risks of later dropout.
CONCLUSION: School-based interventions should address the multiple facets of high school experiences to help adolescents successfully complete their basic schooling. Creating a positive social-emotional learning environment promises better adolescent achievement and, in turn, will contribute to a healthier lifestyle.     

Students with chronic diseases: nature of school physician support

Background: To educate children with chronic diseases in the least restrictive environment, schools must prevent, recognize, and react appropriately to symptom exacerbations. Schools are often pushed to their limits of knowledge, resources, and comfort level. This study determined the health conditions of students for whom districts seek school physician consultation and the nature of school physician consultants’ involvement. Methods: A retrospective record review was performed on 250 of the most recent records of school‐elicited referrals from an academic center that provides physician consultation to school districts. Referrals were sent from 8 school districts in southern California (July 1996 to October 2006). Data collected were nature of student’s special health need, the school physician consultant’s intervention required to satisfy schools’ needs, student grade level, enrollment in special education, and health‐related excessive absenteeism. Results: No single chronic condition, symptom, or special health care need predominated. Six types of school physician consultant activities were used to overcome hurdles schools faced when accommodating students with special health care needs. The 3 most common were direct communication with students’ own physicians (70% of students), recommending an appropriate level of school health services when this was a matter of controversy (42%), and formulating portions of students’ individualized school health plans (38%). Conclusions: A portion of students with special health care needs benefited from district referral to a school physician consultant. Whether some of these referrals can be avoided if school personnel and students’ own physicians are supported and trained to communicate more effectively with one another needs to be explored.     

Emotional/Behavioral Difficulties and Mental Health Service Contacts of Students in Special Education for Non–Mental Health Problems

BACKGROUND:  Emotional/behavioral difficulties and mental health (MH) service contacts of 3 groups of youth were compared: students in special education for non-MH problems, students in special education for MH problems, and youth not in special education.
METHODS:  Parents reported the characteristics, special education placement, emotional/behavioral difficulties, and MH service contacts of 25,122 youth aged 6-17 years in the National Health Interview Survey.
RESULTS:  Two thirds of students in special education received special education services for non-MH problems. Among students in special education for non-MH problems, 17% had serious emotional/behavioral difficulties compared with 51% of students in special education for MH problems and 4% of youth not in special education. MH service contacts were examined only for youth whose difficulties significantly interfered with their ability to function in or out of school. Among youth with serious difficulties, the percentage of youth without a recent MH service contact was greater for students in special education for non-MH problems (40%) and youth not in special education (47%) compared with students in special education for MH problems (13%).
CONCLUSIONS:  Compared with youth not in special education, students in special education for non-MH problems were 4 times more likely to have serious emotional/behavioral difficulties but were just as likely as youth not in special education to lack a recent MH service contact. Study findings provide a national context for considering the MH screening/evaluation needs of students receiving special education for non-MH problems.     

Assessment of health issues and concerns of Israeli seventh graders during school physician examinations: a pilot study

BACKGROUND: The AMA Guidelines for Adolescent Preventive Services (GAPS) recommends annual medical evaluations during adolescence, emphasizing screening and counseling regarding psychosocial issues. In Israel, seventh graders undergo medical examinations within the school health services, focusing on the detection of physical conditions. We addressed the psychosocial issues of these students by introducing an expanded school physician evaluation. METHODS: Twelve school physicians performed structured expanded health evaluations for seventh graders in 11 schools. Each student completed a questionnaire (checklist) with 22 health topics "about which s/he may want to receive information." The physician then carried out a biomedical and psychosocial evaluation, physical examination, and offered counseling to the student. RESULTS: Two hundred and seventy-eight students were examined. The questionnaire required 1-2 minutes, and the physician's evaluation 20-25 minutes. Health behaviors revealed included: currently dieting (28%), no physical activity after school (35%), ever smoked cigarettes (3%), ever smoked a water pipe (9%), used alcoholic beverages (6%), and does not always use front (22%) or rear (55%) seat belt. Nine percent rated their mood as being less than 7 (on a scale from 1 to 10). The leading topics about which the students requested information were height (50%), acne (42%), weight (38%), nutrition/diet (37%), physical activity (35%), and menstrual period (29% of the girls). The physicians counseled the students on an average of 3.6 topics per visit. CONCLUSIONS: An expanded school physician examination identifies students with psychosocial problems otherwise undetected during standard physical examinations, and provides the opportunity to address their personal concerns.     

Bullying and Symptoms of Depression in Chilean Middle School Students

BACKGROUND:  The goal of this study was to assess the association between bullying and symptoms of depression among middle school students in Chile.
METHODS:  Secondary data analysis of Chile's 2004 Global School-Based Health Survey.
RESULTS:  A total of 8131 middle school students participated in the study. Forty-seven percent of students reported having been bullied in the past month and 30% reported having been sad and hopeless for 2 or more weeks in the past year. Students in the seventh and eighth grades were more likely to report having been bullied in the past month than students in ninth grade. Ninth grade students reported higher levels of loneliness, difficulty sleeping, and suicidal thoughts than students in the seventh and eighth grades. Boys were more likely than girls to report being bullied in the past month, but girls were more likely than boys to report symptoms of depression, such as prolonged feelings of sadness and hopelessness, loneliness, difficulty sleeping, and suicidal thoughts. Students who reported being bullied in the past month were more likely than nonbullied students to report symptoms of depression. A higher number of days of being bullied in the past month was associated with a statistically significant increase in reported rates of sadness and hopelessness (p < .001).
CONCLUSIONS:  Bullying is common among middle school children in Chile, and bullying and symptoms of depression are strongly linked. This finding is consistent with studies of bullying and depression in adolescents from other parts of the world.     

School superintendents' perceptions of schools assisting students in obtaining public health insurance

Background: Superintendents' perceptions regarding the effect of health insurance status on academics, the role schools should play in the process of obtaining health insurance, and the benefits/barriers to assisting students in enrolling in health insurance were surveyed. Superintendents' basic knowledge of health insurance, the link between health and learning, and specific school system practices for assisting students were also examined. Methods: A 4‐page questionnaire was sent to a national random sample of public school superintendents using a 4‐wave postal mailing. Results: Only 19% of school districts assessed the health insurance status of students. School districts' assistance in helping enroll students in health insurance was assessed using Stages of Change theory; 36% of superintendents' school districts were in the action or maintenance stages. The schools most often made health insurance materials available to parents (53%). The perceived benefits identified by more than 80% of superintendents were to keep students healthier, reduce the number of students with untreated health problems, reduce school absenteeism, and improvement of students' attention/concentration during school. The 2 most common perceived barriers identified by at least 50% of superintendents were not having enough staff or financial resources. Conclusions: Most superintendents believed schools should play a role in helping students obtain health insurance, but the specific role was unclear. Three fourths of superintendents indicated overwhelmingly positive beliefs regarding the effects of health insurance status on students' health and academic outcomes. School personnel and public policy makers can use the results to support collaboration in getting students enrolled in health insurance.     

SCHIP Directors' Perception of Schools Assisting Students in Obtaining Public Health Insurance

Background:  Health insurance coverage increases access to health care. There has been an erosion of employer-based health insurance and a concomitant rise in children covered by public health insurance programs, yet more than 8 million children are still without health insurance coverage.
Methods:  This study was a national survey to assess the perceptions of State Child Health Insurance Program (SCHIP) directors (N = 51) regarding schools assisting students in obtaining public health insurance. This study examined the perceived benefits of and barriers to working with school systems and the perceived benefits to schools in assisting students to enroll in SCHIPs and what SCHIP activities were actually being conducted with school systems.
Results:  The majority (78%) of SCHIPs had been working with school systems for more than a year. Perceived benefits of working with schools were greater access to SCHIP-eligible children (75%), assistance with meeting mandates to cover all SCHIP-eligible children (65%), and greater ability of state agencies to identify SCHIP-eligible children (58%). A majority of the directors did not identify any of the potential barrier items. The directors cited the following benefits to schools in helping enroll students in public health insurance programs: reduces the number of students with untreated health problems (80%), reduces student absenteeism rates (68%), improves student attention and concentration during school (58%), and reduces the number of students being held back in school because of health problems (53%).
Discussion:  The perceived benefits derived from schools assisting in enrolling eligible students into SCHIPs are congruent with the mission of schools. Schools need to become proactive in helping to establish a healthy student body, which is more likely to be an academically successful body.     

Associations Between School Recreational Environments and Physical Activity

Background:  School environments may promote or hinder physical activity in young people. The purpose of this research was to examine relationships between school recreational environments and adolescent physical activity.
Methods:  Using multilevel logistic regression, data from 7638 grade 6 to 10 students from 154 schools who participated in the 2005/06 Canadian Health Behaviour in School-Aged Children Survey were analyzed. Individual and cumulative effects of school policies, varsity and intramural athletics, presence and condition of fields, and condition of gymnasiums on students' self-reported physical activity (≥2 h/wk vs <2 h/wk) were examined.
Results:  Moderate gradients in physical activity were observed according to number of recreational features and opportunities. Overall, students at schools with more recreational features and opportunities reported higher rates of class-time and free-time physical activity; this was strongest among high school students. Boys' rates of class-time physical activity were 1.53 (95% confidence interval (CI) = 1.12-1.80) times as high at high schools with the most recreational features as at schools with the fewest. Similarly, girls' rates of free-time physical activity at school were 1.62 (95% CI: 0.96-2.21) times as high at high schools with the most opportunities and facilities as compared to schools with the fewest. Modest associations were observed between individual school characteristics and class-time and free-time physical activity.
Conclusions:  Taken together, the cumulative effect of school recreational features may be more important than any one characteristic individually.     

Adolescents' Sleep Behaviors and Perceptions of Sleep

Background:  Sleep duration affects the health of children and adolescents. Shorter sleep durations have been associated with poorer academic performance, unintentional injuries, and obesity in adolescents. This study extends our understanding of how adolescents perceive and deal with their sleep issues.
Methods:  General education classes were randomly selected from a convenience sample of three high schools in the Midwest. Three hundred eighty-four ninth- to twelfth-grade students (57%) completed a self-administered valid and reliable questionnaire on sleep behaviors and perceptions of sleep.
Results:  Most respondents (91.9%) obtained inadequate sleep (≤ 9 hours) on most school nights of the week, with 10% reporting less than 6 hours of sleep each week night. The majority indicated that not getting enough sleep had the following effects on them: being more tired during the day (93.7%), having difficulty paying attention (83.6%), lower grades (60.8%), increase in stress (59.0%), and having difficulty getting along with others (57.7%). Some students reported engaging in harmful behaviors to help them sleep: taking sleeping pills (6.0%), smoking a cigarette to relax (5.7%), and drinking alcohol in the evening (2.9%). Students who received fewer hours of sleep were significantly more likely to report being stressed (p = .02) and were more likely to be overweight (p = .04).
Conclusions:  Inadequate sleep time may be contributing to adolescent health problems such as increased stress and obesity. Findings indicate a need for sleep hygiene education for adolescents and their parents. A long-term solution to chronic sleep deprivation among high school students could include delaying high school start times, such as was done successfully in the Minneapolis Public School District.     

Promoting Tobacco-Free School Policies Through a Statewide Media Campaign

Background:  Comprehensive, enforced tobacco-free school (TFS) policies lead to significant reductions in youth tobacco use. North Carolina is the first state in the United States to develop a statewide mass media campaign to promote the adoption of and compliance with TFS policies.
Methods:  In order to guide campaign development, researchers conducted a literature review as well as interviews with 45 TFS-policy experts, stakeholders, and North Carolina legislators. The experts included state and national TFS researchers and advocates, and the majority of stakeholders were North Carolina school administrators and personnel selected because of their personal knowledge of and experience with TFS policy. Interviewees provided information on messages they believed would be most salient to highlight in the media campaign and the best type of people to appear in ads.
Results:  Recommended themes included (1) a positive message about TFS becoming the norm in the state, (2) experiences of school districts that had successfully passed TFS policies, (3) the importance of adult role modeling, and (4) personal stories from youth about the importance of TFS policy. Recommended people to appear in ads included youth and adults with a personal connection to and experience with TFS policy. Using these recommended themes and people, the TFS media campaign began in the fall of 2006. In the 8 months following the campaign launch, 9 additional school districts adopted TFS policies, increasing the total from 78 to 87 (out of 115) by June 2007. In July 2007, the North Carolina legislature passed legislation mandating that all school districts adopt TFS policies by August 2008.
Conclusions:  Media campaigns can serve as part of a comprehensive strategy to advance TFS policies. Other states should consider these results in designing and evaluating a media campaign to promote adoption of and compliance with TFS policies.     

The Prevalence of Effective Substance Use Prevention Curricula in the Nation’s High Schools

Despite a substantial proportion of high school students who initiate substance use following middle school, the implementation of universal evidence-based prevention curricula appears to be scant. We report data collected in 2005 from 1392 school district-based drug prevention coordinators, from a national, representative study of school-based substance use prevention practices. Altogether, 10.3% of districts that included high school grades reported administering one of six such curricula that were then rated as effective by the Substance Abuse and Mental Health Services Administration’s National Registry of Effective Programs and Practices or Blueprints for Violence Prevention, and 5.7% reported that they used one of these curricula the most. Only 56.5% of the nation’s districts with high school grades administered any substance use prevention programming in at least one of their constituent high schools. Editors’ Strategic Implications: The authors provide a powerful reminder that evidence-based prevention is not common in American high schools, in spite of federal mandates and the increasing availability of strong prevention programs. This should challenge researchers and government officials to improve dissemination and school officials to utilize evaluated programs.     

Transparency and oversight in local wellness policies

BACKGROUND: Advocates have called for increased wellness policy transparency and oversight through the use of health advisory councils. This study examines (1) wellness policy transparency, (2) advisory council requirements, (3) factors associated with each, and (4) whether transparency or advisory council requirements are indicative of a stronger policy addressing nutrition and physical activity. METHODS: Policies for school year 2007–2008 were obtained from a nationally representative sample of 641 districts and analyzed for their applicability to elementary, middle, and high school levels. Main outcome measures included (1) policy transparency (online availability), (2) advisory council requirements, and (3) overall policy strength. T‐tests assessed variability in policy strength by transparency and advisory council requirements. Multivariate logistic and linear regression analyses controlled for district size, socioeconomic status, race/ethnicity, region, and locale; models of advisory council/policy strength relationships also controlled for state advisory council requirements. RESULTS: More than 41% of districts posted wellness policies online and more than 43% required advisory councils. Transparency was less likely in small‐/medium‐sized and non‐southern districts; and, for elementary school policies, most common in majority Hispanic districts. Advisory council requirements were less likely in small‐/medium‐sized districts for middle/high school policies and more likely in majority Hispanic districts for elementary school policies. After adjusting for all covariates, transparency was not associated with policy strength, but advisory council requirements significantly predicted policy strength. CONCLUSIONS: Transparency may facilitate awareness, but it does not mean that wellness policies will be stronger; however, advisory council requirements may be a marker for stronger policies.     

Body mass index measurement in schools

BACKGROUND: School-based body mass index (BMI) measurement has attracted much attention across the nation from researchers, school officials, legislators, and the media as a potential approach to address obesity among youth. METHODS: An expert panel, convened by the Centers for Disease Control and Prevention (CDC) in 2005, reviewed and provided expertise on an earlier version of this article. The panel comprised experts in public health, education, school counseling, school medical care, and a parent organization. This article describes the purposes of BMI measurement programs, examines current practices, reviews existing research, summarizes the recommendations of experts, identifies concerns, and provides guidance including a list of safeguards and ideas for future research. RESULTS: The implementation of school-based BMI measurement for surveillance purposes, that is, to identify the percentage of students in a population who are at risk for weight-related problems, is widely accepted; however, considerable controversy exists over BMI measurement for screening purposes, that is, to assess the weight status of individual students and provide this information to parents with guidance for action. Although some promising results have been reported, more evaluation is needed to determine whether BMI screening programs are a promising practice for addressing obesity. CONCLUSIONS: Based on the available information, BMI screening meets some but not all of the criteria established by the American Academy of Pediatrics for determining whether screening for specific health conditions should be implemented in schools. Schools that initiate BMI measurement programs should evaluate the effects of the program on BMI results and on weight-related knowledge, attitudes, and behaviors of youth and their families; they also should adhere to safeguards to reduce the risk of harming students, have in place a safe and supportive environment for students of all body sizes, and implement science-based strategies to promote physical activity and healthy eating.     

Patterns of Vaginal, Oral, and Anal Sexual Intercourse in an Urban Seventh-Grade Population

Background:  This study examines the prevalence of vaginal, oral, and anal intercourse among a population of urban, public middle school students, the characteristics of early sexual initiators, and the sequence of sexual initiation. Such data are limited for early adolescents.
Methods:  A total of 1279 seventh-grade students (57.3% female, 43.6% black, and 41.8% Hispanic), mean age 12.5 years (SD = 0.63) from 10 middle schools in a large southeastern US public school district completed a cross-sectional survey using audio computer-assisted self-interviews. Main outcomes included lifetime and past 3-months' experience of vaginal, oral, and anal sex; condom use; age of initiation; and number of lifetime partners.
Results:  Overall, 12.0% of students had engaged in vaginal sex, 7.9% in oral sex, and 6.5% in anal sex. Among students who had initiated intercourse, approximately two thirds were currently sexually active and one quarter reported ≥4 lifetime partners. Six percent had engaged in 1 type of intercourse, 4% in 2 types of intercourse, and 4% in all 3 types of intercourse; vaginal sex was typically initiated at an earlier or at the same age as other types of intercourse. Only 2% had engaged in oral sex without engaging in vaginal sex. Although black students were significantly more likely to have initiated sex compared to other racial/ethnic groups, Hispanic students who had initiated each type of intercourse were more likely to be currently sexually active and to have engaged in recent unprotected sex.
Conclusions:  A small percentage of early adolescents are engaging in multiple sexual behaviors. These findings have implications for early adolescent school-based sexual health education.     

Frequent fliers, school phobias, and the sick student: school health personnel's perceptions of students who refuse school

BACKGROUND: This study explored school personnel's perceptions of school refusal, as it has been described as a “common educational and public health problem” that is less tolerated due to increasing awareness of the potential socioeconomic consequences of this phenomenon. METHODS: In‐depth interviews were conducted with school personnel at the middle school (N = 42), high school (N = 40), and district levels (N = 10). The findings focus on emergent themes from interviews with school health personnel (N = 12), particularly those themes related to their perceptions of and role in working with school‐refusing students. RESULTS: Personnel, especially school health services staff, constructed a typification of the school‐refusing student as “the sick student,” which conceptualized student refusal due to reasons related to illness. Personnel further delineated sick students by whether they considered the illness legitimate. School health personnel referenced the infamous “frequent fliers” and “school phobics” within this categorization of students. Overarching dynamics of this typification included parental control, parental awareness, student locus of control, blame, and victim status. These typifications influenced how personnel reacted to students they encountered, particularly in deciding which students need “help” versus “discipline,” thus presenting implications for students and screening of students. CONCLUSIONS: Overall, findings suggest school health personnel play a pivotal role in screening students who are refusing school as well as keeping students in school, underscoring policy that supports an increased presence of school health personnel. Recommendations for school health, prevention, and early intervention include the development of screening protocols and staff training.     

Evaluation of Alabama public school wellness policies and state school mandate implementation

BACKGROUND: This study evaluated wellness policies created by Alabama public school districts and progress made in the implementation of Alabama State Department of Education (ALSDE) school food and nutrition mandates. METHODS: Wellness policies from Alabama public school districts were compared to minimum requirements under the Child Nutrition and Women, Infants, and Children (WIC) Reauthorization Act of 2004. Additionally, data were analyzed from a survey of school district superintendents regarding compliance with ALSDE mandates. Districts were graded based on the percentage of 7 components addressed in wellness policies, and on the percentage of ALSDE mandates implemented. RESULTS: The majority of school districts (71%) were in compliance with all federal wellness policy requirements. An average 6.4 components were addressed, for a mean score of 92%. Mean implementation of ALSDE mandates was 79%; only 7% of districts indicated implementing all of the mandates. No significant differences were found in federal wellness policy or ALSDE mandate compliance scores based on district type, enrollment, percentage of students eligible for free and reduced‐price meals, use of an environmental assessment survey, and use of wellness committee and a nutrition professional during policy development. CONCLUSIONS: The majority of Alabama school districts created school wellness policies with appropriate content. This does not, however, guarantee effective policies. School districts have not done as well implementing ALSDE mandates, demonstrating delay between policy creation and implementation. Future research is needed regarding progress the school districts make in the implementation of school health policy and on factors influencing that progress.