Creating health-promoting schools in China with a focus on nutrition

This pilot project in Zhejiang Province, China, aimed at improving the nutrition and health status of students, school personnel and parents, and developing a model project for nutrition interventions for the development of health-promoting schools (HPS) in China. Three primary and three secondary schools participated. Interventions included establishing school-based working groups, nutrition training for school staff, distribution of materials on nutrition, nutrition education for students, student competitions, school-wide health promotion efforts and outreach to families and communities. Results of a pre- and post-intervention survey one and a half years apart showed improvements in nutrition knowledge, attitudes and behavior among all target groups. Primary school students at the pilot schools made the greatest knowledge gains in the areas of Chinese dietary guidelines (increased from 49.2 to 78.0%, p < 0.01) and adequate dietary principles (increased from 42.9 to 68.0%, p < 0.01). Scores of secondary school students who reported liking school lunches rose at pilot schools from 17.9 to 45.2% (p < 0.01). School staff at control schools who reported taking breakfast declined from 81.4 to 66.6% (p < 0.01), while staff who reported taking lunch at school increased in pilot schools from 87.5% at baseline to 93.9% (p < 0.01). The largest increases in nutrition knowledge among all target groups occurred among parents and guardians. At the pilot schools parents increased their knowledge in the areas of nutritional deficiencies (from 35.0 to 66.2%, p < 0.01) and nutrient-rich foods (from 38.8 to 66.8%, p < 0.01). Talks with target groups confirmed changes in attitudes and behavior, and school visits revealed improvements to school facilities and school health services, establishing of school policies and a positive school climate. This study suggests that nutrition can effectively serve as an entry point to establish HPS in China and that the HPS concept is feasible to improve the dietary knowledge, attitudes and behavior of students, parents and school personnel.     

Strategies for implementing Health-Promoting Schools in a province in China

After successful pilot projects in 10 schools (four schools with tobacco control and six schools with nutrition interventions, plus 10 control schools), Health and Education officials in Zhejiang Province, China, decided to scale up Health-Promoting Schools (HPS) systematically over the entire province, starting with an initial cohort of 51 additional schools, reaching from primary to vocational schools. Interviews with school personnel during the first phase of scaling up illuminated the key pre-implementation, implementation, and monitoring and evaluation activities. Pre-implementation activities included choosing an entry point, setting up a special HPS committee, and establishing a work plan. Implementation activities included conducting mobilization meetings, prioritizing health, popularizing the HPS concept, ensuring community cooperation and participation, acting as role models, offering training, and using new teaching and learning methods. Monitoring and evaluation activities included process, baseline, and final evaluations and changing standards of evaluation to a more holistic evaluation that schools go through to become Health-Promoting Schools. Schools also reported that they faced - and overcame - a number of challenges including understanding and integrating the HPS concept and lack of professional development and support. Results revealed that schools transitioned from a passive model of education to interactive pedagogy put priority on health and viewed it as a co-responsibility, reshaped assessment to a more holistic approach and called for more training and technical support. Participants mentioned that they gained knowledge and skills and developed a deeper understanding about health. Health impact was also demonstrated, for instance in reduced injuries and reduced smoking, and educational impact was demonstrated, for instance in improved relationships of children to parents and teachers, improved social qualities, and improved teacher satisfaction.     

Health-promoting school development in Zhejiang Province, China

In 2003, after three pilot projects successfully implemented WHO's Health-Promoting Schools (HPS) concept, officials in Zhejiang Province, China, expanded to additional 51 schools (93,000 students and their families and 6800 school personnel). Each school identified a health issue to begin HPS development, followed by conceptual orientation, resource mobilization, teacher training, surveys, interventions, outreach and evaluation. This study focused on the extent to which participating schools implemented the HPS concept and improved their psycho-social environments (PSEs). Forty-nine of the 51 schools met China's HPS criteria. Schools with fewer resources and with substantial resources, i.e. schools in both rural and urban areas, met the criteria. Schools' PSEs, as measured by the PSE Profile, improved as they became HPS. Findings from interviews and observations identified strong encouragement and support from officials, school personnel, students, parents and community leaders, and consistency of HPS with the national policy on quality education, as success factors.     

Health-promoting schools

Chronic diseases are now the major causes of death and disability worldwide, and non-communicable diseases (NCD) account for the majority of the global health burden. About half of premature deaths are related to health-risking behaviours that are often established during youth and extend to adulthood. While these diseases might not be curable, they are preventable. Prevention is possible when sustained actions are directed at individuals and families, as well as at the broader social, economic and cultural determinants of NCD. A ‘life-course’ approach to promoting healthy behaviour should begin early in life. The aim of this article is to discuss the impact of the ‘health-promoting school’ (HPS) on improvements in youth health. HPS can be described as a holistic, whole-school approach in which a broad health education curriculum is supported by the environment and ethos of the school. HPS moves beyond individual behavioural change to consider organizational and policy change such as improving the physical and social environment of the school, as well as its curricula and teaching and learning methods. A positive culture for health would facilitate higher levels of health literacy by helping individuals tackle the determinants of health better as they build the personal, cognitive and social skills for maintaining good health. There is reasonable evidence to demonstrate that the whole-school approach using the HPS framework is effective in improving health, ranging from physical activities and healthy eating to emotional health. Schools adopting the HPS framework have demonstrated changes in culture and organizational practice to become more conducive to health improvement. These schools were reported to have better school health policies, higher degrees of community participation, and a more hygienic environment than non-HPS schools, and students in these schools had a more positive health behaviour profile. Health promotion and disease prevention is essential to reduce the healthcare burden of children and adolescents. HPS would help to combat the global burden of childhood obesity by promoting healthy eating behaviours and encouraging higher levels of physical activity. There are gaps in service provision for children and adolescents from both the health and education perspective; the HPS framework has the potential to develop a mechanism of closer integration with the primary healthcare system, making youth health services more school based and student centred. A new model of interconnection between HPS and different components of primary healthcare can be evolved to make services for disease prevention and health promotion more student friendly.     

中国4城市12所健康促进学校创建现状

目的了解南京、温州、嘉兴和深圳4个城市12所健康促进学校的创建现状,为健康促进学校的创建工作提供参考。方法随机抽取4个城市12所学校的923名学生进行问卷调查。结果90.1%的学生树立了“健康第一”的理念;学生的大部分健康相关知识知晓率和相关态度持有率及健康行为发生率较高,但对平衡膳食和烟草危害的认知率较低,分别只有24.2%和17.5%;学生的健康状况较好;学校的社会环境融洽,能有效提供卫生服务;80%以上的学生在学校里获得过健康相关知识,89.3%的学生上学期参加过1次以上以健康为主题的校园活动;过去1 a内,61.6%的学生曾参加过2次以上学校组织的校外健康活动。结论学校健康促进学校的创建工作已经初见成效,但还存在一些问题,需要针对发现的问题予以改进。     

Helping schools to become health-promoting environments--an evaluation of the Wessex Healthy Schools Award

The concept of the health-promoting school embodies a holistic,whole school approach to personal and community health promotion.Healthy school award schemes, which are increasing, are seenas one way of helping schools to become health promoting. Manyare based on the Wessex Healthy Schools Award scheme (WHSA)which was established in 1993. This paper outlines a 3-yearevaluation study of the effectiveness of the WHSA interventionin changing health promotion policy and practice in school,and in influencing health-related knowledge, attitudes and behaviourof pupils. The study design was quasi-experimental, and wasconducted in 11 intervention secondary and five control schools.It involved pupils, teachers, support staff, parents, schoolgovernors, health promotion officers and education advisers,using a range of quantitative and qualitative tools. The Awardprocess, which is linked to nine key areas of health, lasted15 months. Changes in school health promotion were assessedby audit; pupils' health-related knowledge, attitudes and behaviourthrough self-administered questionnaires; and attitudes andperceptions of staff, parents and governors from semi-structuredinterviews. The results showed that audit scores for all areas,except physical activity and taking responsibility for health,increased in intervention schools, indicating positive Award-relatedchanges. There was little improvement in healthy food choices,smoke-free environment and developing community links. Pupils'knowledge, high at the baseline, remained unchanged. Positiveeffects on smoking uptake and drug use were seen, but littlechange in healthy eating and physical activity. Older girlsmade greater progress in all areas. Parents and non-teachingstaff strongly supported school health promotion, perceivedmany benefits of the Award, and wished to be more actively involved.The Award positively influenced the development of a health-promotingschool, perceived as an important component of education. Furtherresearch is needed into ways of improving pupils' diet and activitylevels, how schools can implement a smoke-free environment,the development of community links, and ways in which a wholeschool approach can be achieved.     

Can Health Promoting Schools contribute to the better health and wellbeing of young people? The Hong Kong experience

BACKGROUND: The Health Promoting School (HPS) is a WHO sponsored framework, compiled to enable education and health sectors to be more effective in school based initiatives. AIMS: This study attempted to test the hypothesis that students from schools that had comprehensively embraced the HPS concept as indicated by the Healthy School Award, were better, in terms of health risk behaviour, self reported health status, and academic results, than students from schools that did not reach the standard of the award. METHODS AND RESULTS: The results presented came from nine schools (four primary and five secondary) applying for accreditation of the Healthy Schools Award after adopting the HPS framework for two years. Regular consultancy support and training were available to all schools. Students had completed before and after surveys to assess their health behaviours, self reported health status, and academic standing before the two year intervention, and at its end. Data from the before and after surveys of the students attending schools that reached certain level of HPS standard as indicated by the award, were compared with students whose schools did not receive the award, and the results showed differences. Some differences were found to be more significant among the primary school students than secondary schools students. This illustrated early intervention for lifestyle changes to be more effective. Students' satisfaction with life also improved if their schools adopted the concept of HPS comprehensively. CONCLUSIONS: The results suggest that comprehensive implementation of HPS would contribute to differences in certain behaviours and self reported health and academic status.     

The role of physical environment on student health and education in green schools

The role of physical school environment on student health and education is becoming better understood. A growing body of literature indicates that improved physical environments in schools (e.g., indoor air quality, lighting, and acoustic conditions) can enhance student health outcomes. In parallel, the green building movement centers around designing buildings, including schools, that are more sustainable to decrease energy consumption, minimize environmental impact, and create healthier spaces for occupants. This paper synthesizes the findings from both green design studies and school outcomes studies to provide a systematic evaluation of the potential impacts of green school design features on student health outcomes. Three inter-related topics are covered in detail: (i) overview of the "green" concept, including existing guidelines for "greening" schools, attitudes toward green schools, and condition of the physical environments in non-green schools; (ii) potential effects of the physical environment on school children, including documentation of national statistics and summary of findings from school research studies; (iii) synthesis of findings, including a discussion of the knowledge gaps in the field of green school research and conclusions.     

Evaluation of a Health Promoting Schools program to reduce smoking in Australian secondary schools

This randomized controlled trial evaluated the effectiveness of a multicomponent Health Promoting Schools (HPS) intervention program in improving self-reported smoking outcomes among a cohort of adolescents in 22 public secondary schools in the Hunter Region of New South Wales, Australia. Pre-test surveys were completed by students in the first 2 years of secondary school, with a 2-year post-test survey. Multivariate analyses examined intervention effect for the main outcome, post-test smoking behavior, controlling for pre-test smoking status, school and other confounders. The sample comprised the cohort of 1852 students who completed both surveys. The results demonstrated that the HPS program failed to improve smoking behavior over the 2 years (equal increase of 10% in both groups). The program was successful in improving smoking knowledge, but not attitudes, in intervention versus control group (P < 0.001). Independent predictors of post-test smoking included: pre-test smoking [odds ratio (OR) = 5.44; 95% confidence interval (CI) = 3.20-9.28], being female (OR = 0.55; CI = 0.35-0.87), having more close friends who smoked (OR = 1.42; CI = 1.33-1.52), peer group having no clear opinion about smoking (OR = 3.23; CI = 1.27-8.27), having more positive and less negative attitudes towards smoking, and being less involved in school activities. We discuss methodological issues in multicomponent community-based interventions, and highlight the strengths and limitations of this study.     

A pilot demonstration of comprehensive mental health services in inner-city public schools

BACKGROUND: National policy statements increasingly espouse the delivery of comprehensive mental health services in schools. In response to the limited evidence supporting this recommendation, the purpose of this study was to assess the need for, and feasibility, desirability, and outcomes of a full model of comprehensive mental health services in 2 public elementary schools in inner‐city neighborhoods. METHODS: The program, based upon a national model for comprehensive school mental health services, comprised universal and indicated preventive as well as clinical interventions designed to target needs identified in a baseline screening survey. The program was implemented over 1 school year by mental health professionals in collaboration with school teachers. Mental health outcomes comparing baseline to follow‐up data were assessed in multiple domains among students and teachers. RESULTS: After 1 year of intervention, students had significantly fewer mental health difficulties, less functional impairment, and improved behavior, and reported improved mental health knowledge, attitudes, beliefs, and behavioral intentions. Teachers reported significantly greater proficiency in managing mental health problems in their classrooms. School staff overwhelmingly endorsed satisfaction with the program. CONCLUSION: If the observed favorable findings from this pilot demonstration can be replicated in methodologically rigorous studies, additional support would be garnered for national policy recommendations about comprehensive school mental health services.     

我国四城市部分小学生肥胖控制效果评价

目的探讨学校群体活动模式控制学生肥胖的效果,为有关干预模式的研究提供依据。方法在长春、乌鲁木齐、西安和厦门四城市各选择1所学校作为干预学校,三、四年级全体学生为重点干预对象,选取同一城区条件基本相近的1所学校作为对照学校。将肥胖控制与健康促进学校的创建结合起来,采取以群体干预与个别指导相结合、知识传播与运动/饮食行为干预相结合、学校干预与家庭干预相结合、学生行为改变和学校健康环境改变相结合的综合策略开展肥胖干预。干预前后进行问卷调查。结果干预学校学生肥胖控制知晓率、正确膳食及运动行为形成率的提高幅度高于对照学校学生,差异具有统计学意义(P<0.01);干预学校肥胖率和超重率分别从15.6%和14.1%下降到10.4%和14.2%;其中干预学校三、四年级男生肥胖率从21.5%下降到13.6%。结论学校群体活动控制模式对于小学生的肥胖控制是有效的。     

Do Schools Influence Student Risk-taking Behaviors and Emotional Health Symptoms?

PurposeMany schools engage in health promotion, health interventions, and services aimed at improving the health and well-being outcomes for students. The purpose of this study was to examine the effects of schools on student health risk-taking behaviors and depressive symptoms.MethodA nationally representative sample (n = 9,056) of students from 96 secondary schools completed a health and well-being survey using Internet Tablets that included questions on school climate, health risk-taking behaviors, and mental health. Teachers (n = 2,901) and school administrators (n = 91) completed questionnaires on aspects of the school climate which included teacher well-being and burnout, the staff work environment, health and welfare services for students, and school organizational support for student health and well-being. Multilevel models were used to estimate school effects on the health risk-taking behaviors and depression symptoms among students.ResultsSchools where students reported a more positive school climate had fewer students with alcohol use problems, and fewer students engaging in violence and risky motor vehicle behaviors. Schools where teachers reported better health and welfare services for students had fewer students engaging in unsafe sexual health behaviors. Schools where teachers reported higher levels of well-being had fewer students reporting significant levels of depressive symptoms.ConclusionsMore positive school climates and better school health and welfare services are associated with fewer health risk-taking behaviors among students. However, the overall school effects were modest, especially for cigarette use and suicidal behaviors.     

湖南省中小学校卫生保健能力现状及改善策略

目的 为分析湖南省中小学校卫生保健能力配置现状,改善中小学卫生保健能力提供依据。 方法 开展学校卫生保健能力建设问卷调查,利用学校卫生工作体系和能力建设调查工作数据采集平台直报数据,对湖南省中小学校卫生保健机构设立以及卫生保健人员配备现状进行分析。 结果 湖南省12 614所中小学校中,3 599所寄宿制学校和1 704所600人以上非寄宿制学校,至少需配备专职校医9 967名,实际仅898名,7 311所不足600人非寄宿制学校,专职保健老师仅197名;调查学校中7.3%设置了卫生室,29.6%设置了保健室;7.5%配备了校医,5.3%配备了专职校医,专职校医配备合格率为1.3%;45.6%配备了保健老师,6.6%配备了专职保健老师;90.0%开展了卫生健康相关课程;5.7%的校医和26.5%的保健老师参加过卫生专业技术培训;设置卫生室或保健室、配备(专职)保健老师、配备(专职)校医、开展卫生健康教育、保健老师或校医参加过学校卫生专业知识培训的学校比例,随学龄阶段的上升、经济水平的提高、学校规模的变大,呈逐渐增加趋势(均P<0.001)。 结论 湖南省中小学校卫生保健机构以及卫生保健人员缺口较大,小于600人的小学卫生保健力量需重视;保健老师和校医学校卫生专业知识培训不足;经济水平仍是影响学校卫生保健机构以及人员配置的关键因素之一。建议通过增加学校卫生工作经费投入,不断完善学校卫生保健机构建立,合理增配学校卫生保健人员,并通过卫生保健人员专业技术培训来提升中小学校卫生保健工作能力。     

中小学教师对学校健康教育的认识、态度和需求

目的 了解中小学教师对学校健康教育的认识，态度和需求，为学校健康教育的改革提供科学依据。方法 在6省市57所中小学校中，抽取中小学校教师506名，采用专题小组讨论的方法，共组织55个专题小组讨论。结果 多数学校开设了健康教育课，部分学校还开展了其他形式的健康教育活动；多数教师认为设置健康教育课很有必要；很多教师没有认真读过健康教育课教材，少数教师就教材内容提出了一些建议；教师多认为社会各界对学校健康教育工作的重视不够；多数人表示自己从未接受过关于健康教育方面的培训，并表示愿意多学习一些有关健康的知识，结论 多数学校开展了学校健康教育，但存在着一定的困难和问题，应进行健康教育的培训，加强学校健康环境的建设，学校，家庭，社会共同努力搞好健康教育工作。     

沈阳市中学生预防艾滋病教育影响评价

目的 探讨学校预防AIDS教育对学生知识、态度的影响。方法 以沈阳市9所中学初一、高一学生为研究对象,由受过培训的健康教育教师在学校对学生进行教育,于教育前后对学生进行有关预防AIDS知识和态度方面的不记名问卷调查。结果 教育后学生预防AIDS基本知识平均得分由教育前的6．67提高到10．98（满分为15分）;反对男青年及女青年婚前性行为的比例分别由教育前的47．8％、52．0％上升到57．3％和63．0％;表示愿意与AIDS患同班上课的比例由教育前的5．1％上升到22．6％。结论 学校预防AIDS教育使学生预防AIDS基本知识得到提高,拥有正确态度的学生比例增加。但学生中拥有正确态度的比例仍有待进一步提高,因此,在今后的教育中除了应重视基本知识的传授外,还应重视发展学生与预防AIDS有关的正确态度。     

桐庐县青少年健康危险行为现况的研究

目的了解桐庐县青少年健康危险行为流行现状和特点。方法按浙江省青少年健康危险行为监测方案的实施要求,对桐庐县5所全日制学校(初中、高中和职业高中)1092名在校学生,采用中国青少年健康相关行为调查问卷进行无记名调查。结果19.4%的学生有打架行为;9.5%考虑过自杀,4.8%计划过自杀,1.0%曾采取措施自杀;36.5%想过离家出走,3.2%曾经离家出走;78.1%常感到孤独;44.2%被人恶意取笑;73.7%有失眠现象;严重受伤与扭伤的为12.2%和11.3%;57.8%步行乱穿马路,30.0%骑车带人,7.2%骑车逆行;23.1%到无安全防范措施地方游泳;有吸烟和饮酒史的分别为30.4%和61.9%;5.1%滥用镇静催眠类药物;20.3%希望增加上网时间,10.8%想停止上网不能自控,参加过网络赌博的有42.2%;有22.2%的学生不吃早餐,36.1%的学生存在偏食现象;82.7%的学生缺乏体力活动锻炼;高中阶段学生曾发生性行为的比例为1.4%。结论应该针对青少年危险行为的特点开展综合性干预措施。     

浙江省中小学校校医与保健教师配置现状分析

目的 了解浙江省中小学校校医与保健教师配置现况,为有效改进当前学校卫生工作提供参考.方法 采用流行病学现场调查方法,选择浙江省11个地市99个县区内的5 541所中小学校为对象,用统一问卷收集学校及校医配置数据.结果 调查的5 541所学校中,专职校医与保健教师配置率为75.28％,配置比为1 052.21:1;专职校医配置率为23.26％,配置比为3 054.31:1.根据《学校卫生工作条例》规定,总达标比例为25.30％,其中学生数＜600名的学校总达标比例为61.71％,学生数≥600名的学校达标比例为1.72％.专职校医配置情况较好的分别为城区、十二年制、私立学校.结论 浙江省中小学校的校医配置现况不容乐观.应增加专职校医人员投入,改善校医队伍建设.     

Secondary school health education related to nutrition and physical activity--selected sites, United States, 2004

Eating a healthful diet and engaging in physical activity have important health benefits for youths, such as reducing overweight, a condition that affected 17% of those aged 12-19 years during 2003-2004. School health education that includes information about nutrition and physical activity is an important component of a comprehensive approach to improving dietary behavior, reducing sedentary behavior, and increasing physical activity among youths. A previous study suggested that professional development for health education teachers helps ensure the quality of health education instruction. To identify which nutrition and physical activity topics are being taught in school health education courses and what percentage of lead health education teachers have received professional development on nutrition and physical activity, CDC analyzed data from the 2004 School Health Profiles for public secondary schools (i.e., middle, junior high, and senior high schools) serving students in grades 6-12 in 25 states and 10 large urban school districts. This report summarizes the results of that analysis, which indicated that in 2004, approximately one half to three fourths of schools in the participating states and school districts taught all 15 nutrition and dietary behavior topics listed in the School Health Profiles questionnaire in a required health education course, and approximately one third to two thirds taught all 12 physical activity and fitness topics. State and local education agencies should continue to encourage schools to provide education on nutrition and physical activity as part of a coordinated school health program and promote staff development for health education teachers.     

Creating health-promoting schools in rural China: a project started from deworming

Intestinal helminth infection is highly endemic in rural areasof China. This project was implemented to determine if dewormingefforts through schools could reduce helminth infections andsuccessfully serve as an entry point for developing a more comprehensiveapproach to school health, i.e. the components of ‘health-promotingschools’. Six primary and junior secondary schools with6188 students were involved in the project. Major interventionsin four experiment schools included: examination and treatmentof helminth infections; health education; improvement of schoolphysical environment; establishment of relevant school policiesand regulations; and strengthening relationship between schooland community. The only intervention taken by the other twoschools as controls was deworming. After 1 year of implementation,helminth infection in students and environmental contaminationby helminth eggs in experiment schools decreased by ~80%, significantlyhigher than that in control schools. Remarkable improvementsin students' knowledge, behaviour and skills of health protection,in school physical facilities, in school/community relationship,and in relevant policies and practices, were also observed inthe experiment schools. The conclusions are that the conceptof the health-promoting school has been well accepted by thestudents, teachers, parents and local government officers, andthat helminth reduction is an effective and feasible entry pointfor establishing health-promoting schools in rural areas wherehelminth infection has been an important public health problem.     

深圳市罗湖区学生口腔健康相关因素调查

目的了解罗湖区学生、老师、家长口腔健康状况及特点,制定学生防龋策略。方法随机抽取义务教育阶段学生、家长、老师,采用匿名口腔问卷调查,对问卷进行统计分析。结果中学生口腔状况好于小学（χ^2=109．4,P〈0．01）。学生口腔健康知识知晓及健康行为形成小学高于中学（χ^2=105．3,χ^2=34．6,P〈0．01）。老师口腔状况、健康知识知晓率及健康行为形成小学高于中学（χ^2=17．2,χ^2=22．0,χ^2=7．0,P〈0．01）;家长健康知识知晓及行为形成情况与文化程度呈正相关,除农民受文化程度的影响外,其他职业家长的差异无统计学意义。结论学生健康知识的掌握、行为的形成与知识的传授者相关,家长需带动自己的子女共同形成并保持自我保健习惯,口腔健康教育是持续的,终身的。