Implementation of a coordinated school health program in a rural, low-income community

Background: Coordinated school health programs (CSHPs) bring together educational and community resources in the school environment. This method is particularly important in rural areas like Kansas, where resources and trained health professionals are in short supply. Rural Stafford County, Kansas, struggles with health professional shortages and a low-income, high-need population. Methods: In 2001, Stafford County’s Unified School District 349 began a multiyear CSHP development process, which required adaptations for implementation in a rural area. First, a CSHP team was formed of community and administrative stakeholders as well as school system representatives. Next, the CSHP team assessed school district demographics so the program framework could be targeted to health needs. During a yearlong planning phase, the CSHP team determined 4 priority areas for program development, as limited staff and funds precluded developing programs in all 8 traditional CSHP areas. Program activities were tailored to the population demographics and available resources. Results: Program outcomes were supported by School Health Index (SHI) data. Of the 8 CSHP focus areas, the SHI found high scores in 3 of the Stafford CSHP’s priority areas: Health Services; Psychological, Counseling, and Social Services; and Physical Education. The fourth Stafford CSHP priority area, Nutrition Services, scored similarly to the less prioritized areas. Conclusions: The process by which the Stafford school district modified and implemented CSHP methods can serve as a model for CSHPs in other rural, high-need areas.     

Vaccination perceptions of school employees in a rural school district

Background

There continues to be a need for increases in adult vaccination rates, especially among those working in environments which may easily become communicable disease outbreak centers, such as school employees in the school environment. The purpose of this study was to evaluate why rural Utah school employees were non-compliant with the influenza and measles, mumps, and rubella (MMR) vaccines, as well as to identify their views on mandatory vaccination policies.

Methods

A questionnaire was distributed to all school employees in a rural Utah school district. Data analysis included frequencies and measures of central tendency and dispersion for quantitative items and theme identification for qualitative items.

Results

Only 51% of school employees were adequately vaccinated for influenza. Reasons for noncompliance with the influenza vaccine included inconvenience, lack of perceived need, and questionable vaccine efficacy. There were 39.3% school employees who had not received an MMR during adulthood, which was commonly attributed to lack of knowledge regarding the need for this vaccine. Almost half (45.7%) of school employees believed a mandatory vaccination policy should be instituted, although 24.2% of school employees were opposed to mandatory adult vaccination policies. Reasons for opposing vaccination mandates included violation of personal choice, lack of perceived vaccination safety and efficacy, lack of perceived need for adult vaccines, and vaccine cost.

Conclusions

Suboptimal vaccination rates of school employees may negatively affect the health and well-being of individuals in the school environment. School employees report a variety of beliefs regarding the influenza and MMR vaccines. While over half of school employees support mandatory vaccination policies for adults working in the school environment, those opposing such a policy report concerns regarding violation of personal choice. Public health officials and school administrators should coordinate efforts to increase vaccination rates among adults in the school environment.     

Rural parents' attitudes and knowledge regarding handicapped preschool children: Implication for developing an early identification program

Rural parents are an often overlooked Child Find source. One hundred and seventy-nine parents were assessed to determine parents' ability to identify possible developmental delays and seek appropriate services. The results indicate that parent-orientated Child Find awareness campaigns must focus on: (1) increasing awareness of the role parents can play in early identification and reduce dependency on physicians, (2) heightening awareness of the importance of early intervention, (3) providing a mechanism to enable parents to detect developmental delays, (4) informating parents of services available to handicapped children and their families, and (5) informing parents of handicapped children's educational rights.     

Effect of an anabolic steroid education program on knowledge and attitudes of high school football players

Six varsity high school football teams were assessed by confidential questionnaire regarding anabolic steroids, before and 2 weeks after an education intervention. The education program used the American College of Sports Medicine's position on the “use of anabolic androgenic steroids in sports.” Two teams received a lecture and a four-page handout, two teams were given the handout only, and two teams were controls. Self-report of current use was 1.1% but 38.8% claimed availability of these agents. Although increased awareness of the adverse effects of anabolic steroid was found after the education program, no differences in attitudes toward the use of anabolic steroids occurred as compared to controls. Strategies designed to dissuade adolescent athletes from considering these drugs need to be developed.     

Project SOAR: a training program to increase school counselors' knowledge and confidence regarding suicide prevention and intervention

School counselors are often the lead individuals in school suicide prevention programs. All school counselors in Dallas, Texas, receive training through Project SOAR (Suicide, Options, Awareness, and Relief), a suicide prevention program. This study assessed Dallas school counselors' knowledge of suicidal risk factors and perceived ability to initiate appropriate steps when confronted with a suicidal student. A two-page, 44-item survey was distributed to all Dallas school counselors attending a mandatory meeting in spring 1999. A total of 186 school counselors (75%) responded. Most had been a school counselor for less than 10 years and one-half received initial SOAR training less than four years ago. The majority strongly agreed that they could recognize suicidal warning signs, assess a student's risk for suicide, and offer support to a suicidal student. In addition, most knew the intervention steps to take when a student assessed at high suicidal risk. When compared to school counselors nationwide, these counselors reported increased confidence in identifying students at suicidal risk.     

Implementation effectiveness trial of a social influences smoking prevention program using schools and television

Results are reported from a quasi-experimental implementationeffectiveness trial of a television and school-based smokingprevention program. The program used the social influences approach,focusing on peer, family and media influences on adolescentsto become smokers, and providing grade 7 students (age 12–13)with the knowledge and skills to resist them. The evaluationallowed for assessments of: the value of coordinated televisionprogramming in increasing school, student and parent availabilityand acceptance of the program; the effects of program context(whether all or half of a grade cohort received the programin school) on participation and subsequent smoking behavior;and the effects of parental participation in prevention activitieson subsequent student smoking. Data on availability, acceptance,participation and implementation are reported and immediatepost-test and 1- and 2-year follow-up results. Strong effectsof television programming and context on availability, acceptanceand participation were found. Significant associations werealso found between each television viewing and parental involvementand subsequent student smoking, but a lack of overall programeffects on smoking outcomes limit their interpretation. Constraintson programming and research design suggest: (i) possible limitationsto program effects we might reasonably expect in real-worldapplications of the social influences approach and (ii) theneed for future true experimental efficacy trials to determineexactly what level of programming will be needed to achievesignificant real-world effects.     

Healthier choices and increased participation in a middle school lunch program: effects of nutrition policy changes in San Francisco

In order to address overall nutritional health, including increases in numbers of overweight children and adolescents, the San Francisco Unified School District implemented a progressive nutrition policy beginning in August 2003. We review this policy and focus on its impact on school and district revenues and students' participation in the federally subsidized school lunch program. We examined changes in menu items and the consequent effects of these changes on student eating patterns and school revenues at Aptos Middle School in San Francisco. This case study and additional district data show that provision of healthy menu options led to increased student participation in the federal school lunch program.     

Changes in attitudes, knowledge and behavior associated with implementing a comprehensive school health program in a province of China

After successful pilot projects, Zhejiang Province, China, decided to systematically scale-up health promoting schools (HPS) over the entire province of 47 million. This study describes the interventions and self-reported changes in attitudes, knowledge and behavior during the first phase of scaling-up. Group interviews were conducted with a sample of 191 participants (school administrators, teachers, students and parents) from nine schools with a total of approximately 15 200 students. Grounded theory guided data analysis. Schools implemented all HPS components (school health policy, physical school environment, psychosocial school environment, health education, health services, nutrition services, counseling/mental health, physical exercise, health promotion for staff and outreach to families and communities), adapted to local circumstances. Participants reported a range of changes in attitudes (paying more attention to health, attaining better 'psychological quality' and confidence, forming friendships between teachers and students and feeling more relaxed), knowledge and concepts (increasing knowledge about various health issues, developing a broader concept of health and gaining better understanding about the HPS concept) and behavior (actively participating, increasing physical activity, improving sanitary habits, reducing or quitting smoking, eating more nutritiously, increasing safety behavior, sustaining less injuries and improving parent-child communication). This qualitative study shows the feasibility and efficacy of implementing HPS in Zhejiang Province, China.     

Women's knowledge and attitudes regarding alcohol consumption in pregnancy: a national survey

Background  

Alcohol exposure in pregnancy is a common and modifiable risk factor for poor pregnancy and child outcomes. Alcohol exposure in pregnancy can cause a range of physical and neurodevelopmental problems in the child including the Fetal Alcohol Spectrum Disorders (FASD). In order to improve prevention strategies, we sought to describe the knowledge and attitudes of women of childbearing age regarding alcohol consumption during pregnancy and its effects on the fetus.     

Maternal mortality in a rural district of southeastern Tanzania: an application of the sisterhood method

BACKGROUND: Deaths from maternal causes represent the leading cause of death among women of reproductive age in most developing countries. It is estimated that the highest risk occurs in Africa, with 20% of world births but 40% of the world maternal deaths. The level of maternal mortality is difficult to assess especially in countries without an adequate vital registration system. Indirect techniques are an attractive cost-effective tool to provide estimates of orders of magnitude for maternal mortality. METHOD: The level of maternal mortality estimated by the sisterhood method is presented for a rural district in the Morogoro Region of Southeastern Tanzania and the main causes of maternal death are studied. Information from region-specific data using the sisterhood method is compared to data from other sources. RESULTS: The maternal mortality ratio (MMR) was 448 maternal deaths per 100,000 live births (95%CI : 363-534 deaths per 100,000 live births). Maternal causes accounted for 19% of total mortality in this age group. One in 39 women who survive until reproductive age will die before age 50 due to maternal causes. The main cause of death provided by hospital data was puerperal sepsis (35%) and postpartum haemorrhage (17%); this is compatible with the main causes reported for maternal death in settings with high levels of maternal mortality, and similar to data for other regions in Tanzania. The sisterhood method provides data comparable with others, together with a cost-effective and reliable estimate for the determination of the magnitude of maternal mortality in the rural Kilombero District.     

北京市某城区619名中学生同性恋认知态度调查

目的为了解中学生对同性恋的认知和态度,在中学生中开展有针对性的相关健康教育,为制定性教育计划和艾滋病防治策略提供科学依据。方法采用自行设计的调查问卷,根据概率比例规模抽样原则,采用典型整群抽样方法对北京市中心某城区5所初中、7所普通高中、2所职业高中学校的22个班共619名中学生进行调查。结果35．9％的中学生对同性恋定义、外表特征和行为特征均能正确认知,不同性别之间对同性恋的认知存在显著差异。49．1％的中学生可以接受身边有同性恋存在,42．2％的中学生认为应该保护同性恋的权益,不同学校类别、不同性别中学生对同性恋的态度存有显著差异。33．8％的学生表示身边有同性恋存在,其中有6．5％的学生表示这种现象会对自己产生影响。结论中学生对同性恋的认知程度不高,态度较为宽容,在目前中学校园存在同性恋现象的客观情况下,应加强中学生性知识健康教育,建议有关部门和学校要在中学生中有针对性的开展性教育,宣传同性恋相关知识,同时加强艾滋病防治知识的宣教,引导中学生树立健康的人生观、价值观和性爱观,促进中学生健康成长。