Role differences in gatekeeper perceptions of school-based drug and sexuality education programs: a cross-sectional survey

Using a mail survey, we collected data on attitudes and opinionsabout school drug/sexuality education from 606 individuals representing106 junior and senior high schools in Illinois. Respondentsfrom five role groups (principals, district administrators,school board members, teachers and parents) completed questionsregarding perceptions of student risk behaviors and effectsof school health programs in four areas: drug/alcohol use, tobaccouse, AIDS/STDs and teen pregnancy. For each program area, weanalyzed six constructs across respondent groups: perceivedseriousness of problem, perceived prevalence of problem, perceivedacceptance of school program, perceived program effectivenesson student attitudes and behavior, and satisfaction with schoolprogram. To test role differences, MANOVA and random-effectsregression model analyses were performed. Significant differencesin role perceptions were found for all constructs except perceivedprogram effectiveness on student attitudes. Overall, teachersand parents responded similarly to each other and differentfrom other groups. They tended to be less satisfied with schoolprograms, view programs as less effective and perceive otherrole groups as less accepting. We discuss the discrepancy inrole perceptions in the context of diffusion theory, applicationto designing interventions, and potential impact on school programdecisions, implementation and maintenance of change.     

School-based programs: lessons learned from CATCH, Planet Health, and Not-On-Tobacco

Establishing healthy habits in youth can help prevent many chronic health problems later in life that are attributable to unhealthy eating, sedentary lifestyle, and overweight. For this reason, many public health professionals are interested in working with school systems to reach children in school settings. However, a lack of familiarity with how schools operate can be a substantial impediment to developing effective partnerships with schools. We describe lessons learned from three successful school health promotion programs that were developed and disseminated through collaborations between public health professionals, academic institutions, and school personnel. The programs include two focused on physical activity and good nutrition for elementary and middle school children--Coordinated Approach to Child Health (CATCH) and Planet Health--and one focused on smoking cessation among adolescents--Not-On-Tobacco (N-O-T). Important features of these school health programs include 1) identification of staff and resources required for program implementation and dissemination; 2) involvement of stakeholders (e.g., teachers, students, other school personnel, parents, nonprofit organizations, professional organizations) during all phases of program development and dissemination; 3) planning for dissemination of programs early in the development and testing process; and 4) rigorous evaluation of interventions to determine their effectiveness. The authors provide advice based on lessons learned from these programs to those who wish to work with young people in schools.     

Alcohol and Drug Abuse Prevention in Wisconsin Public Schools

This survey assessed the status of Wisconsin public school district programs designed to prevent alcohol and other drug related problems among students. The assessment involved surveying prevention program directors of 102 school districts that received grants for prevention initiatives since 1981. Most districts (70%) implemented programs at the elementary, middle, and senior high school levels. Typical program strategies involved combining information dissemination with refusal skill and self-concept development. School programs predominantly were school-based and did not systematically involve community members or agencies. The greatest obstacles to providing effective prevention services include high rates of alcohol and other drug use in homes and communities, denial of alcohol and other drug related problems among students, parents, and community members, and lack of staff time for prevention activities. Project directors indicated a need for schools to initiate greater involvement of parents, nonschool alcohol and drug abuse prevention agencies, and other community organizations in school efforts.     

Peer Reviewed: School-based Programs: Lessons Learned from CATCH, Planet Health, and Not-On-Tobacco

Establishing healthy habits in youth can help prevent many chronic health problems later in life that are attributable to unhealthy eating, sedentary lifestyle, and overweight. For this reason, many public health professionals are interested in working with school systems to reach children in school settings. However, a lack of familiarity with how schools operate can be a substantial impediment to developing effective partnerships with schools.

We describe lessons learned from three successful school health promotion programs that were developed and disseminated through collaborations between public health professionals, academic institutions, and school personnel. The programs include two focused on physical activity and good nutrition for elementary and middle school children — Coordinated Approach to Child Health (CATCH) and Planet Health — and one focused on smoking cessation among adolescents — Not-On-Tobacco (N-O-T).

Important features of these school health programs include 1) identification of staff and resources required for program implementation and dissemination; 2) involvement of stakeholders (e.g., teachers, students, other school personnel, parents, nonprofit organizations, professional organizations) during all phases of program development and dissemination; 3) planning for dissemination of programs early in the development and testing process; and 4) rigorous evaluation of interventions to determine their effectiveness. The authors provide advice based on lessons learned from these programs to those who wish to work with young people in schools.

     

Knowledge and Behaviors of Parents in Planning for and Dealing with Emergencies

In recent years, a number of large-scale disasters have occurred both locally and internationally, heightening our awareness of potential dangers. If a disaster were to occur at a school, there is the potential for a large number of children to be injured or affected in some way. The school community includes not only the staff and students who are on campus each day, but also students’ parents and the surrounding neighborhood. How parents react during emergencies and disasters at schools is likely associated with their knowledge and perceptions of emergencies and disasters. Parents’ preparedness levels and their planned response to a school-based emergency and how schools plan and manage for these reactions have not been explored. Utilizing a mixed methods design that included surveys, semi-structured interviews and focus groups with members of the communities in two South Los Angeles school districts, this study aims to provide an overview of parents’ levels of emergency and disaster preparedness and the challenges they face in preparing for these events. Additionally, parents’ planned responses to a school-based emergency or disaster are discussed as well as the challenges that schools may face as a result. Data from this study confirm that there are a number of challenges related to parents’ planned response to a school-based emergency, including an expected inundation of parents to the schools, lack of communication between schools and parents and language barriers. Recommendations for schools are provided to take advantage of parent populations to better integrate them into schools’ emergency planning processes.     

Negotiating family-centered early education: A multidimensional assessment of interests and needs

Reform efforts in early childhood education highlight recommendations to adopt more family-centered practices, including greater family support functions. Yet, there is little research on the processes through which schools develop family-centered programs that are responsive to the participating children and families. This study examines program development priorities from the perspectives of school staff and families. Fifty-three (53) school staff members and one hundred and ninety (190) family members responded to quantitative and qualitative surveys to describe their beliefs about the strategies that two urban public schools should undertake in developing family-centered early childhood programs. Results revealed important differences between the staff and family perspectives. Staff advocated direct methods of assisting families, such as parent education, and expressed comparatively little consideration for informal aspects of family support (e.g., informal staff-parent relationships; parent-child recreation). Families set a priority on receiving support for their informal family functions, and perceived an important role for schools to assume in providing referral information for community resources rather than in providing direct school-based assistance. The results indicated the need for greater staff training in: a) the processes of delivering relationship-based, consumer-driven family services; and b) the utilization of family input to inform schools' instructional activities.     

Transferring a Clinic-based Health Education Program for Children with Asthma to a School Setting

Open Airways is a clinic-based health education program for low income, inner city families of children with asthma. The program was transferred to the public schools to test it in a setting more representative of school-age children with asthma, and to provide health education for families not receiving medical care for asthma. During the transfer, the program changed from placing primary responsibility for management on parents to a child-centered program independent of direct parental involvement. Children's attendance increased greatly and a significant number of families not receiving regular medical care for asthma enrolled. Preliminary analysis showed the child-centered program improved children's school performance and asthma management skills. The findings of this study suggest health education programs designed for medical care settings can be adapted successfully for use in the schools and reach new populations of children with chronic diseases.     

Principal and teacher reports of strategies to enforce anti-tobacco policies in Florida middle and high schools

This study describes anti-tobacco policies implemented by middle and high schools in Florida. All schools had in place formal anti-tobacco policies but implementation of those policies was more rigorous at the middle school level. Principals and tobacco use prevention education teachers reported the formal and informal strategies used to enforce their school's anti-tobacco policies. Punitive enforcement strategies were more commonly reported than nonpunitive strategies. Enforcement strategies were significantly associated with several features of school settings including number of supports for teachers' efforts, teachers' perceptions of program success, and training opportunities for teachers. Middle school staff reported using significantly more enforcement strategies than high school staff, and their strategies were more likely to be associated with school context variables. Implications of these findings for the maintenance of anti-tobacco programs in secondary schools are discussed.     

Working With Non-Dental Groups to Influence Adoption of Self-Applied Fluoride Programs in Schools: One Approach

Although the use of self-applied fluorides in schools has been proven safe and effective, thousands of children are not benefiting from these procedures. This paper describes a dual promotional approach designed to increase the awareness of the need for school-based self-applied fluoride programs. A manned exhibit providing consultation and educational materials was displayed during the entire meeting of a state PTA and was supplemented by a presentation scheduled on the formal program. The workshop participants were parents of school-age children; most held decision-making positions in their local PTAs. Results of the workshop to date include: one participant prevented the demise of an established fluoride mouthrinsing program in her community; and the workshop leaders presented the merits of school-based self-applied fluoride programs to a local PTA and a county school health council. The same programs were described in a county PTA newsletter. These actions suggest that, given the appropriate information and assistance, parents of school children through their PTA can influence adoption of school-based fluoride programs. Furthermore, strategies directed toward members of other groups with an interest and decision-making role in children's health may be effective methods of influencing adoption of school-based self-applied fluoride programs and ultimately promoting children's oral health.     

Promoting uptake of the HPV vaccine: the knowledge and views of school staff

BACKGROUND: School‐based human papillomavirus (HPV)/cervical cancer vaccination programs have been implemented widely, but few studies have investigated the knowledge and views of school staff about this new vaccine. METHODS: Prior to the introduction of the HPV vaccine in 2009, we surveyed staff at 14 socioeconomically diverse schools to assess views toward this new program, including staff's information needs, ideas on promoting return of consent forms, and uptake of the vaccine among minority groups. RESULTS: Of 583 invited staff, 456 participated (78%). About 58% of the participants knew about the link between HPV and cervical cancer, and that HPV is passed on during sexual contact. When asked if vaccination would increase sexual activity at a younger age, 71% disagreed, 6% agreed, and 23% were unsure. The majority of staff agreed that vaccine uptake could be improved through provision of information and consent forms in indigenous and Pacific languages; ensuring parents are well informed and girls educated about the vaccine; involving community groups and by extending availability of the vaccine into community settings as well as school and primary care. Three fourths of the staff surveyed wanted more information about the program before and during its implementation. CONCLUSIONS: This important group of stakeholders requires appropriate information so that they can support girls and their parents in deciding whether to have the vaccine. School staff members are potential health advocates with whom consultation should occur before and during the implementation of such programs.     

Outcomes for a comprehensive school-based asthma management program

This article describes the evaluation of a comprehensive school-based asthma management program in an inner-city, largely African-American school system. All 54 elementary schools (combined enrollment 13,247 students) from a single urban school system participated in this study. Schools were randomly divided between immediate and delayed intervention programs. The intervention consisted of 3 separate educational programs (for school faculty/staff, students with asthma, and peers without asthma) and medical management for the children with asthma (including an Individual Asthma Action Plan, medications, and peakflow meters). Children with asthma were identified using a case detection program and 736 were enrolled into the intervention study. No significant differences were observed in school absences, grade point average, emergency room visits, or hospitalizations between the immediate and delayed intervention groups. Significant increases in knowledge were observed in the immediate intervention group. This study of a school-based asthma management education and medical intervention program did not show any differences between the intervention and control groups on morbidity outcomes. Our experience leads us to believe that such measures are difficult to impact and are not always reliable. Future researchers should be aware of the problems associated with using such measures. In addition, connecting children with a regular source of health care in this population was difficult. More intensive methods of medical management, such as school-based health centers or supervised asthma therapy, might prove more effective in inner-city schools.     

Parent Expectations of the School Health Program in Nebraska

This article presents findings from the first phase of a comprehensive evaluation plan for the school health program in Nebraska public schools. The evaluation utilized the Targeting Outcomes of Programs (TOP) framework to gather parents' perspectives about the benefits of the school health program, and a ranking of important health activities and role providers. A survey was distributed to 1,200 parents randomly selected from 60 school districts. Of these, 450 (38%) were returned: 96% supported funding of health programs; 88% believed families benefited from school health; 92% viewed the health programs as "essential" to the educational mission; 64% preferred a ratio of 1 nurse/500 students; and 89% believed all students needed access to a professional school nurse. The nurse was the only clearly defined role in the health program and had activities rated as "extremely important." Results were reported to the Nebraska legislature for support of state funding for school health nursing.     

Parents' perceptions of curricular issues affecting children's weight in elementary schools

The purpose of this study was to examine Ohio parents' perceptions of the role of elementary schools in preventing childhood overweight. In the United States, overweight is the most widespread health threat facing children and adolescents. Schools may be a useful point of intervention in addressing the escalating prevalence of childhood overweight because children spend over half their day at school. A questionnaire was developed based primarily on the School Health Index, a tool developed by the Centers for Disease Control and Prevention to help schools assess and improve their physical activity, healthy eating, tobacco use prevention, and safety policies and programs. Seven hundred surveys were sent to a random sample of Ohio parents of elementary school-aged children. This study (53% response rate) found that the majority (51-73%) of parents identified 14 items as very important in preventing childhood overweight, which is indicative of their support for these curricular topics within the elementary school. All items from the physical education component had less than 50% of the parents identifying these items as very important. The item that was least supported (16%) by the parents was measuring a child's body mass index. The majority (51%) of parents indicated their preference for elementary students' access to vending machines only if they contained nutritious foods and beverages, while 42% of parents preferred that elementary students should not be allowed access to vending machines at all. The findings from this study suggest that Ohio parents would be supportive of school-based interventions focusing on healthy eating, physical activity, and the school environment to help reduce the prevalence of overweight in elementary children.     

Injuries, Absences, and Visits to the Nurse Among Children in Alternative Schools

Previous research suggests ecological and programmatic characteristics of schools may influence the health and health behavior of schoolchildren. In particular, schools with alternative educational programs, such as "magnet" curricula and extended school hours, have been found to have a higher incidence of student injuries. To examine further the health correlates of alternative educational programs, the authors studied injuries, health office visits, and school absences of 983 elementary schoolchildren during the 1983-1984 academic year. The study population comprised students attending three elementary schools-two with magnet programs and one with a regular primary curriculum. All three had an option for extended school hours. The frequency of school absences was related significantly to school hours, with fewer absences found in schools with extended hours (p less than .01). Enrollment in a magnet school was associated positively and significantly with rates of both health office visits and injuries, even after adjustment for the effects of age, gender, and extended school hours (p less than .001). Finally, an interaction effect was identified in which children enrolled in both a magnet curriculum and an extended day program had substantially higher rates of health office visits than did children enrolled in either program alone (p less than .001). These findings confirm a disproportionate use of school health services for injuries and other health concerns among students attending alternative educational programs. Possible explanations include differences in student characteristics, adult supervision, or the family lifestyles of children in alternative schools.     

The influence of professional factors in determining primary school teachers' commitment to health promotion

The objectives of the study were to identify the professional issues that teachers perceived as important in their commitment to a health promotion (HP) programme launched in their schools and to understand their perceptions of the impact of the programme on themselves as professionals, individuals, on students, on school staff and on the relationship with students' families. A mixed methods design was used. An anonymous questionnaire was distributed to 54 participating teachers exploring their practices and perceptions of the programme and 26 semi-structured interviews were conducted which examined their professional commitment to the programme. The main factors that teachers identified as shaping their commitment were (1) their perceptions of the programme, specifically, its congruence with their own role and practice and also their perceived impact of the programme upon whole staff relations and (2) the specific school environment including school organization, quality of the relationships with parents and student behaviour. If HP programmes are to be successfully developed in schools, it is necessary to anchor them within the schools' mission. HP programmes need to make sense to teachers' educational perspectives. They need to be responsive to school needs. They also need to be cognisant of the internal tensions that programme implementation can engender among the whole staff, some of whom may be committed to HP in their school, while others, may not value HP in the same way. Therefore, implementation processes that are respectful of the challenges schools encounter and of the differing ontological perspectives that teachers may hold with regard to HP is important.     

Implementation of CDC's School Health Index in 3 midwest middle schools: motivation for change

BACKGROUND: The Centers for Disease Control and Prevention's School Health Index (SHI), a guide for completing a coordinated school-based program needs assessment relative to healthy eating, physical activity, a tobacco-free lifestyle, and prevention of other health risk behaviors and conditions, was used to assess current programming at 3 midwestern middle schools. METHODS: Employing somewhat different procedures, data were collected from focus groups comprising school administrators, teachers, parents, community members, and students. Participants responded to SHI module questions and provided comments based on their perceptions. Both quantitative and qualitative data were recorded for each module, after which participants answered 3 planning questions intended to guide prioritization of actions to improve policies and programs based on importance, cost, time, commitment, and feasibility. RESULTS: Each school developed recommendations and strategies based on highest priority needs related to community involvement, professional development, health screenings, and health education materials in classrooms. CONCLUSIONS: The experience of completing the SHI in 3 different schools provided important insights about the data collection process as well as assessment results that have implications for the design and implementation of prevention programs.     

Partners in school asthma management: evaluation of a self-management program for children with asthma

The "Partners in School Asthma Management" program for inner-city elementary school children comprises (1) case finding; (2) linkage of school nurses, parents, and clinicians; (3) a computer-based tailored educational program; and (4) school environmental assessment and intervention. Case finding identified 1730 children in 60 elementary schools with probable asthma; 835 (96% Hispanic or African American) joined the study. Baseline, posttest, and follow-up measures of asthma knowledge, self-efficacy, and self-management behavior were obtained from the children, and data on symptoms, emergency department visits, and hospitalizations were obtained from their parents. The schools provided data on grades and absences. Each school had a baseline and follow-up environmental assessment. The children in the intervention group showed greater increases in knowledge, self-efficacy, and some aspects of self-management. No differences between groups were found in health status variables, school performance, attendance, or levels of environmental allergens in schools. In 15 schools, an enhanced intervention allowed children and their parents to meet with a project physician, develop an asthma action plan, and receive a 1-month supply of medication; the project physician then followed up with the child's community physician. Children participating in this enhanced intervention had better school performance and fewer absences than the comparison group. Overall, the program was effective in improving children's asthma self-management but not in improving their health status. While the case-finding, computer-based self-management training program and linkage system were successfully implemented, the program failed in creating needed changes in the medical (action plans by community physicians) and physical environments (reduced school allergen levels) of the children.     

More than words? The status and impact of smoking policies in Scottish schools

The aim of this study was to investigate the current status of smoking policies in Scottish schools, and the relationship between policy status, enforcement of smoking restrictions and perceptions of smoking behaviour among pupils and teachers. A representative sample of 15-year-old school pupils from 77 Scottish secondary schools was surveyed in 1998 regarding their perceptions of smoking in several locations within and outside the school building. Two staff members from each school were also surveyed regarding school smoking policies for pupils and teachers, the nature of the school's smoking restrictions, and the extent to which the restrictions were enforced. The results showed that more schools had a written policy on teacher smoking than on pupil smoking. All schools in the sample banned smoking by pupils, but the majority allowed smoking by teachers in restricted areas. Irrespective of the type of policy or restrictions on smoking, pupils reported seeing smoking among both pupils and teachers on school premises in all of the sample schools. Whether or not a school had a written policy appeared to be unrelated to pupil smoking in the toilets or teacher smoking outdoors on school premises. However, pupils were less likely to be aware of pupils smoking outdoors and teachers smoking in the staff rooms in schools where there were written policies on pupil and teacher smoking, respectively. Consistent enforcement of a ban on pupil smoking was associated with lower levels of perceived smoking among pupils. Where a complete ban on teacher smoking existed, smoking among teachers was seen less often in the staff rooms, but more often in outside areas on school premises. The results have implications for the use of policy in promoting a healthy school environment.     

Passive versus active parental permission: implications for the ability of school-based depression screening to reach youth at risk

BACKGROUND: Depression is prevalent among children and adolescents and often goes untreated with adverse effects on academic success and healthy development. Depression screening can facilitate early identification and timely referral to prevention and treatment programs. Conducting school-based emotional health screening, however, raises the controversial issue of how to obtain informed parental permission. METHODS: During implementation of a depression screening program in an urban school district in the Pacific Northwest, the district's parental permission protocol changed from passive (information provided to parents via a school mailer with parents having the option to actively decline their child's participation) to active (information provided to parents via a school mailer requiring the written permission of the parents for their child's participation). This change provided an opportunity to examine differences in participation under these 2 conditions. RESULTS: A total of 1533 students were enrolled in this program across both years. Compared to conditions of passive permission, participation was dramatically reduced when children were required to have written parental permission, dropping from 85% to 66% of eligible children. Furthermore, under conditions of active parental permission, participation decreased differentially among student subgroups with increased risk for depression. CONCLUSIONS: Successful implementation of school-based emotional health screening programs requires careful consideration of how to inform and obtain permission from parents.     

Child of the Morning (book)

Despite the increase in early intervention progratos for handicapped children, little attention has been paid to the special needs of the parents of these children Pilot Parents is a peer support program that grew out of these needs This paper reports on a study of Pilot Parents based on questionnaires completed by new parents, experienced parents, and program directors in 13 programs in the United States and Canada and on personal interviews with staff and volunteers at one local program Findings include the process of implementing these programs, their major strengths, and some programmatic concerns that might be noted by professionals who work with this population.