Why and How Schools Make Nutrition Education Programs “Work”

BACKGROUND

There are many potential health benefits to having nutrition education programs offered by expert outside sources in schools. However, little is known about why and how schools initiate, implement, and institutionalize them. Gaining this understanding may allow the impact and reach of nutrition and other health education programs in schools to be extended.

METHODS

A total of 22 school community members from 21 purposefully selected New York City public elementary schools were interviewed using a semistructured interview protocol about their schools' experiences initiating, implementing, and institutionalizing nutrition education programs. Interviews were audiotaped and transcribed. Chronological narratives were written detailing each school's experience and passages highlighting key aspects of each school's experience were identified. These passages (N = 266) were sorted into domains and themes which were regrouped, resorted, and adjusted until all researchers agreed the domains and themes represented the collective experiences of the schools.

RESULTS

The interviews elicited 4 broad domains of action: building motivation, choosing programs, developing capacity, and legitimizing nutrition education. Within each domain, themes reflecting specific actions and thoughts emerged.

CONCLUSIONS

The identified domains of action and their themes highlight specific, practical actions that school health advocates can use to initiate, implement, and institutionalize nutrition education programs in schools.     

Schools, health literacy and public health: possibilities and challenges

Health literacy is a concept that can be widely embraced by schools. Schools throughout the world contribute to the achievement of public health goals in conjunction with their educational commitments. In this paper, the interface between a school's core business of education and public health goals is identified, and examples provided in the area of nutrition demonstrating how these links can operate at school level. The structure and function of the health promoting school is described and the author proposes that there is a very close connection between the health promoting school and the enabling factors necessary in achieving health literacy. Major findings in the literature that provide evidence of good practices in school health education and promotion initiatives are described. Also, those factors that make schools effective and which facilitate learning for students are identified. There is a substantial overlap between the successful components of a health promoting school and effective schools. This enables schools to potentially achieve all three levels of health literacy, including level 3-critical health literacy. However, there are three challenges that must be addressed to enable schools to achieve this level: the traditional structure and function of schools, teachers practices and skills, and time and resources. Strategies are proposed to address all three areas and to reduce the impediments to achieving the goals of health literacy and public health using the school as a setting.     

Applying the School Health Index to a nationally representative sample of schools: update for 2006

BACKGROUND: The School Health Index (SHI) is a tool designed to help schools assess the extent to which they are implementing practices included in the research‐based guidelines and strategies for school health and safety programs developed by the Centers for Disease Control and Prevention (CDC). CDC previously analyzed data from the 2000 School Health Policies and Programs Study (SHPPS) to determine the percentage of US schools meeting the recommendations in the SHI. A new edition of the SHI (2005) and the availability of 2006 SHPPS data made it necessary to update and repeat the analysis. METHODS: SHPPS 2006 data were collected through computer‐assisted personal interviews with faculty and staff in a nationally representative sample of schools. The data were then matched to SHI items to calculate the percentage of schools meeting the recommendations in 4 areas: school health and safety policies and environment, health education, physical education and other physical activity programs, and nutrition services. RESULTS: In accordance with the earlier findings, the present analysis indicated that schools nationwide were focusing their efforts on a few policies and programs rather than addressing the entire set of recommendations in the SHI. The percentage of items related to nutrition that schools met remained high, and an increase occurred in the percentage of items that schools met related to school health and safety policies and environment. CONCLUSIONS: More work needs to be done to assist schools in implementing school health policies and practices; this analysis helps identify specific areas where improvement is needed.     

张家港市校医队伍及卫生室现状调查

目的 了解张家港市校医、保健老师队伍及卫生室基本情况,为加强校医队伍建设提供参考,同时也为主管部门制定和完善相关管理规定、政策提供依据。方法 采用调查问卷对全市各中小学校校医、保健老师基本情况及学校卫生室承担职能、设施配备情况进行调查,调查数据通过Epidata3.1进行录入,使用Excel软件进行统计分析。结果 张家港市中小学学生数与校医配备比例是3 625:1,按照学校规模600:1配备校医、保健老师的中小学校合格率仅为7.4%; 88名校医、保健老师,女性占89.8%,平均年龄为40.6岁,从事学校卫生保健工作的平均年限为10.6年,教育类专业占48.9%,取得教育类专业职称占40.9%,本科学历占53.4%,正式在编人员占54.3%,兼职占47.7%;97.6%的学校配备了独立的卫生室和保健室;对84所学校的卫生室承担职责调查显示,能开设学生门诊,处治常见病、多发病的卫生室占32.1%,开展学生心理咨询的卫生室占25.0%。结论 根据张家港市中小学校校医、保健老师的调查现状,主管部门应按要求配置校医、保健老师,着力解决职称和待遇等切实问题,不断强化校医、保健老师队伍专业知识培训。     

An empirical model for school health promotion: the Western Australian school health project model

Models of school health promotion simplify and support the complexprocess of encouraging schools to adopt health promotion aspart of their organizational practice by outlining phases andareas that bear on adoption and scope of activity. Models providea value conceptual framework on which to base action and a standardagainst which to measure success. The Western Australian SchoolHealth (WASH) model is an empirically designed model that canassist both internal and external agents seeking to interestschools in developing comprehensive school health promotionprograms. The WASH Model schematically represents the main elementsof the WASH Project's process of initiating and developing healthpromotion with Western Australian schools. The model is basedon the project's practical implementation experience (1992–1995)as an external intervention with its own specific health promotionagenda, operating in a setting that requires a participativeapproach to maximize outcomes. The model draws on system theoryrelated to organizational change processes and on previous modelsof school health promotion. The WASH Project, which used thismodel in its interaction with schools, was able to demonstratechange in the level of health promotion activity and structuralsupport in participating schools. Accordingly, the model providesa tested framework on which to base approaches and activityfor school health promotion initiation, development and continuity.     

Parliamentary Inquiry Into Health Promoting Schools in Victoria: Analysis of Stakeholder Views

BACKGROUND: In 2009, the Victorian Parliament Legislative Assembly of Australia commissioned a Parliamentary Inquiry into the opportunities for schools to become a focus for promoting healthy community living. Submissions to the Inquiry varied widely in their positions about school health promotion. The aim of this review is to analyze the submissions to identify core themes in the debates about school health promotion and how stakeholders saw schools becoming a focus for promoting healthy communities. METHODS: Submissions (N = 159) were downloaded from the Inquiry website. Open coding was used to code the data. The codes were then refined into conceptual categories to create themes. The Inquiry's terms of reference were used as an organizing framework. RESULTS: Emergent themes included barriers and enablers to school health promotion including the need for stronger leadership from the Departments of Health (DoH) and Education and Early Childhood Development (DEECD). CONCLUSION: Rather than supporting the idea that schools could have a wider role in communities, submissions pointed to the acute need for increased resource allocation to support health promotion in schools, and for coordinated approaches with stronger leadership from the health and education sectors. Without these structures, schools can only address health in an ad hoc manner with limited resources, capacity, and outcomes.     

云南省青少年健康需求及认知评价

目的：针对青少年健康需求，作相关认知及教育背景的调查。为学校健康教育的深入提供依据。方法：用定势问卷法对整群随机抽取的２８所中学３５９５名初高中生作家境及疾病和保健知识的调查。结果：３５９５名青少年对常见传染病传播途径知晓率ＡＩＤＳ为７６．３８％，甲、乙型肝炎为３７．７２％和５９．５５％，结核５７．３９％，对慢性病及贫血预防措施掌握率为６３．７６％和６７．４５％。并且有重点中学学生优于非重点，城市     

Communicating about pupils in mainstream school with special health needs: the NHS perspective

AIM: To add to previous research carried out with young people, parents and teachers, by investigating health staff's perspectives on the difficulties, and possibilities for, achieving good communication with school staff with regard to children in mainstream school with a chronic illness or physical disability. RESEARCH DESIGN AND METHODS: A qualitative research study was carried out in one NHS Trust. Twenty semi-structured interviews were carried out with a purposive sample of health staff to cover the spectrum of professionals who have responsibility for meeting the needs of children with a chronic illness or physical disability in mainstream schools (paediatricians, school doctors, school nurses, specialist nurses, health visitors, GPs, speech and language therapists, paediatric occupational therapists, paediatric physiotherapists, clinical psychologists and psychiatrists). RESULTS: The extent to which health professionals communicated with school staff, and the way in which they went about it, varied widely. Communication was facilitated by joint meetings, shared documentation, and local policy development. Sources of difficulty in communication between health and education staff were: the parent as a conduit of information; the practical difficulties of arranging meetings; and lack of knowledge about other professionals' roles. The ethos of the school with regard to health matters, and the flow of information within health services, also had an impact on the communication process. Participants' recommendations focused on two key issues: clarification of the roles of health and education staff with regard to this group of pupils; and how information should flow from health to school staff. DISCUSSION: Many of the findings parallel the previous research with teachers, indicating agreement between professionals from different agencies about aspects of the communication process which are problematic and require attention. The findings suggest that improving communication requires both joint work between health and education staff, and improvements to practice within each agency.     

中国城市高中生预防艾滋病知识教育现状调查

目的了解中国城市高中开展预防艾滋病教育的情况和效果,为进一步制定高中生艾滋病预防教育提供依据。方法按照分层整群抽样方法抽取中国18个省、市、自治区109 754名城市高中生,采用《中国青少年健康危险行为》问卷对其进行调查。结果共回收问卷111 670份,其中有效问卷109 754份(男生51 409份,女生58 345份),有效率为98.3%;河北省重点高中、普通高中和职业高中生报告曾在学校接受过艾滋病教育的报告率分别为31.5%(430人)、32.6%(503人)、30.0%(418人),均明显低于全国平均水平58.1%(21 737人)、54.0%(19 212人)5、3.8%(18 569人)(χ2重点高中=380.849χ,2普通高中=270.842χ,2职业高中=305.048,P<0.01);中国重点高中预防艾滋病教育情况好于普通高中,普通高中好于职业高中;不同性别、年级、学校类型、所在地区和社会经济水平的学生比较,曾在学校接受过艾滋病知识教育的学生艾滋病知识掌握和反歧视艾滋病的态度均明显好于未在学校接受过艾滋病知识教育的学生(P<0.01)。结论中国不同学校类型间开展预防艾滋病教育状况不平衡,应加强对职业高中学生艾滋病宣传和健康教育力度,强化艾滋病教育的实效性。     

西方学校心理健康教育的进展

西方学校心理健康教育呈现出目标清晰、领域广泛、依托载体多样、方法独特有效、人才培养科学、资格认证规范、组织机构发展迅速和监督管理严格等最新进展。在急剧变化和迅速发展的现代社会情境下,学生成长的环境日趋复杂,其心理素质状况越来越令人担忧,因此借鉴西方学校心理健康教育的最新发展,对于现阶段加强学校心理健康教育具有重要的现实意义。     

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.     

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.     

Is truth in the eyes of the beholder? Or are Portuguese schools,as viewed by Portuguese pupils,mismatching with what the educational system offers?

Pupils who like school have better academic performance and better perception of health and well-being. This study aims to (1) know the pupils’ views of their schools and their schools’ characteristics, assets and problems and (2) identify the variables that may predict enjoying school. A total of 6026 Portuguese pupils participated in the Health Behaviour in School-aged Children study in 2014. Pupils reported that programme contents are too long and too boring as well as negative parental overpressure regarding school success. They also pinpointed issues regarding their perception of teachers (lack of trust and low person-to-person interaction) and regarding school facilities. These issues have an impact on the perception of how much they like and how they feel about school. Results suggested an urgent need to review present public policies regarding Portuguese education and the need to focus on the length and structure of programme contents and to the dynamics and length of the classes and school workload, as well as investing in school physical structures. Portugal has a ‘chronic’ low ranking regarding academic achievement according to several international studies; thus, some highlights on how to move forward are provided.     

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.     

中国三省中学生健康素养水平及影响因素分析

目的 全面了解我国中学生健康素养的现状及存在的问题,为今后的健康教育工作提出重点及方向。方法 2015年1月-2017年2月采用多阶段整群抽样方法,抽取广东省、吉林省、河北省三省22所中学5 000名初中一、二年级,高中一、二年级学生,分别使用《初中生健康素养评价工具》和《高中生健康素养评价工具》进行健康素养调查,调查内容包括基本情况、健康知识、健康理念、健康技能和健康行为5个部分。结果 三省中学生健康素养平均得分为(69.67±10.04)分,具备基本健康素养的比例为11.5%;二元Logistic回归分析结果显示,来自吉林省(OR=4.15,95%CI:3.03~5.69)及河北省(OR=2.18,95%CI:1.61~2.96)、学校位于郊区(OR=1.25,95%CI:1.01~1.56)、母亲文化程度为高中(OR=1.26,95%CI:0.99~1.60)和大专及以上(OR=1.98,95%CI:1.53~2.57)、喜欢接受健康教育(OR=1.99,95%CI:1.45~2.71)的中学生具备基本健康素养的比例更高;高中生(OR=0.50,95%CI:0.40~0.63)以及仅从学校(OR=0.62,95%CI:0.45~0.85)或家庭(OR=0.73,95%CI:0.53~1.01)接受健康教育的中学生具备基本健康素养的比例更低。结论 我国中学生健康素养水平较低,家庭和学校需要在健康教育中承担相同的责任,健康教育应以学生喜闻乐见的形式展开。     

丹东市高中生性观念和性行为调查

目的 了解高中生性观念、性态度及性行为的状况,分析其影响因素,为学校有针对性地开展性健康教育提供依据.方法 采用随机整群抽样的方法,抽取本市区重点高中、普通高中及职业高中各4所共12所2979名高中学生进行问卷调查.结果 80％的高中学生对恋爱持认同态度,约21％的高中生有恋爱经历,74％的学生对婚前性行为持包容态度;超过80％学生认为爱情是性的前提,性行为发生比例趋于升高（5.1％）;在发生性行为的学生中,近半数学生在性行为时未采取任何避孕措施,而在采取措施的学生中,2种以上（含2种）措施混用最多（26.3％）.职业高中学生性观念、性态度较重点和普通高中学生开放,早恋和性行为发生率也高于重点和普通高中学生.结论 重点高中、普通高中与职业高中学生性观念、性态度及性行为均有显著性差异,要对不同学校学生采取有针对性的教育方法,在高中学生中加强性健康教育非常重要.     

农村学校公共卫生状况与对策研究

采用分层随机抽样方法．抽取浙江省局部地区部分样本学校，进行学校卫生状况的现场调查。了解浙江省农村学校卫生工作状况，对比农村与城镇中小学学校卫生工作的差距。结果表明农村学校的卫生设施配备不足，健康教育薄弱，饮用水、食堂卫生以及学校卫生管理状况与城镇存在差距，存在发生突发公共卫生事件的隐患。针对问题，提出了相应的对策。     

Overview and summary: School Health Policies and Programs Study 2006

BACKGROUND: The School Health Policies and Programs Study (SHPPS) 2006 is the largest, most comprehensive assessment of school health programs in the United States ever conducted. METHODS: The Centers for Disease Control and Prevention conducts 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 districts (n=538). Computer-assisted personal interviews were conducted with personnel in a nationally representative sample of elementary, middle, and high schools (n=1103) and with a nationally representative sample of teachers of classes covering required health instruction in elementary schools and required health education courses in middle and high schools (n=912) and teachers of required physical education classes and courses (n=1194). RESULTS: SHPPS 2006 describes key school health policies and programs across all 8 school health program components: health education, physical education and activity, health services, mental health and social services, nutrition services, healthy and safe school environment, faculty and staff health promotion, and family and community involvement. SHPPS 2006 also provides data to monitor 6 Healthy People 2010 objectives. CONCLUSIONS: SHPPS 2006 is a new and important resource for school and public health practitioners, scientists, advocates, policymakers, and all those who care about the health and safety of youth and their ability to succeed academically and socially.     

A new theory of health promoting schools based on human functioning,school organisation and pedagogic practice

This paper outlines a novel explanatory frame for understanding how schools may intervene in order to promote pupils' health. The new theory is synthesised from an Aristotelian interpretation of human functioning and a theory of cultural transmission. In keeping with recent influential theoretical developments, it is proposed that health has its roots in human functioning. It follows from this concept that the promotion of pupils' health is facilitated by the promotion of pupil functioning and the primary mechanisms through which schools promote pupil functioning and, hence, health, are through the influences of school organisation, curriculum development and pedagogic practice on pupil development. According to the new theory, good human functioning is dependent on the realisation of a number of identified essential human capacities and the meeting of identified fundamental human needs. Two essential capacities, the capacity for practical reasoning and the capacity for affiliation with other humans, plan and organise the other essential capacities. The realisation of these two capacities should, it is argued, be the primary focus of health promoting schools. Additionally, health promoting schools should ensure that fundamental human needs concerning non-useful pain and information about the body are met. A number of testable hypotheses are generated from the new theory. Comparisons with existing interpretations of health promoting schools indicate there are similarities in the actions schools should take to promote health. However, the new theory can, uniquely, be used to predict which pupils will enjoy the best health at school and in adulthood. Additionally, according to the new theory, schools do not need designated health education classes or teaching staff with specialist health education roles in order to be health promoting. It is concluded that the new theory may have a number of advantages over existing theories at both the policy and intervention levels.     

Evaluations of health promoting schools: a review of nine studies

The concept of 'health promoting schools' has been embraced internationally as an effective way of promoting the health of children, adolescents, and the wider school community. It is only recently that attempts have been made to evaluate health promoting schools. This paper reviews evaluations of health promoting schools and draws useful evaluation methodology lessons. The review is confined to school-based interventions that are founded explicitly on the concept of the health promoting school and employ the concept beyond one school domain. We included nine evaluations in this review. Seven of these were published in the peer reviewed scientific literature. Two were unpublished reports. One study was a randomized controlled trial, while a quasi-experimental research design with comparison schools was used in three studies. With three exceptions, combinations of quantitative and qualitative data were collected. There was evidence that the health promoting school has some influence on various domains of health for the school community. It is also possible to integrate health promotion into the school curriculum and policies successfully. However, the evaluation of health promoting schools is complex. We discuss some of the methodological challenges of evaluating health promoting schools and make suggestions for improving future evaluations.