A survey of health promotion at international schools

This study investigated health promotion efforts at international schools serving the education needs of expatriate communities abroad. Factors supporting the implementation of whole-school approaches to health promotion also were examined. Self-completed questionnaires were distributed by a combination of electronic and conventional mail. International school staff in 93 countries (n = 205) completed an adapted version of an instrument used for evaluating the Western Australian School Health Project (WASHP). This survey demonstrated usefulness of the WASHP instrument cross-culturally in a variety of school settings. The level of whole-school approaches to health promotion in the participating international schools varied but tended to be low. Demographic characteristics of schools were not associated with differences in the level of health promotion, with the exception school size. School organizational factors support implementation of health promotion programs.     

Building capacity for system-level change in schools: lessons from the Gatehouse Project.

The Gatehouse Project is an innovative, comprehensive approach to mental health promotion in secondary schools. It sets out to promote student engagement and school connectedness as the way to improve emotional well-being and learning outcomes. The key elements of the whole-school intervention are the establishment and support of a school-based adolescent health team; the identification of risk and protective factors in each school's social and leaning environment from student surveys; and, through the use of these data, the identification and implementation of effective strategies to address these issues. The project evaluation used a cluster-randomized controlled trial design involving 26 schools with initial results demonstrating considerable success in reducing smoking rates among Year 8 children. This article describes and accounts for how system-level changes have been made in schools through a process of capacity building. This encourages teachers, parents, and students to view the core business of education differently.     

The School Nurse As Health Educator

ABSTRACT: Contrary to common opinion, the number of nurses who provide services in the nation's preschool, elementary, and secondary schools is not declining and currently is about 30,000. These members of school health teams can play a variety of roles that have a positive impact on patterns of health behaviors established during school years. Contributions that school nurses can make to school health instruction could include teaching individual clients, providing classroom instruction, being a member of curriculum planning committees, sharing resources with classroom teachers, and modeling health-promoting behavior. Although all school nurses should assume roles in health education, this article provides a framework to help nurses make decisions about which roles are appropriate in their practice setting, which tasks are within their area of expertise, and how health education fits into expectations of their employers. Specific roles in staff health promotion that use the unique experience, knowledge base, and skills of nurses are suggested, as well as ways that nurses can be advocates for comprehensive school health education. The article also poses four questions to assist nurses in evaluating their situation and their ability to be effective providers and advocates of health education in school.     

Position of the American Dietetic Association, School Nutrition Association, and Society for Nutrition Education: comprehensive school nutrition services

It is the position of the American Dietetic Association (ADA), School Nutrition Association (SNA), and Society for Nutrition Education (SNE) that comprehensive, integrated nutrition services in schools, kindergarten through grade 12, are an essential component of coordinated school health programs and will improve the nutritional status, health, and academic performance of our nation's children. Local school wellness policies may strengthen comprehensive nutrition services by encouraging multidisciplinary wellness teams, composed of school and community members, to work together in identifying local school needs, developing feasible strategies to address priority areas, and integrating comprehensive nutrition services with a coordinated school health program. This joint position paper affirms schools as an important partner in health promotion. To maximize the impact of school wellness policies on strengthening comprehensive, integrated nutrition services in schools nationwide, ADA, SNA, and SNE recommend specific strategies in the following key areas: nutrition education and promotion, food and nutrition programs available on the school campus, school-home-community partnerships, and nutrition-related health services.     

Roles of Community Organizations in Improving Cancer Prevention Instruction in Schools

Health education can be an important factor in the development of appropriate health behaviors in children. Community agencies that have not traditionally supported school health education can be of significant influence in improving school health education. This study examined the relationships between the involvement of the American Cancer Society (ACS) in schools and the degree of implementation of cancer prevention curricula. School health specialists from 41 metropolitan school districts in Texas were surveyed regarding the coverage of topical areas related to cancer prevention, health instructional patterns in districts, and collaborative efforts with the ACS. Tobacco use was widely covered in all levels of schools (elementary, middle, and high school), as was nutrition. Cancer detection and the concepts of cancer as a disease received most extensive coverage in high schools, and there were no significant grade level differences regarding coverage of the risks of sun exposure. School personnel had little training and felt little district support for school health education. Most respondents felt that teachers saw the ACS primarily as a resource for cancer information and resources than as a collaborative partner in health education efforts. Community organizations can play three roles in supporting school health education. First, the organizations must certainly provide diseasespecific information (in this case, cancer). They must also promote comprehensive school health education in general. Lastly, the study illustrates that community organizations must act as advocates for broader change in schools by supporting the development of organizational capacity within schools and districts to implement quality school health education, enlisting community support for quality school health education, and supporting policy initiatives that strengthen school health education activities.     

Position of the American Dietetic Association, School Nutrition Association, and Society for Nutrition Education: comprehensive school nutrition services

It is the position of the American Dietetic Association (ADA), School Nutrition Association (SNA), and Society for Nutrition Education (SNE) that comprehensive, integrated nutrition services in schools, kindergarten through grade 12, are an essential component of coordinated school health programs and will improve the nutritional status, health, and academic performance of our nation's children. Local school wellness policies may strengthen comprehensive nutrition services by encouraging multidisciplinary wellness teams, composed of school and community members, to work together in identifying local school needs, developing feasible strategies to address priority areas, and integrating comprehensive nutrition services with a coordinated school health program. This joint position paper affirms schools as an important partner in health promotion. To maximize the impact of school wellness policies on strengthening comprehensive, integrated nutrition services in schools nationwide, ADA, SNA, and SNE recommend specific strategies in the following key areas: nutrition education and promotion, food and nutrition programs available on the school campus, school-home-community partnerships, and nutrition-related health services.     

The School Health Innovative Programs: Integrating School Health and Managed Care in San Diego

ABSTRACT: Managed care organizations (MCOs) are being recruited to support school health services delivered in school clinics. Schools without clinics already provide numerous health services and could provide more if they had support from managed care organizations. This article describes the first two years of a San Diego-based collaborative consisting of MCOs, school districts, and other health care agencies. By establishing trust, developing overriding principles, and creating an interagency communication infrastructure, this collaborative has encouraged shared management of many student health issues. Because the agreements apply to all schools, programs can reduce high rates of absenteeism district-wide and avoid unnecessary doctor appointments for common health problems. These collaborative agreements are designed to be financially self-sustaining. However, data collection, the logistics of obtaining parental consent, and getting health professionals to communicate with each other in new ways remain to be significant challenges.     

The role of community-based organizations in adolescent sexual health promotion

Many scholars and practitioners have advocated for a more ecological approach to sexual health promotion for adolescents, such as one that includes involvement from schools, parents, and community organizations. Although extensive research has been conducted with schools and parents, little is known about the roles community-based organizations (CBOs) may play in the education and promotion of sexual health to young people. This study aimed to (a) identify the types of sexual health and sexuality-related questions asked by youth and programming/services, resources, and referrals currently being provided by CBOs; (b) explore the approaches used by CBOs when developing and implementing sexual health promotion programs; and (c) compare these findings with those from a similar study on school teachers, counselors, and nurses within the same state. Data collected from 169 people working in CBOs indicate that a wide variety of topics were covered by CBOs through programming and services, resources, and/or referral protocols. Topics covered varied in frequency. Overall, participants indicated a relatively comprehensive and accessible approach to providing sexuality information to youth. The results of this study suggest that CBOs should be included in the range of sources to be used for comprehensive sexual health promotion. If such organizations are supported with information, training, and resources, they could play a valuable role in the promotion of sexual health for adolescents.     

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.     

Health promoting schools in England--a way forward in development.

Schools are identified as a key setting for health promotion in the UK Government's consultation report on the public health strategy for England. The concept of the 'healthy' or 'health promoting school' provides the basis for a broad settings approach to health promotion in schools. The approach extends beyond the formal health education curriculum to include a consideration of the physical and social environment of schools and their links and partnerships with parents and the wider community, in pursuit of better health. There is growing evidence that the health promoting school approach is effective in influencing outcomes related to health and education. Initiatives in the form of projects and schemes are commonly used by Health Promotion Specialist services and health partnerships, to stimulate and support the adoption of the approach by schools. A national healthy school scheme is to be launched alongside these local initiatives in 1999. The paper reviews research and practice in this area and makes recommendations to inform the future development of schools as health promoting organizations.     

Faculty and staff health promotion: results from the School Health Policies and Programs Study 2006

BACKGROUND: US schools employ an estimated 6.7 million workers and are thus an ideal setting for employee wellness programs. This article describes the characteristics of school employee wellness programs in the United States, including state-, district-, and school-level policies and programs. METHODS: The Centers for Disease Control and Prevention conducts the School Health Policies and Programs Study every 6 years. In 2006, computer-assisted telephone interviews or self-administered mail questionnaires were completed by state education agency personnel in 49 states plus the District of Columbia and among a nationally representative sample of school districts (n=445). Computer-assisted personal interviews were conducted with personnel in a nationally representative sample of elementary, middle, and high schools (n=873). RESULTS: During the 2 years preceding the study, 67.3% of states provided assistance to districts or schools on how to develop or implement faculty and staff health promotion activities or services. Although nearly all schools offered at least 1 health promotion service or activity, few schools offered coordinated activities and services within a comprehensive employee wellness program. During the 12 months preceding the study, none of the health screenings were offered by more than one third of schools; only a few of the health promotion activities and services were offered by more than one third of schools; about one third of schools offered physical activity programs, employee assistance programs, and subsidies or discounts for off-site health promotion activities; and only 1 in 10 schools provided health-risk appraisals for faculty and staff. CONCLUSIONS: More schools should implement comprehensive employee wellness programs to improve faculty and staff health behaviors and health status.     

Toward ending the marginalization and fragmentation of mental health in schools

For efforts to address mental health and psychosocial concerns in schools to be effective, practices must not be marginalized and must be implemented cohesively at each school and among families of schools. Mechanisms and processes must be established to minimize marginalized and fragmented practice, weave together school and community resources, and develop comprehensive and multifaceted approaches. A school-based, resource-oriented team represents one key mechanism. In addition, schools working in the same neighborhoods and with the same families can use a collaborative council to coordinate school and community resources. Resource team and collaborative council functions include mapping, analyzing, and redeploying existing resources, and formulating plans for evolving a comprehensive, multifaceted continuum of school-community interventions to address barriers to student learning and promote healthy development.     

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.     

The future of health promotion in schools goes through the strengthening of teacher training at a global level

Schools are considered to be settings for both health education and health promotion. But the core business of schools is actually focused on educational outcomes, not reducing health problems. In most countries, schools give low priority to health promotion, and school staffs, mainly teachers, are not aware of their role in health promotion. Studies show that teachers who have received health promotion training tend to be involved more frequently in health promotion projects and have a more comprehensive approach to health education. Pre-service and in-service staff training is then a main challenge. This is the reason why we have launched an initiative to join international forces to strengthen and advocate for teacher training in health promotion. The main goals are to develop research, affirm and reinforce the work done in teacher training in health promotion, support the institutes/colleges/universities in the provision of pre-service and in-service teacher training and stimulate international partnership work.     

Altering School Climate through School-Wide Positive Behavioral Interventions and Supports: Findings from a Group-Randomized Effectiveness Trial

Positive Behavioral Interventions and Supports (PBIS) is a universal, school-wide prevention strategy that is currently implemented in over 7,500 schools to reduce disruptive behavior problems. The present study examines the impact of PBIS on staff reports of school organizational health using data from a group-randomized controlled effectiveness trial of PBIS conducted in 37 elementary schools. Longitudinal multilevel analyses on data from 2,596 staff revealed a significant effect of PBIS on the schools’ overall organizational health, resource influence, staff affiliation, and academic emphasis over the 5-year trial; the effects on collegial leadership and institutional integrity were significant when implementation fidelity was included in the model. Trained schools that adopted PBIS the fastest tended to have higher levels of organizational health at baseline, but the later-implementing schools tended to experience the greatest improvements in organizational health after implementing PBIS. This study indicated that changes in school organizational health are important consequences of the PBIS whole-school prevention model, and may in turn be a potential contextual mediator of the effect of PBIS on student performance.     

Encouraging Schools to Promote Health: Impact of the Western Australian School Health Project (1992 — 1995)

The Western Australian School Health (WASH) Project, a school health promotion intervention operating over a four-year period (1992-1995), provided a comprehensive, year-long intervention to help successive groups of schools develop health promotion programs. The WASH Project worked with self-selected school communities and used community development strategies to support participating schools in identifying and responding to health concerns relevant to their students. This paper reports the school impact results of the WASH Project. School impact data involved 24 variables categorized into two areas: school organizational factors supportive of health promotion, and school health promotion factors. Two methods of analysis were used: logistic regression indicating the direction of change, and linear regression indicating the magnitude of change. Results demonstrated that schools successfully made organizational changes, such as the allocation of additional time, personnel, and monetary resources, to support health promotion.     

Diagnosis of sustainable collaboration in health promotion – a case study

Background  

Collaborations are important to health promotion in addressing multi-party problems. Interest in collaborative processes in health promotion is rising, but still lacks monitoring instruments. The authors developed the DIagnosis of Sustainable Collaboration (DISC) model to enable comprehensive monitoring of public health collaboratives. The model focuses on opportunities and impediments for collaborative change, based on evidence from interorganizational collaboration, organizational behavior and planned organizational change. To illustrate and assess the DISC-model, the 2003/2004 application of the model to the Dutch whole-school health promotion collaboration is described.     

Qualität in Prävention und Gesundheitsförderung

Following the principles of participatory health research, a collaborative study was conducted by the German Federal Association for Prevention and Health Promotion (BVPG) and the Institute for Social Health at the Catholic University of Applied Sciences Berlin (KHSB). The purpose of the study was to create a framework for the members of the BVPG for taking joint action on developing the quality of health promotion and prevention measures. The 129 members of the BVPG are mainly nongovernmental organizations responsible for the implementation and coordination of prevention and health promotion interventions at the state and national levels. One of the explicit goals of the BVPG is to support the development of quality in prevention and health promotion. A theoretical sample was drawn of 14 member organizations to participate in individual interviews and a Delphi process to gather data on their current quality development practice, their need for further support, and their ideas for a common framework. Selected results from the interviews and the proposed framework are presented here.     

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.     

Bridging the gap between community health and K-12 schools

The topic of this article is program planning for K-12 school health programs collaborating with community agencies, businesses, colleges, and organizations. Community involvement was listed as one of the weakest areas of school health efforts in a national coordinated school health study [1]. This article presents the 5-year results demonstrating the outcomes of K-12 schools program planning aimed at community involvement in the coordinated school health model. Directors of the Departments of Education and Health in South Dakota initiated training for school personnel in the coordinated school health model through development of councils in the schools starting in 2000. The expectations of the councils were to design a program plan to support the health of students and staff in their school. The short-term results of a 5-year evaluation indicated the greatest area of gain was in community health involvement to improve student and staff health.