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.     

Food as a reward in the classroom: school district policies are associated with practices in US public elementary schools

The use of food as a reward for good student behavior or academic performance is discouraged by many national organizations, yet this practice continues to occur in schools. Our multiyear cross-sectional study examined the use of food as a reward in elementary schools and evaluated the association between district policies and school practices. School data were gathered during the 2007-2008, 2008-2009, and 2009-2010 school years via mail-back surveys (N=2,069) from respondents at nationally representative samples of US public elementary schools (1,525 unique schools, 544 of which also participated for a second year). During every year, the corresponding district policy for each school was gathered and coded for provisions pertaining to the use of food as a reward. School practices did not change over time and as of the 2009-2010 school year, respondents in 42.1% and 40.7% of schools, respectively, indicated that food was not used as a reward for academic performance or for good student behavior. In multivariate logistic regression analyses controlling for school characteristics and year, having a district policy that prohibited the use of food as a reward was significantly associated with school respondents reporting that food was not used as a reward for academic performance (P<0.05) or for good student behavior (P<0.05). School-level respondents in the West and the Midwest were less likely to report that food was not used as a reward than were respondents in the South and Northeast. As of 2009-2010, only 11.9% of the districts in our study prohibited the use of food as a reward. Strengthening district policies may reduce the use of food rewards in elementary schools.     

Prevalence and implementation of IAQ programs in U.S. schools

In this study, we determined the extent to which U.S. schools are implementing indoor air quality (IAQ) programs. We administered a questionnaire on IAQ programs and practices to a representative sample of schools. Participants were asked to provide information on the use, administration, implementation, challenges, and benefits of the IAQ program in their school. We developed an IAQ Practice Index to determine the level of activity directed toward IAQ in schools. The index was computed based on responses to specific survey questions and was normalized to a range of 0 to 100. Each question was weighted qualitatively according to its contribution to strong IAQ management practices. Forty-two percent of schools in the United States have an IAQ management program, and there has been sustained growth from 1998 through 2002 in the number of schools that have such programs. Nearly half of those schools use the U.S. Environmental Protection Agency's IAQ Tools for Schools program. The IAQ Practice Index scores varied widely for schools with an IAQ management program, suggesting that having a program is not equivalent to implementing effective IAQ policies and procedures. Respondents indicated that their IAQ programs led to improved workplace satisfaction, fewer asthma attacks, fewer visits to the school nurse, and lower absenteeism. When actively supported by the school administration, an IAQ program appears to be a valuable factor in improving the learning environment for U.S. schoolchildren.     

Association and diffusion of nutrition and physical activity policies on the state and district level

BACKGROUND: School district wellness policies designed to reduce obesity and promote student health and well‐being often lack specific requirements or any mandate that schools comply with the policy. Researchers, educators, and policymakers have called for states to take an active role in shaping district policies. The objective of this study was to determine if states with strong school‐based nutrition and physical activity (PA)‐related policies have stronger district wellness policies, and explore the direction of policy diffusion between states and districts. METHODS: State policies and nationally representative samples of district policies for the 2006–2007 and 2008–2009 school years were obtained across 5 domains—competitive foods, school meals, nutrition education, physical education (PE), and PA—and were classified as “strong” or “weak,” based on policy language, in each grade level (elementary, middle, high). Linear models estimated the cross‐sectional and longitudinal associations between state and district policies. RESULTS: In 2006–2007 and 2008–2009, district elementary school competitive food policies were stronger in states with strong policies. For policies governing competitive foods in high schools and school meals at all grade levels, mean district policy strength increased from 2006–2007 to 2008–2009 in states with strong 2006–2007 policies. States that strengthened their PE policies from 2006–2007 to 2008–2009 saw an increase in mean district PE policy strength. Across all domains, states that had weak 2006–2007 policies and made no changes saw little increase in district policy strength. CONCLUSION: District competitive food, school meal, and PE policies are stronger in states that have developed strong policies in these domains.     

School environment as predictor of teacher sick leave: data-linked prospective cohort study

ABSTRACT: BACKGROUND: Poor indoor air quality (IAQ) and psychosocial problems are common in schools worldwide, yet longitudinal research on the issue is scarce. We examined whether the level of or a change in pupil-reported school environment (IAQ, school satisfaction, and bullying) predicts recorded sick leaves among teachers. METHODS: Changes in the school environment were assessed using pupil surveys at two time points (2001/02 and 2004/05) in 92 secondary schools in Finland. Variables indicating change were based on median values at baseline. We linked these data to individual-level records of teachers' (n = 1678) sick leaves in 2001--02 and in 2004--05. RESULTS: Multilevel multinomial logistic regression models adjusted for baseline sick leave and covariates showed a decreased risk for short-term (one to three days) sick leaves among teachers working in schools with good perceived IAQ at both times (OR = 0.6, 95% CI: 0.5-0.9), and for those with a positive change in IAQ (OR = 0.6, 95% CI: 0.4-0.9), compared to teachers in schools where IAQ was constantly poor. Negative changes in pupil school satisfaction (OR = 1.8, 95% CI: 1.1-2.8) and bullying (OR = 1.5, 95% CI: 1.0-2.3) increased the risk for short-term leaves among teachers when compared to teachers in schools where the level of satisfaction and bullying had remained stable. School environment factors were not associated with long-term sick leaves. CONCLUSIONS: Good and improved IAQ are associated with decreased teacher absenteeism. While pupil-related psychosocial factors also contribute to sick leaves, no effect modification or mediation of psychosocial factors on the association between IAQ and sick leave was observed.     

Parent reports of sun safety communication and behaviour for students in a randomised trial on a school policy implementation intervention

Objective : Schools are an important setting for skin cancer prevention. An intervention for implementation of school sun safety policy, Sun Safety Schools (SSS), was evaluated. Methods : Primary schools (n=118) in California school districts that had already adopted a sun safety policy were enrolled in a study with a randomised controlled design. Half of the schools were randomised to SSS intervention (N=58). Parents completed an online post‐test. Results : More parents in intervention schools received information about sun safety (mean=26.3%, sd=3.1%, p=0.017) and children more frequently wore sun‐protective clothing when not at school (mean=2.93, sd=0.03, p=0.033) than in control schools (mean=18.0%, sd=2.5%; mean=2.83, sd=0.03, respectively). In schools where principals reported implementing sun safety practices, parents reported that children spent less time outdoors at midday (mean=14.78 hours, sd=0.25, p=0.033) and fewer were sunburned (mean=12.7%, sd=1.1%, p=0.009) than in non‐implementing schools (M=16.3 hours, sd=0.67; mean=21.2%, sd=3.8%, respectively). Parents who received sun safety information (mean=3.08, sd=0.04, p=0.008) reported more child sun protection than parents not receiving information (mean=2.96, sd=0.02). Conclusions : A school district sun protection policy and support for implementation increased dissemination of sun safety information to parents and student sun safety. Implications for public health : Technical assistance for sun safety policies may increase sun protection of children.     

Health education: results from the School Health Policies and Programs Study 2006

BACKGROUND: School health education can effectively help reduce the prevalence of health-risk behaviors among students and have a positive influence on students' academic performance. This article describes the characteristics of school health education policies and programs in the United States at the state, district, school, and classroom levels. 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 all 50 states plus the District of Columbia and among a nationally representative sample of districts (n=459). Computer-assisted personal interviews were conducted with personnel in a nationally representative sample of elementary, middle, and high schools (n=920) 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). RESULTS: Most states and districts had adopted a policy stating that schools will teach at least 1 of the 14 health topics, and nearly all schools required students to receive instruction on at least 1 of these topics. However, only 6.4% of elementary schools, 20.6% of middle schools, and 35.8% of high schools required instruction on all 14 topics. In support of schools, most states and districts offered staff development for those who teach health education, although the percentage of teachers of required health instruction receiving staff development was low. CONCLUSIONS: Health education has the potential to help students maintain and improve their health, prevent disease, and reduce health-related risk behaviors. However, despite signs of progress, this potential is not being fully realized, particularly at the school level.     

The relationship among state laws, district policies, and elementary school-based measurement of children's body mass index

BACKGROUND: School‐based measurement of children's body mass index (BMI) is a useful tool for tracking childhood obesity rates, and may be an effective intervention strategy for reducing the increasing trends in obesity. This article examines the relationship between state law, district policy, and school‐level BMI measurement practices. METHODS: Data were collected during 3 school years (2006‐2007, 2007‐2008, 2008‐2009) as part of an annual study on health policies and practices in a nationally representative sample of US public elementary schools. Data collected included school‐level data via a mailed questionnaire, and district‐level policies and state laws from publicly available sources. We examined whether state laws and district policies were linked to school‐level BMI measurement, either directly, or via a mediation effect. RESULTS: Schools were most likely to measure student BMI if there was a state law in place (65.0% of schools) than where there was not a state law regarding BMI measurement (38.4% of schools; χ² = 120.91, p < .001). However, school‐level BMI measurement did not differ by whether the district had a relevant policy or not (49.8% vs. 49.2%, ns). These effects held up in multivariate logistic regression models controlling for relevant school‐level covariates (region, race/ethnicity, location, school size, and socioeconomic status). Schools in the south and those with a majority of White students were most likely to measure students' BMI. CONCLUSION: State laws are associated with school‐level BMI measurement, and therefore may be a helpful tool in monitoring and addressing childhood obesity.     

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.     

School‐Level Practices and Perceptions Associated With Salad Bars in Schools

BACKGROUND

Salad bars are placed in schools to promote fruit and vegetable consumption among students. This study assessed differences in school nutrition practices and perceptions in schools with and without salad bars.

METHODS

Cross‐sectional surveys were completed by school nutrition managers (N = 648) in Arizona schools participating in the National School Lunch Program during 2013–2014. Mixed general estimating equation binomial regressions assessed factors related to having a salad bar after mutually adjusting for clustering within districts, school level, free/reduced rate, and respondents' time in current position.

RESULTS

On average, 61% of schools reported having a salad bar. After adjustment, school nutrition managers were significantly more likely to report having a salad bar if they served lunch by grade level (vs mixed grades), had a full‐service kitchen, and their personal perception of salad bars was positive; schools were less likely to have a salad bar if menu and food service decisions were made at the school level.

CONCLUSIONS

Several school‐level nutrition practices and perceptions were associated with having a salad bar in schools. Enhancement of these factors may facilitate having salad bars in schools.

     

Strength and comprehensiveness of district school wellness policies predict policy implementation at the school level

BACKGROUND: In 2006, all local education agencies in the United States participating in federal school meal programs were required to establish school wellness policies. This study documented the strength and comprehensiveness of 1 state's written district policies using a coding tool, and tested whether these traits predicted school‐level implementation and practices. METHODS: School wellness policies from 151 Connecticut districts were evaluated. School principal surveys were collected before and after the writing and expected implementation of wellness policies. Sociodemographic variables were assessed for each district, including enrollment, population density, political climate, racial composition, and socioeconomic status. Changes in school‐level policy implementation before and after the federal wellness policy mandate were compared across districts by wellness policy strength; policies were compared based on district‐level demographics. RESULTS: Statewide, more complete implementation of nutrition and physical activity policies at the school level was reported after adoption of written policies. Districts with stronger, more comprehensive policies were more successful in implementing them at the school level. Some sociodemographic characteristics predicted the strength of wellness policies. CONCLUSIONS: Written school wellness policies have the potential to promote significant improvements in the school environment. Future regulation of school wellness policies should focus on the importance of writing strong and comprehensive policies.     

Association of the presence of state and district health education policies with school tobacco prevention program practices

BACKGROUND: Texas does not require health education or tobacco use prevention education (TUPE) in its middle schools. During planning for the Texas Tobacco Prevention Initiative, this baseline research was conducted to (1) describe tobacco prevention and control practices in middle schools prior to the pilot, (2) analyze implementation of a state law prohibiting tobacco use on campuses and at school events, and (3) identify how schools are influenced by district policies requiring health education. METHODS: Written surveys derived from the 2000 School Health Education Profile Tobacco Module developed by the Centers for Disease Control and Prevention were completed by principals and health coordinators at schools in districts requiring health education (n = 31) and schools without district requirements (n = 32). RESULTS: School tobacco policy familiarity and enforcement were consistently reported in response to a state law with rigorous recommendations prohibiting tobacco use. Significantly more activity in numerous components of TUPE was reported in schools in districts with a health education requirement. CONCLUSIONS: Results have implications for intervention programs planned in schools located in states seeking to develop or strengthen state laws, or in states without health education or specific health content requirements.     

2017—2019年合肥市学校肺结核患者密切接触者筛查分析

目的 了解全市学校肺结核疫情发生时对密切接触者筛查情况,查找和解决筛查存在问题,以便更好处理学校疫情。方法 按照《学校结核病防控工作规范（2017版）》开展筛查,每季度逐级上报筛查结果。结果 2017—2019年,全市学校肺结核患者的密切接触者人数有40 825人,规范筛查率为84.38%。15岁以下规范筛查率为97.62%,15岁及以上规范筛查率为82.98%,差异有统计学意义（χ2 = 573.32,P＜0.01)。2017年规范筛查率为61.66%;2019年规范筛查率为94.84%,呈上升趋势（χ2趋势 = 4 721.55,P＜0.01)。2017—2019年,规范筛查率前3的地区为:庐阳区、长丰县和庐江县;后3位为肥西县、瑶海区和巢湖市。学校肺结核密切接触者筛查患者发现率为0.18%。PPD试验强阳性率为3.61%,最高为初中（4.40%）,最低为幼儿园、小学（1.31%）。预防性服药率为7.94%,且不同类型学校之间有差异。结论 合肥市学校肺结核疫情处置日趋规范,但依然存在一些问题,需要教育和卫生部门共同努力。     

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.     

Geographic variations in elementary school-based physical activity practices

BACKGROUND: Physical activity (PA) is associated with health and academic benefits among children, but many schools do not meet national recommendations. This study examined school‐based PA practices in nationally representative samples of public elementary schools, and geographic variations in those practices. METHODS: Mail‐back surveys were used to gather data from 578 public elementary schools during the 2006‐2007 school year and 680 public elementary schools during the 2009‐2010 school year. RESULTS: Nationwide, only 1 in 5 schools met the national recommendation of at least 150 minutes of physical education (PE) per week, although PE was more prevalent in the South. Nearly three‐fourths of schools nationwide met recommendations for 20 or more minutes of recess daily, and this was more prevalent in the Midwest but less so in the South. Approximately 40% of schools offered sports and approximately 40% offered other opportunities for PA during the school day. The only practice that increased over time was formal classroom instruction on PA. CONCLUSIONS: There has been little change in elementary school‐based PA practices nationwide in recent years. With the upcoming renewal of the Elementary and Secondary Education Act, policymakers have an important opportunity to promote increased PA in schools.     

Healthy and safe school environment, Part II, Physical school environment: results from the School Health Policies and Programs Study 2006

BACKGROUND: As society continues to focus on the importance of academic achievement, the physical environment of schools should be addressed as 1 of the critical factors that influence academic outcomes. The School Health Policies and Programs Study (SHPPS) 2006 provides, for the first time, a comprehensive look at the extent to which schools have health-promoting physical school environment policies and programs. METHODS: The Centers for Disease Control and Prevention conducts the 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 and the District of Columbia and among a nationally representative sample of school districts (n=424). Computer-assisted personal interviews were conducted with personnel in a nationally representative sample of elementary, middle, and high schools (n=992). RESULTS: One third (35.4%) of districts and 51.4% of schools had an indoor air quality management program; 35.3% of districts had a school bus engine-idling reduction program; most districts and schools had a policy or plan for how to use, label, store, dispose of, and reduce the use of hazardous materials; 24.5% of states required districts or schools to follow an integrated pest management program; and 13.4% of districts had a policy to include green design when building new school buildings or renovating existing buildings. CONCLUSIONS: SHPPS 2006 results can guide education and health agency actions in developing and implementing evidence-based tools, policies, programs, and interventions to ensure a safe and healthy physical school environment.     

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.     

Physical education and physical activity: results from the School Health Policies and Programs Study 2006

BACKGROUND: Comprehensive school-based physical activity programs consist of physical education and other physical activity opportunities including recess and other physical activity breaks, intramurals, interscholastic sports, and walk and bike to school initiatives. This article describes the characteristics of school physical education and physical activity policies and programs in the United States at the state, district, school, and classroom levels. 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 all 50 states plus the District of Columbia and among a nationally representative sample of districts (n=453). Computer-assisted personal interviews were conducted with personnel in a nationally representative sample of elementary, middle, and high schools (n=988) and with a nationally representative sample of teachers of required physical education classes and courses (n=1194). RESULTS: Most states and districts had adopted a policy stating that schools will teach physical education; however, few schools provided daily physical education. Additionally, many states, districts, and schools allowed students to be exempt from participating in physical education. Most schools provided some opportunities for students to be physically active outside physical education. Staff development for physical education was offered by states and districts, but physical education teachers generally did not receive staff development on a variety of important topics. CONCLUSIONS: To enhance physical education and physical activity in schools, a comprehensive approach at the state, district, school, and classroom levels is necessary. Policies, practices, and comprehensive staff development at the state and district levels might enable schools to improve opportunities for students to become physically active adults.     

Implementation of a School‐Based State Policy to Increase Physical Activity*

Background: In 2005, the North Carolina State Board of Education updated the Healthy Active Children Policy to include a requirement that all kindergarten through eighth‐grade children receive at least 30 minutes of moderate‐to‐vigorous physical activity each school day through physical education, recess, and other creative approaches. This study describes how districts are meeting the physical activity‐related portion of this policy and explores the policy implementation successes and challenges. Methods: An online survey was conducted in summer 2007 in all school districts in the state (response rate 106/111; 95.5%). Respondents were asked to describe the implementation successes and challenges associated with including 30 minutes of physical activity in the school day. Answers were double coded, checked, and grouped into themes. Results: The physical activity requirement was most often met through recess, physical education, classroom Energizers, and intramural sports. School districts reported numerous positive effects of the policy in elementary and middle schools. Benefits included increased student focus on studies, physical activity participation, awareness of healthy habits, alertness and enjoyment, and higher staff involvement. Implementation challenges to the policy included lack of time in the school day, teacher participation, and concerns about academics. Conclusions: School districts reported that implementation of the policy produced many positive results for students and staff. Addressing several implementation challenges common across school districts would strengthen the ongoing success of the policy.