Impact of a School Health Coordinator Intervention on Health-Related School Policies and Student Behavior

BACKGROUND: Health-related, school-based interventions may serve to prevent disease and improve academic performance. The Healthy Maine Partnerships (HMP) initiative funded local school health coordinators (SHCs) as a part of Maine's Coordinated School Health Program (CSHP) beginning in January 2001. SHCs established school health leadership teams and implemented annual work plans to address health risk behaviors. This study evaluates the impact of the Healthy Maine Partnerships SHC (HMPSHC) intervention on school policies and student risk behaviors after its first 5 years. METHODS: Data sources include the Maine School Health Profiles Survey and the Maine Youth Drug and Alcohol Use Survey/Youth Tobacco Survey. Cross-sectional analyses were performed on 2006 data to assess physical activity, nutrition, and tobacco-related policy associations with the HMPSHC intervention. Finally, policy and student behavior analyses were conducted to assess associations. RESULTS: Intervention schools were more likely to be associated with physical activity intramural offerings, improved nutritional offerings, and tobacco cessation programs. In intervention schools, supportive school policies were associated with decreased soda consumption, decreased inactivity, and decreased tobacco use. Required school health education curricula were more predictive of decreased risk behavior in intervention schools than in nonintervention schools. CONCLUSIONS: In schools with SHCs, there exists a stronger association with improved school programs. Improved policies and programs were associated with decreases in risk behavior among students in intervention schools. The HMPSHC intervention may be a viable CSHP model to replicate and evaluate in other settings.     

‘Coalition’1 – what does it mean for schools?

Since the formation of a coalition government in May 2010, there have been substantial changes in government policies relating to the education system in England and Wales. The previous Labour administration strengthened education in food and nutrition and promoted healthy eating in schools. The National Curriculum relating to food technology states what pupils should learn, making reference to practical cooking skills, food safety and hygiene and nutrition and healthy eating. This remains a statutory requirement. The Comprehensive Spending Review (CSR), announced in October 2010, meant that substantial financial cuts would be made across government, including the Department for Education. A huge swathe of quangos has already been cut, including the Qualifications and Curriculum Development Agency (QCDA) and the National Healthy Schools Programme (NHSP). The School Food Trust (SFT) has faced budget cuts, and further massive savings will come from the scrapping of Building Schools for the Future (BSF). The White Paper and Education and Children's Bill will provide greater freedom for schools and academies to determine their own curriculum, length of the school day and lesson times. David Cameron's vision of a ‘Big Society’ will require greater collaboration from a wide range of organisations, including industry and charitable organisations to support high quality education in food and nutrition in schools. Individual Headteachers will be freed to make decisions at a local level. This will leave individual schools with greater decision making and funding responsibility.     

Foods and beverages offered in US public secondary schools through the National School Lunch Program from 2011–2013: Early evidence of improved nutrition and reduced disparities

ObjectiveTo present data on trends in foods and beverages offered through the National School Lunch Program (NSLP) in public middle and high schools in the years immediately preceding and following implementation of new NSLP standards.MethodFrom 2011 to 2013, primary data collection through the annual Youth, Education, and Society study involved use of mailed questionnaires to obtain data on NSLP meals from schools attended by nationally representative samples of US 8^th, 10^th, and 12^th grade students (N = 792 middle schools and 751 high schools). Each school was weighted to represent the percentage of target grade students enrolled, thus allowing analyses examining changes over time in the percentage of students enrolled in (attending) schools with specified NSLP measure outcomes, as well as disparities in NSLP measures based on school characteristics.ResultsSignificantly more US secondary students attended schools with specified NSLP measures in 2013 than in 2011; increases were observed at both middle and high school levels. Increase rates for some NSLP measures were moderated by school characteristics; where this was the case, moderating associations decreased prior NSLP nutrition environment disparities that were especially evident in smaller schools and schools with higher percentages of minority students.ConclusionMeaningful improvements have been made in the nutritional content of NSLP meals offered to US secondary students; these improvements have reduced prior NSLP meal disparities associated with school characteristics. Schools will need continued help with implementation and compliance monitoring in order to have the best opportunity to improve the nutrition environments for US students.     

Pupil welfare in Finnish schools – communal or falling apart?

The need for pupil welfare has increased in schools as has the need to renew the traditional teacher's work. The purpose of this article is to find out how committed the teachers are to pupil welfare work and how the school organisation supports pupil welfare work structurally and practically. The original research was carried out in northern Finland which is scarcely populated and the long distances already pose a challenge to welfare services in general. The research was qualitative and based on a phenomenographic approach. The research data consist of 15 interviews among comprehensive school teachers in the area of northern Finland. According to the research results, an overall model that defines the pupil welfare work was created. Based on the model, pupil welfare at school can be developed both in teacher education and teachers' in-service education as well as in the supervision of work.     

Factors affecting sugar-sweetened beverage availability in competitive venues of US secondary schools

BACKGROUND: This study explores sugar‐sweetened beverage (SSB) availability in US secondary school competitive venues during the first 3 years following the school wellness policy requirement (2007‐2009). Furthermore, analyses examine associations with school policy and SSB availability. METHODS: Analyses use questionnaire data from 757 middle and 762 high schools in the nationally representative Youth, Education, and Society study to examine soda and non‐soda SSB availability associations with school policy including (1) beverage bottling contracts and related incentives, (2) individuals/organizations responsible for decisions regarding beverages available in vending machines, and (3) school wellness policies and nutrition guidelines. RESULTS: Non‐soda SSBs made up the majority of SSBs in both middle and high schools. Soda was especially likely to be found in vending machines; non‐soda SSBs were widely available across competitive venues. Access to soda decreased significantly over time; however, non‐soda SSB access did not show a similar decrease. School policy allowing beverage supplier contractual involvement (bottling contract incentives and beverage supplier “say” in vending machine beverage choices) was related to increased SSB access. However, the existence of developed nutritional guidelines was associated with lower SSB availability. CONCLUSIONS: Students had high access to SSBs across competitive school venues, with non‐soda SSBs making up the majority of SSB beverage options. Efforts to reduce access to SSBs in US secondary schools should include a focus on reducing both soda and non‐soda SSBs, reducing beverage supplier involvement in school beverage choices, and encouraging the development of targeted nutritional guidelines for all competitive venues.     

Improving elementary school quality through the use of a social-emotional and character development program: a matched-pair, cluster-randomized, controlled trial in Hawai'i

BACKGROUND: School safety and quality affect student learning and success. This study examined the effects of a comprehensive elementary school‐wide social‐emotional and character education program, Positive Action, on teacher, parent, and student perceptions of school safety and quality utilizing a matched‐pair, cluster‐randomized, controlled design. The Positive Action Hawai'i trial included 20 racially/ethnically diverse schools and was conducted from 2002‐2003 through 2005‐2006. METHODS: School‐level archival data, collected by the Hawai'i Department of Education, were used to examine program effects at 1‐year post‐trial. Teacher, parent, and student data were analyzed to examine indicators of school quality such as student safety and well‐being, involvement, and satisfaction, as well as overall school quality. Matched‐paired t‐tests were used for the primary analysis, and sensitivity analyses included permutation tests and random‐intercept growth curve models. RESULTS: Analyses comparing change from baseline to 1‐year post‐trial revealed that intervention schools demonstrated significantly improved school quality compared to control schools, with 21%, 13%, and 16% better overall school quality scores as reported by teachers, parents, and students, respectively. Teacher, parent, and student reports on individual school‐quality indicators showed improvement in student safety and well‐being, involvement, satisfaction, quality student support, focused and sustained action, standards‐based learning, professionalism and system capacity, and coordinated team work. Teacher reports also showed an improvement in the responsiveness of the system. CONCLUSIONS: School quality was substantially improved, providing evidence that a school‐wide social‐emotional and character education program can enhance school quality and facilitate whole‐school change.     

Self-efficacy and Social Settings Matter for Fostering Healthy Eating in Mexican Schoolchildren

ObjectiveTo identify differences in schoolchildren's self-efficacy for eating behaviors across social settings and self-efficacy sources favoring healthy and unhealthy eating.DesignA cross-sectional, mixed-methods study using self-efficacy and demographic surveys, focus groups, and school environment semistructured observations.SettingMorelos, Mexico, Cuernavaca City school district, public elementary schools in the National School Lunch Program.Participants and RecruitmentWe studied 274 fifth- and sixth-grade children from 8 elementary schools during the 2016–2017 school year.Variables MeasuredChildren's self-efficacy for healthy and unhealthy eating across 3 settings (school cafeteria, recess, and home). Children's perceptions about sources of self-efficacy, which favor their healthy or unhealthy eating (performance accomplishments, behavior modeling, verbal persuasion, and emotional or physiological states). Sociodemographic information was obtained from parents.AnalysisWe performed a variance components analysis with school and students within schools as random effects with paired t tests (quantitative data) and content analysis on the basis of the Social Cognitive Theory (qualitative data).ResultsSchoolchildren's self-efficacy for healthy eating differed across social settings, being greater in the school cafeteria than at recess or home, except for drinking water. On average, self-efficacy for unhealthy eating was lower in the cafeteria than in other studied settings. Performance achievements and behavior modeling were key sources of self-efficacy for healthy and unhealthy eating.Conclusion and ImplicationsSources of self-efficacy and social settings matter to understanding schoolchildren's healthy and unhealthy eating. Future interventions might consider developing collective efficacy among the school community and boosting children's participation in home meal planning. Further research could explore locus of control and other intrapersonal dimensions influencing self-efficacy.     

Schools and neighborhoods: organizational and environmental factors associated with crime in secondary schools

Background: While crime and violence in schools are derived primarily from factors external to schools, violent behavior may also be aggravated by factors in the school environment, including the physical environment, its educational and social climate, and its organizational capacity and composition. The objective of this study is to examine the effect of the school’s organizational and educational environment on crime rates in secondary schools and to examine how neighborhood factors influence these relationships. Methods: School and neighborhood crime rates for 95 middle (MS) and high (HS) schools were calculated using data from the Los Angeles Unified School District (LAUSD) Police Department and Los Angeles Police Department, respectively. School‐level organizational and educational variables, including the academic performance index (API), were obtained from the California Department of Education. A measure of neighborhood dilapidation was created using variables collected on a neighborhood environmental survey. Linear regression was used to examine the relationship between organizational and educational school variables and school crime rates. Community crime and dilapidation were added to the model to examine the influence of the school‐community context relationships. Results: HS had higher crime rates than MS. As the percentage of certified teachers and student to staff ratios increased, school crime decreased (p < .01). An API of below basic performance was significantly associated with increasing school crime rates (p < .05). Neighborhood crime was not significantly associated with school crime, although dilapidation was positively and significantly associated with school crime even after controlling for community crime (p < .05). Conclusions: Both school‐ and neighborhood‐level factors were associated with increasing crime rates in secondary schools. School violence prevention efforts should include school and community partnerships to address these potentially modifiable factors.     

A Survey of Elementary School Health Education in West Virginia

The Elementary School Health Education Survey was conducted to determine the health knowledge, health practices, and awareness of the consequences of health behavior of selected elementary school students in West Virginia. An 80-item, multiple-choice inventory was developed to collect student data, and a questionnaire-checklist was employed for each classroom teacher whose students participated in the survey. The survey involved 1,441 students from 85 classrooms in 35 schools. The results indicated a need for mandated health instruction as part of the elementary school curriculum and a need for graduate course work in Health Education for elementary school teachers.     

Reducing Calories and Added Sugars by Improving Children's Beverage Choices

Because childhood obesity is such a threat to the physical, mental, and social health of youth, there is a great need to identify effective strategies to reduce its prevalence. The objective of this study was to estimate the mean calories from added sugars that are saved by switching sugar-sweetened beverages (including soda, fruit-flavored drinks, and sport drinks) and flavored milks consumed to unflavored low-fat milk (<1% fat) at meals and water between meals. Simulation analyses used 24-hour dietary recall data from the third School Nutrition Dietary Assessment Study (n=2,314), a 2005 national cross-sectional study of schools and students participating in the National School Lunch Program, to estimate changes in mean calories from added sugars both at and away from school. Overall, these changes translated to a mean of 205 calories or a 10% savings in energy intake across all students (8% among children in elementary school and 11% in middle and high schools). Eighty percent of the daily savings were attributed to beverages consumed away from school, with results consistent across school level, sex, race/ethnicity, and weight status. Children's consumption of sugar-sweetened beverages at home contributed the greatest share of empty calories from added sugars. Such findings indicate that parental education should focus on the importance of reducing or eliminating sugar-sweetened beverages served at home. This conclusion has implications for improving children's food and beverage environments for food and nutrition educators and practitioners, other health care professionals, policy makers, researchers, and parents.     

The School Food Trust: transforming school lunches in England

School food has been provided to pupils in England for many decades. From the mid‐1970s, however, both the number of meals provided and the quality of food have declined. Legislation was introduced in 2001 to ensure that school catering services provided healthy options, but surveys of consumption in 2004–2005 and in 1997 showed that improved availability of healthy options in school had little or no impact on children's eating habits. In February 2005, Jamie Oliver presented a series of television programmes highlighting the poor quality of school food. The government responded by setting up the School Meals Review Panel to make recommendations on how to improve school food and the School Food Trust, a non‐departmental public body to promote the education and health of children and young people by improving the quality of food supplied and consumed in schools. Legislation was introduced in 2006–2008 that set out what caterers could and could not provide for children in schools. At the same time, the Trust worked with caterers, schools, pupils, parents, manufacturers, food distributors, institutions providing further education for catering staff and others in a coordinated programme of change. This paper reports clear evidence of the improvements in provision, choice and consumption of food in schools following the introduction of legislation and a national programme of work to change catering practices and the attitudes of pupils, parents and others to healthier food provision in schools. It also provides objective evidence of the impact of healthier food on children's learning behaviour in the classroom, and overall costs and benefits. It concludes by outlining the future work of the Trust as it moves from being a non‐departmental public body to a not‐for‐profit social enterprise.     

The Well-being Profile--an Internet tool for school health promotion

For years, the WHO has, in accordance with the 'settings' idea, encouraged a whole school approach when trying to promote health and well-being in schools. This developmental study analyses the implementation and pilot phase experiences of a holistic well-being evaluation tool for schools, the School Well-being Profile, on the Internet. The Profile is based on the theoretically established School Well-being Model. The School Well-being Profile consists of electronic survey forms and an automatic facility that analyses and produces results on the data in graphic and numeric form. After the data has been entered, the primary user within the school can immediately view and print out the results. The figures can be compared with the averages of all schools to pinpoint areas where well-being is different from that in the other schools. The Profile resides on a Finnish National Board of Education server (www2.edu.fi/hyvinvointiprofiili) and its use is free of charge for all schools. The Profile became popular in its first year: it was used by 33 primary schools, 28 lower secondary schools and 9 upper secondary schools with a total of 9,169 respondents. Overall, 94% of the students and 99% of the personnel expressed that it had been at least fairly easy to fill in the questionnaire. The paper shows that theoretical research in health promotion can effectively be put into practice using information technology tools. The project that produced the School Well-being Profile ended in 2004, yet the WWW-Profile continues to gain new users. The school administrators, personnel and students have found the Profile easy to use and worth the time and effort invested by the school. The strategies adopted in the design and dissemination of the Profile seem to have been successful in providing a sustainable resource to contribute to the future promotion of well-being in schools.     

Health Education Programs in New Jersey Public Schools*

A mail survey of school health education programs in New Jersey was completed in 1977 by 45% of the public schools. The survey findings suggest that the 1973 resolution of the State Board of Education, designed to promote a more comprehensive approach to health education in New Jersey schools, has by no means been uniformly implemented. The comprehensive approach to health education has developed slowly at the elementary school level and in the least affluent and more heavily populated school districts, particularly those with the highest minority group enrollment. Increasing trends in teenage pregnancy, venereal disease and substance abuse suggest that the current approaches to health education have not been effective. More research and evaluation is needed to identify the most effective means of promoting positive health practices at an early age.     

How School Volunteers can Help to Raise Standards and Enthusiasm for Literacy

This article discusses findings from an evaluation of a national 'School Friends' project set up by British Telecom (BT) in the UK in response to the 'Year of Reading' (1998) backed by the Secretary of State for Education and Employment. In this project employees, with the support of the company, volunteered to help with literacy learning in a number of primary schools throughout the UK. Factors to emerge included the significant part which role models from industry, both male and female, can have in raising confidence and enthusiasm for reading amongst school pupils, particularly boys. The evaluation findings are analysed as a means of drawing some conclusions about what constitutes 'good practice' in terms of voluntary support for literacy learning in schools.     

Gesundheitsförderung im Setting Schule

Health promotion in the school setting has two aims: a problem-based approach to health promotion in the school setting and the setting approach of the Health-Promoting School. Four action areas for school health promotion can be identified which are structured by five action-guiding principles. The setting approach feels an especially strong commitment to these principles. The concept of the Health-Promoting School, which represents an alliance of health and education, is the most common approach throughout Europe where it has been developed and tested in 40 national networks. First results show main focuses of projects, indicate supportive as well as disturbing structures, and include hints about project development. While this approach proved to be a useful concept with which schools can work, research in the area has to be seen more critically.Due to the lack of reliable data about students' and teachers' health, cause-oriented prevention and health promotion cannot be planned meaningfully. Furthermore, there are not enough significant results that could help identify evidence-based strategies for the Health-Promoting School.Publicizing so-called models of good practice will not help.     

Recent status of detection,treatment, and control of hypertension in the community

The Hypertension Detection and Follow-up Program (HDFP), a national collaborative study, screened approximately 159,000 people for high blood pressure in 14 communities between 1973 and 1974. Results show that detection, treatment, and control of high blood pressure has improved considerably since the 1960s. Whereas in the past about half of all hypertensives knew they had high blood pressure, half of those detected were under treatment, and half of those under treatment had their high blood pressure under control, the corresponding percentages in the 14 HDFP communities a decade later indicate that 75% of hypertensives were detected, 72% of those were under treatment, and 70% of those under treatment had a diastolic blood pressure under 95 mm Hg. While the differences inprevalence of hypertension are between races rather than sexes (with black individuals in some age groups being about twice as likely as white individuals to have hypertension), the differences indetection andtreatment rate are largely between sexes and not between races. Women are considerably more likely to be aware of their hypertension, to be under treatment for it, and to have their high blood pressure under control. Rates of control vary considerably among age-sex-race subgroups, from only 8% of white male hypertensives aged 30–39 to 67% of white female hypertensives aged 60–69.It appears that although efforts to combat this disease over the past decade have probably made considerable progress in improving the recognition and treatment of high blood pressure, there remain a large number of undetected, untreated, and uncontrolled hypertensives.The research upon which this publication is based was performed pursuant to Contract Numbers NO1-HV-124 (33–42), NO1-HV-229 (31,37,38,39,45), NO1-HV-32933, and NO1-HV-72915, with the National Heart, Lung, and Blood Institute, NIH, Department of Health, Education, and Welfare. Requests for reprints should be addressed to: Scientific Project Officer, Hypertension Detection and Follow-up Program, DHVD, National Heart, Lung, and Blood Institute, NIH, Room 204, Federal Building, 7550 Wisconsin Avenue, Bethesda, Maryland 20205.     

Residential mobility and long-term treatment of Hypertension

Maintenance of long-term care of populations with high mobility patterns poses problems for programs designed to prevent and treat cardiovascular and other chronic diseases. The Hypertension Detection and Follow-up Program (HDFP)—a community-based screening and treatment program implemented in 1973—provided an opportunity to examine residential mobility among adults under long-term treatment in 13 communities. Whereas 11% of hypertensives included in the HDFP changed residence in the first two years of the study, only 4% moved outside the service areas of the programs. Although a higher proportion of blacks (to whites) moved within the service areas, a similar proportion moved outside the service areas. This low residential mobility, especially the low rate of movement outside the service areas of the treatment centers, suggests that mobility of cohorts under long-term treatment and observation may present lesser problems to continuous, long-term community health care programs than do other factors affecting adherence.The research upon which this publication is based was performed pursuant to Contract Numbers N01-HV-124 (33–42), N01-HV-229 (31, 37, 38, 39, 45), N01-HV-32933, and N01-HV-72915, with the National Heart, Lung, and Blood Institute, NIH, Department of Health, Education, and Welfare. Requests for reprints should be addressed to: Scientific Project Officer, Hypertension Detection and Follow-up Program, DHVD, National Heart, Lung, and Blood Institute, NIH, Room 204, Federal Building, 7550 Wisconsin Avenue, Bethesda, Maryland 20205.     

Mississippi Elementary School Teachers' Perspectives on Providing Nutrition Competencies under the Framework of Their School Wellness Policy

ObjectiveIdentify elementary teachers' implementation of nutrition competencies as part of their school wellness policies (SWP) guided by Organizational Change Theory (OCT) constructs.MethodsA 32-item, cross-sectional survey was distributed through a Web link e-mailed to teachers in Mississippi public elementary schools. Response rate was 34% (n = 947) from 30 schools. Principal component factor analysis for inter-item correlations and theoretical fit to OCT was used with internal consistency reliability coefficients determined using Cronbach's α for Likert-type scales.ResultsA majority of teachers (85.5%) favors their SWPs and has transitioned through the unfreezing stage. Lack of teacher input, time, resources, and recognition for providing nutrition education reflects that teachers do not have support for transitioning through the moving stage.Conclusions and ImplicationsUse of evaluation tools to facilitate teachers' progress through the moving stage into the refreezing stage would be advantageous in supporting organizational change as school administrations implement SWPs.     

Effects of a school-based nutrition program diffused throughout a large urban community on attitudes, beliefs, and behaviors related to fruit and vegetable consumption

BACKGROUND: Obesity among US children has increased in recent years. Although increased fruit and vegetable consumption has not been directly linked to obesity prevalence, it has been posited that more fruits and vegetables (FV) could reduce the consumption of high‐fat, energy‐dense foods and may protect against childhood illnesses including asthma and other respiratory diseases. The purpose of this current research was to assess the impact of a large public school district's hybrid approach to nutrition education programming on attitudes, beliefs, and behaviors related to fruit and vegetable consumption. METHODS: A total of 12 elementary schools from the Los Angeles Unified School District (9 intervention schools, 3 control schools) were randomly selected to participate in a “hybrid” school‐based nutrition education program. Data were collected at baseline (beginning of school year) and postintervention data (end of school year 9 months later). Linear mixed models were developed to assess the impact of the intervention. RESULTS: The intervention resulted in a significant change in teacher influence on students' attitudes toward FV (p < .05) and students' attitudes toward vegetables (p < .01), even after adjusting for gender, grade, and race/ethnicity. Although not statistically significant, there was a slight increase in fruit and vegetable consumption from pretest to posttest for both the intervention and control schools. CONCLUSION: The hybrid model reflects a more accurate representation of school‐based interventions. More research is needed to identify the specific components of this model that are most successful in impacting fruit and vegetable consumption among US children.     

Evaluation of Nutrition Education and Training mini-grant programs

This study monitored the Nutrition Education and Training (NET) program in three public elementary schools in upstate New York and determined the program effectiveness. We compared data from kindergarten through sixth grade students (n = 530) and from their parents, teachers and food service personnel in the three NET schools to that of a similar sample (n = 627) in three non-NET schools. The children's nutrition knowledge and their attitudes toward certain foods improved in both NET and non-NET schools. Significant improvements in snacking practices at home and away occurred only among children at NET schools. Children in the NET school with the most intensive nutrition program exhibited the greatest improvements.