Bridging student health risks and academic achievement through comprehensive school health programs

The Good Food for Learning Universal Curriculum-Integrated Healthy School Lunch Intervention: Protocol for a Two-Year Matched Control Pre-Post and Case Study

Background

Good nutrition affects children’s health, well-being, and learning, and schools offer an important setting to promote healthy behaviors that can last a lifetime. Once children reach school age, they spend more of their waking hours in school than in any other environment. Children’s eating habits may be easier to influence than those of adults. In Canada, households with children are more likely to experience food insecurity, and school food programs that are universally available to all children can support the development of healthy eating patterns across groups of varying socioeconomic status. There is a significant gap in the rigorous community-engaged academic research on the impact of school meal programs, especially universal ones.

Objective

The aim of this population health intervention research is to study the impact of a 2-year universal, curriculum-integrated healthy school lunch program in elementary schools in Saskatoon, Saskatchewan, Canada, on food consumption, dietary quality and food and nutrition-related knowledge, attitudes, and practices.

Methods

This population health intervention study will be conducted in 2 intervention elementary schools matched with 2 control schools. We will collect preintervention data, including objective measurements of food eaten at school and food-related knowledge, attitudes, and behaviors. This will be followed by the intervention itself, along with qualitative case studies of the intervention process in the 2 intervention schools. Then, we will collect postintervention data similar to the preintervention data. Finally, we will finish the data analysis and complete the ongoing sharing of learning from the project.

Results

This study was funded in April 2020 but because of the COVID-19 pandemic, data collection did not begin until May 2021. The intervention will begin in September 2021 and end in June 2023, with end point data collection occurring in May and June 2023. The case study research will begin in September 2021 and will be ongoing for the duration of the intervention.

Conclusions

The opportunity we have to systematically and comprehensively study a curriculum-integrated school lunch program, as well as the promising practices for school food programs across Canada, is without precedent.

International Registered Report Identifier (IRRID)

DERR1-10.2196/30899

Hidden Hunger: Understanding the Complexity of Food Insecurity Among College Students

OBJECTIVE

The aim of this research was to explore the complexity of college student food insecurity through eating patterns, food assistance, and health of food-insecure university students.

METHODS

A mixed-methods approach utilizing qualitative focus groups and individual interview data and survey quantitative data was used. All data collection took place on campus at a large Midwestern university in the Spring semester of 2018. Participants were Midwestern university students (n = 30), freshman to graduate level classified, with very low food security (USDA-Six Item Short Form).

RESULTS

Seven percent (n = 2) were currently enrolled in food assistance programming (SNAP), and 30% (n = 9) reported family enrollment growing up (WIC and SNAP). Seven major themes emerged highlighting nutritional habits, food adaptations, health and well-being impacts, and additional campus programming addressing food assistance. Data triangulation informed a complexity diagram with the major categories of student characteristics of food insecurity, campus resource barriers, additional student needs, health and well-being impacts, and student adaptations and coping influencing the complexity surrounding student food insecurity.

CONCLUSIONS

College student food insecurity is multifaceted and complex. Common themes emerged among both individual-level factors and university structures, providing a deeper understanding of both the complexity and contributors to the college student experience. Further research and intervention are needed to explore this phenomenon and address student needs.

Health-related impediments to learning among dental and oral surgery students

Dental education is a challenging experience that places significant demands on students' intellectual, financial, and psychosocial well-being. Dental students who simultaneously experience physical illness, emotional upset, or interpersonal difficulty may be at greater risk of experiencing negative academic consequences. It is well documented that stress affects student learning, however, the impact of other health concerns on academic success is less understood. The purpose of this manuscript is to document the prevalence and perceived academic impact of 24 health concerns on the academic performance of a sample of 130 undergraduate dental students as measured by the National College Health Assessment (NCHA). Health concerns that were most prevalent among dental students were generally also perceived to be most detrimental to their learning. These included upper respiratory infections (cold, flu, sore throat), interpersonal concerns (concerns about a troubled friend or family member, and relationship difficulty), and mental health issues (depression/anxiety/seasonal affective disorder, and stress).

Physical Activity and Academic Performance: The Mediating Effect of Self-Esteem and Depression

An important step to enhance the academic efficiency of students is increasing their physical activity. For this reason, it is necessary to see to what extent physical activity is related to the academic performance of the students and what might mediate this. A major objective of the study is to explore self-esteem and depression as mediators between physical activity and academic performance. On the basis of informed consent to participate in the study, 358 participants have been selected from Universities in Pakistan, and they were asked about their physical activity, depression during their study and self-esteem through self-report. Participants self-reported their self-esteem, level of depression and their physical activity through standardized measures; the Rosenberg Self-esteem scale (1965), the University stress scale (2016), and the short form of the International Physical Activity questionnaire (2003), respectively. Academic performance had been measured as the cumulative grade point average (CGPA) of the last two consecutive semesters. Self-esteem and depression were found to be significant mediators between physical activity and academic performance. The total effect of physical activity on academic performance was significant but smaller than the total indirect effect through mediators. Though total indirect effect is the combination of the effect of self-esteem and depression, but the larger contribution is of self-esteem which has been found to be the strongest mediator between physical activity and academic performance. The study has implications for future research, both in terms of testing the model and testing psychological constructs. Also, the study emphasizes that the importance of physical activity has to be kept in mind while designing a curriculum of an educational institution in order to foster sustainable development.

Associations of health behaviors, school performance and psychosocial problems in adolescents in The Netherlands

School-based health-promoting interventions show promising results in improving various health outcomes of adolescents. Unfortunately, much is still unknown about the relations between health behaviors and school performances, while improving these would give schools a stronger incentive to invest in health promotion. This paper presents the associations of several health behaviors with school performances and studies the mediating effects of psychosocial problems. Health behavior and socio-demographic data were gathered from 905 Dutch high school students via an online survey, completed in-class. These data were matched with school records of the students' overall grade average (GA) on the three core subjects in Dutch high schools (Dutch, English and Math). The associations between health behaviors and school performances, and the potentially mediating effects of psychosocial problems, were studied via mixed-effects regression models. Smoking, being bullied, compulsive and excessive internet use and low physical activity were directly associated with lower school grades. Additionally, being bullied, bullying, smoking, excessive and compulsive internet use were associated with students' grades via mediation of psychosocial problems. This means that lower school grades were (also) associated with those behaviors through the effects of psychosocial problems in those students. This study showed the strong links between health behaviors and academic achievements among adolescents. Schools and health promoters should be educated more on these relations, so that they are aware of this common interest to get more support for health-promoting interventions. Additionally, the role of psychosocial problems in the relations between behaviors and school performances should be studied further in future research.

Promoting Fitness and Safety in Elementary Students: A Randomized Control Study of the Michigan Model for Health

BACKGROUND

In elementary grades, comprehensive health education curricula have demonstrated effectiveness in addressing singular health issues. The Michigan Model for Health (MMH) was implemented and evaluated to determine its impact on nutrition, physical fitness, and safety knowledge and skills.

METHODS

Schools (N = 52) were randomly assigned to intervention and control conditions. Participants received MMH with 24 lessons in grade 4 and 28 more lessons in grade 5 including material focusing on nutrition, physical fitness, and safety attitudes and skills. The 40-minute lessons were taught by the classroom teacher who received curriculum training and provided feedback on implementation fidelity. Self-report survey data were collected from the fourth-grade students (N = 1983) prior to the intervention, immediately after the intervention, and 6 weeks after the intervention, with the same data collection schedule repeated in fifth grade. Analysis of the scales was conducted using a mixed-model approach.

RESULTS

Students who received the curriculum had better nutrition, physical activity, and safety skills than the control-group students. Intervention students also reported higher consumption of fruits; however, no difference was reported for other types of food consumption.

CONCLUSION

The effectiveness of the MMH in promoting fitness and safety supports the call for integrated strategies that begin in elementary grades, target multiple risk behaviors, and result in practical and financial benefits to schools.

Barriers and Facilitators to Sustaining School Health Teams in Coordinated School Health Programs

Coordinated school health (CSH) programs address multiple factors related to students' overall health, thereby increasing their physical and mental readiness to learn. A formative evaluation of three school districts in 2010-2011 examined strategies for sustaining the school health teams (SHTs) that lead CSH efforts. Qualitative data from 39 interviews and 13 focus groups revealed facilitators and barriers for sustaining SHTs. Quantitative data from 68 questionnaires completed by SHT members and school principals examined factors associated with having more active SHTs and district and school characteristics SHT members believed to be important to their schools' efforts to implement CSH. Facilitators of sustaining SHTs included administrative support, staff engagement in the SHT, and shared goals and responsibility. Barriers to sustaining SHTs included limited time and competing priorities, budget and funding constraints, and staff turnover. Findings provide valuable insight into challenges and potential solutions for improving the sustainability of SHTs to enable them to better support CSH efforts.

Socioeconomic Disconnection as a Risk Factor for Increased HIV Infection in Young Men Who Have Sex with Men

PURPOSE

HIV disproportionately affects young men who have sex with men (YMSM), particularly black YMSM. Increasingly, researchers are turning to social, economic, and structural factors to explain these disproportionate rates. In this study, we explore the relationship between socioeconomic disconnection and HIV status and factors related to HIV infection, including drug use, condomless anal sex, and binge drinking. We operationalize socioeconomic disconnection in this young population as lack of engagement in educational and employment opportunities.

METHODS

Baseline data were analyzed from a longitudinal cohort study of YMSM aged 16-20 years recruited from the Chicago area (N = 450). Bivariate analyses of the association of socioeconomic disconnection and HIV-positive status, drug and alcohol use, and condomless anal sex were assessed using chi-square tests. The relationship of socioeconomic disconnection and HIV-positive status was then examined in multivariate logistic regression models, controlling for age and race/ethnicity and significant behavioral factors.

RESULTS

Among study participants, 112 (25%) were not in school, 310 (69%) were not currently working, and 81 (18%) were neither in school nor working. Black MSM were more likely to be socioeconomically disconnected (neither in school nor working; n = 56, 23.3%). The results revealed that disconnected YMSM were more likely to binge drink (AOR = 2.34; 95% CI = 1.16, 4.74) and be HIV positive (AOR = 2.24; 95% CI = 1.04, 4.83). Subpopulation analysis for black participants revealed similar associations (AOR of binge drinking = 2.92; 95% CI = 1.07, 8.01; AOR of HIV positive = 2.38; 95% CI = 1.03, 5.51). Controlling for substance use, the association between disconnection and HIV-positive status remained significant (AOR = 2.37; 95% CI = 1.08, 5.20).

CONCLUSION

Socioeconomic disconnection is significantly and positively associated with HIV status among YMSM, suggesting that the two factors are related. Socioeconomic factors present an important area for future research focusing on HIV infection in this high-risk group.

From recipients to partners: children in malaria education in Uganda

Purpose

– Health education that integrates community participation is essential for malaria control. However, children’s participation is not generally as active as that of adults, thus turning children into recipients, as opposed to partners in malaria control. The purpose of this paper is to develop a better understanding of how children can transform from mere recipients to active partners in malaria control efforts, by exploring the implementation of a school health education program in Uganda.

Design/methodology/approach

– A qualitative multi-case study involving six schools where the health education program was implemented was undertaken, using six focus group discussions with 72 school children and respondent interviews with 14 teachers and district health promotion staff.

Findings

– Children acted as health messengers, offered peer support and engaged in environmental management to minimize mosquito breeding. The benefits of the school malaria program included increasing access to malaria information, boosting malaria knowledge, improving children’s self-esteem and their skill as health educators. However, implementation was undermined by hostility from adults, inadequate time and tight school schedules, which should be addressed in future malaria programs.

Practical implications

– The findings suggest that children can play an important role in malaria programs. Therefore, programs should be sufficiently structured to facilitate children’s participation. Practitioners should be encouraged to be conscious of the applicability of the health promoting school approach to malaria control.

Originality/value

– This research facilitated a more comprehensive understanding of the role children can play in malaria control, thus providing a basis for their involvement in malaria programs. It also adds to a relatively scarce area of literature on the school health-malaria control nexus.

Let's talk about sex (again): advancing the conversation around long-acting reversible contraception for teenagers

Long-acting reversible contraception (LARC) has incredible potential for decreasing teenage pregnancy rates in the USA, but use among adolescents remains low. LARC methods, including intrauterine devices and implants, are recommended as first-line choices for teenagers by multiple medical professional associations. Barriers at the system, provider and patient level persist, but new demonstration projects, in addition to provisions of the Affordable Care Act, show great promise in facilitating LARC use. A renewed national discourse should acknowledge the reality that many US teenagers have sex, that LARC is safe and effective and that LARC offers an opportunity to prevent teenage pregnancy. By encouraging widespread access and use, a large, positive impact across multiple health and economic sectors can be achieved.

The ASCD Healthy School Communities project: formative evaluation results

Purpose

– The purpose of this paper is to report the formative evaluation results from the Association for Supervision and Curriculum Development Healthy School Communities (HSC) pilot project.

Design/methodology/approach

– This study utilized 11 HSC pilot sites in the USA (eight sites) and Canada (three sites). The evaluation question was “What are the levers of change in a school community that allow for the initiation and implementation of best practice and policy for improving school health?” Pre- and post-site visits along with in-depth interviews with school teams, teachers, students, administrators, community stakeholders and other involved individuals, school site report reviews, Healthy School Report Card results and school improvement plans were used for evaluation purposes.

Findings

– This study identified nine levers of change: principal as leader of the HSC efforts; active and engaged leadership; distributive team leadership; effective use of data for continuous school improvement; integration of the HSC process with the school improvement process; ongoing and embedded professional development; authentic and mutually beneficial community collaborations; stakeholder support of the local HSC effort; and creation or modification of school policy related to HSC that increased the likelihood that school improvement via health promotion would be pursued and sustained.

Research limitations/implications

– Owing to the qualitative methods used in this study and the number of schools in the pilot project, the research results may lack generalizability. Therefore, researchers are encouraged to test the proposed evaluation question further.

Practical implications

– This study has implications for schools seeking to create sustainable, systemic integration of health and education for effective health-promoting schools and continuous school improvement.

Originality/value

– This study provides evidence that integration of health and education can become a sustainable and integral part of a school’s culture.

Coordinated school health and the contribution of a district wellness coordinator

BACKGROUND

A San Francisco Bay Area school health initiative was established in fall 2010 to improve wellness programs in 4 local school districts using the Coordinated School Health (CSH) model. This study examines the role of district-wide wellness coordinators and the ways in which they contribute to intentional coordination of health and wellness programs and activities in their school districts.

METHODS

This study included 8 schools across 4 school districts. Researchers conducted semistructured interviews and focus groups with district and school staff, students, parents, wellness committee members, and wellness coordinators in 2012 to examine a range of perspectives about the coordination of school health and wellness.

RESULTS

District wellness coordinators' efforts were linked to an increase in (1) awareness of health and wellness, (2) integration of wellness activities within and across schools and districts, and (3) leveraged resources.

CONCLUSIONS

Wellness coordinators are critical to successful CSH efforts. Through intentional and strategic collaboration with key stakeholders, wellness coordinators advance CSH goals of integrating health and wellness programs within and across school districts, reaching more students equitably and leveraging resources.

Understanding the relationship between school-based health center use, school connection, and academic performance

School-based health centers (SBHCs) benefit the overall health of underserved communities. In fact, there is an abundance of evidence suggesting the positive effects that SBHCs have on physical and mental health. However, research related to understanding the relationship of SBHCs to academic outcomes such as performance and school connectedness is sparse. The purpose of the current study was to (a) compare differences between elementary, middle, and high school student SBHC users and nonusers on school connectedness and (b) test the pathways between SBHC usage and academic performance. A structural equation model was tested and found significant pathways between SBHCs, school connectedness, and academic performance.

Visiting again? Subjective well-being of children in elementary school and repeated visits to school health nurses

BACKGROUND

Children with vague complaints are without chronic illness, and who repeatedly visit the school nurse may be at risk for limited academic success. This study compares student reports of subjective well-being between children who do and do not repeatedly visit the school nurse with vague complaints.

METHODS

Children in grades 4 through 6 completed the School Well-Being Profile-American English (SWBP-AE), a questionnaire with 4 well-being subscales: health status, school environment, social relationships, and school as a means of self-fulfillment. School nurses extracted data on clinic visits from clinic records. Logistic regression explored associations between well-being subscales and repeated visits to the school nurse.

RESULTS

Of the 320 students participating in the study, 33 (12.04%) students made repeated visits to the school nurse. Perception of health status (OR = 2.072; 95% CI = 1.037, 4.163) was the only significant (p < .05) predictor of repeated visits to the nurse.

CONCLUSION

Children with poor perception of their health status are more likely to repeatedly visit the school nurse. Children's perceptions of their school environment, social relationships, or school as a means of self-fulfillment are not statistically significant predictors of repeated visits to the school nurse.

Relation between physical activity and academic performance in 3rd-year secondary education students

The main aim of this study was to analyze the relationship between the amount of physical activity and academic performance in 3rd-year secondary education students. The sample was taken from three secondary schools in the area of Barcelona. 284 students (158 girls, 126 boys) with an average age of 14.7 yr. participated. The International Physical Activity Questionnaire was used by students to self-report their amount of physical activity. Students' academic records were obtained for comparisons. Results showed that there was a linear relationship between academic performance and physical activity; nevertheless, there was a trend to stronger correlation when modeling the relationship between these variables with a quadratic equation. Further research should focus on whether academic performance and physical activity might be better explained with a second-order equation.

Reducing childhood obesity through policy change: acting now to prevent obesity

Childhood obesity is epidemic in the United States, and is expected to increase the rates of many chronic diseases. Increasing physical activity and improving nutrition are keys to obesity prevention and control. But changing individual behavior is difficult. A comprehensive, coordinated strategy is needed. Policy interventions that make healthy dietary and activity choices easier are likely to achieve the greatest benefits. There is emerging evidence on how to address childhood obesity, but we must take action now to begin to reverse the epidemic.

What's in the lunchbox? Dietary behaviour of learners from disadvantaged schools in the Western Cape, South Africa

OBJECTIVE

To identify and describe factors associated with food shop (known as tuck shop in South Africa) and lunchbox behaviours of primary-school learners in South Africa.

DESIGN

Analysis of data collected in 2008 from a cross-sectional survey.

SETTING

Sixteen primary schools in the Western Cape, South Africa.

SUBJECTS

A total of 717 grade 4 learners aged 10-12 years.

RESULTS

A 24 h recall established that 69 % of learners carried a lunchbox to school and 49 % had consumed at least one item purchased from the school food shop/vendor. Most lunchboxes contained white bread with processed meat, whereas the most frequent food shop/vendor purchase comprised chips/crisps. Learners who carried a lunchbox to school had significantly lower BMI percentiles (P = 0·002) and BMI-for-age (P = 0·034), compared with their counterparts. Moreover, they were younger, had higher standard-of-living and dietary diversity scores, consumed more meals per day, had greater self-efficacy and came from predominantly urban schools, compared with those who did not carry a lunchbox to school. Learners who ate food shop/vendor purchases had a lower standard-of-living score and higher dietary diversity and meal scores. Only 2 % of learners were underweight, whereas 19 % were stunted and 21 % were overweight/obese (BMI ≥ 25 kg/m2).

CONCLUSIONS

Children who carried a lunchbox to school appeared to have greater dietary diversity, consumed more regular meals, had a higher standard of living and greater nutritional self-efficacy compared with those who did not carry a lunchbox to school.

Declining physical activity levels as an unintended consequence of abolishing mandatory campus service fees

OBJECTIVE

This study investigates the effect of the introduction of voluntary student unionism and subsequent increase in campus facility fees on engagement in physical activity on campus.

PARTICIPANTS

Participants were 1,904 students from a large regional NSW (Australia) university across 3 time periods (926 in 2005, 504 in 2006, and 474 in 2007).

METHODS

Students completed a survey across the 3 time periods, responding to questions about physical activity levels, use of on-campus and off-campus facilities, and barriers to facility use.

RESULTS

Participation in physical activity at university facilities was low overall, and declined substantially between 2005 and 2007, with the proportion of students identifying cost as a barrier more than doubling over this time period.

CONCLUSIONS

There is a need for policy makers to consider the unintended health impacts of such policy changes, particularly in relation to the impact on already insufficient levels of physical activity.

Is tobacco use associated with academic failure among government school students in urban India?

BACKGROUND

Not much is known about the academic correlates of tobacco use among students in developing countries. This study investigated associations between multiple forms of tobacco use, psychosocial risk factors, and academic failure among 10- to 16-year-old government school students in Delhi and Chennai, India.

METHODS

This study was a secondary analysis of data gathered from students in 7 government schools during a larger tobacco intervention trial in India. Mixed-effects regression analyses were carried out on a cross-sectional sample of 3799 students and a retrospective cohort of 2586 students. Data on tobacco use and risk factors were collected from self-reported student surveys in 2006 and 2004. Using school records, academic failure was defined as repeating the same grade level once or twice between 2004 and 2006.

RESULTS

In 2006, academic failure was significantly more prevalent among students who reported use of chewing tobacco, bidis, or cigarettes, as compared with nonusers. Students with academic failure had greater social susceptibility and intentions for future tobacco use, and poor knowledge and self-efficacy for avoiding tobacco. Cohort analyses showed that students who had reported tobacco use in 2004 were more likely to have academic failure by 2006, as compared with nonusers.

CONCLUSIONS

School health programs that incorporate tobacco control measures should be offered to government school students with poor academic outcomes in India, along with remedial education efforts. School-based longitudinal research is needed to assess effects of tobacco use in early adolescence on academic, social, and behavioral outcomes in later adolescence and young adulthood.

Physical activity and body mass index of school children and adolescents in Abeokuta, Southwest Nigeria

BACKGROUND

Physical inactivity and sedentary lifestyles are known to predispose to overweight and obesity. These lifestyles are also known to track from childhood into adulthood with consequent cardiovascular and metabolic problems. This study aimed to describe the frequency of physical activity and the relationship between physical activity and body mass index of urban Nigerian school children and adolescents.

METHODS

Children from seven schools in Abeokuta, southwest Nigeria were selected using a multi-staged random sampling technique.

RESULTS

Of 570 children, 411 (72.1%) were involved in moderate to vigorous physical activities. Involvement in physical activity was higher in older children (P<0.001), males (P<0.001), and children of mothers with a higher educational level (P=0.03). Eleven (1.9%) children were overweight or obese whereas 163 (28.6%) were underweight. There were more children with underweight than overweight among the subject population with a high level of physical activity (35.6% vs. 4.4%, P=0.499).

CONCLUSIONS

A large proportion of the children in urban Nigeria participate in physical activity. The prevalence of overweight and obesity is low but undernutrition is a major nutritional problem among these children.

The relationship between school-based health centers, rates of early dismissal from school, and loss of seat time

BACKGROUND

This study sought to understand the relationship between school-based health centers (SBHCs) and academic outcomes such as early dismissal and loss of seat time (the time students are available in school to learn or to access support services).

METHODS

A quasi-experimental research design was used to compare rates of early dismissal and loss of seat time between students who received SBHC and traditional school nursing services and students who received only traditional school nursing services. This study was a secondary data analysis of 764 "walk-in" visits during a 3-week period in 2 urban high schools in western New York state. Both schools provided school nursing services, and 1 of the 2 offered the option to enroll in an SBHC.

RESULTS

SBHCs significantly reduced the number of early dismissals from school (p = .013) in a comparison with students who received school nursing services alone. Students not enrolled in an SBHC lost 3 times as much seat time as students enrolled in an SBHC. Race, gender, age, poverty status, and presence of a preexisting illness did not influence these findings.

CONCLUSIONS

These findings suggest that SBHCs have a direct impact on educational outcomes such as attendance. Recommendations for further research include replication of this study to increase confidence in its findings and using early dismissal and loss of seat time as indicators of attendance to measure other health outcomes related to SBHCs and school nursing.

Toward a healthy high schools movement: strategies for mobilizing public health for educational reform

Although research shows that education and health are closely intertwined, health professionals have difficulty using this evidence to improve health and educational outcomes and reduce inequities. We call for a social movement for healthy high schools in the United States that would improve school achievement and graduation rates; create school environments that promote lifelong individual, family, and community health and prevent chronic illness, violence, and problems of sexual health; and engage youths in creating health-promoting environments. Achieving these goals will require strengthening and better linking often uncoordinated efforts to improve child health and education. Only a broad social movement has the power and vision to mobilize the forces that can transform educational and health systems to better achieve health and educational equity.

Is the health and wellbeing of university students associated with their academic performance? Cross sectional findings from the United Kingdom

This study explored the associations between health awareness, health behaviour, subjective health status, and satisfaction of students with their educational experience as independent variables and three outcomes of educational achievement as dependent variables. We undertook two simultaneous cross-sectional surveys among students from one University in the UK during 2008-2009. The first survey was a general health survey; the second survey measured students' satisfaction with different aspects of their learning and teaching experience. Students' registration numbers linked the responses of both questionnaires together, and subsequently linked the questionnaires to the university database to import the grades that students actually achieved in their studies. Generally, on average, students (N = 380) exhibited medium to high satisfaction with their educational experiences. In the multivariate regression analyses, students' satisfaction with their educational experiences was not associated with any of the three indicators of educational achievement (actual module mark; perceived own performance; importance of achieving good grades). The associations of educational satisfaction, health, health behaviours, heath complaints and financial parameters with the three outcomes of educational achievement did not differ between male and female students. Each of the health, health behaviours, health complaints and financial parameters were selectively associated with only some but not all three indicators of student educational achievement. We conclude that the findings support a conceptual framework suggesting reciprocal relationships between health, health behaviour and educational achievement. Comprehensive health promotion programmes may have the potential to influence relevant predictors of educational achievement in university students.

Understanding barriers to implementing the Norwegian national guidelines for healthy school meals: a case study involving three secondary schools

The main goal of the present study was to investigate the barriers to implementing the Norwegian national guidelines for healthy school meals as perceived by principals, project leaders, teachers and students. This study employed a multiple-case design using an explorative approach. Data were collected at three secondary schools in Norway participating in the intervention project Physical activity and healthy school meals. Individual interviews were conducted with school principals and project leaders, and focus group interviews were conducted separately with teachers and students. Four categories of barriers were identified: (1) lack of adaptation of the guidelines to the target group; (2) lack of resources and funding; (3) conflicting values and goals; and (4) access to unhealthy food outside school. The research identified differences in perceived barriers between the staff responsible for implementation and the students as the target group of the measures. All staff groups perceived barriers relating to both resources, and conflicting values and goals. The teachers were more concerned about issues of relevance for adaptation to the target groups than were the principals and project leaders. The students were concerned mostly with issues directly affecting their experience with items offered in the canteen.

Changes in psychosocial factors and physical activity frequency among third- to eighth-grade girls who participated in a developmentally focused youth sport program: a preliminary study

BACKGROUND

Despite the numerous physiological, psychological, and academic benefits of physical activity (PA), declines in PA levels among girls have been observed over the last decade. The purpose of this preliminary study was to assess the short-term changes pertaining to Girls on the Run and Girls on Track developmentally focused youth sport programs (DYS) on global self-esteem, body image, commitment to PA, and PA frequency.

METHODS

This preliminary study employed a nonexperimental, one-group, pre- and postintervention study design using a 29-item paper-and-pencil assessment tool (n = 1034).

RESULTS

Paired sample t-tests from pre- to postintervention revealed statistically significant differences in self-esteem (p < .001), body size satisfaction (p < .001), and vigorous PA frequency (p < .001). Stratification by the number of times participating in the intervention revealed the greatest changes at first participation followed with continued improvements in self-esteem (p = .013) and body size satisfaction (p < .001) for those participating in a second time. Age differences were also observed between participants </=10 years old and 11-15 years; in that significant improvements in commitment to PA (p = .003) were observed for the older girls.

CONCLUSIONS

Findings suggest DYS programs Girls on the Run and Girls on Track may produce beneficial changes in self-esteem, body size satisfaction, PA commitment, and PA frequency. Although the findings from the current report are preliminary, they suggest that DYS programs designed exclusively for girls may provide the necessary framework to promote PA to achieve the numerous associated benefits.

A coordinated school health approach to obesity prevention among Appalachian youth: the Winning with Wellness Pilot Project

Childhood obesity has been an increasing problem in the United States, especially in rural areas. Effective prevention approaches are needed. This article describes the development, implementation, effectiveness, feasibility, and sustainability of a school-based obesity prevention pilot project, Winning with Wellness. The program was based on the coordinated school health model and included a community-based participatory research approach aimed at promoting healthy eating and physical activity in a rural Appalachian elementary school. Findings from this preliminary project revealed improvements in nutrition offerings and increased physical activity during the school day. In addition, the program was found to be acceptable to teachers, successfully implemented utilizing both existing and newly developed resources, and sustainable as evidenced in continued practice and expansion to other area schools.

A retrospective examination of the relationship between implementation quality of the coordinated school health program model and school-level academic indicators over time

BACKGROUND

Although models such as the coordinated school health program (CSHP) are widely available to address student health needs, school professionals have been unconvinced that scarce resources should be allocated to improving student health. Concern that attention may be diverted from meeting academic accountability goals is often seen as a reason not to attend to student health. Despite continuing calls for the study of multicomponent health programs in relation to educational achievement, the understanding of the extent to which adherence to the characteristics of CSHP contributes to or compromises academic outcomes over time remains incomplete.

METHODS

A retrospective study was conducted of CSHP implementation across 158 public schools in Delaware, serving grades K-12. Using a doubly multivariate design, this study examined 3 levels of CSHP implementation across 5 school-level academic indicators for 3 years. Indicators included school performance, school progress, and aggregated student performance in 3 content areas--reading, mathematics, and writing. Data for the years prior to, during, and following implementation of CSHP were analyzed.

RESULTS

Multivariate main effects of year by implementation level were detected. CSHP schools with high levels of implementation had better school-level performance and progress ratings. CSHP implementation did not have an effect on reading, math, and writing indicators, though all groups showed significant improvements over time in these areas.

CONCLUSIONS

Results of this study suggest that quality implementation of CSHP does not adversely impact school-level academic indicators over time. Moreover, findings suggest a better fit with school-wide accountability indicators than with specific content-based achievement indicators.

Nursing students' perceptions of the academic impact of various health issues

Nursing education is a challenging experience for many students, particularly those facing physical illness or emotional upset. Although we know that stress affects student learning, the impact of other health concerns is less well known. On the basis of their study, the authors discuss the most frequent and threatening health concerns reported by students, including sleep difficulties, interpersonal concerns (concerns about troubled friends or family members, and relationship difficulty), and mental health concerns (depression/anxiety/seasonal affective disorder and stress), and the implications for faculty and the provision of comprehensive student support services follows.

Grounds for movement: green school grounds as sites for promoting physical activity

An environmental factor of particular importance to children's physical activity levels appears to be the presence of parks and open space. Thus, in promoting children's health, school grounds merit consideration as a potential setting for intervention. This paper explores how 'green' school grounds, which contain a greater diversity of landscaping and design features, affect the quantity and quality of physical activity among elementary school children. Teachers, parents and administrators associated with 59 schools across Canada completed questionnaires (n = 105). Analysis reveals that through greening, school grounds diversify the play repertoire, creating opportunities for boys and girls of all ages, interests and abilities to be more physically active. Complementing the rule-bound, competitive games supported by asphalt and turf playing fields, green school grounds invite children to jump, climb, dig, lift, rake, build, role play and generally get moving in ways that nurture all aspects of their health and development. Of particular significance is the potential to encourage moderate and light levels of physical activity by increasing the range of enjoyable, non-competitive, open-ended forms of play at school. Seen in this light, green school grounds stand to be an important intervention to be included in school health promotion initiatives.

Health promotion and education policy and practice in urban schools in Liaoning province, China

This paper reviews the status of health education in urban schools in three cities in Liaoning province, China. The cities represent the upper, middle and lower levels of city economy based on the GDP per person within the province. A self-administered questionnaire was provided to 500 primary and secondary schools and 436 questionnaires (87.2%) were returned completed. The questionnaire assessed health education offerings in the schools, permitting the comparison of similarities and differences in school practices, and the identification of obstacles that prevent schools becoming health promoting. The analysis revealed that 0.7% of schools fulfilled criteria for good status of health education. The negative attitudes of school management, teachers and pupils towards health education, as well as the lack of in-service training for staff, were perceived as key obstacles to school health education. Few provincial and school-based policies mentioned pupil involvement in health policy development and only a small number of schools acknowledged the need to improve community and parental involvement. In this paper we discuss the challenges facing provincial education and health authorities, and make recommendations about how to assist Chinese schools to develop and implement high quality health education initiatives.

Grounds for movement: green school grounds as sites for promoting physical activity

An environmental factor of particular importance to children's physical activity levels appears to be the presence of parks and open space. Thus, in promoting children's health, school grounds merit consideration as a potential setting for intervention. This paper explores how 'green' school grounds, which contain a greater diversity of landscaping and design features, affect the quantity and quality of physical activity among elementary school children. Teachers, parents and administrators associated with 59 schools across Canada completed questionnaires (n = 105). Analysis reveals that through greening, school grounds diversify the play repertoire, creating opportunities for boys and girls of all ages, interests and abilities to be more physically active. Complementing the rule-bound, competitive games supported by asphalt and turf playing fields, green school grounds invite children to jump, climb, dig, lift, rake, build, role play and generally get moving in ways that nurture all aspects of their health and development. Of particular significance is the potential to encourage moderate and light levels of physical activity by increasing the range of enjoyable, non-competitive, open-ended forms of play at school. Seen in this light, green school grounds stand to be an important intervention to be included in school health promotion initiatives.

Integrating a school-based health intervention in times of high-stakes testing: lessons learned from full court press

Because of the growing focus on the production of favorable academic standardized test scores, schools have become increasingly resistant to sponsoring nonacademic programming, such as tobacco cessation services for students. Nevertheless, the need for such programs has not diminished. The purpose of this article is to provide descriptive information about the logistics of establishing and delivering a health intervention in schools that are resistant to nonacademic programming. The data were collected as part of a qualitative retrospective process evaluation of Full Court Press, a 5-year youth tobacco demonstration project funded by the Robert Woods Johnson Foundation and implemented in Tucson, Arizona. Lessons learned about recruiting schools, integrating programs, and managing facilitators are presented.

Increasing School Success Through Partnership-Based Family Competency Training: Experimental Study of Long-Term Outcomes

An expanding body of research suggests an important role for parent or family competency training in children's social-emotional learning and related school success. This article summarizes a test of a longitudinal model examining partnership-based family competency training effects on academic success in a general population. Specifically, it examines indirect effects of the Iowa Strengthening Families Program (ISFP) on school engagement in 8th grade and academic success in the 12th grade, through direct ISFP effects on intervention-targeted outcomes-parenting competencies and student substance-related risk-in 6th grade. Twenty-two rural schools were randomly assigned to either ISFP or a minimal-contact control group; data were collected from 445 families. Following examination of the equivalence of the measurement model across group and time, a structural equation modeling approach was used to test the hypothesized model and corresponding hypothesized structural paths. Significant effects of the ISFP were found on proximal intervention outcomes, intermediate school engagement, and the academic success of high school seniors.

Building capacity for the continuous improvement of health-promoting schools

BACKGROUND

There has been much educational verbosity over the past decade related to building capacity for effective schools. However, there seems to be a scarcity of clarification about what is meant by school capacity building or how to accomplish and sustain this process. This article describes the preexisting conditions and ongoing processes in Pueblo, Colorado School District 60 (Pueblo 60) that built capacity for the development and continuous improvement of health-promoting schools.

METHODS

Capacity building strategies and a program-planning model for continuous improvement for health-promoting schools were used that included: (a) visionary/effective leadership and management structures, (b) extensive internal and external supports, (c) development and allocation of adequate resources, (d) supportive policies and procedures, and (e) ongoing, embedded professional development.

RESULTS

Pueblo 60 strategically developed an infrastructure through which they successfully delivered a wide array of health programs and services.

CONCLUSIONS

Through building organizational capacity at the school district and school level, additional school health programming can be developed and sustained.

Achieving good standards in health promoting schools: Preliminary analysis one year after the implementation of the Hong Kong Healthy Schools Award scheme

BACKGROUND

Improving health literacy can be a strategy for the achievement of public health goals, and the concept of the Health Promoting School can help to build on the health literacy of students. The Centre for Health Education and Health Promotion of The Chinese University of Hong Kong launched the Hong Kong Healthy Schools Award (HKHSA) in 2001. This paper reports the results for the ten secondary schools that underwent assessment in 2002.

METHODS

Based on the overall score for each school, cluster analysis was performed. Each cluster of schools reflected different levels of HKHSA achievement.

RESULTS

This study has shown that those schools reaching high Health Promoting School standards have adopted the concept of a whole school approach in addressing health and social issues, rather than topic-based and school-located health promotion. The schools performing less satisfactorily mainly follow a prescriptive approach.

CONCLUSIONS

These results are a good source of reference for other schools in their Health Promoting Schools programmes.

Elementary School Nurse Interventions: Attendance and Health Outcomes

Regular school attendance is a necessary part of the learning process; student absenteeism has a direct association with poor academic performance. School nurses can influence student attendance. This study describes the impact of school nurse interventions on student absenteeism and student health. A retrospective review of 240 randomly selected elementary student health folders and attendance records was conducted. School nurses were involved with 75% of high-absence students as compared to 66% of low-absence students; they were also more involved with students who had previously identified health conditions. There were no referrals to the school nurse for absenteeism and school nurse interventions were not targeted to attendance, despite 17% of students missing 11 or more school days. Nursing documentation was sparse and primarily task related. Few records contained entries of nursing diagnoses, interventions, or outcomes. Of the 134 interventions provided, only 56 (41.2%) had some information about the condition outcome, but it was insufficient to determine the effectiveness of nursing interventions. Furthermore, the record system did not support the collection of standard information for interventions or outcomes from which effectiveness could be determined. Recommendations include establishment of an attendance referral policy and improved documentation systems, including the use of standardized nursing language to demonstrate student outcomes.

Reducing overweight through a multidisciplinary school-based intervention

OBJECTIVE

This study sought to evaluate the effectiveness of a multidisciplinary elementary school-based intervention entitled Wellness, Academics & You. The primary areas of impact examined were BMI, consumption of fruits and vegetables, and physical activity.

RESEARCH METHODS AND PROCEDURES

The sample consisted of 1013 students in fourth and fifth grades from 69 classes in four states. Intervention and comparison classes were randomly selected at each school. Intervention teachers participated in workshops on the intervention and received program materials. BMI was calculated for baseline and post-data points based on measured height and weight collected by trained research teams. Baseline surveys were administered by the students' teacher in the presence of one of the research team members and collected.

RESULTS

SPSS (SPSS, Inc., Chicago, IL) analysis of post-data shows significant positive shifts (p = 0.01) in BMI in the intervention group compared with the comparison group. Notable increases in the consumption of fruits and vegetables and increased physical activity levels were reported in the intervention group.

DISCUSSION

Data from this study indicate that this school-based program may contribute to the reduction of overweight and obesity. The intervention was well received by the classroom teachers and shows promise for a school-based obesity prevention initiative. This program has shown the capacity to effect positive changes in BMI through consumption of fruits and vegetables and physical activity. The evaluation covered a limited time period and, therefore, warrants additional studies to determine whether long-term program fidelity will result in continued improvement.