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Healthy Youth


School Health Index (SHI)
Use of the SHI

Who uses the SHI?
Promoting the SHI
Impact on Policies & Programs
Modifying the SHI
Evaluating the SHI
Feedback from the Field

Since the release of the first edition of CDC’s School Health Index: A Self-Assessment and Planning Guide (SHI) in 2000, this tool has been widely implemented across the nation to improve school health policies and programs. Many groups have used creative approaches to promote, modify, and evaluate the SHI, leading to thousands of schools using it to make a significant impact in the lives of young people.

This list is a sampling of the SHI-related activities that are occurring across the country. But we want to know more! We know that many of you are doing great things with the SHI, so please tell us about your successes.

Who uses the School Health Index?

  • Reports of use in at least 46 states (plus adaptations in Mexico, Canada, and Saudi Arabia).

  • “SHI” is one of the most searched terms on CDC's Division of Adolescent and School Health (DASH) Healthy Youth Web site, and often more copies of the SHI are ordered than any other DASH publication.

Examples of usage



Delaware All 19 school districts.
Florida 700 schools have been trained on using the SHI.
Georgia About 200–250 schools statewide; all DeKalb County schools (142) and Cobb County schools (113) are required to use the SHI annually.
Kansas 109 schools have used it in 59 districts.
Louisiana 644 schools have used Louisiana's version.
Maine All schools within 54 administrative units.
Missouri At least 303 schools.
Pennsylvania In 2005, 1,133 schools from 66 of 67 counties participated in Pennsylvania's version.
Tennessee All 130 Metropolitan Nashville schools.
Texas 93 schools in Austin area; more than 50% of middle schools in Houston.

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Promoting the SHI

State Departments of Health, State Departments of Education, universities, and other groups are promoting the use of the SHI in a variety of ways. They are—

  • Creating policies or mandates to require or encourage schools to use the SHI.
    • Arkansas: The State Board of Education passed a policy in August 2005 stating that all schools are required to develop School Nutrition and Physical Activity Advisory Committees that are responsible for completing the SHI annually and incorporating results into School Improvement Plans.
    • Cobb County, Georgia: County policy states that all schools are required to use the SHI annually (113 schools).
    • DeKalb County, Georgia: County policy states that all schools are required to use the SHI annually (142 schools).
    • Tennessee: The State Board of Education passed a policy in August 2005 stating that all schools are required to use SHI and implement Coordinated School Health Programs (CSHP).
  • Offering $1,000–$25,000 in mini-grants to schools to implement the SHI assessment and action plans (Arkansas, California, Connecticut, Georgia, Hawaii, Kansas, Kentucky, Michigan, Mississippi, Missouri, Montana, New Hampshire, New York, North Carolina, Oklahoma, Pennsylvania).
  • Offering trainings or workshops (Alaska, Arkansas, Arizona, California, Connecticut, Delaware, Florida, Hawaii, Kansas, Louisiana, Massachusetts, Michigan, Minnesota, Missouri, Mississippi, Montana, New Jersey, New York, Ohio, Oklahoma, Oregon, Rhode Island, South Carolina, Tennessee, Texas, Vermont, West Virginia).
  • Providing copies or sending out bulk mailings (Connecticut, Delaware, Louisiana, Massachusetts, Michigan, New Jersey, New Mexico, New York, Oklahoma, Pennsylvania, Washington).
  • Creating healthy school awards programs using the SHI to develop their criteria (Louisiana, New York, Ohio, Pennsylvania, Utah, Wisconsin).
  • Training teachers and other school staff to use the SHI through pre-service education (Adelphi University, Georgia State University, Morehead State University, Purdue University, Southeastern Louisiana, University of Arizona, University of Florida, University of Tennessee-Chattanooga, Youngstown State University).
  • Encouraging or requiring schools to incorporate the SHI results into overall School Improvement Plans (Alabama, Alaska, Arkansas, Florida, Indiana, Tennessee).

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Impact on Policies and Programs

Schools across the country have made many changes in their health and safety policies and programs after implementing the SHI. Examples of some of the changes that have been made include the following:

  • Physical Activity
    • Developed walking clubs and adopted Kids Walk to School programs
    • Increased time for physical education
    • Installed fitness stations for student and community use
  • Nutrition
    • Offered cooking classes or cooking clubs
    • Incorporated vegetable gardening into science classes
    • Removed unhealthy food choices from vending machines
  • Tobacco
    • Made schools tobacco-free
    • Offered tobacco cessation programs
  • Unintentional Injury and Violence Prevention
    • Offered CPR training for staff
    • Revised and update school crisis response plans
    • Provided training on conflict resolution
  • Asthma
    • Offered in-service asthma training to staff
    • Used Open Airways curriculum to educate families about asthma
    • Started Power Breathers club for support and asthma education
  • Cross-Cutting
    • Sponsored Healthy Activity Nights
    • Provided health tips of the day to students and periodically in school newsletters
    • Created a school health team
  • More...

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Modifying and Adapting the SHI

The SHI’s science-based approach has inspired others to modify the tool to fit their state or local needs. Modifications include adding health topics and offering the SHI in different forms, such as online or in Spanish. Examples of modifications include the following:

  • Topics added—
    • Mental health (Alabama, Michigan, Oregon)
    • HIV/AIDS prevention, sexual risk behaviors, and blood borne pathogens (Kentucky, Montana, Massachusetts, Maine)
    • Substance abuse (Maine)
    • Fruit and vegetable promotion (California)
    • Safe Routes to School (New York)
  • Spanish version (Arizona, California)
  • Online versions or customized version for state (Delaware, Louisiana, Indiana, Maine, Michigan, New York, Pennsylvania, Texas)
  • District-level SHI (Kentucky, North Carolina, South Carolina)
  • Student version (Massachusetts)

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Evaluating the SHI

Early efforts to evaluate the SHI focused on process evaluations (North Carolina, Michigan, Arizona, Georgia) and compilations of success stories (Kansas, Michigan, Oregon). Several articles have been published in scientific journals that have evaluated the SHI implementation process and described the results of the process.1-5

The Massachusetts Department of Public Health developed a school-based overweight prevention initiative, 5-2-1 Go! (eat 5 servings of fruits and vegetables daily, limit screen time to no more than 2 hours a day, and get at least 1 hour of physical activity daily). The program has two main components, the SHI and Planet Health, that work together to make positive changes in both individual behaviors and organizational decision making. The intervention has been shown to be effective in preventing disordered weight-control behaviors in early adolescent girls.6 Items from the SHI are also being used as indicators of best practices. CDC/DASH applied the SHI to a nationally representative sample of schools using data from the School Health Policies and Programs Study (SHPPS) to assess the percentage of schools nationwide achieving the school health recommendations described in the SHI.7

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Feedback from the Field

See what others have said about the School Health Index in Feedback from the Field.


  1. Austin SB, Fung T, Cohen-Bearak A, Wardle K, Cheung LWY. Facilitating change in school health: a qualitative study of schools’ experiences using the School Health Index. Prev Chronic Dis [serial online] 2006 Apr.
  2. Pearlman DN, Dowling E, Bayuk C, Cullinen K, Thacher AK. From concept to practice: using the School Health Index to create healthy school environments in Rhode Island elementary schools. Prev Chronic Dis [serial online] 2005 Nov.
  3. Staten LK, Teufel-Shone NI, Steinfelt VE, Ortega N, Halverson K, Flores C, et al. The School Health Index as an impetus for change. Prev Chronic Dis [serial online] 2005 Jan.
  4. Sherwood-Puzzello CM, Miller M, Lohrmann D, Gregory P. Implementation of CDC's School Health Index in 3 midwest middle schools: motivation for change. J Sch Health. 2007; 77: 285-293.
  5. 5. Geiger BF, Petri CJ, Barber C. A university-school system partnership to assess the middle school health program. American Journal of Health Studies 2004; 19(3):158-163.
  6. Austin SB, Kim J, Wiecha J, Troped PJ, Feldman HA, Peterson KE. School-Based Overweight Preventive Intervention Lowers Incidence of Disordered Weight-Control Behaviors in Early Adolescent Girls. Arch Pediatr Adolesc Med 2007; 161(9):865-869.
  7. Brener N, Pejavara A, Barrios L, Crossett L, Lee SM, McKenna M, Michael S, Wechsler H. Applying the School Health Index to a Nationally Representative Sample of Schools. J Sch Health 2006;76(2):57–66.

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Page last reviewed: October 03, 2007
Page last modified: January 03, 2008
Content source: National Center for Chronic Disease Prevention and Health Promotion, Division of Adolescent and School Health

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National Center for Chronic Disease Prevention and Health Promotion
Division of Adolescent and School Health