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Back to School Health Profiles
Profiles 2000
School Health Profiles
Surveillance for Characteristics of Health Education
Among Secondary Schools
U.S. Department of Health and Human Services
Published 2003
Table of Contents
Authors, Suggested
Citation, and Ordering Information
State and Local
Profiles Coordinators
Introduction
Methodology
Sampling
Data Collection
Data Analysis
Background
Health Education
School Health Policies
Results
Health Education
- Required Health Education
- Standards, Curricula, Guidelines, and Frameworks for Required Health
Education Courses
- Content of Required Health Education Courses
- Coordination of Health Education
- Professional Preparation of Lead Health Education Teachers
- Staff Development of Lead Health Education Teachers
- Parental and Community Involvement
School Health Policies
- HIV Infection/AIDS
- Tobacco Use
- Unintentional Injuries and Violence
Trends in Health Education and School
Health Policies
Comparison to National Data
Discussion
References
Tables
TABLE 1. Sample Sizes and Response
Rates, Selected U.S. Sites—School Health Education Profiles, Principals’
and Teachers’ Surveys, 2000
TABLE 2. Percentage of Schools That Required Health Education in Grades
6–12 and, Among Those Schools, Percentage That Taught >=1 Separate Health Education Course, Selected U.S. Sites—School
Health Education Profiles, Principals’ Surveys, 2000
TABLE 3. Percentage of Schools With a Required Health Education Course
That Required Teachers To Use Standards, a Specific Curriculum, Guidelines, Framework, or Other Selected Materials,
Selected U.S. Sites—School Health Education Profiles, Teachers’ Surveys, 2000
TABLE 4. Percentage
of Schools That Tried To Increase Student Knowledge in Specific Topics,
Selected U.S. Sites—School Health Education Profiles, Teachers’ Surveys,
2000
TABLE 5. Percentage
of Schools That Tried To Improve Specific Student Skills, Selected U.S.
Sites—School Health Education Profiles, Teachers’ Surveys, 2000
TABLE 6. Percentage of Schools That Taught Specific Topics Related to
HIV Infection/AIDS Prevention, Selected U.S. Sites—School
Health Education Profiles, Teachers’ Surveys, 2000
TABLE 7. Percentage of Schools in Which a Specific Person Was
Responsible for Coordinating Health Education, Selected U.S. Sites—School Health Education Profiles, Principals’ Surveys, 2000
TABLE 8. Percentage
of Schools in Which Health Education Teachers Planned or Coordinated
Health-Related Projects or Activities With Other Groups, Selected U.S.
Sites—School Health Education Profiles, Teachers’ Survey, 2000
TABLE 9. Percentage
of Schools in Which the Lead Health Education Teacher Had Professional
Preparation in a Specific Area, Selected U.S. Sites—School Health
Education Profiles, Teachers’ Surveys, 2000
TABLE 10.
Percentage of Schools in Which the Lead Health Education Teacher Had
Received >= 4 Hours of Staff Development During the Preceding 2 Years in
Specific Health Education Topics, Selected U.S. Sites—School Health
Education Profiles, Teachers’ Surveys, 2000
TABLE 11. Percentage of Schools in Which the Lead Health Education
Teacher Wanted Staff Development in Specific Health Education Topics, Selected U.S. Sites—School Health Education
Profiles, Teachers’ Surveys, 2000
TABLE 12. Percentage of Schools in Which the Lead Health Education
Teacher Received Staff Development in Specific Teaching Methods, Selected U.S. Sites—School Health Education Profiles,
Teachers’ Surveys, 2000
TABLE 13. Percentage of Schools in Which the Lead Health Education
Teacher Wanted Staff Development in Specific Teaching Methods, Selected U.S. Sites—School Health Education Profiles,
Teachers’ Surveys, 2000
TABLE 14. Percentage of Schools That
Received Parental Feedback About Health Education in Their School and,
Among Those Schools, Percentage That Received a Specific Type of Feedback,
Selected U.S. Sites—School Health Education Profiles, Principals’ Surveys,
2000
TABLE 15. Percentage of Schools With a Written Policy on HIV-Infected
Students or School Staff and, Among Those Schools, Percentage That Addressed Specific Topics, Selected U.S. Sites—School
Health Education Profiles, Principals’ Surveys, 2000
TABLE 16. Percentage of Schools With a Policy Prohibiting Cigarette
Smoking by Students and, Among Those Schools, Percentage That Had a Policy Prohibiting Cigarette Smoking in Specific
Locations, Selected U.S. Sites— School Health Education Profiles, Principals’ Survey, 2000
TABLE 17. Percentage of Schools That Took Specific Actions When
Students Were Caught Smoking Cigarettes, Selected U.S. Sites—School Health Education Profiles, Principals’ Survey, 2000
TABLE 18. Percentage of Schools That Prohibited Tobacco Advertising in
Specific Places, Through Sponsorship of School Events, and on Student Apparel, Selected U.S. Sites—School Health Education
Profiles, Principals’ Surveys 2000
Table 19. Percentage of Schools That
Implemented Safety and Security Measures, Selected U.S. Sites—School
Health Education Profiles, Principals’ Surveys, 2000
Authors
Phyllis Storch, M.P.H.
Jo Anne Grunbaum, Ed.D.
Laura Kann, Ph.D.
Barbara Williams, Ph.D.
Steve Kinchen
Lloyd Kolbe, Ph.D.
Suggested Citation
Storch P, Grunbaum JA, Kann L, Williams B, Kinchen S, Kolbe L. School
Health Education Profiles: Surveillance for Characteristics of Health
Education Among Secondary Schools (Profiles 2000). Atlanta, GA:
Centers for Disease Control and Prevention, 2003.
Ordering Information
For additional information about school health or to request free copies
of this report, send an e-mail to
Healthyyouth@cdc.gov; call 888–231–6405; or visit our internet site at
http://www.cdc.gov/healthyyouth/profiles
Back to Table of Contents |
STATE AND LOCAL SCHOOL HEALTH EDUCATION PROFILES
COORDINATORS |
Site |
Coordinator
|
Affiliation |
Alabama |
Gay
Allen |
Department of Education |
Alaska |
Beth Shober |
Department of Education and Early
Development |
Arkansas
|
Kathleen Courtney, M.S.
|
Department of Education |
California
|
Caroline Roberts
|
Department of Education |
Chicago, IL
|
Margaret M. Finnegan, M.S.
|
Chicago Public Schools |
Dallas, TX
|
Phyllis E. Simpson, Ph.D., M.S.
|
Dallas Independent School District |
Delaware
|
Janet Arns Ray, M.S.
|
Department of Education |
District of Columbia
|
Linda Wright, M.A.
|
District of Columbia Public Schools |
Fort Lauderdale, FL
|
Mike Weissberg, M.S.
|
School Board of Broward County |
Georgia
|
Phil Hulst
|
Department of Education |
Hawaii
|
Lynn Shoji
|
Department of Education |
Houston, TX
|
Rose Haggerty,M.Ed.
|
Houston Independent School District |
Idaho
|
Barbara Eisenbarth, M.Ed.
|
Department of Education |
Illinois
|
Glenn Steinhausen, Ph.D.
|
State Board of Education |
Indiana
|
Phyllis J. Lewis,M.S.N.
|
Department of Education |
Iowa
|
Sara A. Peterson, M.A.
|
Department of Education |
Kentucky
|
Renee White, M.S.H.A.
|
Department of Education |
Louisiana
|
Lillie Burns, M.A.
|
Department of Education |
Los Angeles, CA
|
Rona Cole, M.A.
|
Los Angeles Unified School District |
Maine
|
Joni Foster
|
Department of Education |
Maryland
|
Lynne Weise,M.Ed.
|
Department of Education |
Massachusetts
|
Belinda Abbruzzese, M.P.H.
|
Department of Education |
Miami, FL
|
Rodolfo Abella, Ph.D.
|
Miami-Dade County Public Schools |
Michigan
|
Merry Stanford, M.Ed., M.S.W.
|
Department of Education |
Minnesota
|
Jim Colwell
|
Department of Children, Families and Learning |
Missouri |
Kevin Miller, M.A.
|
Department of
Elementary and Secondary Education |
Montana
|
Susan Court
|
Office of Public Instruction |
Nebraska
|
Jeff Armitage
|
Department of Education |
New Hampshire
|
Virginia C. St.Martin, M.A.T.
|
Department of Education |
New Jersey
|
Sarah Kleinman
|
Department of Education |
New Orleans, LA
|
Stephanie M.Turlich
|
Orleans Parish School
Board |
North Dakota
|
Linda Johnson, M.S.
|
Department of Public Instruction |
Ohio
|
Mary Lou Rush, Ph.D.
|
Department of Education |
Oklahoma
|
Cecily Welter
|
Department of Education |
Orange County, FL
|
Kathy Bowman-Harrow, M.S.
|
Orange County Public Schools |
Palm Beach, FL
|
Dani Fitzgerald
|
School District of Palm Beach County |
Pennsylvania
|
Shirley A. Black, M.Ed.
|
Department of Education |
Philadelphia, PA
|
Bettyann Creighton, M.Ed.
|
School District of Philadelphia |
San Diego, CA
|
Marge Kleinsmith-Hildebrand, M.S.
|
San Diego Unified School District |
San Francisco, CA
|
Phong Pham, M.A.
|
San Francisco Unified School District |
South Carolina
|
Aaron Bryan, M.A.
|
Department of Education |
Tennessee
|
Jerry Swaim, M.S.
|
Department of Education |
Texas
|
Tommy Fleming
|
Texas Education Agency |
Utah
|
Vicky Dahn, Ph.D.
|
Office of Education |
Virginia
|
Fran Anthony Meyer, Ph.D.
|
Department of Education |
West Virginia
|
J.Dean Lee
|
Department of Education |
School health education has the potential to reduce and
prevent some of the most critical public health problems
in the United States, including cardiovascular disease,
cancer, motor-vehicle crashes, homicide, and suicide.1
The importance of school health education is exemplified
by Objective 7-2 of Healthy People 2010, which is
to “Increase the proportion of middle, junior high, and
senior high schools that provide school health education
to prevent health problems in the following areas:
unintentional injury; violence; suicide; tobacco use
and addiction; alcohol and other drug use; unintended
pregnancy, HIV/AIDS, and STD infection; unhealthy
dietary patterns; inadequate physical activity; and environmental
health.”2(pg.7–14)
The seven National Health Education Standards, developed
by the Joint Committee on National Health Education
Standards, describe what students should know and be able
to do as a result of school health education.3 According
to these standards, students should be able to
- Comprehend concepts related to health
promotion and disease prevention.
- Demonstrate the ability to access
valid health information and health-promoting products and services.
- Demonstrate the ability to practice
health-enhancing behaviors and reduce health risks.
- Analyze the influence of culture,
media, technology, and other factors on health.
- Demonstrate the ability to use
interpersonal communication skills to enhance health.
- Demonstrate the ability to use
goal-setting and decision-making skills to enhance health.
- Demonstrate the ability to advocate
for personal, family, and community health.
The quality of school health education is determined,
in part, by the curriculum planning and development
process, teacher preparation, curriculum implementation,
and assessment and evaluation,4 as
well as by resources available to complement these tasks.
In 1995, CDC collaborated with state and large local education and
health agencies to develop the School Health Education Profiles
(Profiles). The purpose of the Profiles is to monitor and assess
characteristics of and trends in health education and health policies
among middle/junior high schools and senior high schools across states and
cities. Data were collected in 1996, 1998, and 2000 from each school’s
principal and lead health education teacher (i.e., the person who
coordinates health education policies and programs within a middle/junior
high school or senior high school) using a self-administered
questionnaire.
This report summarizes data from the 2000 Profiles.
Principals’ and lead health education teachers’ surveys
were conducted in 38 states and 13 cities to assess trends
in school health education and school health policies
since the mid-1990s. In addition, this report compares
the 2000 Profiles data with national data on health
education and school health policies from the School
Health Policies and Programs Study 2000 (SHPPS 2000).
SAMPLING
The Profiles employ systematic equal-probability sampling
strategies to produce representative samples of schools
serving students in grades 6–12 in each jurisdiction. In
most states and cities, the sampling frame consists of all
regular secondary public schools with one or more of
grades 6–12. Some education and health agencies
modify this procedure by inviting all schools, rather
than just a sample, to participate.
DATA COLLECTION
Data are collected from each sampled school during the
spring semester. Both questionnaires are mailed to the
principal, who then identifies the school’s lead health
education teacher. Participation in the survey is confidential
and voluntary; follow-up telephone calls and
written reminders are used to encourage participation.
The principal and teacher record their responses in the
questionnaire booklets and return them directly to the
state or local education or health agency.
DATA ANALYSIS
A weighting factor is applied to each record to reflect
the likelihood of principals or teachers being selected
and to adjust for differing patterns of nonresponse. Data
from a state or city that had an overall response rate of
70% or greater and appropriate documentation were
weighted, whereas data from a state or city that did not
meet these criteria were not weighted. Weighted data
represent all public schools serving grades 6–12 in that
jurisdiction; unweighted data represent only the participating
schools. Because of a low response rate, data from
principals’ surveys conducted in four states and lead
health education teachers’ surveys conducted in five
states are not included in this report. Thus, this report represents information from 33 states with data from
both principals’ and lead health education teachers’ surveys,
one state with data from the principals’ survey
only, and 13 cities with data from both principals’ and
lead health education teachers’ surveys (Table 1).
Across states, the sample sizes of the principals’ surveys
ranged from 56 to 573, and the response rates ranged
from 53% to 98%; across cities, the sample sizes ranged
from 24 to 242, and the response rates ranged from 58%
to 100% (Table 1). The sample sizes of the lead health
education teachers’ surveys across states ranged from 47
to 563, and the response rates ranged from 50% to 91%;
across cities, the sample sizes ranged from 24 to 235, and
the response rates ranged from 60% to 100%.
SAS software was used to compute point estimates.
Medians are presented for all states (i.e., those with
weighted data and those with unweighted data combined)
and for all cities (i.e., those with weighted data
and those with unweighted data combined). The
Wilcoxon rank-sum test was used to test for differences
between 1996 and 2000 data across states and cities.
This is a nonparametric analogue to a two-sample t-test.
This statistical procedure (a) rank-ordered all sites for
both years separately for states and cities, (b) summed
the ranks separately by year and for states and cities,
and (c) compared the rank sums separately for states
and cities to determine if the distribution of the variable
was the same for 1996 and 2000. Assuming the percentages
have an underlying continuous distribution, the
distribution of ranks is approximately normal; therefore,
a z-value was used as the test statistic. The distributions
were considered significantly different at p ≤ .05.
HEALTH EDUCATION
The Institute of Medicine (IOM) recommends that
schools require at least a one-semester health education
course at the secondary school level.1 School health education
provides students with the knowledge, attitudes,
and skills they need to avoid or modify behaviors related
to the leading causes of death, illness, and injury during
youth and adulthood. Health education should address
the physical, mental, emotional, and social dimensions
of health and be age appropriate.5 Health education curricula
should be planned, sequential, and implemented
for all grades in elementary and middle/junior high
schools and through at least one semester in senior
high schools.1, 4
A necessary component of effective health education is
management and coordination by a professional who
is trained in health education.6 That person may work
directly within the school or at the school district level.
Curriculum planning and development is enhanced
when schools have a school health coordinator. In addition,
collaboration among health education teachers and
other school staff members also improves the implementation
of health education curricula. To supplement a
separate health education course, health-related information
can be included in a range of disciplines, including
physical education, the sciences, mathematics, language
arts, social studies, home economics, and the arts.7
Professional preparation and staff development for
teachers are critical for the implementation of effective
school health education programs.8, 9 Lack of teacher
training is a serious obstacle to the implementation of
effective school health education.10 Staff development
for health education teachers should focus on those
strategies that will actively engage students as well as facilitate their mastery of critical health information and
skills.4 Teachers who receive training implement health
education curricula with more fidelity than teachers who
do not receive training, resulting in more knowledge
gain among students.11
Partnerships between schools, parents, community
members, and other professionals are a key element of
effective school health programs. Those partnerships
contribute to successful school health education programs
and to improved student health-related knowledge
and skills.12 A health committee or advisory
council within the school or school district can help
build support for school health initiatives. Schools that
have a good relationship with parents are more likely to
gain parent cooperation with school health efforts.13
Support from parents can lead to the overall success or
failure of a student as well as the success or failure of a
new health program in the school. In addition, parent
involvement in health education increases both student
achievement and self-esteem.14
SCHOOL HEALTH POLICIES
Effective school health policies can help create a safe,
positive physical and psychological school environment,
prevent injuries from occurring at school, and prevent
school failure, substance use, and violence.15, 16
Because 50% of new cases of HIV infection occur among
adolescents and young adults,17 having school health
policies that address issues raised by HIV infection and
AIDS is critical for protecting the rights of affected
students and school staff members. The policies should
cover school attendance, employment, privacy, infection
control, participation in athletics, HIV prevention education,
counseling services, and staff development.18
Tobacco use is the single leading preventable cause of
death in the United States.19 Approximately 80% of
tobacco users initiate use before the age of 18 years.20
CDC’s Guidelines for School Health Programs to Prevent
Tobacco Use and Addiction identify strategies for schools
to help prevent tobacco use among youth.21 An important
strategy is the development and enforcement of a school
policy on tobacco use. The policy should include prohibitions
against tobacco use by students, school staff members,
parents, and visitors on school property, in school
buildings, and at school functions away from school
property. In addition, the policy should prohibit tobacco
advertising in school buildings, on school property, and
in school publications. An effective tobacco control policy
is essential in helping to achieve the Healthy People
2010 objective to decrease tobacco use among youth.2
Seventy-one percent of all deaths among persons 10–24
years of age result from only four causes: motor vehicle
crashes, other unintentional injuries, homicide, and suicide.22
The No Child Left Behind Act of 2001 authorizes
federal funds for school programs to prevent violence in
and around schools.23 Effective and safe schools are well
prepared for any potential crisis or violent acts.24 The
CDC’s School Health Guidelines to Prevent Unintentional
Injury and Violence identify strategies for schools that
can help prevent unintentional injuries, violence, and
suicide.25 An important strategy is to establish both social
and physical environments that promote safety and
prevent unintentional injuries, violence, and suicide.
HEALTH EDUCATION
Required Health Education
- Across states, the percentage of schools that required
health education for students in grades 6–12 ranged
from 31.4% to 100.0% (median: 91.7%) (Table 2).
Among those schools, the median percentage that
taught one or more separate health education courses
was 95.4% and ranged from 78.1% to 100.0% across
states.
- Across cities, the percentage of schools that required
health education for students in grades 6–12 ranged
from 0.0% to 100.0% (local median: 88.0%) (Table 2). Among those schools, the median percentage that
taught one or more separate health education courses
was 93.2% and ranged from 69.0% to 100.0% across
cities.
Standards, Curricula, Guidelines, and Frameworks
for Required Health Education Courses
Many schools required teachers in a required health
education course to use specific standards, curricula, or
materials. The range in percentages of schools that
required their use was as follows* (Table 3):
* Schools could report use of one or more types of material.
- The National Health Education Standards: from
16.5% to 60.8% across states (state median: 32.2%)
and from 27.1% to 73.7% across cities (local median:
45.1%).
- A state, district, or school curriculum, guidelines,
or framework: from 81.0% to 100.0% (state median:
95.9%) across states and from 93.9% to 100.0% across
cities (local median: 100.0%).
- Materials from health organizations such as the
American Red Cross or the American Cancer
Society: from 10.5% to 59.0% across states (state
median: 36.2%) and from 34.8% to 78.7% across
cities (local median: 67.9%).
- A commercially developed teacher’s guide: from
20.5% to 80.1% across states (state median: 52.1%)
and from 32.7% to 78.2% across cities (local median:
63.5%).
Content of Required Health Education Courses
Required health education courses aim to increase student
knowledge about a variety of health-related topics. The
range in percentages of schools that covered specific
health-related topics was as follows (Table 4):
- Alcohol or other drug-use prevention: from 94.6%
to 100.0% across states (state median: 99.2%) and
from 98.1% to 100.0% across cities (local median:
100.0%).
- Dietary behavior and nutrition: from 85.9% to
98.6% across states (state median: 93.6%) and from
90.1% to 100.0% across cities (local median: 96.4%).
- HIV prevention: from 74.7% to 100.0% across states
(state median: 97.8%) and from 95.8% to 100.0%
across cities (local median: 100.0%).
- Physical activity and fitness: from 88.1% to 98.1%
across states (state median: 94.3%) and from 84.9%
to 100.0% across cities (local median: 95.6%).
- Pregnancy prevention: from 45.0% to
97.5% across states (state median: 85.9%) and from 79.5% to 100.0% across
cities (local median: 92.8%).
- STD prevention: from 62.4% to 100.0%
across states (state median: 93.1%) and from 88.2% to 100.0% across cities
(local median: 98.6%).
- Suicide prevention: from 56.6% to 90.4% across
states (state median: 74.3%) and from 50.2% to 95.2% across cities (local
median: 79.6%).
- Tobacco-use prevention: from 92.9% to 100.0% across
states (state median: 99.2%) and from 95.0% to 100.0% across cities (local
median: 100.0%).
- Violence prevention: from 72.4% to 94.9% across states
(state median: 82.8%) and from 85.6% to 100.0% across cities (local
median: 90.2%).
Required health education courses aim to improve
student skills. The range in percentages of schools that
covered specific skills was as follows (Table 5):
- Analysis of media messages: from 62.3% to 93.6%
across states (state median: 81.0%) and from 57.1%
to 90.1% across cities (local median: 77.9%).
- Communication: from 85.4% to 97.7% across states
(state median: 91.3%) and from 87.9% to 100.0%
across cities (local median: 94.4%).
- Decision making: from 91.2% to 99.6% across states
(state median: 97.7%) and from 93.9% to 100.0%
across cities (local median: 98.3%).
- Goal setting: from 84.8% to 98.6% across states (state
median: 93.1%) and from 84.6% to 100.0% across
cities (local median: 95.6%).
- Conflict resolution: from 78.7% to 100.0% across
states (state median: 86.4%) and from 84.6% to
100.0% across cities (local median: 92.2%).
- Resisting peer pressure: from 88.9% to 99.2% across
states (state median: 97.2%) and from 93.9% to
100.0% across cities (local median: 98.0%).
- Stress management: from 75.8% to 98.8% across
states (state median: 89.6%) and from 72.1% to
100.0% across cities (local median: 86.3%).
Specific HIV prevention topics were covered in required
health education courses. The range in percentages of
schools that covered those HIV prevention topics was as
follows (Table 6):
- Abstinence to avoid HIV infection: from 70.3% to
100.0% across states (state median: 95.1%) and from
92.3% to 100.0% across cities (local median: 100.0%).
- How HIV is transmitted: from 69.0% to 99.3%
across states (state median: 95.3%) and from 93.1%
to 100.0% across cities (local median: 100.0%).
- How to correctly use a condom: from 9.5% to 68.5%
across states (state median: 35.8%) and from 29.8% to
90.9% across cities (local median: 66.3%).
- Condom efficacy: from 40.6% to 84.3% across states
(state median: 71.2%) and from 67.2% to 100.0%
across cities (local median: 90.8%).
- The number of young people who get HIV: from
67.7% to 95.6% across states (state median: 87.8%)
and from 86.3% to 100.0% across cities (local median:
96.0%).
- How to find valid information on HIV: from 61.7%
to 91.5% across states (state median: 82.1%) and from
83.5% to 100.0% across cities (local median: 95.4%).
Coordination of Health Education
Across states and cities, a health education teacher
was identified most often (state median: 45.7%; local
median: 50.8%) as being responsible for coordinating
health education (Table 7). A school district administrator
was less likely (state median: 22.5%; local median:
21.9%) to be responsible for coordinating health education,
as was a school administrator (state median:
20.7%; local median: 22.4%). A school nurse infrequently
or rarely (state median: 1.6%; local median:
1.2%) coordinated health education. The median percentage
of schools in which no one was responsible for
coordinating health education was 4.4% across states
and 3.7% across cities.
Health education staff worked with other school staff
and community members on health education activities.
The range in percentages of schools that coordinated
health-related activities was as follows (Table 8):
- Physical education (PE) staff: from 47.6% to 90.1%
across states (state median: 67.9%) and from 35.8%
to 100.0% across cities (local median: 62.1%).
- School health services staff: from 30.8% to 85.5%
across states (state median: 67.8%) and from 36.6%
to 95.0% across cities (local median: 74.9%).
- School mental health staff: from 36.0% to 78.9%
across states (state median: 52.9%) and from 38.1%
to 81.5% across cities (local median: 60.2%).
- Food service staff: from 8.4% to 29.1% across states
(state median: 17.3%) and from 10.5% to 56.5%
across cities (local median: 16.8%).
- Community members: from 30.7% to 74.6% across
states (state median: 50.3%) and from 38.2% to
74.1% across cities (local median: 49.7%).
Professional Preparation of Lead Health
Education Teachers
Lead health education teachers reported professional
preparation in an array of disciplines. The median percentage
of schools in which the lead health education
teacher had professional preparation in a specific discipline
was as follows (Table 9):
- Health and physical education: 51.6% across states
and 37.3% across cities.
- Health education only: 6.6% across states and 8.4%
across cities.
- Physical education only: 13.2% across states and
4.7% across cities.
- Science or other education degree: 16.2% across
states and 29.0% across cities.
- Nursing or counseling: 3.1% across states and 0.0%
across cities.
- Another discipline: 3.5% across states and 5.6%
across cities.
Staff Development of Lead Health Education Teachers
Lead health education teachers had 4 or more hours of staff
development during the preceding 2 years in many health-related topics.
The range in percentages of schools in which the lead health education
teacher had received staff development in specific topics was as follows
(Table 10):
- Alcohol or other drug-use prevention: from 36.5%
to 79.6% across states (state median: 48.4%) and from
35.8% to 100.0% across cities (local median: 56.5%).
- Dietary behavior and nutrition: from 16.8% to
70.8% across states (state median: 27.9%) and from
11.0% to 66.7% across cities (local median: 31.0%).
- HIV prevention: from 30.3% to 88.0% across states
(state median: 48.4%) and from 54.2% to 100.0%
across cities (local median: 74.1%).
- Physical activity and fitness: from 22.9% to 61.9%
across states (state median: 43.1%) and from 13.3%
to 91.4% across cities (local median: 36.0%).
- Pregnancy prevention: from 14.0% to 63.4% across
states (state median: 26.2%) and from 32.1% to
97.7% across cities (local median: 42.9%).
- STD prevention: from 17.3% to 80.7% across states
(state median: 36.3%) and from 48.3% to 97.7%
across cities (local median: 64.7%).
- Suicide prevention: from 13.6% to 73.0% across
states (state median: 23.0%) and from 13.1% to
75.7% across cities (local median: 32.1%).
- Tobacco use prevention: from 15.4% to 78.5%
across states (state median: 33.8%) and from 28.4%
to 100.0% across cities (local median: 47.4%).
- Violence prevention: from 32.7% to 73.3% across states (state
median: 50.5%) and from 33.5% to 93.4% across cities (local median:
61.5%).
The range in percentages of schools in which the lead health education
teacher wanted but had not yet received staff development was as follows
(Table 11):
- Alcohol or other drug-use prevention: from 54.2%
to 85.9% across states (state median: 71.1%) and from
60.7% to 94.3% across cities (local median: 75.5%).
- Dietary behavior and nutrition: from 44.5% to
79.3% across states (state median: 62.7%) and from
37.8% to 79.2% across cities (local median: 70.8%).
- HIV prevention: from 50.1% to 85.0% across states
(state median: 68.2%) and from 59.3% to 85.7%
across cities (local median: 70.3%).
- Physical activity and fitness: from 45.9% to 75.1%
across states (state median: 58.3%) and from 26.6%
to 82.9% across cities (local median: 57.0%).
- Pregnancy prevention: from 43.9% to 79.3% across
states (state median: 58.5%) and from 53.1% to
87.5% across cities (local median: 67.1%).
- STD prevention: from 49.7% to 84.0% across states
(state median: 65.4%) and from 61.3% to 95.8%
across cities (local median: 73.3%).
- Suicide prevention: from 60.1% to 84.9% across
states (state median: 72.0%) and from 56.7% to
91.4% across cities (local median: 73.5%).
- Tobacco-use prevention: from 50.0% to 87.3%
across states (state median: 63.4%) and from 47.7%
to 91.4% across cities (local median: 64.2%).
- Violence prevention: from 64.3% to 91.5% across
states (state median: 77.9%) and from 61.3% to
97.1% across cities (local median: 81.5%).
Lead health education teachers received staff development
during the preceding 2 years on various teaching
methods. The range in percentages of schools in which
the lead health education teacher had received staff
development in specific teaching methods was as follows
(Table 12):
- Teaching students with physical or cognitive
disabilities: from 26.8% to 57.1% across states
(state median: 38.8%) and from 11.1% to 70.6%
across cities (local median: 46.2%).
- Teaching students of various cultural backgrounds:
from 12.4% to 66.2% across states (state median:
34.2%) and from 41.3% to 79.8% across cities (local
median: 66.5%).
- Teaching students with limited English proficiency:
from 2.4% to 59.2% across states (state median:
14.5%) and from 16.2% to 85.6% across cities (local
median: 50.7%).
- Using interactive teaching methods such as roleplays
or cooperative group activities: from 40.2% to
67.4% across states (state median: 53.1%) and from
54.0% to 85.1% across cities (local median: 66.7%).
- Teaching skills for behavior change: from 22.6% to
60.1% across states (state median: 43.6%) and from
34.1% to 80.0% across cities (local median: 51.1%).
The range in percentages of schools in which the lead
health education teacher wanted but had not yet
received staff development in specific teaching methods
was as follows (Table 13):
- Teaching students with physical or cognitive
disabilities: from 47.7% to 84.2% across states
(state median: 61.5%) and from 54.0% to 88.6%
across cities (local median: 73.1%).
- Teaching students of various cultural backgrounds:
from 33.2% to 70.0% across states (state median:
52.0%) and from 51.9% to 82.6% across cities (local
median: 70.5%).
- Teaching students with limited English proficiency:
from 19.7% to 77.6% across states (state median:
45.0%) and from 38.9% to 79.5% across cities (local
median: 62.2%).
- Using interactive teaching methods such as roleplays
or cooperative group activities: from 44.5% to
83.1% across states (state median: 61.0%) and from
51.0% to 95.8% across cities (local median: 68.4%).
- Teaching skills for behavior change: from 65.8% to
88.7% across states (state median: 76.8%) and from
62.2% to 88.6% across cities (local median: 78.7%).
Parental and Community Involvement
The percentage of schools that had a school health
advisory committee to address health issues ranged from
20.4% to 78.8% across states (median: 42.9%) and from
41.2% to 95.5% across cities (median: 68.6%).
The percentage of schools that received parental feedback
about health education in their children’s school
ranged from 30.4% to 65.9% (state median: 52.5%)
across states and from 44.5% to 69.9% across cities
(local median: 57.1%) (Table 14). Among those schools
that received feedback, the median percentage of
schools that received mainly positive feedback was
88.7% across states and 90.0% across cities. The median
percentage of schools that received mainly negative
feedback was 1.0% across states and 0.0% across cities.
The median percentage of schools that received equally
positive and negative feedback was 10.3% across states
and 10.0% across cities.
SCHOOL HEALTH POLICIES
HIV Infection/AIDS
The percentage of schools with a written policy that
protects the rights of HIV-infected students or school
staff ranged from 26.7% to 75.4% across states (state
median: 54.8%) and from 37.8% to 100.0% across cities
(local median: 67.5%) (Table 15). Among those that
had a written policy, the range in percentages of schools that addressed specific topics was as follows (Table
15):
- Attendance at school of HIV-infected students:
from 84.3% to 100.0% across states (state median:
94.8%) and from 78.3% to 100.0% across cities (local
median: 95.3%).
- Protection of HIV-infected students and staff
members from discrimination: from 89.9% to 100.0%
across states (state median: 97.0%) and from 91.7%
to 100.0% across cities (local median: 100.0%).
- Maintenance of confidentiality for HIV-infected
students and staff members: from 92.4% to 100.0%
across states (state median: 98.5%) and from 95.8%
to 100.0% across cities (local median: 100.0%).
- Worksite safety: from 90.9% to 100.0% across states
(state median: 97.3%) and from 87.5% to 100.0%
across cities (local median: 100.0%).
- Confidential counseling for HIV-infected students:
from 63.3% to 84.6% across states (state median:
75.8%) and from 0.0% to 100.0% across cities (local
median: 87.4%).
- Communication of the policy to students, school
staff, and parents: from 74.3% to 92.3% across states
(state median: 86.1%) and from 78.3% to 100.0%
across cities (local median: 86.7%).
Tobacco Use
The percentage of schools with a policy that prohibits
cigarette smoking by students ranged from 96.1% to
100.0% across states (state median: 99.4%) and from
92.5% to 100.0% across cities (local median: 98.0%)
(Table 16). Among those that had a policy, the range
in percentages of schools that prohibited smoking in
specific locations was as follows (Table 16):
- In school buildings: from 99.1% to 100.0% across
states (state median: 100.0%) and from 97.7% to
100.0% across cities (local median: 100.0%).
- On school grounds: from 98.2% to 100.0% across
states (state median: 99.6%) and from 96.8% to
100.0% across cities (local median: 100.0%).
- In school buses or other vehicles used to transport
students: from 95.4% to 100.0% across states (state
median: 99.6%) and from 97.7% to 100.0% across
cities (local median: 100.0%).
- At off-campus, school-sponsored events: from 84.7%
to 100.0% across states (state median: 96.8%) and
from 91.3% to 100.0% across cities (local median:
97.9%).
The percentage of schools with a policy that prohibits
cigarette smoking by students in all four locations (in
school buildings, on school grounds, in school buses, and
at off-campus events) ranged from 84.0% to 100.0%
across states (state median: 96.3%) and from 90.6% to
100.0% across cities (local median: 97.9%).
Consequences exist for students who are caught smoking
cigarettes in schools that have a policy prohibiting cigarette
smoking by students. The range in percentages of
schools that took specific actions was as follows (Table 17):
- Referring students to a school counselor: from
42.3% to 81.1% across states (state median: 59.6%)
and from 34.8% to 100.0% across cities (local median:
71.9%).
- Referring students to a school administrator: from
93.7% to 100.0% across states (state median: 98.8%)
and from 85.0% to 100.0% across cities (local median:
96.3%).
- Encouraging students to participate in a cessation
program: from 28.5% to 75.5% across states (state
median: 54.9%) and from 21.3% to 76.5% across
cities (local median: 63.6%).
- Requiring students to participate in a cessation
program: from 9.6% to 57.7% across states (state
median: 25.4%) and from 8.6% to 90.5% across
cities (local median: 36.6%).
- Placing students in detention: from 33.0% to 66.3%
across states (state median: 49.7%) and from 29.5%
to 91.3% across cities (local median: 60.3%).
- Suspending students from school: from 43.1% to
90.5% across states (state median: 74.0%) and from
50.0% to 100.0% across cities (local median: 75.0%).
- Informing parents or guardians: from 93.3% to
100.0% across states (state median: 98.6%) and from
74.3% to 100.0% across cities (local median: 97.7%).
Tobacco advertising is prohibited by many schools. The
median percentage of schools that prohibited tobacco
advertising was as follows (Table 18):
- Tobacco advertising in school buildings, on school
grounds, on school buses, and in school publications:
92.5% across states and 92.1% across cities.
- Tobacco advertising through sponsorship of school
events: 90.2% across states and 90.7% across cities.
- Student wear of tobacco brand-name apparel: 92.1%
across states and 85.8% across cities.
Unintentional Injuries and Violence
The median percentage of schools that had a written
plan for responding to violence was 94.5% across states
and 97.6% across cities. The range in percentages of
schools that implemented safety and security measures
was as follows (Table 19):
- Requiring visitors to report to the main office: from
84.6% to 100.0% across states (state median: 99.6%)
and from 97.8% to 100.0% across cities (local median:
100.0%).
- Maintaining a closed campus: from 33.7% to 100.0%
across states (state median: 87.3%) and from 78.8% to
100.0% across cities (local median: 95.7%).
- Using staff or adult volunteers to monitor school
halls: from 67.9% to 93.8% across states (state
median: 87.1%) and from 87.0% to 100.0% across
cities (local median: 95.8%).
- Checking bags, desks, and lockers: from 7.4% to
77.5% across states (state median: 45.6%) and from
6.1% to 92.9% across cities (local median: 59.3%).
- Prohibiting backpacks: from 0.0% to 54.2% across
states (state median: 21.1%) and from 0.0% to 45.5%
across cities (local median: 7.9%).
- Requiring school uniforms: from 0.0% to 53.3%
across states (state median: 3.2%) and from 0.0% to
87.5% across cities (local median: 31.2%).
- Using metal detectors: from 0.0% to 49.3% across
states (state median: 6.4%) and from 0.0% to 93.3%
across cities (local median: 35.7%).
- Having uniformed police: from 6.5% to 83.3% across
states (state median: 32.8%) and from 56.3% to
100.0% across cities (local median: 92.6%).
The Profiles were first conducted in 1996 and repeated biennially with
all surveys using many of the same questions. For this report, the data
from questions that were the same in 1996 and 2000 were analyzed for
changes over time.
- The following are improvements in health education and health
policy that occurred from 1996 to 2000:
- Across states and cities, the percentage of schools
in which teachers taught about tobacco-use prevention increased.
- Across states, the percentage of schools in which teachers
tried to improve student skills in communication, decision making,
goal setting, conflict resolution, resisting peer pressure, and stress
management increased.
- Across states and cities, the percentage of schools
in which the health education teacher coordinated health education
increased.
- Across states, the percentage of schools in which health
education teachers planned or coordinated health-related projects or
activities with school health services staff increased.
- Across states, the percentage of schools that had a written
HIV policy on procedures to protect students and staff from
discrimination; maintain confidentiality of HIV-infected students and
staff; ensure worksite safety; and communicate the policy to students,
staff members, and parents increased.
- Across cities, the percentage of schools that had a written
HIV policy on worksite safety increased.
- Across states and cities, the percentage of schools
that had a health advisory group to address health issues increased.
- The following deteriorations in health education and health
policy occurred from 1996 to 2000:
- Across states and cities, the percentage of schools
that required a health education course decreased.
- Across states, the percentage of schools in which teachers
taught about dietary behavior and nutrition decreased.
- Across states, the percentage of schools in which teachers
taught how HIV is transmitted decreased.
- No changes in health education and health policy were detected
from 1996 to 2000 in the following areas:
- Across states and cities, the percentage of schools
in which teachers taught about alcohol or other drug-use prevention,
HIV prevention, physical activity and fitness, pregnancy prevention,
STD prevention, suicide prevention, and violence prevention.
- Across cities, the percentage of schools in which teachers
taught about nutrition and dietary behavior.
- Across cities, the percentage of schools in which teachers
tried to improve student skills in communication, decision making,
goal setting, conflict resolution, resisting peer pressure, and stress
management.
- Across states, the percentage of schools in which teachers
taught how to correctly use a condom and about condom efficacy.
- Across cities, the percentage of schools in which teachers
taught how HIV is transmitted, how to correctly use a condom, and
about condom efficacy.
- Across states and cities, the percentage of schools
in which health education teachers planned or coordinated health
education projects or activities with physical education staff, school
mental health staff, and food service staff.
- Across cities, the percentage of schools in which health
education teachers planned or coordinated health-related projects or
activities with school health services staff.
- Across cities, the percentage of schools that had a written
HIV policy on procedures to protect students and staff from
discrimination; maintain confidentiality of HIV-infected students and
staff; and communicate the policy to students, staff members, and
parents.
To provide a comprehensive description of school health education and
other components of the school health program, CDC periodically conducts
the School Health Policies and Programs Study (SHPPS). SHPPS was first
conducted in spring 199426 and repeated in spring 2000.27
SHPPS 2000 school-level data were collected from a nationally
representative sample of public and private elementary, middle/junior
high, and senior high schools. A comparison of 2000 Profiles data (states
and cities) with the national SHPPS 2000 data from middle/junior high and
senior high schools demonstrates the following:
- Nearly all schools across states and cities (median: 91.7% and
88.0%, respectively) and nationally (96.2%) required some health
education.28
- Across states and cities, the median percentage of schools that
tried to increase student knowledge on specific topics in a required
health education course was higher for nearly all topics as compared to
the national percentage.28
- Across states and cities, the median percentage of
schools in which the health education teacher
planned or coordinated projects with PE staff (median:
67.9% and 62.1%, respectively), health services
staff (median: 67.8% and 74.9%, respectively), and
mental health staff (median: 52.9% and 60.2%,
respectively) was similar to the national percentage
of schools in which the health education teacher
planned or coordinated projects with PE staff, health
services staff, and mental health staff (59.9%, 60.4%,
and 49.2%, respectively).28
- Across states and cities, the median percentage of schools that
required visitors to report to the main office (median: 99.6% and
100.0%, respectively) and that maintained a closed campus (median: 87.3%
and 95.7%, respectively) was similar to the national percentage of
middle/junior and senior high schools that required visitors to report
to the main office (94.3% and 99.2%, respectively) and that maintained a
closed campus (89.4% and 73.4%, respectively). However, the median
percentage of schools that used metal detectors and had uniformed police
varied greatly between states and cities (metal detectors: 6.4% and
35.7%, respectively; uniformed police: 32.8% and 92.6%) and nationally
in middle/junior and senior high schools (metal detectors: 10.0% and
10.0%, respectively; uniformed police: 19.2% and 30.1%, respectively).29
- Nearly all schools across states and cities (median: 99.4% and
98.0%, respectively) and nationally (95.0%) had a policy prohibiting
cigarette smoking by students.29 Among those schools, nearly all schools
across states and cities and nationally prohibited student smoking in
school buildings, on school grounds, in school buses, and at
school-sponsored, off-campus events.
School health education could be one of the most effective means to
reduce and prevent serious health problems, including cardiovascular
disease, cancer, motor vehicle crashes, homicide, and suicide, in the
United States.1 The Profiles provide information on curriculum planning,
curriculum implementation, and teacher qualifications and preparation,
which are all important areas of focus as schools and districts work to
improve school health education and health policies.
The 2000 Profiles data demonstrated that many schools have implemented
programs and policies that can positively influence health education
curriculum planning and development. Although the median percentage of
schools that required a health education course was 91.7% across states
and 88.0% across cities, this represents a decrease from 1996 for both
states and cities. The median percentage of schools that had a person to
coordinate health education was very high: 95.6% across states and 96.3%
across cities.
Nationwide, high school students continue to practice behaviors that
place them at risk for the development of serious health problems.30 The
Profiles data indicated that, across states and cities, most schools tried
to increase student knowledge in specific topics and a large percentage
tried to improve student skills to reduce risk behaviors. Across states
and cities, more than 85% of schools taught about diet and nutrition,
physical activity and fitness, and the prevention of HIV infection and
tobacco, alcohol, and drug use. However, since 1996 the median percentage
of states in which teachers taught about dietary behavior and nutrition,
how HIV is transmitted, and how to correctly use a condom has decreased.
Collaboration between schools and the community is critical to the
success of health education programs within schools, but the median
percentage of schools that planned or coordinated health education
projects or activities with community members was only 50.3% across states
and 49.7% across cities. This clearly shows that most schools have room
for improvement in their rates of collaboration with community members.
A large percentage of schools had a lead health education teacher with
professional preparation in health education or in health and physical
education combined. However, some schools had a lead health education
teacher whose professional preparation was not in health education. Health
education could be more effective if a greater percentage of schools
employed a lead health education teacher who was professionally trained in
health education.
Opportunities for professional development are important for
maintaining and increasing teachers’ knowledge and skills. The median
percentage of schools in which a lead health education teacher had
received 4 or more hours of staff development during the preceding 2 years
in a specific health topic varied by topic. However, the median percentage
of schools in which the lead health education teacher wanted, but had not
yet received, staff development ranged from 58.3% (physical activity and
fitness) to 77.9% (violence prevention) across states and from 57.0%
(physical activity and fitness) to 81.5% (violence prevention) across
cities. More frequent staff development with the most up-to-date
information is needed to help teachers confidently and effectively present
health topics to their students.
The findings in this report are subject to several limitations. First,
these data apply only to public middle/junior high schools and senior high
schools. Second, the data are self-reported by school principals and lead
health education teachers. Finally, the Profiles data do not provide an
in-depth assessment of all elements of health education or health
policies.
State and local education and health officials use Profiles data to
improve school health education and health policies. Data are used to
advocate for health education and to identify health education topics that
are taught. Data also are used to identify and monitor community and
parental involvement in health education, to identify areas for
improvement, to encourage appropriate professional preparation, and to
identify topics for staff development. Finally, Profiles data can help
school administrators and staff members determine how well their schools
are addressing the health and safety needs of their students.
- Institute of Medicine. Schools and Health: Our Nation’s
Investment.Washington, DC: National Academy Press, 1997.
- U.S. Department of Health and Human Services. Healthy People 2010.
2nd ed. with Understanding and Improving Health and Objectives for
Improving Health, 2 vols. Washington, DC: U.S. Department of Health
and Human Services, November 2000.
- Joint Committee on National Health Education Standards. National
Health Education Standards: Achieving Health Literacy. Atlanta, GA:
American Cancer Society, 1995.
- Lohrmann DK, Wolley SF. Comprehensive school health education. In:
Marx E, Wooley SF, eds., with Northrop D. Health Is Academic: A Guide
to School Health Programs. New York, NY: Teachers College Press,
1998:43–66.
- McKenzie FD, Richmond JB. Linking health and learning: an overview
of coordinated school health. In: Marx E, Wooley SF, eds., with Northrop
D. Health Is Academic: A Guide to School Health Programs. New
York, NY: Teachers College Press, 1998:1–14.
- National Commission on the Role of the School and the Community to
Improve Adolescent Health. Code Blue: Uniting for Healthier Youth.
Alexandria, VA: National Association of State Boards of Education, 1990.
- Palmer JM. Planning wheels turn curriculum around. Educational
Leader 1991;49:57–60.
- Allensworth, D. Health education: state of the art. Journal of
School Health 1993;63:14–20.
- Lavin AT. Comprehensive school health education: barriers and
opportunities. Journal of School Health 1993;63:24–27.
- Hamburg MV. School health education: what are the possibilities? In:
Cortese P, Middleton K, eds. The Comprehensive School Health
Challenge: Promoting Health Through Education. Santa Cruz, CA: ETR
Associates, 1994:3–19.
- Ross JG, Luepker RV, Nelson GD, Saavedra P, Hubbard BM. Teenage
health teaching modules: impact of teacher training on implementation
and student outcomes. Journal of School Health 1991;61:31–34.
- Epstein JL. School/family/community partnerships. Phi Delta
Kapaan 1995;76:701–712.
- Carlyon P, Carlyon W, McCarthy A. Family and community involvement
in school health. In: Marx E, Wooley SF, eds., with Northrop D.
Health Is Academic: A Guide to School Health Programs. New York, NY:
Teachers College Press, 1998:67–95.
- Birch, D. Involving families in school health education:
implications for professional preparation. Journal of School Health
1994:296–299.
- Henderson A, Rowe DE. A healthy school environment. In: Marx E,
Wooley SF, eds., with Northrop D. Health Is Academic: A Guide to
Coordinated School Health Programs. New York, NY: Teachers College
Press, 1998:96–115.
- Di Scala C, Gallagher SS, Schneps SE. Causes and outcomes of
pediatric injuries occurring at school. Journal of School Health
1997;67:384–389.
- Rosenberg PS, Biggar RJ, Goedert JJ. Declining age at HIV infection
in the United States. New England Journal of Medicine
1994;330:789–790.
- National Association of State Boards of Education. Someone at
School Has AIDS: A Comprehensive Guide to Education Policies Concerning
HIV Infection. Alexandria, VA: National Association of State Boards
of Education, 2001.
- CDC. Youth tobacco surveillance—United States, 1998–1999. MMWR
2000;49(SS–10).
- U.S. Department of Health and Human Services. Preventing Tobacco
Use Among Young People: A Report of the Surgeon General. Atlanta,
GA: U.S. Department of Health and Human Services, CDC, 1994.
- CDC. Guidelines for school health programs to prevent tobacco use
and addiction. MMWR 1994;43(RR–2).
- Anderson RN. Deaths: leading causes for 1999. National Vital
Statistics Reports 2001;49(11):1–88.
- No Child Left Behind Act of 2001, Pub. L. No. 107-110, §1061, 115
Stat. 2083 (2002).
- Dwyer K, Osher D, Warger C. Early Warning, Timely Response: A
Guide to Safe Schools. Washington, DC: U.S. Department of Education,
1998.
- CDC. School health guidelines to prevent unintentional injury and
violence. MMWR 2001;50(RR–22).
- Kann L, Collins JL, Pateman BC, Small ML, Ross JG, Kolbe LJ. The
School Health Policies and Programs Study (SHPPS): rationale for a
nationwide status report on school health programs. Journal of School
Health 1995;65:291–294.
- Kolbe L, Kann L, Brener N. Overview and summary of findings: School
Health Policies and Programs Study 2000. Journal of School Health
2001;71:253–260.
- Kann L, Brener N, Allensworth D. Health education: results from the
School Health Policies and Programs Study 2000. Journal of School
Health 2001;72:266–278.
- Small M, Jones SE, Barrios L, Crosset L, Dalhberg L, Albuquerque M,
Sleet D, Greene B, Schmidt E. School policy and environment: results
from the School Health Policies and Programs Study 2000. Journal of
School Health 2001;71:325–334.
- Grunbaum JA, Kann L, Kinchen SA, Williams B, Ross JG, Lowry R, Kolbe
L. Youth risk behavior surveillance—United States, 2001. MMWR
2002;51(SS–4).
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