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SCHOOL HEALTH PROGRAMS
Improving the Health of Our Nation’s Youth

At A Glance 2009

Schools: The Right Place for a Healthy Start

Establishing healthy behaviors during childhood and maintaining them is easier and more effective than trying to change unhealthy behaviors during adulthood. Schools play a critical role in promoting the health and safety of young people and helping them establish lifelong healthy behavior patterns. Each day, the nation’s 126,000 schools provide

• An opportunity for 56 million students to learn about health and practice the skills that promote healthy behaviors.
   
• A place for students to practice healthy behaviors such as eating healthy foods and participating in physical activity.

Risk Behaviors Are Established Early in Life

Six types of health risk behaviors contribute to the leading causes of death, disability, and social problems in the United States: tobacco use; unhealthy eating; inadequate physical activity; alcohol and other drug use; sexual behaviors that may result in HIV infection, other sexually transmitted diseases (STDs), and unintended pregnancy; and behaviors that contribute to unintentional injury and violence. These behaviors are often established during childhood or adolescence, persist into adulthood, and are preventable.

School health programs should focus on those health risk behavior areas, as well as other key health issues such as asthma and mental health, that have a great impact on the overall health and well-being of students.

Effective School Health Programs Reduce Risk Behaviors and Improve Learning

Research has shown that school health programs can reduce the prevalence of health risk behaviors among young people and have a positive effect on academic performance. The following findings demonstrate the effectiveness of school health programs:

• A North Carolina youth antismoking campaign increased the percentage of school districts in the state that adopted 100% tobacco-free school (TFS) policies from 5% in 2000 to 75% in 2007. Building on that momentum, the state legislature bolstered the campaign by passing legislation in 2007 mandating statewide TFS compliance. By July 2008, all of North Carolina’s 115 school districts were 100% tobacco free.

• Students participating in a culturally appropriate school-based diabetes prevention program in San Antonio, Texas, had significantly decreased fasting glucose levels, increased fitness scores, and increased dietary fiber intake compared with students who did not participate in the program.
   
• Inner-city children in Baltimore, Maryland, who participated in a school breakfast program increased their nutrient intake and were more likely to improve their academic and psychosocial functioning than those who did not participate in the program.
   
• Implementation of a multicomponent, school-based physical activity and nutrition program slowed the increase in rates of obesity and overweight among low-income Hispanic elementary students in El Paso, Texas. Specifically, the increase in rates of obesity and overweight for students in program schools (girls [2%], boys [1%]) was less than that of students not in program schools (girls [13%], boys [9%]).
   
• Girls enrolled in South Carolina high schools who participated in a multicomponent, school-based physical activity program increased their participation in regular vigorous physical activity compared with girls who did not receive the program. The program included tailored physical and health education classes, role modeling by faculty and staff, increased communication about physical activity, promotion of physical activity by the school nurse, and family- and community-based activities.
   
• An evaluation of a school-based HIV, STD, and unintended pregnancy prevention intervention for high school students found that for every dollar invested in the program, about $2.65 in total medical and social costs were saved. These costs were determined based on the estimated cases of HIV, chlamydia, gonorrhea, pelvic inflammatory disease, and number of pregnancies prevented by positive behaviors adopted by students as a result of the program.

CDC’s Response: Advance and Support School Health Programs

Coordinated School Health

Schools by themselves cannot solve the nation’s most serious health and social problems. However, schools have a critical role to play in partnership with community agencies and organizations to improve the health and well-being of young people. One approach recommended by CDC is coordinated school health (CSH). CSH brings together school administrators, teachers, other staff, students, families, and community members to assess health needs; set priorities; and plan, implement, and evaluate school health activities.

CSH typically integrates health promotion efforts across eight interrelated components that already exist to some extent in most schools. These components include the following:

• Health Education
   
• Physical Education
   
• Health Services
   
• Nutrition Services
   
• Counseling, Social, and Psychological Services
   
• Healthy and Safe School Environments
   
• Staff Wellness
   
• Family/Community Involvement

CDC has consistently used an eight-component CSH model as an organizing framework for its school health guidelines, surveillance systems, recommendations for promising practices, and research application tools. Many states and cities have embraced this model to guide their school health efforts.

CDC’s Leadership

CDC funds education and health agencies in 22 states and 1 tribal government to help schools implement CSH, with an emphasis on promoting physical activity, healthy eating, and a tobacco-free lifestyle. CDC also funds 50 state education agencies (including the District of Columbia), 1 tribal government, 6 territorial education agencies, and 16 large urban school districts for school-based HIV prevention. Ten large urban school districts receive CDC support for school-based asthma management programs.

To help states, districts, and schools improve school health programs, CDC has developed science-based guidelines, strategies, and tools and identified priority actions that states can take to support CSH locally. Specifically, CDC supports the efforts of state, territorial, and local agencies to implement science-based, cost-effective programs by undertaking the following:

• Monitoring health risk behaviors and school health policies and programs through the Youth Risk Behavior Surveillance System (YRBSS), the School Health Policies and Programs Study (SHPPS), and School Health Profiles.
   
  • YRBSS consists of national, state, and large urban school district surveys of representative samples of high school students. Conducted every 2 years, these surveys monitor health risk behaviors among young people so that health and education agencies can more effectively target and improve programs.
     
  • Conducted every 6 years, SHPPS is the most comprehensive study of U.S. school health policies and programs. SHPPS assesses the characteristics of school health policies and programs at the state, district, school, and classroom levels nationwide across all eight CSH components.
     
  • Profiles, a biennial survey conducted by state and local education and health agencies, provides data on school health policies and practices in states and large urban school districts.
     
• Analyzing research findings to develop guidelines for addressing priority health risk behaviors among students and creating tools to help schools implement these guidelines. Examples include the following:
   
  • Guidelines for School Health Programs to Prevent Tobacco Use and Addiction was developed in collaboration with tobacco-use prevention experts across the nation and identifies the most effective policies and practices schools can implement to prevent tobacco use and addiction among young people and create a tobacco-free environment in which students can learn.
     
  • School Health Index (SHI): A Self-Assessment and Planning Guide helps schools implement evidence-based policies and practices that promote safe and healthy behaviors. SHI provides the tools and resources needed to assist stakeholders (e.g., teachers, parents, students, and community members) in assessing health policies and programs and developing an improvement plan based on assessment results.
     
  • Physical Education Curriculum Analysis Tool (PECAT) helps school districts conduct a clear, complete, and consistent analysis of physical education curricula, based upon national physical education standards. Results from the analysis can help school districts provide quality physical education in schools.
     
• Expanding knowledge of how to address youth health risks through research on determinants of health risk behaviors and evaluations of innovative school-based approaches to health promotion.
   
• Supporting the efforts of 23 national nongovernmental organizations to build the capacity of states, territories, tribal governments, and cities to implement effective school health programs. Some of these organizations also are funded to help community-based organizations implement science-based programs to help youth in high-risk situations (e.g., those in juvenile justice facilities or not enrolled in school) avoid critical health risks, such as HIV infection.

[A text description of this map is also available.]

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Success Stories

Wisconsin: Building Healthier Schools to Foster Healthier Students

The nation’s major chronic disease killers—heart disease and stroke, cancer, and diabetes—are often caused by risk behaviors such as physical inactivity, unhealthy eating, and tobacco use. The 2007 Youth Risk Behavior Survey (YRBS) indicated that among Wisconsin’s high school students

• 49% have ever smoked and 20.5% were current smokers.
   
• 11% were obese.
   
• Less than 18% ate fruits and vegetables at least 5 times a day.

Wisconsin’s Coordinated School Health Program, supported in part through CDC’s Division of Adolescent and School Health, has developed or supported initiatives to reduce tobacco use and increase physical activity and healthy eating among students, their families, and school staff. Efforts include the following:

• The School Tobacco Prevention Program is increasing the use of CDC’s tobacco-use prevention guidelines in Wisconsin schools, implementing evidence-based educational programs, and making cessation services more available to youth.
   
• The Movin’ and Munchin’ Schools campaign is helping Wisconsin’s young people, families, and school staff develop lifetime skills and habits of physical activity and healthy nutritional choices.
   
• The Governor’s School Health Award is recognizing schools with policies, programs, organizational capacity, and parental and community involvement to support and promote healthy lifestyles and staff wellness.

Major accomplishments of the Wisconsin program include the following:

• The smoking rate among high school students decreased from 38.1% in 1999 to 20.5% in 2007.
   
• During the Movin’ and Munchin’ Schools campaign, 101,641 students, 39,143 parents, and 9,265 staff reported increases in physical activity and fruit and vegetable consumption.
   
• Wisconsin was one of 15 states selected as a National Governors Association Healthy Kids, Healthy America grantee for 2007–2008 to advance programs to help prevent childhood obesity.

North Carolina: Making Tobacco Free Schools a Reality in a Tobacco-Growing State

Each year, cigarette smoking accounts for approximately one of every five deaths in the United States. For high school students in North Carolina, the 2007 YRBS results indicated that about 22% smoked cigarettes. Among those students, more than half had tried to quit smoking cigarettes during the 12 months before the survey.

Tackling the smoking problem among youth has long presented a significant challenge for both the public health and public school sectors. The North Carolina Prevention and Control Branch, Health and Wellness Trust Fund Commission, and the state’s Tobacco-Free Schools (TFS) initiative have made significant strides in addressing this major health concern. Partnerships and cross-agency efforts at multiple levels were key to North Carolina’s progress in preventing smoking among its youth.

The North Carolina Healthy Schools Initiative, funded in part through CDC’s Division of Adolescent and School Health, supported development and implementation of school policies to advance the state’s youth antismoking campaign. Individuals and teams working with the Healthy Schools Initiative did the following:

• Helped develop and review model language for TFS policies.
   
• Sponsored regional workshops to train principals, other administrators, school nurses, and Safe and Drug-Free Schools staff in ways to attain compliance with TFS policies.
   
• Conducted forums with school superintendents, principals, and school board members to encourage them to join the growing ranks of other districts endorsing TFS policies.

The percentage of school districts in North Carolina adopting 100% TFS policies increased from 5% in 2000 to 75% in 2007. Building on that momentum, the state legislature further bolstered the campaign by passing a law in 2007 mandating statewide TFS compliance. By July 2008, all 115 of North Carolina’s school districts were 100% tobacco-free.

California: Investment in Training for School Leaders Yields Huge Benefits for Students

In 2007, less than 30% of California students in grades 5, 7, and 9 met the fitness standards for the state’s FITNESSGRAM, an annual physical fitness test given to students in selected grades in the state’s public schools. In recent years, many of California’s school districts have seen substantial reductions in resources available for supporting efforts to improve student health. Motivated by the growing concerns over student health and fitness levels, school health leaders in California decided to enhance their knowledge and skills in managing and promoting school health programs.

Funded by CDC’s Division of Adolescent and School Health to promote coordinated school health (CSH), the California Department of Education’s School Health Connections Program collaborated with the state Department of Health Services to conduct state- and local-level leadership institutes. These were modeled after the American Cancer Society’s (ACS) National School Health Leadership Institutes and were conducted in partnership with the California Division of the ACS, which also provided local staff and financial support.

Since 2005, more than 40 district teams in California have participated in School Health Leadership Institutes, learning how to build, promote, and sustain school health programs. Successful activities include the following:

• The El Dorado High School District obtained a Carol M. White Award for almost $100,000 for 3 years to improve physical education programs.
   
• The Los Angeles Unified School District created a CSH District Council, launched CSH pilot programs, formally adopted a Policy and Blueprint on Wellness, and created the District’s first comprehensive program to address childhood obesity and diabetes.

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Related Materials

• Healthy Youth—At A Glance 2009 (PDF–3Mb)
• Healthy Youth—Success Stories (PDF–1Mb
• CDC's Healthy Youth Web Site
• State and Program Examples (143K–PDF)

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Page last reviewed: February 11, 2009
Page last modified: February 11, 2009
Content source: National Center for Chronic Disease Prevention and Health Promotion