Transcript School Health Association of North Carolina

The Interdependence of Health
and Learning
California Department of Education
School Health Connections
July 2002
Impact of Focus on Testing
Testing, testing, testing
Causes stress among teachers and
administrators, which is not good for learning.
Narrows the mission of education and
contributes to teacher burnout,which is not good
for learning.
Causes stress in students,which is not good for
learning.
Holds schools accountable for only part of their
mission.
Education Goals 2000
1. All children will start school ready to learn.
With proper nutrition, physical activity, and access
to health care, children get the basics that support
learning.
2. 90% of students will graduate from high
school.
Dropout prevention, substance use prevention,
sexuality education and integration of services help
students stay in school.
Education Goals 2000
3. All students will demonstrate competency in
core subject areas.
Though not designated a core subject in Goals 2000,
health education is fundamental. National and
California Challenge Standards have been developed
for health education.
4. The Nation’s teachers will have access to
programs to improve professional skills.
Quality school programs provide ongoing
professional development for staff.
Education Goals 2000
5. Every school will be free of drug, violence
and firearms.
Substance use and violence prevention,
counseling/mental health and safety programs
indicate school is a place for healthy behavior.
6. Every school will promote partnerships to
improve parent and community involvement.
School health councils, integrated services, and
community wide health promotion strategies
indicate:
Participation in health risk
behaviors has been linked to
negative outcomes on the
following measures of school
performance:
Symons, 1997, JOSH V.67 (6)
Education Behaviors are
Impacted by Health
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Attendance
Drop-out rates
Behavioral problems at school
Degree of involvement in school activities
(homework and extracurricular activities)
Symons, 1997, JOSH V.67 (6)
Education Outcomes are
Impacted by Health
• Graduation rates
• Grades
• Performance on standardized tests
Symons, 1997, JOSH V.67 (6)
Student Attitudes are
Impacted by Health
• Toward school (aspirations for
postsecondary education)
• Feelings concerning safety on school
property
• Personal attitudes (self-esteem)
Symons, 1997, JOSH V.67 (6)
Negative Educational
Outcomes Impacted by Heatlth
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A lack of interest in school
Behavior problems at school
Low self-esteem
High drop-out rate
Truancy
Destruction of school property
Symons, 1997, JOSH V.67 (6)
Testing only addresses one of the
educational goals BUT it now
dominates the education process
Focusing instructional attention on testing
is causing neglect of other important facets
of the educational process.
Ironically, the neglect of those facets will
result in lower test scores as well as failure
to achieve our goals related to those other
important facets.
Coordinated School Health
Health Education
Family &
Community
Involvement
Physical
Education
School-site
Health Promotion
for Staff
Healthy
School
Environment
School Health
Services
School Nutrition
Services
School
Counseling &
Social Services
Physical Education
Schools have reduced time for physical
education and physical activity to increase
instructional time.
Studies show it does not improve test
scores.
Physical Education
Schools that offer intensive physical activity
programs see positive effects on academic
achievement even when time for PE is taken
from the academic day, including:
• increased concentration;
• improved mathematics, reading and
writing scores; and
• reduced disruptive behaviors.
Shepard RJ. (1997). Pediatr Exerc Sci, 9 113-126.
Sallis JF, et al. (1999). Res Q Exerc Sport, 70(2), 127-134.
Physical Activity has been Shown
to Improve Brain Function
Controlled Studies Indicate that School Based
Physical Activity Programs:
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Increase oxygen uptake;
Improve physical performance measures;
Reduce susceptibility to stress;
Reduce disruptive behaviors;
Improve concentration; and
Improve reading, math, and writing scores.
Symons, 1997, JOSH V.67 (6)
School Nutrition Services
Testing has little direct effect on nutrition
services.
However, stress affects diet, with those who
don’t need calories eating more and those
who do need calories eating less.
School Nutrition Services
Poor diet, high in sugar, inadequate
breakfast and snack food availability may
all contribute to poor concentration.
Resources are diverted to other programs,
which motivates schools to raise money by
the sale of non-nutritious foods, including
exclusive soft drink contracts.
School Nutrition Services
Schools that incorporate school breakfast
programs in their food service see increases in
academic test scores and daily attendance and
class participation.
Powell CA, et al. (1998). Am J Clin Nutrition, 68(4), 873-879.
Murphy JM, et al. (1998). Arch Pediatr Adolesc Med, 152(9), 899-907.
Meyers AF, et al. (1989). Am J Dis Child, 143(10), 1234-1239.
Symons CW, et al. (1997). J Sch Health, 67(6), 220-227.
Healthy Kids Survey Links
Nutrition and API Scores
Percent in school who ate breakfast
during the day of the survey
84
74
API
Quintiles
1st (Low est)
2nd
64
3rd
4th
5th (Highest)
54
44
API Quintiles
Opinions of Parents of Adolescents
About School Health Education
• 84% said that health education is either more
important than or as important as other
subjects taught in school.
• 74% said schools should spend more time or
the same amount of time teaching health
education as they do for other subjects taught
in school.
http://www.mcrel.org/standards/articles/survey/
Health Education
Studies show that health
education is linked to improved
academic achievement.
Health Education
Five years after a substance abuse curriculum,
participants had higher overall academic achievement
scores on the Comprehensive Test of Basic Skills than
their national peers.
(Elias et al Am. Jl. Of Orthopsychiatry 61,no.3 (1991)
After participating in a life-skills class, 259 high risk
youth in grades 9-12, showed increased grade point
averages (GPA) across all classes while the GPAs of
non-participants stayed essentially the same.
(Eggert et al, Am. Jl. Health Promotion 8(3):202-15,
1994)
Use of Tobacco, Alcohol, and
Other Drugs has been Linked to:
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Poorer relationships with parents
Lower grades
Increased absenteeism
More frequent depression
More frequent risk-taking behaviors
Stifled creativity and ambition
Symons, 1997, JOSH V.67 (6)
Students who use Drugs Display
Similar Attributes to School
Dropouts, Including:
• Less commitment and attachment to
conventional values and institutions of
family and school
• Lowered sense of well-being
Symons, 1997, JOSH V.67 (6)
Drug Use is a Threat to
School Climate Through:
• Erosion of self-discipline
• Decreased motivation toward academic
success
• Increased risk for injury, violence,
sexual behavior, and legal problems
Symons, 1997, JOSH V.67 (6)
Studies Confirm that School-Age
Childbearing is associated with:
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Significantly reduced academic achievement
Higher drop-out rates
Decreased participation in school activities
Lower grades
Ongoing sexual risks
Symons, 1997, JOSH V.67 (6)
School Counseling and Social Services
School-based mental health services, with the
involvement and support of families and educators,
improve educational outcomes by addressing
behavioral and emotional issues and other barriers to
learning.
Youth receiving mental health services have
experienced decreases in course failures, absences, and
disciplinary referrals, and improved grade point
averages.
Jennings J, et al. (2000). J School Health, 70(5), 201-205.
Nabors L, Reynolds M. (2000). Child Serv Soc Pol Res Pract, 3, 175-189.
Nabors L, Prodente M. (August, 2000). Poster presented at the annual meeting of
the American Psychological Association, Washington, DC.
School Health Services
School-based (or linked) health
services reduce absenteeism by
providing on-site care for problems.
School-based providers detect
numerous emotional problems early
and institute needed care.
Staff Health Promotion
The greatest challenge facing public
education today is not API testing.
It is recruiting, training and retaining
excellent teachers and administrators.
The University of California projects a
shortfall of 65,000 teachers in California by
2010.
Staff Health Promotion
Many teachers are disheartened by the
increasing demands placed upon them, the
lack of public support, the long hours and
poor wages, and the diminishing opportunities
to see how their teaching makes a difference
in the lives of students.
Reducing education to just test preparation
may break the camel’s back.
Staff Health Promotion
Staff health promotion programs:
• Send a supportive message to teachers.
• Improve morale, absenteeism, and future
health and well being.
A healthy staff does a better job of teaching,
creates a better working and learning
environment, and sets a good example for
students.
Essential Functions of a
Healthy School Environment
• Minimizes distractions
• Minimizes physical, psychological and
social hazards
• Creates a climate for students and teachers
to do their best work
• Expects that all students can succeed
• Implements supportive policies
(Health is Academic, 1998)
Indoor Air Quality (IAQ) and Schools
• 5.5 million children in the US suffer from asthma
(up 160% in 20 years in children under 5).
• Asthma is the leading cause of school absenteeism
due to chronic illness.
• IAQ is a key factor in asthma exacerbations and
half the nation’s schools have poor IAQ.
Environmental Protection
Agency and IAQ
• EPA’s response:
– Indoor Air Quality: Tools for Schools (1999)
– Institute of Medicine study, Clearing the Air
(2000)
– IAQ Practices in Schools Survey (voluntary,
2001)
– By 2005, 15% of public and private schools will
implement sound IAQ practices
http://www.epa.gov/iaq/schools/index.html
A Healthy School Environment Sets the
Stage for Other Seven Components
• Tobacco-free policies reinforce health
education.
• Tasty, healthy food choices reinforce physical
education and health education.
• Counseling, psychological & social services
can help identify and resolve conflicts and
reduce violence at school.
(Health Is Academic, 1998)
Family and Community Involvement
Schools that collaborate with students’
families, local businesses, community
organizations, and health services see
improved classroom behavior, increased
PTA membership, and improved family
functioning.
McDonald L & Sayger T. (1998). Drugs & Society, 12, 61-85.
Family and Community Involvement
School districts that collaborate with social service
providers across other districts, counties, and cities
strengthen social structures for students and their
families and observe improved scholastic
performance.
“The combined academic, health, and social
programs began to show positive achievement
gains by the third year of the project.”
Mitchell M. (2000). Public Health Reports, 115, 222-7.
Six Preventable Health Risks
1. Tobacco use
2. Abuse of alcohol and other drugs
3. Sexual behaviors that increase risk for
HIV, STDs and pregnancy
4. Behaviors that risk intentional and
unintentional injuries
5. Physical inactivity
6. Poor eating habits
Let’s take a look at a single risk
factor over time.
OBESITY
Data from the National Behavioral Risk Surveillance System reported
in the Journal of American Medical Association 1999; 282:16
Preva lence of Obesity* Among U.S. Adults
BRFSS, 1985
(*Approximately 30 pounds overweight)
< 10%
10% to 15%
Source: Mokdad AH, et al. J Am Med Assoc 1999;282:16.
> 15%
Preva lence of Obesity* Among U.S. Adults
BRFSS, 1986
(*Approximately 30 pounds overweight)
< 10%
10% to 15%
Source: Mokdad AH, et al. J Am Med Assoc 1999;282:16.
> 15%
Preva lence of Obesity* Among U.S. Adults
BRFSS, 1987
(*Approximately 30 pounds overweight)
< 10%
10% to 15%
Source: Mokdad AH, et al. J Am Med Assoc 1999;282:16.
> 15%
Preva lence of Obesity* Among U.S. Adults
BRFSS, 1988
(*Approximately 30 pounds overweight)
< 10%
10% to 15%
Source: Mokdad AH, et al. J Am Med Assoc 1999;282:16.
> 15%
Preva lence of Obesity* Among U.S. Adults
BRFSS, 1989
(*Approximately 30 pounds overweight)
< 10%
10% to 15%
Source: Mokdad AH, et al. J Am Med Assoc 1999;282:16.
> 15%
Preva lence of Obesity* Among U.S. Adults
BRFSS, 1990
(*Approximately 30 pounds overweight)
< 10%
10% to 15%
Source: Mokdad AH, et al. J Am Med Assoc 1999;282:16.
> 15%
Preva lence of Obesity* Among U.S. Adults
BRFSS, 1991
(*Approximately 30 pounds overweight)
< 10%
10% to 15%
Source: Mokdad AH, et al. J Am Med Assoc 1999;282:16.
> 15%
Preva lence of Obesity* Among U.S. Adults
BRFSS, 1992
(*Approximately 30 pounds overweight)
< 10%
10% to 15%
Source: Mokdad AH, et al. J Am Med Assoc 1999;282:16.
> 15%
Preva lence of Obesity* Among U.S. Adults
BRFSS, 1993
(*Approximately 30 pounds overweight)
< 10%
10% to 15%
Source: Mokdad AH, et al. J Am Med Assoc 1999;282:16.
> 15%
Preva lence of Obesity* Among U.S. Adults
BRFSS, 1994
(*Approximately 30 pounds overweight)
< 10%
10% to 15%
Source: Mokdad AH, et al. J Am Med Assoc 1999;282:16.
> 15%
Preva lence of Obesity* Among U.S. Adults
BRFSS, 1995
(*Approximately 30 pounds overweight)
< 10%
10% to 15%
Source: Mokdad AH, et al. J Am Med Assoc 1999;282:16.
> 15%
Preva lence of Obesity* Among U.S. Adults
BRFSS, 1996
(*Approximately 30 pounds overweight)
< 10%
10% to 15%
Source: Mokdad AH, et al. J Am Med Assoc 1999;282:16.
> 15%
Preva lence of Obesity* Among U.S. Adults
BRFSS, 1997
(*Approximately 30 pounds overweight)
< 10%
10% to 15%
Source: Mokdad AH, et al. J Am Med Assoc 1999;282:16.
> 15%
Preva lence of Obesity* Among U.S. Adults
BRFSS, 1998
(*Approximately 30 pounds overweight)
< 10%
10% to 15%
Source: Mokdad AH, et al. J Am Med Assoc 1999;282:16.
> 15%
Prevalence of Obesity Among U.S. Adults
BRFSS, 1999
Source: Mokdad AH, et al. J Am Med Assoc1999;282:16.
Obesity* Trends Among U.S. Adults
BRFSS, 2000
(*BMI  30, or ~ 30 lbs overweight for 5’4” person)
No Data
<10%
10%-14%
Source: Mokdad A H, et al. JAMA 2001;286:10
15-19%
20%
Healthy Schools/Healthy Communities
Healthy Children
Increased Social
Capital
School
Performance
Healthy Communities
“The relationship between schooling and health
outcomes is one of the strongest generalizations to
emerge from empirical research in the U.S.”
Nagya R. (2000). Applied Economics, 32, 815-822
Conclusions
• Hold schools accountable for their entire
mission of education and the promotion of
successful child development.
• Coordinated school health programming is a
fundamental piece of this larger mission.
• Even if we must narrowly focus on test results,
the scores will be better if we incorporate
coordinated school health into our education
system.
California School Health Coordinator
Leadership Institute
These slides can be downloaded from:
http://www.cde.ca.gov/cyfsbranch/lsp/health/Links.htm
Some slides courtesy of
Alan W. Cross, MD
Director, Center for Health Promotion and Disease Prevention
University of North Carolina at Chapel Hill