Transcript The Future of Coordinated School Health

Glancing Back,
Moving Forward
Howell Wechsler, EdD, MPH
Director, Division of Adolescent and School Health
Healthy Maine Partnerships Annual Meeting
Augusta ME, January 20, 2011
National Center for Chronic Disease Prevention and Health Promotion
Division of Adolescent and School Health
October 2000
Blaine House Summit on a
Healthy Maine
Governor Angus King
10 Years of Great Accomplishments
• Smoke-free environment policies
• Decrease in teen pregnancy rates
• Graduated licensing system for teen drivers
• 43 School Health Coordinators; 11 intensive coordinated
school health SAUs
• Elimination of soda sales in schools
• Wellness activities with tribal governments and schools
• Restaurant menu labeling legislation
Overview
• How Are We Doing?
• A Systematic, Integrated Approach
• Strategies for Nutrition and Physical Activity
• Outlook for the Future
Percent of Maine High School Students Engaging in
Selected Health Risk Behaviors, 1997 and 2009
Source: CDC, Youth Risk Behavior Survey
Percent of Maine High School Students Engaging in
Selected Health Risk Behaviors, 1997 and 2009
Source: CDC, Youth Risk Behavior Survey
Percent of Maine High School Students Engaging in
Selected Health Risk Behaviors, 1997 and 2009
Source: CDC, Youth Risk Behavior Survey
Maine High School Students Were Less
Likely Than US High School Students to:
• Be in a physical fight (23% - 32%)
• Feel sad or hopeless (23% - 26%)
• Use tobacco products (23% - 26%)
• Drink alcohol (32% - 42%)
• Have sex with >4 partners (12% - 14%)
• Watch too much TV (25% - 33%)
• Have no days with >60 minutes of physical activity (18% 23%)
Source: CDC, 2009 Youth Risk Behavior Survey
Maine High School Students Were More
Likely Than US High School Students to:
• Be bullied at school (22% - 20%)
• Smoke cigarettes frequently (9% - 7%)
• Sniff glue (15% - 12%)
• Use a needle to inject drugs (5% - 2%)
• Not eat fruit (13% - 11%)
• Vomit or take laxatives to lose weight (7% - 4%)
• Not be enrolled in a PE class (58% - 44%)
Source: CDC, 2009 Youth Risk Behavior Survey
Maine Youth Risk Behavior Survey, 2009
Number of students in a high school class of 30 who:
Attempted suicide1 (7.9%)
Smoked cigarettes2 (18.1%)
Used marijuana2 (20.5%)
Had been in a physical fight1 (22.8%)
Had at least one drink of alcohol2 (32.2%)
2
5
6
7
10
Had ever had sexual intercourse (46.0%)
Did not eat enough fruit3 (70.9%)
14
21
Did not get enough physical activity3
(82.1%)
1 - During the past 12 months; 2 – During the past 30 days; 3 – During the past week
Source: Maine Youth Risk Behavior Survey
25
Percentage of Secondary Schools that
Prohibited All Tobacco Use in All Locations*
18% - 41%
42% - 50%
51% - 58%
59% - 73%
No Data
*Prohibited the use of all tobacco, including cigarettes, smokeless tobacco, cigars, and pipes; by students, faculty and school staff, and visitors; in
school buildings; outside on school grounds; on school buses or other vehicles used to transport students; and at off-campus, school-sponsored
events; during school hours and non-school hours.
School Health Profiles, 2008
Percentage of Secondary Schools that Prohibited All
Tobacco Use in All Locations*
18% - 41%
42% - 50%
51% - 58%
59% - 73%
No Data
MAINE: 59%
*Prohibited the use of all tobacco, including cigarettes, smokeless tobacco, cigars, and pipes; by students, faculty and school staff, and visitors; in
school buildings; outside on school grounds; on school buses or other vehicles used to transport students; and at off-campus, school-sponsored
events; during school hours and non-school hours.
School Health Profiles, 2008
Percentage of Secondary Schools that Provided Tobacco Cessation
Services for Students, Faculty, and Staff at School or Through
Arrangements with Providers Not on School Property
11% - 19%
20% - 25%
26% - 30%
31% - 48%
No Data
MAINE: 38%
School Health Profiles, 2008
Percentage of Secondary Schools that Offered Opportunities
For All Students to Participate in Intramural Activities or
Physical Activity Clubs
40% - 56%
57% - 65%
66% - 78%
79% - 85%
No Data
MAINE: 79%
School Health Profiles, 2008
Percentage of Secondary Schools That Taught 15 Key
Tobacco-Use Prevention Topics in a Required Course
33% - 42%
43% - 49%
50% - 58%
59% - 79%
No Data
MAINE: 44%
School Health Profiles, 2008
Percentage of Secondary Schools That Taught 14 Key
Nutrition and Dietary Behavior Topics
in a Required Course
42% - 55%
56% - 63%
64% - 69%
70% - 85%
No Data
MAINE: 57%
School Health Profiles, 2008
Percentage of Secondary Schools that Worked With Local
Agencies or Organizations on Efforts To Reduce Tobacco Use
During the Two Years Before the Survey
36% - 47%
48% - 53%
54% - 60%
61% - 84%
No Data
MAINE: 45%
School Health Profiles, 2008
Overview
• How Are We Doing?
• A Systematic, Integrated Approach
• Strategies for Nutrition and Physical Activity
• Outlook for the Future
Government Agencies
Family
Needed: A Systematic Approach
to Prevention
• Sets priorities based on relevant data, rigorous
analysis, and available resources
• Carefully examines scientific evidence of
effectiveness for specific interventions
• Allows for community involvement and
ownership
Needed: An Integrated Approach
to Prevention
• Recognizes that many youth engage in multiple
risk behaviors that share common antecedents
and can be prevented through common
protective factors
• Applies existing, categorical, evidence-based
interventions in a strategic and sustained fashion
• Implements cross-cutting interventions that
address multiple outcomes simultaneously
Coordinated School Health:
The Components
Health Education
Physical Education
Family and
Community
Involvement
Health Services
Health
Promotion
for Staff
Healthy and Safe
School Environment
Nutrition
Services
Counseling,
Psychological, and
Social Services
Coordinated School Health:
The Process
• Promoting health is embraced as a fundamental
part of the school mission
• Strong administrative and school board support
• School health council / school health team
• School health coordinator
• Health goals included in school improvement plan
Coordinated School Health:
The Process
• Priorities determined through a
systematic assessment and
planning process that
– Is evidence-based and datadriven
– Includes extensive input
from the school and
community
State Actions to Support Coordinated
School Health
• Require each school district establish and maintain a
School Health Council with designated responsibilities (AR,
FL, IN, MD, MS, NC, NM, OH, OK, RI, SC, TN, TX, VA)
• Require a school health coordinator for district (KY, MS, TN)
• Require use of School Health Index by schools (AR, HI, TN)
• Include health goals and objectives in School
Improvement Plan (AR, DE, RI, WV)
Overview
• How Are We Doing?
• A Systematic, Integrated Approach
• Strategies for Nutrition and Physical
Activity
• Outlook for the Future
Key Strategies for Nutrition
• Ensure that all foods and beverages sold or served are
nutritious and appealing
• Promote fruit and vegetable intake through
procurement, marketing, salad bars, and Farm to
School strategies
• Increase access to plain drinking water
• Use marketing strategies and behavioral economics
• Increase the professional qualifications of child
nutrition program managers and directors
Maine’s Nutrition Standards for
Competitive Foods in Schools (2006)
• Sale of foods of minimal nutritional value (e.g., sodas,
gum, licorice) prohibited 24/7 (exceptions allowed for
public events and sales to school staff)
• Only foods and beverages that contribute to the
nutritional needs of children shall be sold
• Only healthy foods and beverages may be advertised
on school grounds
Existence of State Policies Establishing Nutrition
Standards for Competitive Foods in Schools
*
= Has Standards for Competitive Foods
= Developing Standards
= No State Standards
•
Federally reimbursable
school nutrition programs
should be the main source of
nutrition in schools.
•
Opportunities for
competitive foods should be
limited.
•
If competitive foods are
available, they should
consist primarily of fruits,
vegetables, whole grains,
and fat-free or low-fat milk
and milk products.
o
Standards for Food Content(1-6)
• ≤35% calories from fat, ≤10% calories from saturated
zero trans fat
• Total calories ≤ 200
• ≤35% of calories from total sugar
• ≤ 200 mg sodium snacks, ≤480 mg for à la carte entrée
• No caffeine in food and beverage & limits non-nutritive sweeteners
o
Standards for the School Day (7-11)
• Drinking water available to all students free of cost
• Food and beverages not used as reward or discipline
• Sports drinks not available during the school day
• Minimize marketing of foods and beverages
o
Standards for the After School Setting (12-13)
• Standards for on-campus fundraisers and after school activities
fat,
West Virginia Policy for Competitive Foods and
Beverages in Schools (2008)
Per product/package:
• <200 total calories
• <35% of calories from total fat and <10% from saturated fat
(excluding nuts, seeds or cheese); <0.5 grams of trans fat
• <35% of calories from sugar (excluding fruits)
• <200 mg of sodium
• Prohibited
• Caffeine containing beverages with >trace amounts
• Foods containing non-nutritive sweeteners
• Use of food and beverages as a reward or punishment
• FMNV all day throughout elementary and middle school campus
also
• Guidelines for foods brought from the home to the classroom
• Availability of fresh drinking water at no cost
Financial Implications of Nutrition Standards
• Schools can have strong nutrition standards and maintain
financial stability
– WV – 80% of principals: little or no change in revenue
– CT–Pilot study (5 schools): increase in NSLP, no changes
in school finances
– Making It Happen – 15/16 schools and districts reported
increase or no change in revenue
• Careful selection and clever marketing of healthier choices
can minimize financial risk
Key Strategies for Nutrition
• Ensure that all foods and beverages sold or served are
nutritious and appealing
• Promote fruit and vegetable intake through
procurement, marketing, salad bars, and Farm to
School strategies
• Increase access to plain drinking water
• Use marketing strategies and behavioral economics
• Increase the professional qualifications of child
nutrition program managers and directors
Key Strategies for Physical Activity
• High quality physical education as foundation
• Elementary school: daily recess period
• Physical activity throughout the school day
• Extra-curricular physical activity programs
− Inclusive, intramural programs and physical
activity clubs
− High school: Interscholastic athletics
• Walk/bike to school program (“safe routes”)
• Staff wellness program
High Quality Physical Education
• Based on national
standards
• Emphasizes lifetime
physical activity
• Meets the needs of all
students
• Keeps students active
most of class time
• Is enjoyable
High Quality Physical Education Requires
• Adequate time (150
min/week for elementary;
225 min/week for secondary)
• Highly qualified teachers
• Adequate facilities and
supplies
• Reasonable class sizes
• A written curriculum
• Student assessment
How States and Districts Are Helping
• Implement policies to increase time for PE
• Require time for daily physical activity
• Promote standards-based curricula and evidencebased programs
• Implement student assessment for PE
• Prohibit use of physical activity to punish
• Collect data on youth fitness
Overview
• How Are We Doing?
• A Systematic, Integrated Approach
• Strategies for Nutrition and Physical Activity
• Outlook for the Future
Some Reasons for Pessimism
• Resistance to change
• Ongoing pressures for accountability based
on standardized test scores
• Budget crises
• Aging population
Some Reasons for Optimism
• Agenda for action and data systems in
place
• Growing evidence of effectiveness
• Federal funding and national leadership
• Support from key sectors of society
Other Federal Initiatives
• Communities Putting Prevention to Work
• Patient Protection and Affordable Care Act
• Child Nutrition Act Re-authorization
• Physical Education Program (PEP)
A Survey of >400 Employers
• # 1 factor that will have the largest
impact on the workplace over the
next five years:
Rising Health Care Costs
• #1 emerging content area in terms of
its importance for future graduates
entering the U.S. workforce in the
next five years:
Making Appropriate Choices
Concerning Health and
Wellness (76% of employer
respondents rated it as “most
critical”)
Estimated Financial Costs of Our Failure to
Sufficiently Address Youth Health Problems
• Among 15-24 year olds in 2000:
– Total lifetime costs of injuries: $79.8 billion1
– Costs of new cases of STDs: $6.5 billion2
• Average annual costs associated with a child born to
a teen mother in 2004: $9.1 billion3
• Total costs for treating asthma in 2006: $8 billion4
1 - Finkelstein EA et al. The Incidence and Economic Burden of Injuries in the United States. 2006
2 - Chesson HW et al. Perspectives on Sexual and Reproductive Health 2004; 36(1):11-19
3 - The National Campaign to Prevent Teen Pregnancy. By the Numbers: The Public Costs of Teen Childbearing
4 - AHRQ. Statistical Brief # 242. April 2009
Economic Costs Associated
with Obesity are High
Direct health care costs of obesity and overweight:
• 1998: $74 billion
• 2008: $147 billion
• ½ of costs publicly financed by Medicare or Medicaid
• Obesity accounts for 9.1% of annual medical spending
Finkelstein EA, Trogdon JG, Cohen JW, Dietz W. Annual medical spending attributable to obesity: payer
and service-specific estimates. Health Affairs. 2009;28(4)
Weight Issues
Plague the Military
• The Department of Defense estimates as many as 1/3
of military-age youth are ineligible for service because
of their weight.2
• In 2007, approximately 15,000 military recruits failed
the entrance physical exam because of weight/body fat
limits; this was the most common reason for medical
disqualification among applicants for active duty
enlisted service.3-4
1. Mission Readiness press release , Feb 9, 2010 2.Hsu et al. J Adolesc Health. 2007 3. AMSARA Annual Report 2008.
4. Reading, Willing , and Unable to Serve, 2010.
Obesity:
A National Security Threat
“Obesity rates threaten the overall health of
America and the future strength of our military.
We must act, as we did after World War II, to
ensure that our children can one day defend our
country, if need be.”
-Retired U.S. Army Gens. John M. Shalikashvili and Hugh Shelton
Source: The Washington Post, April 30, 2010
Obesity:
A National Security Threat
“We urge Congress to:
• Get the junk food and high-calorie beverages out of
our schools.
• Upgrade the quality of meals served in schools.
• Develop research-based strategies, implemented
through our schools, to help parents and children
adopt healthy habits.”
-Retired U.S. Army Gens. John M. Shalikashvili and Hugh Shelton
Source: The Washington Post, April 30, 2010
Keys to Success
Keys to Success
• Laws and regulations
• Reference materials
• Collaboration / team approach
• Involving students and families
• Attention to the process /
intensive follow-up
Keys to Success
• Marketing techniques /
customer focus
• Positive attitude / enthusiasm
• Data collection
• Developing quality first
The Single Most Consistent
and Important Key to Success:
The Local Change Agent
Glancing Back,
Moving Forward
Howell Wechsler, EdD, MPH
Director, Division of Adolescent and School Health
Healthy Maine Partnerships Annual Meeting
Augusta ME, January 20, 2011
National Center for Chronic Disease Prevention and Health Promotion
Division of Adolescent and School Health