Coordinated School Health Research Articles

Design, protocol and baseline data of Nurturing Healthy Teachers, a cluster non-randomized controlled trial to improve the health, well-being, and food security of preschool and elementary school teachers in Houston, Texas

BackgroundWe present the conceptual framework, design, and study measures of Nurturing Healthy Teachers, a quasi-experimental study to examine the short- and long-term effectiveness of the Nurturing Healthy Teachers (NHT) nutrition intervention on food insecurity, dietary behaviors, mental health and cardiometabolic health among preschool and elementary school teachers. MethodsA convenience sample of 28 elementary schools with pre-kindergarten and elementary classrooms were recruited in Houston, Texas. Nurturing Healthy Teacher intervention includes Brighter Bites, an evidence-based coordinated school health program that combines access to fresh produce and nutrition education, and Create Healthy Futures, a web-based nutrition education program that targets nutrition knowledge, self-efficacy, mindfulness, and social support to create healthy habits among teachers. The primary outcome is food insecurity. Secondary outcomes include diet quality, mental health, and cardiometabolic health. Metabolic markers and skin carotenoid levels were assessed using in-person assessments, while all other measures were obtained via questionnaire. ResultsAt baseline, most of the participants were female, 63 % identified as Hispanic, were highly educated, and had a mean age of 42.6 years. Overall, 50 % of teachers were classified as being obese and 20 % had high cholesterol. At baseline teachers had a mean HbA1c (%) of 5.6 %.Moderate to severe depression was experienced by 18 % of teachers and 23 % of teachers experienced moderate to severe anxiety. ConclusionsThe results of this study will inform next steps towards future implementation and evaluation of teacher-focused interventions.

Coordinated School Health and a Holistic Approach to Fostering Improved Youth Wellness Through a Built Environment Initiative

Coordinated School Health and a Holistic Approach to Fostering Improved Youth Wellness Through a Built Environment Initiative

Coordinated Approach: Comprehensive Policy and Action Planning.

Schools play a vital role in student health, and a collaborative approach may affect health factors such as physical activity (PA) and nutrition. There is a lack of recent literature synthesizing collaborative approaches in K-12 settings. We present updated evidence about interventions that used a coordinated school health approach to support K-12 student PA and nutrition in the United States. A 2-phase literature review search included a search of systematic reviews for individual qualifying studies (2010-2018), followed by a search for individual articles (2010-2020) that evaluated a coordinated approach or use of school wellness councils, committees, or teams to address PA and/or nutrition. We identified 35 articles describing 30 studies and grouped them by intervention type. Interventions demonstrated promising findings for environmental changes and student dietary and PA behaviors. Coordinated and multicomponent interventions demonstrated significant improvements or null results, indicating that implementation of programs and/or policies to promote healthier eating and PA practices may support and do not appear to hinder environmental or behavioral outcomes. Schools can use a coordinated approach to implement opportunities for PA and nutrition; this may influence students' PA and dietary behaviors.

The Relationship Between Food Insecurity and Food Assistance Program Participation in Families of Preschool Children in the Rio Grande Valley

ABSTRACT The South Texas Early Prevention Study-PreK, a cluster randomized trial, explored the Bienestar Coordinated School Health Program’s influence on health variables in South Texas children. Factors associated with food insecurity (FI) were analyzed. Income-to-poverty ratio, income, and food assistance (FA) program participation were all associated with FI. Forty percent of families (257/643) reporting FI did not utilize FA. Of those families with FI, but who reported no FA participation, 31.8% were FA eligible. Families experiencing FI may underutilize FA programs, despite eligibility. Curtailing obstacles preventing FA program participation and matching those who are eligible with FA programs are crucial.

Design for a cluster randomized controlled trial to evaluate the effects of the CATCH Healthy Smiles school-based oral health promotion intervention among elementary school children

BackgroundThe top two oral diseases (tooth decay and gum disease) are preventable, yet dental caries is the most common childhood disease with 68% of children entering kindergarten having tooth decay. CATCH Healthy Smiles is a coordinated school health program to prevent cavities for students in kindergarten, 1st, and 2nd grade, and is based on the framework of Coordinated Approach to Child Health (CATCH), an evidence-based coordinated school health program. CATCH has undergone several cluster-randomized controlled trials (CRCT) demonstrating sustainable long-term effectiveness in incorporating the factors surrounding children, in improving eating and physical activity behaviors, and reductions in obesity prevalence among low-income, ethnically diverse children. The aim of this paper is to describe the design of the CATCH Healthy Smiles CRCT to determine the effectiveness of an oral health school-based behavioral intervention in reducing incidence of dental caries among children. MethodsIn this CRCT, 30 schools serving low-income, ethnically-diverse children in greater Houston area are recruited and randomized into intervention and comparison groups. From which, 1020 kindergarten children (n = 510 children from 15 schools for each group) will be recruited and followed through 2nd grade. The intervention consists of four components (classroom curriculum, toothbrushing routine, family outreach, and schoolwide coordinated activities) will be implemented for three years in the intervention schools, whereas the control schools will be offered free trainings and materials to implement a sun safety curriculum in the meantime. Outcome evaluation will be conducted at four time points throughout the study period, each consists of three components: dental assessment, child anthropometric measures, and parent survey. The dental assessment will use International Caries Detection and Assessment System (ICDAS) to measures the primary outcome of this study: incidence of dental caries in primary teeth as measured at the tooth surface level (dfs). The parent self-report survey measures secondary outcomes of this study, such as oral health related behavioral and psychosocial factors. A modified crude caries increment (mCCI) will be used to calculate the primary outcome of the CATCH Healthy Smiles CRCT, and a two-tailed test of the null hypothesis will be conducted to evaluate the intervention effect, while considering between- and within-cluster variances through computing the weighted-average of the mCCI ratios by cluster. ConclusionIf found to be effective, a platform for scalability, sustainability and dissemination of CATCH already exists, and opens a new line of research in school oral health. Clinical trials identifierAt ClinicalTrials.gov - NCT04632667.

Non-profit Coordinated School Health Program Achieves Student Outcomes in Both Beginning and Experienced Schools

Objective: The purpose of this study was to determine the efficacy of an ongoing health promotion program to sustain student outcomes over an extended period, and to determine if student outcomes are affected by the schools’ duration of program participation. Methods: The repeatmeasures study used secondary data from Healthy Schools Oklahoma for School Years 2016-2019. FITNESSGRAM assessed changes in student fitness levels (N = 12,219); an electronic health survey assessed changes in knowledge and behaviors (N = 6840). McNemar tests examined change in the proportion of students reaching the healthy fitness zone (HFZ) for 6 FITNESSGRAM tests, and the proportion of students with accurate knowledge or meeting dietary and physical activity recommendations. Poisson regression tested for change in student outcomes based on duration of program participation. Results: The proportion of students reaching HFZ increased for 5 of 6 fitness tests (p ≤ .004) and with accurate nutrition and physical education knowledge (p ≤ .009). We found statistically significant main effects for outcomes (p ≤ .016) and duration (p ≤ .030); there was no effect for the interaction. Conclusion: Students achieved similar gains in outcomes regardless of the schools’ duration of program participation.

Addressing the Whole Child: The Power of Data and Teams.

As 21st-century school nurses, we address students holistically to meet their needs. The ASCD and the Centers for Disease Control and Prevention's coordinated school health model "Whole School, Whole Child, Whole Community" resonates with many school nurses. However, implementing the model can be challenging. This article explains how the school district of St. Johnsbury, Vermont, uses data to leverage their whole child team to meet their school district's needs.

REL Healthy School: Health Innovation Through Coordinated School Health Program in YWKA Elementary School

Schools as places for teaching and learning to take place are expected to become Health Promotion Schools. This can be maximally pursued by planning innovative health program activities in schools. The implementation of this community service activity provides solutions through health innovation in Trias UKS using Coordinated School Health Program. The method of activity is community empowerment, which is accomplished through a series of outreach, training, education, and coaching activities. Dokcil Students in SD YWKA improved their cognitive, attitude, and behavior as a result of the practice.

Social and Health Risk Factor Levels of Preschool Children Living Along the Texas-Mexico Border.

Childhood obesity is a public health concern that disproportionately affects populations from low socioeconomic status (SES) and minority groups. Evaluation of social and health risk factors of preschool children living along the Texas-Mexico border provides feedback to design health interventions. South Texas Early Prevention Study-PreK (STEPS-PreK) is a cluster randomized trial designed to assess the effect of the Bienestar coordinated school health program on children's health outcomes. Family characteristics, dietary intake, fitness, and anthropometric data were collected from 1277 preschool students enrolled in 28 preschools. The response rate was 67%. Overall, 57% of families lived in poverty. The mean age of students was 4.7 years, 95% were Hispanic, and 51% were male. The average serving of fruits and vegetables per day were 1 and 1/3, respectively. Of these, students consumed 39.7% of fruits and 18.9% of vegetables. Obesity prevalence for boys was 19.2% and for girls 16.8%. Nearly one-half reported some form of food insecurity. Children living in low-income areas are affected by high levels of social and health risk factors. It is these families who should be targeted with early-age and culturally appropriate health programs.

The Association Between Child Cooking Involvement in Food Preparation and Fruit and Vegetable Intake in a Hispanic Youth Population.

ABSTRACTBackgroundCooking interventions have been linked to reductions in obesity and improvements in dietary intake in children.ObjectiveTo assess whether child cooking involvement (CCI) was associated with fruit intake (FI), vegetable intake (VI), vegetable preference (VP), and vegetable exposure (VE) in children participating in the Texas, Grow! Eat! Go! (TGEG) randomized controlled trial.MethodsBaseline data from TGEG included 1231 3rd grade students and their parents. Conducted in 28 low-income, primarily Hispanic schools across Texas, TGEG schools were assigned to: 1) Coordinated School Health (CSH) only (control group), 2) CSH plus gardening and nutrition intervention (Learn, Grow, Eat & Go! or LGEG group), 3) CSH plus physical activity intervention (Walk Across Texas or WAT group), and 4) CSH plus LGEG plus WAT (combined group). Height, weight, dietary intake, VE, VP, and CCI were collected at baseline and postintervention. Linear regressions were used to assess the relation between baseline CCI and fruit and vegetable (FV) intake, VE, and VP. A priori covariates included age, sex, race/ethnicity, and TGEG treatment group.ResultsChildren who were always involved in family cooking had higher VP and VE when compared with children who were never involved in family cooking (β = 3.26; 95% CI: 1.67, 4.86; P < 0.01 and β = 2.26; 95% CI: 0.67, 3.85; P < 0.01, respectively). Both VI and FI were higher for children who were always involved in family cooking compared with children who never cooked with their family (β = 2.45; 95% CI: 1.47, 3.44; P < 0.01 and β = 0.93; 95% CI: 0.48, 1.39; P < 0.01, respectively). VI and fruit consumption were higher for children who reported being sometimes involved in family cooking compared with children who were never involved in family cooking, (β = 1.47; 95% CI: 0.51, 2.42; P < 0.01, and β = 0.64; 95% CI: 0.20, 1.08; P < 0.01, respectively).ConclusionsResults show a positive relation between family cooking and FV intake and preference in high-risk, minority children.

Coordinated School Health Initiatives: The Rationale for School Level Implementation-A Commentary.

Coordinated School Health Initiatives: The Rationale for School Level Implementation-A Commentary.

Parent Perspectives on Health and Functioning of School-Aged Adolescents With Disabilities.

Youth living with disabilities are at risk of experiencing poor health outcomes. Coordinated school health programs have an opportunity to help youth with disabilities and their families through health education, health services, and community engagement. The World Health Organization developed the International Classification of Functioning, Disability, and Health (ICF) as a framework to analyze factors related to health conditions. We used the ICF to examine parental perceptions of health and function among students with disabilities living in rural and urban areas. We surveyed parents (N = 71) using the parent-report versions of the Pediatric Outcomes Data Collection Instrument and Child Health and Illness Profile. From this group, parents were asked to volunteer to participate in in-depth, individual interviews (N = 18). The interviews were audio-recorded and transcribed verbatim. Researchers used the ICF linking rules to analyze and code the transcriptions. Emergent themes were assigned numerical ICF codes. There were more similarities than differences among rural and urban families. Children living with disabilities face significant environmental barriers regardless of context. Schools can facilitate education to improve the quality of life of parents and families of children with disabilities. School authorities should consider the many environmental barriers both urban and rural these families face in the community. The ICF can be used as a framework for program planning for community-based, health education for this population.

Developing a Staff Physical Activity Program at Your School: Implementing the Lesser-used Component of the CSPAP Model

The purpose of this article is to explore staff physical activity programs in the school setting, describe a viable option for a staff walking program in an elementary school, and determine elementary school staff members' participation and perceptions in one such program. Previous research has shown that placing a focus on staff involvement and staff wellness can contribute to the overall physical activity culture of a school and shows increased support for student physical activity participation. This article first describes the comprehensive school physical activity program as one model for coordinated school health. Second, it discusses staff programming in nontraditional organizations, such as schools. Third, it presents the possible steps schools can take to plan and implement a staff physical activity program, and provides an example of a school-staff program in Arizona along with the outcomes from the program.

Increasing equitable care for youth through coordinated school health

AbstractNearly a quarter of the students in the U.S. education system have a chronic health condition, disability, or special healthcare need. Students living in poverty and those at risk for or with disabilities have higher rates of health issues and encounter more barriers to accessing appropriate health care than their peers. The reciprocal influences between health and education as critical social determinants for youth are well established and prompted the development of a comprehensive model of school‐based coordinated health, the Whole School, Whole Community, Whole Child (WSCC) model. A brief overview of (a) education‐related health issues experienced by students living in poverty and those at risk for or with disabilities, (b) access to health care, (c) the need for coordinated care, and (d) the WSCC model are provided. The WSCC model represents an unprecedented opportunity to increase equitable care for youth through coordinated school health.

Achieving Consensus on Principles of Good Practice for School Health in Independent Schools: A Delphi Study.

Although the 8 components of the coordinated school health (CSH) framework have been implemented to various degrees in the nation's public schools, principles of good practice (PGPs) to guide health promotion efforts in independent schools do not exist. The purpose of this study was to generate PGPs and rate their feasibility of implementation. A modified Delphi process was used to generate PGPs for school health in independent schools and develop consensus regarding their feasibility of implementation. A working group of 6 independent school health professionals (ISHPs) was convened to propose draft PGPs based on the CSH framework. The proposed PGPs were then reviewed by a national and geographically diverse expert panel of 10 school health researchers and 23 ISHPs that completed 3 Delphi rounds to achieve consensus on the PGPs. Of 33 participants originally invited to participate, 27 completed the Delphi process. A total of 27 panelists rated 67 PGPs, provided 399 comments, and achieved consensus using interquartile range on 56 (84%) of the proposed PGPs, 41 of which were rated feasible and 15 somewhat feasible. This study has generated empirical support for the feasibility of PGPs for school health in independent schools.

Childhood Obesity: A Survey of the Nutrition and Physical Activity Components of the Coordinated School Health (CSH) Program in Rural Tennessee

Childhood Obesity: A Survey of the Nutrition and Physical Activity Components of the Coordinated School Health (CSH) Program in Rural Tennessee

Analysis of the Partnership for Health Promotion at School in Bulgaria

According to the concept of health promotion, health is a shared responsibility of individuals, the community, the state, and non-governmental organizations. Partnership offers great potential for addressing problems and achieving goals, but it is also associated with certain difficulties. Establishing a successful partnership requires common purpose, shared responsibilities, complementary competencies, collaboration, and mutual respect. The aim of this paper is to analyze whether partnership as a main principle of health promotion has been put into practice in the observed school community. A comprehensive medico-social survey on school health promotion was conducted from September 2012 to May 2013 over a representative sample of schools in the Pleven region of Bulgaria. Data were collected through a self-administered questionnaire among 1,280 members of the school community, interviews with school principals, and a review of the documents. Questions are directed toward the elements of the coordinated school health model. Data analysis of the presented part of the study, which examined the partnership for health promotion at school, was consistent with the methodology of the partnerships analysis tool using a specially designed checklist for evaluation. Over 90% of the investigated subjects and organizations realize the necessity of partnership. They have a clear goal to improve the well-being of the school community and a shared understanding that the benefits from partnership outweigh the exertions and costs. On the other hand, not all potential partners are included in the process of planning priorities for action. Almost half do not always have a clear idea about their responsibilities for fulfilling the goals. Both the positive and weak points of the partnership were able to be considered. The necessity for partnerships in promoting school health is recognized but difficult to transform into real action due to limited competencies and collaborations.

Implementation of Early Childhood Physical Activity Curriculum (SPARK) in the Central Valley of California (USA)

Abstract The aim of this paper is to describe the methodology applied to develop and launch the implementation of physical activity curriculum (SPARK) at several schools in the Central Valley of California. The SPARK Early Childhood Program is one of eight within the SPARK Coordinated School Health (CSH) model. This research try to create environments that promote healthful behaviors at school and in the community for both children and adults. Overweight and obese children are likely to develop serious health problems. Among children in the U.S., Latino children are affected disproportionally by the obesity epidemic. Ninos Sanos, Familia Sana (Healthy Children, Healthy Family) is a five-year, multi-faceted intervention study to decrease the rate of BMI growth in Mexican origin children in California's Central Valley. This study is funded by the National Institute of Food and Agriculture of the United States Department of Agriculture, grant number 2011-68001-30167. The NSFS project consists of four major component interventions in the areas of nutrition, physical activity, economic and art-community engagement to induce behavioral change in our target population in order to achieve obesity prevention. SPARK Physical Education (PE) represents a paradigm shift in the traditional PE world. The SPARK programs are designed to involve all children, be more active, inorporate social skills, and emphasize both health-related fitness and sill development.

Adoption of Comprehensive School Physical Activity Programs: A Literature Review

P-12 physical education (PE) has evolved significantly over the last several decades, with one of the most important changes occurring recently with the inclusion of PE as a core academic subject (Society of Health and Educators [SHAPE America], 2015c). Well-designed PE programs have been acknowledged as having the unique potential to address student learning in all three of Bloom's domains (psychomotor, cognitive, and affective; National Association for Sport and Education [NASPE], 2011; SHAPE America, 2015a), but PE did not become a validated core subject until the recent 2015 revision of the federally legislated Elementary and Secondary Education Act (ESEA), a designation long since desired in the field (SHAPE America, 2015c).The advancement of a holistic approach emphasizing the education and health of students began in the late 1980s with the promotion of the Coordinated School Health Program model by the Centers for Disease Control and Prevention (CDC). The model identifies schools as essential agencies of change in youth health behaviors (Wechsler, McKenna, Lee, & Dietz, 2004) and includes eight components known to strongly influence student health, with PE serving as one of the components (Allensworth & Kolbe, 1987). In 1991, Sallis and McKenzie published the seminal paper Physical Education's Role in Public Health, highlighting the vital potential contribution of schools and PE in addressing the nationwide concerns related to childhood obesity and physical inactivity.In response to this critical national concern, the U.S. Department of Health and Human Services (USDHHS, 2008) introduced the first set of approved guidelines addressing physical activity (PA): the 2008 Activity Guidelines for Americans. The guidelines recommend that children and adolescents engage in at least 60 min of moderate to vigorous physical activity (MVPA) daily. To further convey the importance of increasing PA opportunities, NASPE (2008) released a position statement recommending that all P-12 schools implement a Comprehensive School Activity Program (CSPAP). A CSPAP should include (a) quality PE (QPE), (b) PA during school, (c) PA before and after school, (d) school employee wellness and involvement, and (e) family and community involvement.The National Activity Plan (NPAP Alliance, 2010) includes comprehensive strategies to promote PA by eight sectors of society. The education sector is responsible for outlining strategies and tactics that could be implemented in and around the school setting (NPAP, 2010), with the first of seven strategies specifically targeting the comprehensive approach of the CSPAP. The goal of Strategy 1 is to access to and opportunities for high-quality, comprehensive physical activity programs, anchored by physical education, in Pre-kindergarten through grade 12 educational (Education section, para. 4). In line with this strategy and the NASPE (2008) recommendation, schools have been identified as one of the most appropriate settings for increasing PA (Institute of Medicine [IOM], 2013; Kelder, Karp, Scruggs, & Brown, 2014; NPAP Alliance, 2010; USDHHS, 2008), and national initiatives such as Let's Move! Active Schools (n.d.) have been established to provide schools and teachers with the necessary resources and tools to increase PA opportunities for students.Most recently, in The Essential Components of Education, SHAPE America (2015a) outlines four components that establish a more direct path for attaining QPE programs: (a) policy and environment, (b) curriculum, (c) appropriate instruction, and (d) student assessment. SHAPE America (2015a) identifies these as foundational components designed to guide schools and physical educators in making PE a more validated subject area. In addition to emphasizing more rigorous policies and higher accountability in the field, SHAPE America (2015a) also strongly endorses the use of the CSPAP framework to increase overall PA opportunities for students. …

Impact of school-based vegetable garden and physical activity coordinated health interventions on weight status and weight-related behaviors of ethnically diverse, low-income students: Study design and baseline data of the Texas, Grow! Eat! Go! (TGEG) cluster-randomized controlled trial.

BackgroundCoordinated, multi-component school-based interventions can improve health behaviors in children, as well as parents, and impact the weight status of students. By leveraging a unique collaboration between Texas AgriLife Extension (a federal, state and county funded educational outreach organization) and the University of Texas School of Public Health, the Texas Grow! Eat! Go! Study (TGEG) modeled the effectiveness of utilizing existing programs and volunteer infrastructure to disseminate an enhanced Coordinated School Health program. The five-year TGEG study was developed to assess the independent and combined impact of gardening, nutrition and physical activity intervention(s) on the prevalence of healthy eating, physical activity and weight status among low-income elementary students. The purpose of this paper is to report on study design, baseline characteristics, intervention approaches, data collection and baseline data.MethodsThe study design for the TGEG study consisted of a factorial group randomized controlled trial (RCT) in which 28 schools were randomly assigned to one of 4 treatment groups: (1) Coordinated Approach to Child Health (CATCH) only (Comparison), (2) CATCH plus school garden intervention [Learn, Grow, Eat & Go! (LGEG)], (3) CATCH plus physical activity intervention [Walk Across Texas (WAT)], and (4) CATCH plus LGEG plus WAT (Combined). The outcome variables include student’s weight status, vegetable and sugar sweetened beverage consumption, physical activity, and sedentary behavior. Parents were assessed for home environmental variables including availability of certain foods, social support of student health behaviors, parent engagement and behavior modeling.ResultsDescriptive data are presented for students (n = 1369) and parents (n = 1206) at baseline. The sample consisted primarily of Hispanic and African American (53 % and 18 %, respectively) and low-income (i.e., 78 % eligible for Free and Reduced Price School Meals program and 43 % food insecure) students. On average, students did not meet national guidelines for vegetable consumption or physical activity. At baseline, no statistical differences for demographic or key outcome variables among the 4 treatment groups were observed.ConclusionsThe TGEG study targets a population of students and parents at high risk of obesity and related chronic conditions, utilizing a novel and collaborative approach to program formulation and delivery, and a rigorous, randomized study design.