Healthy Schools Programme Research Articles

Perceptions of oral health promotion in primary schools among health and education officials, community leaders, policy makers, teachers, and parents in Gulu district, northern Uganda: A qualitative study.

One in every two cases of caries in deciduous teeth occurs in low- and middle-income countries (LMICs). The aim of the World Health Organisation's (WHO) Healthy Schools Program is to improve the oral health of children. This study explored perceptions of implementation of the Ugandan oral health schools' program in Gulu district, northern Uganda. Semi-structured interviews were conducted with a purposive sample of 19 participants including health and education officials, community leaders, policy makers, teachers, and parents. All interviews were transcribed verbatim and analysed thematically. Our study identified three themes: (1) components of oral health promotion, (2) implementation challenges of oral health promotion, and (3) development of an oral health policy. The components of oral health promotion in schools included engagement of health workers, the community, companies, skills-based education, and oral health services. Participants were concerned about insufficient funding, unsatisfactory skills-based education, and inadequate dental screening. Participants reported that there was an urgent need to develop oral health policy to guide implementation of the program at scale. Schools provided oral health promotion that aligned with existing features of the WHO's health-promoting school framework. Implementation of this strategy could be enhanced with increased resources, adequate oral health education, and explicit development of oral health policy.

What are the environmental factors that affect implementation of the Manchester Healthy Schools programme? A qualitative exploration of staff perspectives

ObjectivesPrimary/elementary schools are crucial settings for early weight management interventions but effects on children’s weight are small. This may be because the environments in which these schools are situated support...

The Role of Technical Assistance in School Wellness Policy Enhancement.

School settings offer an opportunity to impact student health and wellness. Quality wellness policies are important in establishing strong wellness environments, but current resources to support policy development, maintenance, and dissemination are lacking. The Building Healthy Schools Program aimed to develop capacity of school districts to improve the strength and comprehensiveness of wellness policies and sustain these activities. Fifteen school districts in Pennsylvania participated in a program to facilitate the improvement of district wellness policies and practices. Program staff provided technical assistance to evaluate wellness policies before and after program implementation. Professional development and tailored training was provided for school personnel to create sustainability. Statistical analysis was performed to evaluate policy improvement. Thirteen of the 15 participating districts completed a policy revision. Median strength (p=.001) and comprehensiveness (p=.002) scores improved from baseline to post-program and there were significant improvements in most assessment sub-sections. Some districts were hesitant to make strong language improvements due to their limited capacity (ie, staff) for implementation. Champions (n=13; 87%) reported confidence to revise wellness policy language independently in the future. Technical assistance provided to districts facilitated significant improvements to wellness policy language, especially in the implementation, evaluation, and communication; critical components for policy impact on school wellness environments. In addition, participant feedback suggested an ability to sustain activities in the future. Both external (ie, technical assistance) and internal resources are needed to facilitate school districts' ongoing wellness policy improvement and implementation, including improved model wellness policy language and enforcement within schools, respectively.

Physical Activity and Healthy Eating Programming in Schools to Support Student's Health-Related Fitness: An Observational Study.

Centers for Disease Control (CDC) guidelines recommend schools use a coordinated health approach to support healthy eating and physical activity. This study examines whether the number of healthy eating and physical activity programs and activities used by schools and their perceived success relate to students’ health-related fitness. This observational study used data from the Healthy Zone Schools Program. Data (collected in 2017–2019) were integrated from three sources: (1) school surveys, (2) FitnessGram®, and (3) the Texas Education Agency. Independent variables were the number of health promotion programs and activities and their perceived success; dependent variables were meeting Healthy Fitness Zone Standards (HFZ) for aerobic capacity and body mass index (BMI). We used mixed-effects logistic regression models. Fifty-six schools were in the analytic sample (n = 15,096 students with aerobic capacity data and n = 19,969 with BMI data). Results indicated the perceived success of physical activity programs/activities was significantly associated with students meeting HFZ standards for aerobic capacity (OR = 1.32, CI = 1.06–1.63). There was a significant direct association between the number of physical activity and healthy eating activities implemented (OR = 1.04, CI = 1.01–1.06) and students meeting HFZ for BMI. Schools using multiple health programs and activities need to balance the number provided with their capacity to maintain success.

Promovendo a saúde escolar: a experiência de Hong Kong na parceria saúde e educação

Lee A, Tsang C, Lee SH, et alA comprehensive “Healthy Schools Programme” to promote school health: the Hong Kong experience in joining the efforts of health and education sectorsJournal of Epidemiology & Community Health 2003;57:174-177.

When a “One Size” Model Doesn't Fit All: The Building Healthy Schools Program

Although research suggests various effective interventions to curb obesity, there remains a gap between current evidence and sustainable practice in schools and communities. School settings present a logical platform for this work, since children spend much of their time in school. This article describes the Building Healthy Schools Program, a school-based partnership model that builds on the comprehensive school physical activity program framework by incorporating technical assistance and components of the Whole School, Whole Community, Whole Child model. The Building Healthy Schools Program aligns with the current school structure by utilizing wellness councils to plan and implement evidence-based obesity-prevention strategies over a two-year period. Participating school districts focus on creating and sustaining quality physical activity and nutrition environments by developing a strong wellness-council foundation and through policy revision. The utilization of evidence-based models, alignment with the standard school structure, and flexibility to meet districts “where they are” makes it possible for any school district to replicate the program, effectively connecting the gap between obesity-prevention research and community practice.

A review of the sustainability and impact of a healthy lifestyles programme in primary schools 2-5 years after the intervention phase.

There has been an emphasis on schools to promote healthy lifestyles and many intervention programmes have attempted this. Most programmes are evaluated at the time and/or shortly afterwards. This is a review of the impact and sustainability of the Health for Life programme 2-5 years after the initial phase. It captures the experiences of the senior school staff who delivered the programme through semi-structured interviews. Senior teachers recognized the importance of promoting healthy lifestyles in primary schools. They reported positively on aspects of the programme, in particular its flexibility and how it enabled schools to develop a new relationship with parents and how schools have sustained the initial programme. They discussed the main barriers to intervention and how they could be mitigated. Delivering a sustainable healthy lifestyle primary schools programme which has an impact is feasible but challenging for school staff. To maximize the likelihood of delivery, interventions must be championed by a member of the Senior Leadership Team, embedded in the curriculum, hands-on, easy to manage, and flexible to the needs of individual schools but requires support (financial, training and advisory). With these conditions the sustainability and impact of the programme was significant.

The Adopt-a-School Service-learning Program: Igniting Comprehensive School Physical Activity Programs through School and University Partnerships

Physical educators have been identified as ideal school champions to lead comprehensive school physical activity program (CSPAP) efforts within their schools. As such, they should be adequately prepared to take on this role. Faculty from three physical and health education teacher education programs have collaboratively developed the Adopt-a-School program to address this need. This problem-based service-learning program aids inservice professionals as they implement CSPAPs while simultaneously developing the skills, knowledge and confidence of future physical activity leaders. Through mutually beneficial partnerships, teacher candidate teams and local elementary school champions use the Active Schools and Alliance for a Healthier Generation's Healthy Schools Program websites to support and assess each school's current CSPAP, design and activate an action plan, and celebrate each school's success. Because each school and its needs are unique, teacher candidates have created and completed a variety of school physical activity initiatives over the past six years. An overview of service-learning is provided, followed by an in-depth description of the Adopt-a-School program and perceived stakeholder benefits.

Quality of local school wellness policies for physical activity and resultant implementation in Pennsylvania schools.

In 2006, United States public schools participating in federal school meal programs were required to adopt school wellness policies. The effect of these policies on school nutrition environments is well documented; however, evaluation of physical activity policies has received less investigation. We aimed to evaluate how district wellness policies aligned to practice for physical activity implementation in 40 schools with high obesity rates (>24%). Wellness policies were evaluated using the validated Wellness School Assessment Tool (WellSAT). Concurrently, schools completed the validated Alliance for a Healthier Generation's Healthy Schools Program (HSP) self-assessment to evaluate physical activity practices. Overall, 13 of 20 physical activity measures from WellSAT and 12 of 13 physical activity measures from HSP were aligned to match policy with practice. Most policy items scored 0 or 1, indicating either 'no mention in the policy' or 'containing weak or vague language'. Corresponding HSP results indicated that school physical activity practices are 'not in place' or 'under development'. A strong, positive, correlation (r = 0.92, P < 0.001) indicated that a significant relationship exists between policy and implementation. Results indicate that most districts currently have weak policies regarding physical activity, limiting the potential to positively influence school-based physical activity.

Establishing Community Wellness Teams

Grants Competitive and Non-competitive in 2013 and 2014. Poster will highlight training, nutrition education, and wellness policy work. Evaluation: Kansas State Department of Education has reached over 19,500 students through nutrition education promotion, over 4,200 foodservice professionals in training classes developed through the TNTG, and over 450 school staff through regional Impacting School Wellness Workshops. Conclusions and Implications: Evaluations from programs conducted under the Kansas State Department of Education's Team Nutrition Training Grants have shown positive response to program activities. Funding: USDA Grant #CNTN-14-KS(C).

Effect of the Healthy Schools Program on prevalence of overweight and obesity in California schools, 2006-2012.

IntroductionThe Alliance for a Healthier Generation’s Healthy Schools Program (HSP) is a national evidence-based obesity-prevention initiative aimed at providing the schools in greatest need with onsite training and technical assistance (TTA) and consultation with national experts (HSP national advisors) to create sustainable healthy change in schools’ nutrition and physical activity environments. The objective of this study was to evaluate the impact of HSP on the prevalence of overweight and obesity in California schools, from HSP’s inception in 2006 through 2012.MethodsWe used statewide body mass index (BMI) data collected annually from 5th-, 7th-, and 9th-grade students to determine whether enrolling in the HSP’s onsite intervention reduced the prevalence of overweight and obesity in intervention schools (n = 281) versus propensity-score matched control schools (n = 709) and whether increasing exposure to the program (TTA and contact with HSP national advisors) was associated with reductions in the prevalence of overweight and obesity.ResultsAnalyses showed no difference between HSP schools and control schools in overweight or obesity prevalence. However, program exposure varied widely among participating schools, and each additional contact with TTA or HSP national advisors was associated with a 0.3% decline in overweight and obesity prevalence (P < .05).ConclusionHSP appears to be an important means of supporting schools in reducing obesity. Although participation in HSP alone was not sufficient to improve weight status in California schools, there was a clear dose–response relationship to the program. HSP serves as an effective model for addressing childhood obesity among engaged schools.

Development of a point-of-use fortification technology for delivery of micronutrients in Honduras.

Micronutrient deficiencies continue to afflict children rural populations around the world. A micronutrient delivery vehicle (MDV) was developed as a point-of-use technology for fortification of meals for school-age children beneficiaries of the Healthy Schools Program (HSP) in Honduras. MDV combines micronutrient powder through a traditional dough-making process, using staple flours (wheat and nixtamalized corn), oil and water as ingredients. After mixing the ingredients and kneading, dough is extruded through a specially designed hand press into noodles. After drying (overnight, 23°C), noodles are broken into small pieces, mixed (1:100 w/w) with rice and cooked as customary. Dispersion studies with NaFeEDTA showed adequate distribution (<10% RSD) and recovery (>90%) in white rice. Color changes in MDV due to addition of vitamin A and iron (NaFeEDTA) carried forward into cooked rice. In Honduras, children from two rural schools (N = 47, 6-12 years) were not able to differentiate (triangle test) between control and unfortified MDV mixed (1:100 w/w) with white rice. Children from four schools (N = 83, 7-12 years) accepted control and iron fortified rice (3 mg Fe per serving) based on color and flavor similarly. This is a feasible point-of-use fortification technology for improvement of meals provided by the HSP in Honduras.

Health literacy in schools: prioritising health and well-being issues through the curriculum

Health literacy (HL) is a relatively new concept in health promotion and is concerned with empowering people through enhancing their knowledge of health issues and improving their ability to make choices about their health and well-being. Schools are seen increasingly as key settings for the dissemination of health messages through curricula and other on-site provision. However, such opportunities are amongst many demands being placed on educational providers and finding space in the school day to support the health agenda is a challenge. This practice-based, qualitative study examines the current practices in three schools in the UK. In total 34 pupils (n=16 from Year 9 and n = 18 from Year 11) were interviewed in six focus groups (3 in each school), with up to 6 pupils in each focus group. School staff (n = 8) were also interviewed individually. Findings suggest that pupils and staff have an understanding of health and a capacity for HL, though health education (via taught subjects) is not statutory across the four Key Stages of the National Curriculum. In order to engender health literate young people, with a view to reducing health inequalities, it is recommended that key health messages are delivered through an agenda that integrates current provision for health via the curriculum and other school-based practices, such as the Healthy Schools Programme.

Abstract B74: Raising healthy youth: Using the Manitoba Youth Health Survey to identify predictive factors of childhood obesity

Abstract In 2006, schools, communities and regional health authorities (RHAs) in Manitoba, Canada recognized the need for local risk factor surveillance data, and formed Partners in Planning for Healthy Living (PPHL) to pool in kind human resources, financial support and expertise in the pursuit of this common goal. PPHL was established as a network of partners involving collaboration with all Manitoba's RHAs, Manitoba Education, Manitoba Healthy Living (Healthy Schools program), Healthy Child Manitoba, Manitoba Health, NGOs, Manitoba Physical Education Supervisors' Association and the Public Health Agency of Canada Manitoba/Saskatchewan division. Between 2005 and 2008, PPHL implemented the Youth Health Survey (YHS) to explore the physical activity, healthy eating, BMI, tobacco use, substance use and school connectedness of Manitoba's youth. The survey was administered to students in grades 6-12 at more than 400 schools across Manitoba including First Nations, francophone and independent schools (n= 48,449). Local-level reports were provided to schools, school divisions and RHAs. The YHS data has been used extensively by schools, regional health authorities and other community health partners to help in planning and implementing healthy school policies and programs with support from Manitoba Healthy Living, RHAs and other community partners. The data has also provided a baseline for the evaluation of the recently implemented Grades 11 and 12 Active Healthy Lifestyles: Physical Education/Health Education curriculum. Secondary analysis of the data has recently begun to delve deeper into the relationships among the variables. One of the key areas of analysis is childhood obesity and its related factors. Obesity and its causes are major contributing factors to the development of certain cancers. Childhood obesity rates are rising at an alarming pace and as such, the development of programs aimed at curbing this rise is of primary importance to PPHL and its members. Recent research has provided information on the lifelong risks of childhood obesity which leads to healthy eating and adequate physical activity being top priorities in Manitoba. The purpose of our study is to identify factors related to and contributing to obesity levels of the children and youth who participated in the Manitoba YHS. A multilevel logistic regression approach with students nested within schools will be used to investigate both student- and school-level factors associated with (1) being underweight vs. a healthy weight and (2) being overweight vs. a healthy weight. Partners working and learning together has strengthened and developed relationships between health, education and communities. The partnerships have been critical to improving the health of our students in MB. The second cycle of the YHS will be implemented in all Manitoba schools this fall (2012). Citation Format: Jane Griffith, Tannis Erickson, Katherine Fradette, Oliver Bucher, Carly Leggett, Kate McGarry, Elizabeth Harland. Raising healthy youth: Using the Manitoba Youth Health Survey to identify predictive factors of childhood obesity. [abstract]. In: Proceedings of the Eleventh Annual AACR International Conference on Frontiers in Cancer Prevention Research; 2012 Oct 16-19; Anaheim, CA. Philadelphia (PA): AACR; Cancer Prev Res 2012;5(11 Suppl):Abstract nr B74.

Baseline Results of the First Healthy Schools Evaluation Among a Community of Young, Irish, Urban Disadvantaged Children and a Comparison of Outcomes With International Norms

In 2008, the Irish Government initiated a pilot Healthy Schools Programme based on the World Health Organization Health Promoting Schools Model among children attending schools officially designated as urban and disadvantaged. We present here the first results on physical and emotional health and the relationship between childhood depression and demographic and socioeconomic factors. The Healthy Schools Programme evaluation was a 3-year longitudinal outcome study among urban disadvantaged children aged 4 to 12 years. Physical and psychological health outcomes were measured using validated, international instruments at baseline. Outcomes at baseline were compared with international norms and where differences were found, results were statistically modeled to determine factors predicting poor outcomes. A total of 552 children responded at baseline, representing over 50% of all eligible children available to participate from 7 schools. Findings at baseline revealed that in general, children did not differ significantly from international norms. However, detailed analysis of the childhood depression scores revealed that in order of importance, psychological well-being, the school environment, social support, and peer relations and age were statistically significant predictors of increased childhood depression in children under 12 years of age. Future health and well-being studies in schools among urban disadvantaged children need to broaden their scope to include measures of depression in children under 12 years of age and be cognisant of the impact of the school environment on the mental and emotional health of the very young.

Alliance for a Healthier Generation's Competitive Beverage and Food Guidelines: Do Elementary School Administrators Know About Them and Do They Report Implementing Them?

The availability of competitive foods in schools is a modifiable factor in efforts to prevent childhood obesity. The Alliance for a Healthier Generation launched the Healthy Schools Program in 2006 to encourage schools to create healthier food environments, including the adoption of nutritional guidelines for competitive beverages and foods. This study examines nationwide awareness and implementation of the guidelines in US public elementary schools. Data were collected from a nationally representative sample of elementary schools using mail-back surveys in 2006-2007, 2007-2008, 2008-2009, and 2009-2010. From 2006-2007 to 2009-2010, awareness of the Alliance's beverage guidelines increased from 35.0% to 51.8% among school administrators (p < .01); awareness of the food guidelines increased from 29.4% to 40.2% (p < .01). By 2009-2010, almost one third of the schools that sold competitive beverages and foods reported having implemented or being in the process of implementing the guidelines. Implementation was higher among schools from Southern states. Schools with a majority of Black or Latino students were less likely to implement the guidelines. Awareness and implementation of the Alliance's beverage and food guidelines has significantly increased since the 2006-2007 school year, indicating successful diffusion of the guidelines. However, many administrators at schools who sold competitive products were not aware of the guidelines, indicating a need for continued efforts. In addition, lower implementation among schools serving minority students suggests that the Alliance's targeted efforts to provide intensive technical assistance to such schools is warranted and necessary.

Measuring and modelling body mass index among a cohort of urban children living with disadvantage

To report on baseline outcomes of body mass index, eating habits and physical activity of a cohort of urban disadvantaged children from a longitudinal evaluation of a school based, health promoting initiative. The healthy schools programme was developed for implementation in schools located in disadvantaged areas of Dublin, Ireland. A prospective, cohort study design was implemented. A 3-year longitudinal evaluation was conducted in five intervention and two comparison schools between 2009-2011. Data were collected on each participating child to determine their eating habits, levels of physical activity and body mass index at year 1 (baseline), year 2 and year 3. Independent t-tests were used to compare mean values, chi-square and Fishers exact tests were used to compare proportions at baseline. Participation rates were over 50%. Older children reported eating on average more fruit and vegetables than younger children; breakfast was often eaten on the way to, or in school and in one age group 16.7% of intervention children reported they did not eat breakfast that day. Levels of physical activity varied with over 70% of younger children stating they never played a sport. In intervention schools over one quarter of all children were either overweight or obese. A comparison was conducted between the proportion of 9-year olds overweight and obese in our disadvantaged cohort and a national random sample of 8500 9-year olds and no important differences were observed. Baseline results indicate that body mass index rates particularly among pre adolescent, urban disadvantaged girls are of concern.

Evaluation of the healthy schools program: Part I. Interim progress.

Federal and state policies identify schools as a setting to prevent childhood obesity, but schools need better health-promoting strategies. The objective of this study was to evaluate interim progress in schools receiving hands-on training from the Healthy Schools Program, the nation's largest school-based program aimed at preventing childhood obesity. The 4-year program targets schools with predominantly low-income, African American, or Hispanic students. In 2010 we assessed schools that enrolled in the 2007-2008 and 2008-2009 school years. School representatives completed an inventory of 8 content areas: policy and systems, school meals, competitive foods and beverages, health education, physical education, physical activity outside of physical education, before- and after-school programs, and school employee wellness. Schools' baseline inventory was compared by t test with the most recent inventory available. Schools made significant changes in all content areas, and effect sizes were moderate to large. Participating schools improved environmental policies and practices to prevent childhood obesity. The program is a resource to implement recent federal and state policies.

Evaluation of the healthy schools program: Part II. The role of technical assistance.

Evidence-based technical assistance may be needed to implement recent federal policy to prevent childhood obesity through the schools. The Healthy Schools Program is the largest school-based obesity prevention program in the United States. The objectives of this study were to evaluate the role of the program's training and technical assistance and to explore other contributing factors in changing school policies, practices, and environments. We analyzed interim progress of schools recruited during the 2007-2008 and 2008-2009 school years as of December 2010. Schools reported progress through an online inventory of policies, practices, and school environment. We compared baseline inventories to the most recent follow-up and tracked both training attendance and contact with national experts. To identify the factors associated with progress, we performed regression analysis on school level and demographics, number of months between baseline and follow-up, and technical assistance. The amount of training and technical assistance was significantly associated with school progress, controlling for school level and demographics, number of months between baseline and follow-up, and school status at baseline. Although all types of schools saw progress, schools in the South had the most progress and urban schools had the least progress. Evidence-based training and technical assistance were associated with school progress in changing policies, practices, and environment to prevent childhood obesity.

Engagement with the National Healthy Schools Programme is associated with higher fruit and vegetable consumption in primary school children

Improving children's diets is currently a government focus. However, fruit and vegetable consumption, a key target, is still far below the government guidelines of five portions per day. The present study aimed to assess the impact of engagement with the National Healthy Schools Programme (NHSP) on fruit and vegetable consumption in a sample of primary school children. A sample of 511 children, aged 7-9 years, who were attending 10 randomly selected schools in Hampshire, completed the Day in the Life Questionnaire, a validated 24-h recall method of dietary assessment. Fruit and vegetable intake in pupils attending schools engaged with the NHSP was compared with that of pupils attending schools not engaged with the programme. Children attending schools engaged with the NHSP ate a median of two (interquartile range, 0-8.0) portions of fruit and vegetables, compared to one portion (interquartile range, 0-8.0) consumed by pupils attending a school not engaged with the programme (P=0.001). Gender was also a significant predictor of fruit and vegetable consumption, with girls being 1.68 times more likely to consume 2.5 or more portions of fruit and vegetables. After adjustment for free school meal eligibility (as a measure of socio-economic status) and gender, pupils attending schools engaged with NHSP were twice as likely to eat 2.5 portions of fruit and vegetables or more per day. Engagement with the NHSP may be an effective way of increasing fruit and vegetable consumption in primary school children. Further evaluation of the programme is recommended to determine which aspects of the NHSP are successful in achieving this.