Healthy Schools Research Articles

The Role of Pediatric Health-care Providers in Promoting Students' Asthma Health.

The Role of Pediatric Health-care Providers in Promoting Students' Asthma Health.

Using Roger’s Diffusion of Innovation Theory to Implement the Healthy Schools National Accreditation

Background: In Jordan, The Healthy School National Accreditation has been introduced in 2008 as anational health-promoting school program where schools are invited to voluntarily join the accreditation.Unfortunately, financial challenges and lack of resources among many other factors led to very low enrollmentrate. Method: Adopting a selected change theory can be beneficial in making the decision and successfullyimplementing the intended change. Rogers’s diffusion of innovations theory was adopted by a public schooladministration to join the accreditation. This theory provides an explanation on how and at what rate newinnovations take place and spread out over time in any system.The school health committee went throughthe five stages proposed by the theory and successfully implemented the accreditation.Conclusion: Adopting Rogers’s diffusion of innovations theory can be beneficial iN implementing theschool health-promoting programs.Implication for School Health: School administrators, school health nurses and school health teachersare strongly advised to adopt this theory while they are considering joining the school health-promotingprograms.

Teacher-Student-Relationship Quality in Inclusive Secondary Schools: Theory and Measurement of Emotional Aspects of Teaching

Inclusive healthy schools are committed to provide a learning environment for a healthy development and optimal learning support for all students, regardless of their performance, language, learning and behavior disposition or disability. In order to achieve this goal, the relationship between teacher and students is crucial. Research in this area has shown the importance of emotional aspects as a mark of quality of teacher-student relationships, recognizing them as strong predictors for better achievement, compared to professional and subject-related aspects of teaching. Nevertheless, empirical studies in inclusive schools are seldom considering teacher-student relationships, as a theoretically sound conceptualization is missing in the context of research in inclusive schools. In the present paper, based on the attachment theory and the research on joint attention, two emotional components of teacher-student relationships are examined as key-concepts of high relevance for inclusive schools (emotional resonance and shared intentionality). It is also discussed how to empirically operationalize and measure these emotional components with the intention of analyzing the current situation of inclusive schools in future studies.

Peningkatan Implementasi Sanitasi Lingkungan melalui Pelatihan bagi Siswa Sekolah Dasar di Bogor

Clean and healthy life behavior (PHBS) in schools is an activity to empower students, teachers, and the community to run a healthy lifestyle and create healthy schools. The activity aims to socialize the importance of environmental sanitation in schools and raise awareness about the importance of environmental health in schools, through socialization and implementation training conducted in September 2020 in Bantarjati District, Bogor City, West Java. The activity was followed by students in grade 4 (four) elementary school totaling 35 students with implementation activities consisting of the preparation, core program and evaluation stages, then analyzed qualitatively through field observations and participant understanding interviews. The implementation of sanitation that has been carried out on students is one of the basic sanitation, which is washing hands and sorting waste by type. Minister of Health Regulation No. 3 of 2014 concerning STBM explains that washing hands with soap is the behavior of washing hands using clean running water and soap. Waste in general is divided into two, namely organic and inorganic waste. Both of these wastes have benefits for us, but they also have an impact on the environment. The results showed that the students' level of understanding at SDN 6 Bantarjati Bogor had a fairly good level. However, periodic socialization needs to be carried out as a process of forming student character and becomes a habit that is carried out so that it can be applied in everyday life through implementation training (practice).

Building Support for Place-Based Solutions to Childhood Obesity: Findings From Missouri.

Place-based efforts offer promise in reducing childhood obesity. Yet, lack of public demand and support may hinder implementation. This study aimed to assess whether the emphasis on place-based solutions, community-wide strategies, and multisector engagement in the Healthy Schools Healthy Communities (HSHC) initiative would shift public views on obesity including the need for greater public involvement and an increase in awareness and support for strategies. As part of the evaluation, two surveys were conducted-in 2014 and 2016-to examine the relationship between HSHC strategies and changes in public perception, support, and awareness of obesity. Both surveys were cross-sectional and conducted with a randomized sample of households. Most respondents indicated that parents/family (84.3% in 2014; 87.8% in 2016) and children (70.9% in 2014; 74.8% in 2016) had a large/very large responsibility for addressing childhood obesity. A higher percentage of 2016 respondents indicated willingness to work with others to increase availability of healthy foods (71.3% vs. 64.2%, respectively; p = .0280) and increase the number of places to be physically active in their community (71.1% vs. 60.7%, respectively; p = .0015). Findings suggest awareness and support of place-based efforts and willingness to engage may help garner ongoing support. However, individuals and families are still perceived as primarily responsible for addressing childhood obesity. Countering this mindset remains an ongoing challenge. Streamlined messaging regarding the issue and associated solutions, enhanced skills and capacity to implement these efforts, and citizen engagement to garner support for place-based initiatives are important.

Association between multi-component initiatives and physical activity-related behaviors: interim findings from the Healthy Schools Healthy Communities initiative

BackgroundAlthough successful, assessment of multi-component initiatives (MCIs) prove to be very challenging. Further, rigorous evaluations may not be viable, especially when assessing the impact of MCIs on long-term population-level behavior change (e.g., physical activity (PA) and health outcomes (e.g., childhood obesity). The purpose of this study was to use intensity scoring, to assess whether higher intensity MCIs implemented as part of Healthy Schools Healthy Communities (HSHC) were associated with improved physical activity and reduced sedentary behaviors among youth (dependent variables).MethodsPA-related interventions were assigned point values based on three characteristics: 1) purpose of initiative; 2) duration; and 3) reach. A MCI intensity score of all strategies was calculated for each school district and its respective community. Multivariate longitudinal regressions were applied, controlling for measurement period, Cohort, and student enrollment size.ResultsStrategy intensity scores ranged from 0.3 to 3.0 with 20% considered “higher-scoring” (score > 2.1) and 47% considered “lower-scoring” (< 1.2). Average MCI intensity scores more than tripled over the evaluation period, rising from 14.8 in the first grant year to 32.1 in year 2, 41.1 in year 3, and 48.1 in year 4. For each additional point increase in average MCI intensity score, the number of days per week that students reported PA for at least 60 min increased by 0.010 days (p < 0.01), and the number of hours per weekday that students reported engaging in screen time strategies decreased by 0.006 h (p < 0.05). An increase of 50 points in MCI intensity score was associated with an average 0.5 day increase in number of weekdays physically active and an increase of 55 points was associated with an average decrease of 20 min of sedentary time per weekday.ConclusionsWe found a correlation between intensity and PA and sedentary time; increased PA and reduced sedentary time was found with higher-intensity MCIs. While additional research is warranted, practitioners implementing MCIs, especially with limited resources (and access to population-level behavior data), may consider intensity scoring as a realistic and cost effective way to assess their initiatives. At a minimum, the use of intensity scoring as an evaluation method can provide justification for, or against, the inclusion of an individual strategy into an MCI, as well as ways to increase the likelihood of the MCI impacting population-health outcomes.

Healthier schools during the COVID-19 pandemic: ventilation, testing and vaccination.

Healthier schools during the COVID-19 pandemic: ventilation, testing and vaccination.

Program for Healthier School Cafeterias in Rio Grande do Sul, Brazil: Protocol for a Community-Based Randomized Trial.

BackgroundSchool cafeterias can promote poor eating habits, as these retail outlets have a variety of foods considered to be nonnutritive and unhealthy. However, despite the need for effective preventive strategies, there is still disagreement on the best approach due to the lack of evidence on interventions to prevent and treat obesity in the school settings.ObjectiveWe aim to verify the efficacy of an educational intervention program to improve the hygienic conditions and the composition of the menu offered in school cafeterias in the state of Rio Grande do Sul, Brazil.MethodsWe will conduct a randomized, parallel, two-arm, community-based controlled study. Elementary and high schools, both public and private, in the State of Rio Grande do Sul, Brazil, that have a cafeteria will be eligible. Schools will be recruited and randomly assigned to the intervention (n=27) or control (n=27) group. The intervention group will receive an educational intervention program based on the guidelines issued by the Ministry of Health of Brazil, consisting of a 160-hour distance-learning qualification course, for 10 weeks, and using the Moodle platform and WhatsApp app. The intervention targets the owners and people in charge of the cafeterias, food handlers, principals, vice principals, teachers, pedagogical coordinators, dietitians, representatives of students' parents, and students over 16 years old. Meanwhile, the control group will receive only a printed copy of the book containing the guidelines used. The efficacy of the intervention will be determined by the hygienic conditions of the cafeteria and the composition of the menu offered, also considering the levels of processing of food sold. All outcomes will be analyzed as intention-to-treat and per-protocol. We will use covariance analysis or a generalized linear model for continuous data and ordinal logistic regression for ordinal categorical data. The level of statistical significance considered will be P<.05 for a 95% CI.ResultsThis project was funded in early 2018. We administered the intervention program in 2019. All data have already been collected, and we are analyzing the data. The results are expected in 2021.ConclusionsTo our knowledge, this may be the first randomized controlled study in school cafeterias held in Brazil. The results will provide evidence for the formulation of public food and nutritional security policies and for the development of effective strategies to provide safe and healthy school meals.Trial RegistrationBrazilian Clinical Trials Registry RBR-9rrqhk; https://ensaiosclinicos.gov.br/rg/RBR-9rrqhkInternational Registered Report Identifier (IRRID)DERR1-10.2196/22680

Building healthy schools through technology-enabled citizen science: The case of the our voice participatory action model in schools from Bogotá, Colombia

ABSTRACT The physical and social environment of school settings are important for health promotion among children and adolescents. Efforts to create supportive environments at the school level can benefit from including community engagement and empowerment processes to advocate for health promotion. The Our Voice model presents a unique opportunity for Latin American students to improve their school environments. The objective of this study was to engage and empower students (9–18 years) from five schools in Bogotá, Colombia to use the Our Voice model to assess and seek to improve their local school environments. This study employed Our Voice’s ‘citizen science by the people’ method using a mobile application for data collection. The Our Voice initiative included the following four phases: (1) Design, planning and recruitment; (2) Data collection; (3) Community meetings for thematic analysis, priority setting and initial design of feasible solutions; and (4) Community meetings with decision-makers to advocate for changes. The citizen scientists identified and advocated for safer physical activity-supportive environments and healthier food and drinks availability. This study allowed children and adolescent citizen scientists to make their voices heard by policymakers and empowered them as agents of change in the process of building healthier schools.

BMI trajectories after primary school-based lifestyle intervention: Unravelling an uncertain future. A mixed methods study.

This mixed methods study aimed to examine plausible body mass index (BMI) trajectories after exposure to a primary school-based lifestyle intervention to aid in estimating the long-term intervention benefits. BMI trajectories for children at control schools (mean 7.6years of age) were modelled until 20years of age through extrapolating trial evidence (N=1647). A reference scenario assumed that the observed 2-year effects of the 'Healthy Primary Schools of the Future' (HPSF) and 'Physical Activity Schools' (PAS) were fully maintained over time. This was modelled by applying the observed 2-year BMI effects until 20years of age. Expert opinions on likely trends in effect maintenance after the 2-year intervention period were elicited qualitatively and quantitatively, and were used for developing alternative scenarios. Expert elicitation revealed three scenarios: (a) a constant exposure-effect and an uncontrolled environment with effect decay scenario, (b) a household multiplier and an uncontrolled environment with effect decay scenario, and (c) a household multiplier and maintainer scenario. The relative effect of HPSF at 20years of age was -0.21kg/m2 under the reference scenario, and varied from -0.04kg/m2 (a) to -0.06kg/m2 (b), and -0.50kg/m2 (c). For PAS, the relative effect was -0.17kg/m2 under the reference scenario, and varied from -0.04kg/m2 (a, b), to -0.21kg/m2 (c). The mixed methods approach proved to be useful in modelling plausible BMI trajectories and specifying uncertainty on effect maintenance. Further observations until adulthood could reduce the uncertainty around future benefits. This trial was retrospectively registered at Clinicaltrials.gov (NCT02800616).

Thai ‘Healthy Schools’ teacher professional competency needs development analyses

Thai ‘Healthy Schools’ teacher professional competency needs development analyses

Physiological and Lifestyle Factors Associated With Abnormal Blood Pressure in Adolescents Before and After a School-Based Wellness Program in Michigan: A Report From Project Healthy Schools

PurposeHypertension (HTN) is associated with increased cardiovascular risk and unhealthy lifestyles in adults. However, data on both physiological and lifestyle factors associated with abnormal blood pressure (BP) in adolescents, as well as the effectiveness of interventions in improving these factors among adolescents with abnormal BP, is scarce. MethodsStudents enrolled in a middle-school-based wellness program, Project Healthy Schools (PHS), between 2005–2016 were eligible. Three systolic (SBP) and diastolic (DBP) BP measurements were taken pre-PHS and post-PHS; averages of the final two were analyzed. Students were grouped by baseline BP: abnormal BP (≥90th percentile for SBP and/or DBP, or ≥120/80 mmHg) or normal BP (<90th percentile for SBP and/or DBP, or <120/80 mmHg). Demographics, physiologic measures, and health behaviors were compared between groups pre- and post-PHS. ResultsOf 2,865 students, 812 (28.3%) had abnormal BP. Median SBP was 119 mmHg in abnormal BP students and 103 mmHg in normal BP students (p < .001). Females were less likely to have abnormal BP than males (48.4% vs. 51.6%, p < .01). Pre-PHS, abnormal BP students were more likely to be overweight (62.3% vs. 28.2%, p < .001) or obese (38.9% vs. 11.3%, p < .001) than normal BP students. Their total cholesterol, triglycerides, random glucose, resting, and recovery heart rates were also higher, and they had worse dietary and sedentary habits. Post-PHS, abnormal BP students demonstrated greater reduction in SBP (−4.0 vs. 2.8 mmHg, p < .001) and DBP (–3.3 vs. .8 mmHg, p < .001) than normal BP students. ConclusionsAbnormal BP was prevalent and associated with worse cardiometabolic health parameters and behaviors at baseline. Abnormal BP students demonstrated significant improvements in BP post-PHS, suggesting school-based programs may be effective as nonpharmacological lifestyle interventions in this population.

Everyone Matters: Eliminating Dehumanizing Practices in Physical Education

Recently, discussions regarding how to create a positive school climate where all can be successful has come to the forefront. Healthy schools support student learning, well-being, time, space to be active, and opportunities for social and emotional growth. However, a host of numerous trends suggest that the school climate is becoming increasingly hostile towards students who are from immigrant, LBGTQ, and ethnic minority groups. What is often seen as disrespectful behavior toward these students is in fact actions that can be more accurately defined as dehumanization. This article overviews the practice of dehumanization, the implications for learning, and introduces proactive strategies to promote the success of all students.

A Canadian-wide perspective on the essential conditions for taking a comprehensive school health approach

BackgroundThe primary purpose of this research was to explore Comprehensive School Health (CSH) stakeholders’ perceptions of the essential conditions for taking a CSH approach in other contexts across Canada. The secondary purpose was to examine the need for and development of an evaluative tool or resource to assess the implementation of the essential conditions.MethodsData were generated through individual semi-structured interviews (n = 38) and small group interviews (n = 3) with 45 participants across Canada involved in implementing policies or programs which take a CSH approach. Interviews were subjected to content analysis.ResultsThere was positive support for the essential conditions and results indicated the essential conditions are relevant across Canada. Findings revealed the necessity for a new essential condition that reflected support and leadership from the school district and/or provincial/territorial governing bodies. Modifications to the description of each of the essential conditions were also suggested to provide clarity. Results also indicated that an evaluative tool that was concise, meaningful, and provided immediate feedback would be useful to school communities to establish readiness, assess, and improve ongoing implementation of CSH approaches.ConclusionsThis research contributes to the evidence-base of CSH by providing school communities across Canada with a set of refined and understandable essential conditions that support successful implementation. Further, the development of an evaluation tool will support school health champions, researchers, and policymakers in the optimization and implementation of policies or programs which take a CSH approach, ultimately supporting healthier school communities across the country.

Implementation and outcome evaluation of a team nutrition intervention: increasing knowledge, attitudes, and preferences.

Low-income, rural children are at a greater risk for poor dietary intake. Schools offer a venue to deliver appropriate interventions. Our aim was to evaluate the implementation and effectiveness of Healthy Schools, Healthy Students (HSHS). We conducted a mixed-methods evaluation using a cluster-randomized trial design with 20 schools in a rural, Midwestern state. HSHS included education sessions, cafeteria coaching and taste testing. We interviewed implementers (n = 13) and nutrition educators (n = 8), conducted six focus groups with cafeteria coaches, and surveyed fourth graders (n = 1057) about their nutrition knowledge, attitudes toward and preferences for fruits and vegetables (F&V), F&V consumption and MyPlate awareness. We used multi-level linear models to estimate the intervention effect and qualitative data were coded. There were very few challenges to implementation. HSHS participation was positively associated with knowledge, attitudes toward F&V, preferences for vegetables from the taste tests, MyPlate awareness and vegetable consumption. HSHS was viewed as beneficial and easy to deliver, suggesting this type of intervention could be widely implemented. Improving knowledge and attitudes through nutrition education and preferences through taste testing have the potential to improve dietary intake among rural students. Low-cost nutrition interventions can be successfully implemented in rural elementary schools with positive outcomes.

МЕТОД ПРОЄКТІВ ЯК ЗАСІБ ФОРМУВАННЯ ЗДОРОВОГО СПОСОБУ ЖИТТЯ

Статтю присвячено дослідженню методу проєктів як інноваційної технології. Визначено, що метод проєктів стимулює розвиток пізнавальних здібностей учнів, сприяє формуванню вмінь самостійно знаходити шляхи розв’язання проблем через різноманітні форми діяльності. Встановлено, що метод проєктів ґрунтується на ідеї спрямованості освітньої діяльності школярів, на результат, який можна отримати завдяки вирішенню тієї чи іншої теоретично-практично значущої для здобувача освіти проблеми. Метод проєктів є інноваційною педагогічною технологією, що дає змогу найповніше враховувати індивідуальні особливості кожного учня, тобто реалізувати особистісно орієнтований підхід у навчанні, заснований на особистісних характеристиках. Визначено, що проєктна діяльність належить до унікальних способів людської практики, пов’язаної із передбаченням майбутнього, створенням його ідеального образу, здійсненням та оцінкою наслідків реалізації задумів.&#x0D; Колектив Рівненської спеціалізованої школи І-ІІІ ступенів № 15 взяв участь у Програмі «Healthy Schools: заради здорових і радісних школярів». «Healthy Schools: заради здорових і радісних школярів» – це програма, що реалізується Центром «Розвиток корпоративної соціальної відповідальності» та Mondelēz International Foundation з метою популяризації здорового способу життя, раціонального харчування серед учнів та концепції «здорового дизайну» рекреацій і приміщень, де перебувають і харчуються діти.

From Consultation to Shared Decision-Making: Youth Engagement Strategies for Promoting School and Community Wellbeing.

ABSTRACTBACKGROUNDThe benefits of youth engagement are well documented. In this paper, we examine youth engagement in America's Promise Alliance's Every School Healthy initiative, a part of the Robert Wood Johnson Foundation's Together for Healthy and Successful Schools Initiative (THSS). METHODSSix community acceleration sites were selected through a competitive grant‐making process. Sites were required to describe youth engagement strategies. A case study design was employed to examine how sites conceptualize youth engagement as well as youth engagement strategies employed across 6 sites. Data sources included observations, team member debriefs, and document review.RESULTSThere was variation in how youth engagement and youth voice are conceptualized in educational settings, and readiness for youth engagement. Sites actively solicited and implemented youth engagement resources and strategies.CONCLUSIONSBy failing to engage young people, well‐intentioned adults miss important opportunities. Youth engagement presents an exciting opportunity for school leaders, policymakers, and program planners to gain a deeper understanding of the factors that influence individual and community health and wellbeing and, in turn, helps them to develop responsive policies and programs.

Research to Translation: The Healthy Schools Toolkit and New Approaches to the Whole School, Whole Community, Whole Child Model.

ABSTRACTBACKGROUNDThe Whole School, Whole Community, Whole Child (WSCC) model is an evidence‐based comprehensive framework to address health in schools. WSCC model use improves health and educational outcomes, but implementation remains a challenge.METHODSWorking with 6 schools in 2 districts in the Midwest, we used a mixed‐methods approach to determine the people, systems, and messages needed to activate WSCC implementation. We report on social network analysis and message testing findings and research translation to develop the Healthy Schools Toolkit.RESULTSSocial networks for both districts included more than 150 individuals. Both demonstrated network densities less than half of the desirable threshold, with evidence of clustering by role and minimal cross‐school relationships, posing challenges for WSCC implementation. Across stakeholder groups, messages that emphasize empathy, teamwork, and action were well‐received, especially when shared by trusted individuals through communication channels that align with stakeholder needs.CONCLUSIONSThe Healthy Schools Toolkit provides an example of a translational product that helps to bridge research with practice. With features that highlight 6 design principles, the toolkit provides complementary activities that schools and districts can use as they plan for integration of the WSCC model.

Impact on staff of the Mentally Healthy Schools Framework

PurposeThe Mentally Healthy Schools Framework (MHSF), based on the population-wide Act-Belong-Commit mental health promotion campaign, is a whole-school approach primarily targeting student mental health, but it is also intended for staff. This paper presents the results of an impact survey on staff after the implementation of the Framework in a number of schools in Western Australia.Design/methodology/approachA baseline questionnaire was completed by n = 87 staff at schools that had just signed up to the programme, and a participant questionnaire was completed by n = 146 staff at schools that had been participating for at least 17 months.FindingsThe results show that the Framework has had a substantial impact on many staff in terms of increased mental health literacy and taking action to improve their mental health.Originality/valueMental health interventions in schools generally focus on students' well-being and how to deal with student mental health problems. There are few comprehensive interventions that also include staff well-being.

Associations between gender, school socioeconomic status, and cardiorespiratory fitness among elementary and middle school students

BackgroundSchools play an important role in providing access to physical activity opportunities for children. There are common economic and gender disparities in physical activity and health-related fitness among children, which may inform a school’s programming needs. The purpose of this study is to gain a better understanding about gender, school-level socioeconomic status, and children’s cardiorespiratory fitness.MethodsThis observational study used 2017–2018 school year data from schools in the Dallas Metropolitan area participating in the Healthy Zone School (HZS) program. Three data sources were integrated: 1) FitnessGram® data, 2) school-level data from the Texas Education Agency, and 3) HZS survey data. Being in the Healthy Fitness Zone (HFZ) for aerobic capacity was the dependent variable, and gender and the percentage of economically disadvantaged students (at the school-level) were key independent variables. Mixed-effects logistic regression models examined associations between dependent and independent variables. Final models were adjusted for age and type of aerobic test.ResultsThere were 67 schools and 15,052 students included in the analysis. When testing main effects, girls had lower odds for being in the HFZ for aerobic capacity than boys (OR = 0.54, CI = 0.47–0.62). Additionally, having a greater percentage of students who were economically disadvantaged was associated with lower odds for being in the HFZ for aerobic capacity (0.98, CI = 0.98–0.99). There was a significant interaction between gender and the percentage of economically disadvantaged students. Results indicated girls had even lower odds (than boys) for being in the HFZ in schools with 90% economically disadvantaged students (OR = 0.44, CI = 0.35–0.55) versus in schools with 15% economically disadvantage students (OR = 0.62, CI = 0.51–0.76).ConclusionsResults suggest girls in Healthy Zone Schools have lower odds to meet aerobic capacity fitness standards than boys. Additionally, boys and girls in schools serving a greater percentage of economically disadvantaged students have lower odds to meet aerobic capacity fitness standards. Last, girls have even lower odds of meeting HFZ standard when attending a school serving a greater percentage of economically disadvantaged students. Thus, schools need to provide more programs for girls targeting aerobic physical activity. This is especially important for schools serving a high percentage of low-income students.