Characteristics Associated With School Health Services for the Management of Chronic Health Conditions.

It is unknown how health services staff (school nurse or school physician) or school characteristics are associated with the number of services provided for chronic health conditions in schools. Using data from the 2014 School Health Policies and Practices Study, four services (identification or school-based management, tracking, case management, and referrals) were analyzed using a multivariable ordered logistic regression. Approximately 57.2% of schools provided all four, 17.5% provided three, 10.1% provided two, 5.8% provided one, and 9.4% did not provide any such services. Schools with a school nurse were 51.5% (p < .001) more likely to provide all four, and schools with access to consult with a school physician were 15.4% (p < .05) more likely, compared to schools without one. Schools comprised of mostly racial/ethnic minority students (less than or equal to 50% non-Hispanic White) were 14.7% (p < .05) less likely to provide all four, compared to schools with greater than 50% White students.

Do Schools That Screen for Body Mass Index Have Recommended Safeguards in Place?

The Centers for Disease Control and Prevention recommends that schools adopt 10 safeguards before launching a body mass index (BMI) screening program; however, little is known about schools' safeguard adoption. Authors identified questions from the 2014 School Health Policies and Practices Study that aligned with 4 of the 10 safeguards to estimate safeguard prevalence among schools that screened students for BMI (40.7%, N = 223). Among these schools, 3.1% had all four safeguards and 56.5% had none or one. The most prevalent safeguard was having reliable and accurate equipment (54.1%, 95% confidence interval [CI] = [46.1, 62.1]). Providing staff with appropriate expertise and training was the least prevalent; respondents in 26.4% (95% CI [17.1, 35.6]) of schools received recent training on weight status assessment, weight management, and eating disorder identification. School-based BMI screening is common, but adopting multiple recommended safeguards is not. Absent these safeguards, BMI screening programs may fall short of intended outcomes and potentially incur unintended consequences.

Health-Related Behaviors and Academic Achievement Among High School Students - United States, 2015.

Studies have shown links between educational outcomes such as letter grades, test scores, or other measures of academic achievement, and health-related behaviors (1-4). However, as reported in a 2013 systematic review, many of these studies have used samples that are not nationally representative, and quite a few studies are now at least 2 decades old (1). To update the relevant data, CDC analyzed results from the 2015 national Youth Risk Behavior Survey (YRBS), a biennial, cross-sectional, school-based survey measuring health-related behaviors among U.S. students in grades 9-12. Analyses assessed relationships between academic achievement (i.e., self-reported letter grades in school) and 30 health-related behaviors (categorized as dietary behaviors, physical activity, sedentary behaviors, substance use, sexual risk behaviors, violence-related behaviors, and suicide-related behaviors) that contribute to leading causes of morbidity and mortality among adolescents in the United States (5). Logistic regression models controlling for sex, race/ethnicity, and grade in school found that students who earned mostly A's, mostly B's, or mostly C's had statistically significantly higher prevalence estimates for most protective health-related behaviors and significantly lower prevalence estimates for most health-related risk behaviors than did students with mostly D's/F's. These findings highlight the link between health-related behaviors and education outcomes, suggesting that education and public health professionals can find their respective education and health improvement goals to be mutually beneficial. Education and public health professionals might benefit from collaborating to achieve both improved education and health outcomes for youths.

Opportunities for public health to increase physical activity among youths.

Despite the well-known benefits of youths engaging in 60 or more minutes of daily physical activity, physical inactivity remains a significant public health concern. The 2008 Physical Activity Guidelines for Americans (PAG) provides recommendations on the amount of physical activity needed for overall health; the PAG Midcourse Report (2013) describes effective strategies to help youths meet these recommendations. Public health professionals can be dynamic change agents where youths live, learn, and play by changing environments and policies to empower youths to develop regular physical activity habits to maintain throughout life. We have summarized key findings from the PAG Midcourse Report and outlined actions that public health professionals can take to ensure that all youths regularly engage in health-enhancing physical activity.

Using Health Education to Address Student Physical Activity and Nutrition: Evidence and Implications to Advance Practice.

BACKGROUND: School-based health education can provide students with learning experiences that improve knowledge, attitudes, and perceptions (KAP) and behaviors regarding physical activity and nutrition. METHODS: We conducted a 2-phase systematic review. Phase 1 was a review of reviews (ie, systematic reviews or meta-analyses) that were published 2010-2018. Phase 2 was a search for individual articles published 2010-2020 addressing topics relevant to our review; we searched for articles that had not been part of a sufficiently relevant or recent review or that had been part of a review that concluded that too few articles were available to assert sufficient evidence. RESULTS: Forty-three studies were assessed: 20 randomized controlled trials and 23 quasi-experimental designs. Collectively, interventions had a favorable impact on students' PA and nutrition KAP, but behavioral and secondary outcome results (eg, body mass index) were mixed. CONCLUSIONS: Using the evidence-based health education strategies identified in this review can help contribute to improvements in students' KAP and behaviors.

A Whole School, Whole Community, Whole Child Approach to Support Student Physical Activity and Nutrition: Introduction/Methods.

BACKGROUND: We introduce the Whole School, Whole Community, Whole Child approach to supporting student and school staff physical activity and nutrition and describe the methods used to generate the evidence synthesized across the special issue articles. METHODS: A 2-phase literature review search included a search of systematic reviews (2010-2018) for individual qualifying articles (Phase 1) and a search for individual articles on topics not addressed by a review (2010-2020) or that needed an update because they were in a review that was older (2010-2016) or showed insufficient evidence (Phase 2). Research librarians developed search strategies. In each phase, pairs of subject matter experts applied criteria to review abstracts and full-text articles and extracted data using standardized forms. We included 314 articles, describing 293 studies. FINDINGS: Most of the included studies looked at elementary or secondary school level interventions; 51% were rated poor quality, and few took place in a rural setting. IMPLICATIONS FOR SCHOOL HEALTH POLICY, PRACTICE, AND EQUITY: Most of the identified studies engaged majority minority or racially/ethnically diverse schools, suggesting that these interventions are feasible in a variety of settings. CONCLUSIONS: This collection of 10 articles identifies evidence-based interventions, gaps in research, and implications for health equity.

Dietary and Physical Activity Behaviors in 2021 and Changes from 2019 to 2021 Among High School Students - Youth Risk Behavior Survey, United States, 2021.

The fall of 2021 was the first school semester to begin with widespread in-person learning since the COVID-19 pandemic began. Understanding dietary and physical activity behaviors of adolescents during this time can provide insight into potential health equity gaps and programmatic needs in schools and communities. This report uses data from the 2021 national Youth Risk Behavior Survey conducted among a nationally representative sample of U.S. public and private school students in grades 9-12 to update estimates of dietary and physical activity behaviors among U.S. high school students overall and by sex and race and ethnicity. In addition, 2-year comparisons (2019 versus 2021) of these behaviors were examined. In 2021, daily consumption of fruits, vegetables, and breakfast during the past 7 days remained low and decreased overall with specific disparities by sex and race and ethnicity from 2019 to 2021. The overall prevalence of students attending physical education classes daily, exercising to strengthen muscles on ≥3 days/week (i.e., met the guideline for muscle-strengthening activity), and playing on at least one sports team decreased from 2019 to 2021; whereas being physically active for ≥60 minutes/day on all 7 days (i.e., met the guideline for aerobic activity) and meeting both aerobic and muscle-strengthening guidelines remained low but did not change. These findings underscore the need for strategies to increase healthy dietary and physical activity behaviors both in the recovery phase of COVID-19 and longer term.

Surveillance of Meeting the Youth Physical Activity Guideline: Impact of Including Vigorous-Intensity and Bone-Strengthening Activities.

Purpose: The US youth physical activity guideline recommends participation in four types of physical activity: moderate-to-vigorous intensity aerobic (MVPA), vigorous-intensity aerobic (VPA), muscle-strengthening, and bone-strengthening physical activity. Current national prevalence estimates of meeting the youth physical activity guideline are typically based on measures of the MVPA and muscle-strengthening components. This study sought to examine differences in prevalence estimates using this current approach and then including measures of all four components. Methods: Data from US high school student respondents to the 2010 National Youth Physical Activity and Nutrition Survey were analyzed (n = 10,596). Prevalence of students meeting the youth physical activity guideline were assessed and compared using 1) measures of MVPA and muscle-strengthening components only and 2) also including measures of the VPA and bone-strengthening components. Results: Overall, 15.2% students met the MVPA, 50.7% met the muscle-strengthening, 70.6% met the VPA, and 80.7% met the bone-strengthening components. In total, 12.1% (95% confidence interval: 10.9, 13.3) of students met both the MVPA and muscle-strengthening components, and 11.2% (95% confidence interval: 10.0, 12.4) met all four components. Conclusions: Incorporating additional measures of VPA and bone-strengthening activity into current surveillance systems may not meaningfully impact national estimates of meeting the youth physical activity guideline.

Individual and Collective Positive Health Behaviors and Academic Achievement Among U.S. High School Students, Youth Risk Behavior Survey 2017.

PURPOSE: We examined associations between academic grades and positive health behaviors, individually and collectively, among U.S. high school students. DESIGN: Cross-sectional study design. SETTING: Data were from the 2017 national Youth Risk Behavior Survey. Response rates were 75% for schools, 81% for students, and 60% overall (n = 14,765 students). SUBJECTS: Youth in grades 9th-12th. MEASURES: We focused on youth behaviors that can prevent or delay the onset of chronic health conditions. Seven dietary, 3 physical activity, 2 sedentary screen time, and 4 tobacco product use behaviors were assessed. Variables were dichotomized (0/1) to indicate that a score was given to the positive health behavior response (e.g.,, did not smoke cigarettes = 1). A composite score was created by summing each positive health behavior response among 16 total health behaviors. ANALYSIS: Multivariable logistic regression analyses for each individual health behavior, and a multivariable negative binomial regression for the composite score, were conducted with self-reported academic grades, controlling for sex, grade in school, race/ethnicity, and body mass index (BMI) categories. RESULTS: Controlling for covariates, students who reported mostly A's had 2.0 (P < .001) more positive health behaviors; students who reported mostly B's had 1.3 (P < .001) more positive health behaviors; and students who reported mostly C's had .78 (P < .001) more positive health behaviors, compared to students who reported mostly D's/F's. CONCLUSIONS: Higher academic grades are associated with more positive individual and cumulative health behaviors among high school students. Understanding these relationships can help inform efforts to create a healthy and supportive school environment and strive for health equity.

The association between school-based physical activity, including physical education, and academic performance: a systematic review of the literature.

OBJECTIVE: The purpose of this review is to synthesize the scientific literature that has examined the association between school-based physical activity (including physical education) and academic performance (including indicators of cognitive skills and attitudes, academic behaviors, and academic achievement). METHOD: Relevant research was identified through a search of nine electronic databases using both physical activity and academic-related search terms. Forty-three articles (reporting a total of 50 unique studies) met the inclusion criteria and were read, abstracted, and coded for this synthesis. Findings of the 50 studies were then summarized. RESULTS: Across all the studies, there were a total of 251 associations between physical activity and academic performance, representing measures of academic achievement, academic behavior, and cognitive skills and attitudes. Slightly more than half (50.5%) of all associations examined were positive, 48% were not significant, and 1.5% were negative. Examination of the findings by each physical activity context provides insights regarding specific relationships. CONCLUSION: Results suggest physical activity is either positively related to academic performance or that there is not a demonstrated relationship between physical activity and academic performance. Results have important implications for both policy and schools.

Disparities in Youth Sports Participation in the U.S., 2017-2018.

INTRODUCTION: In 2019, the National Youth Sports Strategy was released and called for regular analysis, interpretation, and dissemination of U.S. youth sports surveillance data. The purpose of this study is to provide the recent national estimates of U.S. youth aged 6-17 years who participate in sports and examine the differences in participation by demographic characteristics, overall and across age groups. METHODS: Nationally representative data on parent-reported youth sports participation from the 2017-2018 National Survey of Children's Health (n=36,779) were analyzed in 2019. The prevalence and 95% CIs of youth sports participation were estimated by demographic characteristics, overall and by age group. Investigators assessed the significant (p<0.05) differences and trends in participation using pairwise t-tests and orthogonal polynomial contrasts and effect modification by age group using logistic regression models. RESULTS: Overall, 57.7% (95% CI=56.6, 58.9) of U.S. youth participated in sports. Participation was highest among youth who were aged 10-13 years, male, and white, non-Hispanic and increased with increasing parent/caregiver education and household income (all p<0.05). Differences in participation by demographic characteristics were more pronounced among younger youth. For example, prevalence by household income level ranged from 32.7% to 79.9% among children aged 6-9 years and from 41.6% to 67.2% among youth aged 14-17 years. CONCLUSIONS: Although nearly 6 in 10 U.S. youth participate in sports, substantial disparities exist, especially among younger children. Identifying and overcoming the barriers may help increase youth sports participation in the U.S.

Dietary and Physical Activity Behaviors Among High School Students - Youth Risk Behavior Survey, United States, 2019.

Establishing healthy dietary and physical activity patterns among youths is an important public health strategy for improving health and preventing chronic diseases; however, few adolescents meet U.S. government recommendations for dietary or physical activity behaviors, and disparities by sex and race/ethnicity exist. CDC analyzed data from the 2019 Youth Risk Behavior Survey to update estimates of dietary and physical activity behaviors among U.S. high school students overall and by sex and race/ethnicity. In addition, 2-year comparisons (2017 and 2019) and trends in prevalence of these behaviors during 2009-2019 were examined. In 2019, overall, during the 7 days before the survey, 41.8% of students had eaten fruit or drunk 100% fruit juices <1 time/day; 40.7% had eaten vegetables <1 time/day; and 16.7% had not eaten breakfast on all 7 days. Moreover, although 57.4% of students had played on ≥1 sports team during the 12 months before the survey, less than half of students had been physically active for ≥60 minutes/day on all 7 days (23.2%), had exercised to strengthen or tone their muscles on ≥3 days/week (49.5%), had met both aerobic and muscle-strengthening physical activity guidelines (16.5%), or had attended physical education classes on all 5 days in an average school week (25.9%). Trend data indicate limited progress in shifting dietary and physical activity behaviors. That is, with the exception of decreases in the percentage of students who had consumed soda ≥1 time/day (2009: 29.2%; 2019: 15.1%), sports drinks ≥1 time/day (2015: 13.8%; 2019: 10.6%), and <3 glasses/day of plain water (2015: 50.5%; 2019: 44.6%), high school students' dietary and physical activity behaviors have not improved and, in certain cases, have worsened. These findings support the need for multicomponent approaches, including policy and environmental changes, and opportunities for adolescents to learn about and practice making healthy choices.

The role of lay health advisors in cardiovascular risk reduction: a review.

Interventions are needed to reduce the negative impact of cardiovascular disease. The combination of health risks for disease, disability, and mortality, particularly among underserved populations, might be best addressed with programs designed to enhance awareness and development of resources within a context of community support. The objectives of this review were to: (1) provide a comprehensive review and evaluation of the roles, evaluation, and effectiveness of LHA in community-based programs with an emphasis on cardiovascular risk reduction; and (2) provide recommendations for future research involving LHA in such programs. Computer and manual searches were conducted of articles in the English-language literature from 1980 to 2007. Twenty articles were evaluated, which emphasized the role of the LHA in cardiovascular risk reduction. A review of research literature provides a starting point for determining salient approaches for intervention and evaluation, issues related to program implementation and sustainability, and strengths and limitations of existing approaches.

Physical Education Policies in US Schools: Differences by School Characteristics.

BACKGROUND: We assessed the extent to which schools in the United States implement physical education policies identified in SHAPE America's Essential Components of Physical Education document and how implementation of these policies varies by school characteristics. METHODS: School policy data were collected as part of the 2014 School Health Policies and Practices Study via computer-assisted personal interviews in a nationally representative sample of K-12 schools and were linked to extant data on school characteristics. Bivariate analyses and Poisson regression model were used to examine how physical education policies differed by school characteristics. RESULTS: Five physical education policies varied by region and 3 varied by school level. Requiring certified, licensed, or endorsed physical education teachers varied by all school characteristics except school level and percentage of students eligible for free or reduced-price lunch. The average number of physical education policies implemented by schools was 3.0. The number of policies varied by metropolitan status and school level. CONCLUSIONS: The findings suggest many schools are only implementing a few of the physical education policies that can strengthen their physical education programs. These findings can be used to target professional development and technical assistance for physical education practitioners on policy and implementation.

Concussion and Academic Impairment Among U.S. High School Students.

INTRODUCTION: Sports and physical activities are a frequent cause of traumatic brain injury, primarily concussions, among adolescents. These concussions may adversely affect students' ability to learn and impair academic achievement in educational settings. METHODS: The 2017 Youth Risk Behavior Survey, conducted among a nationally representative sample of 14,765 U.S. high school students, was analyzed in 2018 to examine associations between self-reported sports- and physical activity-related concussions and symptoms of cognitive impairment (difficulty concentrating, remembering, or making decisions) and self-reported academic grades (mostly A's=4.0, mostly B's=3.0, mostly C's=2.0, mostly D's=1.0, mostly F's=0.0). Adjusted prevalence ratio and the difference in self-reported estimated grade point average were adjusted for sex, race/ethnicity, grade, and athlete status (participation on sports teams) and considered statistically significant if p<0.05. RESULTS: Male students were more likely than female students (17.1% vs 13.0%), and athletes were more likely than nonathletes (21.4% vs 7.6%) to have a self-reported sports- and physical activity-related concussion in the 12 months preceding the survey. Students with a reported sports- and physical activity-related concussion were more likely than students without one to report symptoms of cognitive impairment regardless of whether they were male (adjusted prevalence ratio=1.49), female (adjusted prevalence ratio=1.37), athletes (adjusted prevalence ratio=1.45), or nonathletes (adjusted prevalence ratio=1.42). Self-reported grade point averagedecreased significantly from 3.14 among students who reported no concussions (referent), to 3.04 among students who reported a single concussion, and 2.81 among students who reported ≥2 concussions. CONCLUSIONS: School-based programs are needed to monitor students' academic performance and provide educational support and resources to promote academic success following a concussion.

Practices That Support and Sustain Health in Schools: An Analysis of SHPPS Data.

BACKGROUND: The Whole School, Whole Community, Whole Child (WSCC) model provides an organizing framework for schools to develop and implement school health policies, practices, and programs. The purpose of this study was to examine the presence of practices that support school health for each component of the WSCC model in US schools. METHODS: Data from the School Health Policies and Practices Study 2014 were analyzed to determine the percentage of schools with practices in place that support school health for WSCC components. RESULTS: Less than 27% of schools had a school health council that addressed any specific WSCC component, but more than 50% had a coordinator for all but one component. The use of other practices that support school health varied widely across the WSCC components. For example, more than 80% of schools reported family engagement for health education and nutrition environment and services, but less than 50% reported family engagement for other components. CONCLUSIONS: These results indicate that many US schools are using practices that support school health and align with WSCC components, but improvement is needed. These results also highlight discrepancies in the types of practices being used.

Physical education and academic achievement in elementary school: data from the early childhood longitudinal study.

OBJECTIVES: We examined the association between time spent in physical education and academic achievement in a longitudinal study of students in kindergarten through fifth grade. METHODS: We used data from the Early Childhood Longitudinal Study, Kindergarten Class of 1998 to 1999, which employed a multistage probability design to select a nationally representative sample of students in kindergarten (analytic sample = 5316). Time spent in physical education (minutes per week) was collected from classroom teachers, and academic achievement (mathematics and reading) was scored on an item response theory scale. RESULTS: A small but significant benefit for academic achievement in mathematics and reading was observed for girls enrolled in higher amounts (70-300 minutes per week) of physical education (referent: 0-35 minutes per week). Higher amounts of physical education were not positively or negatively associated with academic achievement among boys. CONCLUSIONS: Among girls, higher amounts of physical education may be associated with an academic benefit. Physical education did not appear to negatively affect academic achievement in elementary school students. Concerns about adverse effects on achievement may not be legitimate reasons to limit physical education programs.

Application of a walking suitability assessment to the immediate built environment surrounding elementary schools.

This study examines the usefulness of applying a walking suitability assessment to a specific geographic area surrounding elementary schools. Streets within a 0.25-mile radius were measured to create a summary walking suitability score for seven schools from high-busing strata and seven from low-busing strata. Summary walking suitability scores were calculated for each school. A Mann-Whitney U test was conducted to determine any differences in scores between the high- and low-busing schools. The median walking suitability score was 3.7 (a good rating); the 25th percentile score was 2.9 (very good), and the 75th was 22.3 (poor). No statistical differences existed between busing strata. Walking suitability is an important consideration when examining the feasibility of walk-to-school programs within school settings; however, it might not be the main factor limiting children's active commuting to school. Several aspects of the environment were captured that researchers, practitioners, school personnel, and transportation experts may deem useful.