The Future of School Health Education in the United States: An Ontology.

BACKGROUND: As summarized in this article, the widespread implementation of modern school health education (SHE) could become one of the most effective means available to improve the well-being of people in the United States and in other nations. However, the development and evolution of SHE largely remains unorganized, underdeveloped, and neglected by health and education agencies, policymakers, and the public. METHODS: Essential to the development of any scientific discipline, scientists today use the word ontology to refer to efforts to organize knowledge in particular domains. A useful working definition of a scientific ontology is an explicit, formal specification of a shared conceptualization-a systematic set of shared terms and an explication of their interrelationships. Nine interdependent questions are outlined to help guide the development of an initial, broad, and actionable scientific ontology for SHE. RESULTS: Whether and how we respond to these questions arguably will determine the future of SHE research, policy, practice, and equity in the United States. CONCLUSIONS: An initial ontology might help conceptualize, inform, and facilitate more systematic and strategic local, state, national, and international deliberations and actions to improve SHE.

School Gun Violence in the United States.

BACKGROUND: Although less than 2% of all homicides among young people are school-associated, since 1970 1373 K-12 school gun violence incidents have injured 1403 people and killed another 728. These incidents have changed the education landscape. Informed stakeholders must work together to prevent school gun violence. METHODS: We reviewed the nature of school gun violence in the United States and efforts to prevent it. RESULTS: We briefly outline a public health approach to prevent school gun violence, major actions the nation has taken, current school gun violence surveillance systems, the effects of school gun violence nationwide, the extent to which our schools are implementing various interventions to prevent it, and a national strategy to move forward. CONCLUSIONS: Our young people and our schools deserve a more organized national effort.

School Health as a Strategy to Improve Both Public Health and Education.

Because schools materially influence both health and education, they substantially determine the future well-being and economic productivity of populations. Recent research suggests that healthier children learn better and that more educated adults are healthier. School health is a cross-disciplinary field of study and a fundamental strategy that can be used to improve both health and education outcomes. Modern school health programs include 10 interactive components: health education; physical education and physical activity; nutrition environment and services; health services; counseling, psychological, and social services; physical environment; social and emotional climate; family engagement; community involvement; and employee wellness. This review is written for both health and education audiences. It integrates recent research and developments in relationships among health, education, and economic outcomes; health and education systems; the school health program, its components, and their effectiveness; cross-disciplinary collaboration; local, state, national, and international infrastructures and strategies; implementation science; and relevant academic research, training, and service.

Hazardous Chemical Releases Occurring in School Settings, 14 States, 2008-2013.

Children are considered to be a vulnerabletion when it comes to exposures to hazardous substances. Schools, where children spend about one third of their day, are expected to be a safe environment. Yet, there are many hazardous substances in schools that can be inadvertently or intentionally released and harm the health of students and teachers alike. The purpose of this analysis is to characterize acute chemical release incidents in school settings and identify prevention practices. The acute chemical incident surveillance programs of the Agency for Toxic Substances and Disease Registry (ATSDR) captured 24,748 acute chemical release incidents from 14 states that participated during 2008-2013. We examined 335 of these incidents that occurred at schools. While only 1.3% (n = 335) of all chemical incidents reported to ATSDR occurred in schools, these incidents represented a larger part of the total impacts, including 8.5% of incidents with persons injured, 5.7% of evacuations ordered, and 31.1% of people evacuated. Natural gas (21.8%) and mercury (18.2%) were the chemicals most frequently released. Collecting and analyzing data on acute school chemical releases allows stakeholders to target prevention initiatives and provide a school environment safe from these chemical exposures.

Federal Public Health Service: In Retrospect and Prospects.

In this article, I offer a retrospective case study about my early, short-term work within the U.S. Office of the Assistant Secretary for Health and then my later, longer-term work within the U.S. Centers for Disease Control and Prevention, where I endeavored for two decades largely to help our nation's schools improve health and associated education outcomes. First, for context, I briefly portray the nature of our related political and public health systems. I then frame this retrospective by illustrating how my serial employment within other public health system organizations led to, and then resulted from, my work within these two federal public health agencies. To represent the many talented individuals in each organization with whom I had the good fortune to work, I name only one in each organization. I then characterize how these individuals and organizations progressively shaped my work and career. I conclude by speculating about prospects for academic institutions to more purposefully prepare students and faculty to work within federal government public health agencies.

What have we learned from collaborative partnerships to concomitantly improve both education and health?

BACKGROUND: Collaborative partnerships are an essential means to concomitantly improve both education outcomes and health outcomes among K-12 students. METHODS: We describe examples of contemporaneous, interactive, and evolving partnerships that have been implemented, respectively, by a national governmental health organization, national nongovernmental education and health organizations, a state governmental education organization, and a local nongovernmental health organization that serves partner schools. RESULTS: Each of these partnerships strategically built operational infrastructures that enabled partners to efficiently combine their resources to improve student education and health. CONCLUSIONS: To implement a Whole School, Whole Community, Whole Child Framework, we need to purposefully strengthen, expand, and interconnect national, state, and local collaborative partnerships and supporting infrastructures that concomitantly can improve both education and health.

Secondhand smoke exposure and other correlates of susceptibility to smoking: a propensity score matching approach.

Secondhand smoke (SHS) exposure is responsible for numerous diseases of the lungs and other bodily systems among children. In addition to the adverse health effects of SHS exposure, studies show that children exposed to SHS are more likely to smoke in adolescence. Susceptibility to smoking is a measure used to identify adolescent never-smokers who are at risk for smoking. Limited research has been conducted on the influence of SHS on susceptibility to smoking. The purpose of this study was to determine a robust measure of the strength of correlation between SHS exposure and susceptibility to smoking among never-smoking U.S. adolescents. This study used data from the 2009 National Youth Tobacco Survey to identify predictors of susceptibility to smoking in the full (pre-match) sample of adolescents and a smaller (post-match) sample created by propensity score matching. Results showed a significant association between SHS exposure and susceptibility to smoking among never-smoking adolescents in the pre-match (OR=1.47) and post-match (OR=1.52) samples. The odds ratio increase after matching suggests that the strength of the relationship was underestimated in the pre-match sample. Other significant correlates of susceptibility to smoking identified include: gender, race/ethnicity, personal income, smoke-free home rules, number of smoking friends, perception of SHS harm, perceived benefits of smoking, and exposure to pro-tobacco media messages. The use of propensity score matching procedures reduced bias in the post-match sample, and provided a more robust estimate of the influence of SHS exposure on susceptibility to smoking, compared to the pre-match sample estimates.

Secondhand smoke exposure in cars and rooms: trend comparisons among subpopulations of nonsmoking U.S. middle and high school students.

INTRODUCTION: Young people in the United States are exposed to secondhand smoke (SHS) primarily in 2 settings: homes and cars. Recently, researchers reported that the prevalence of U.S students exposed to SHS in cars decreased from 2000 to 2009; however, comparisons of trends across school levels, gender, and racial/ethnic groups were not assessed. Moreover, no studies have examined trends of exposure to SHS in rooms. METHODS: We used data from the 2000, 2002, 2004, 2006, and 2009 waves of the National Youth Tobacco Survey, a nationally representative cross-sectional survey of U.S. middle and high school students. For SHS in cars and rooms, we identified exposure trends among nonsmokers from 2000 to 2009 and compared trends across subpopulations with binary logistic regression. RESULTS: We identified significant downward linear trends in SHS in cars and rooms for nearly all measured subpopulations of nonsmoking students from 2000 to 2009. SHS exposure in cars and rooms declined at a significantly greater rate for males than for females. SHS exposure in cars declined at a significantly greater rate for non-Hispanic (NH) Blacks than for NH Whites. SHS exposure in rooms declined at a significantly greater rate for NH Whites than for Hispanics and Native Hawaiians/Pacific Islanders. CONCLUSIONS: Although prevalence of exposure to SHS in cars and rooms among nonsmoking U.S. middle and high school students has declined from 2000 to 2009, the rates of decline were not equal across genders and racial/ethnic groups. Identification of these differing rates of exposure can help the public health community advocate for interventions focused on reducing adolescent SHS exposure.

Effectiveness of the energize elementary school program to improve diet and exercise.

BACKGROUND: The rate of childhood obesity has more than tripled during the past 30 years. Research shows that prevention at an early age is more effective than treatment later in life. Energize is a multicomponent intervention incorporated into the school day that combines nutrition education and physical activity aimed at maintaining healthy weight among elementary school youth. This study evaluated the effectiveness of the Energize program for changing dietary and physical activity habits compared to a control group of children not participating in the program. METHODS: A total of 104, 3rd and 4th graders in 3 southern Indiana elementary schools took part in the study. A quasi-experimental design was used to assess dietary and exercise habits of students in Energize and control groups through 12-week diet/activity logs and post-test questionnaires after controlling for the pre-test results. RESULTS: Energize reduced consumption of French fries and potato chips, but did not increase physical activity. CONCLUSIONS: This study provides future researchers with a foundation for preparing longer studies of Energize or to compare multiple years of a standardized Energize curriculum.

Understanding African American women's decisions to buy and eat dark green leafy vegetables: an application of the reasoned action approach.

OBJECTIVE: Examine intentions to buy and eat dark green leafy vegetables (DGLV). DESIGN: Cross-sectional survey assessing demographics, behavior, intention, and Reasoned Action Approach constructs (attitude, perceived norm, self-efficacy). SETTING: Marion County, Indiana. PARTICIPANTS: African American women responsible for buying and preparing household food. MAIN OUTCOME MEASURE(S): Reasoned Action Approach constructs explaining intentions to buy and eat DGLV. ANALYSIS: Summary statistics, Pearson correlations, and multiple regression analyses. RESULTS: Among participants (n = 410, mean age = 43 y), 76% and 80%, respectively, reported buying and eating DGLV in the past week. Mean consumption was 1.5 cups in the past 3 days. Intentions to buy (r = 0.20, P < .001) and eat (r = 0.23, P < .001) DGLV were positively associated with consumption. Reasoned Action Approach constructs explained 71.2% of the variance in intention to buy, and 60.9% of the variance in intention to eat DGLV. Attitude (ß = .63) and self-efficacy (ß = .24) related to buying and attitude (ß = .60) and self-efficacy (ß = .23) related to eating DGLV explained significant amounts of variance in intentions to buy and eat more DGLV. Perceived norm was unrelated to either intention to buy or eat DGLV. CONCLUSIONS AND IMPLICATIONS: Interventions designed for this population of women should aim to improve DGLV-related attitudes and self-efficacy.

Social-ecological factors of leisure-time physical activity in Black adults.

OBJECTIVES: To develop and test an explicative model of leisure-time physical activity (LTPA), including 6 selected contributory factors: self-efficacy, self-regulation, social support, perceived physical environment, outcome-expectancy value, and policy beliefs. METHODS: A social-ecological model of LTPA using the structural equation modeling technique was estimated in a regional, church-going sample of 649 African Americans. RESULTS: The results indicated this model is good fit to the data. LTPA was associated with self-regulation and gender directly (P<.05) and social support, self-efficacy, perceived access to LTPA facilities, and positive outcome-expectancy value indirectly (P<.05). CONCLUSIONS: Multitiered interventions considering cultural relevance are recommended to improve LTPA engagement.

The combined effect of behavioral intention and exposure to a smoke-free air law on taking measures to quit smoking.

Because of the large burden of disease attributable to cigarette smoking, a variety of tobacco control interventions, some focused on changing individual behavior and others focused on influencing societal norms, have been introduced. The current study tested the combined effect of behavioral intention and exposure to a comprehensive smoke-free air law as a prospective predictor of taking measures to quit smoking. Participants were 187 adults living in 7 Texas cities, 3 with a comprehensive smoke-free air law and 4 without such a law, who reported current cigarette smoking at baseline and completed a 1-month follow-up interview. Data were collected by telephone administration of a questionnaire. Results showed that, compared with smokers with low behavioral intention to take measures to quit smoking and no exposure to a comprehensive smoke-free air law, the smokers with high behavioral intention and exposure to a comprehensive law had the greatest odds of taking measures to quit smoking. This longitudinal study provides further evidence that the most successful smoking cessation campaigns will be multifaceted addressing individual factors with educational strategies designed to change beliefs and intentions and environmental factors with policy-based interventions.

Applying the theory of planned behavior to explore the relation between smoke-free air laws and quitting intentions.

Smoke-free air policies have been shown to reduce smoking, but the mechanism of behavior change is not well understood. The authors used structural equation modeling to conduct a theory of planned behavior analysis with data from 395 smokers living in seven Texas cities, three with a comprehensive smoke-free air law and four without a comprehensive law. Agreement with regulating smoking in public places was significantly associated with attitudes and perceived normative pressure about quitting. Nicotine dependence was significantly associated with attitudes and perceived behavioral control. There was also a direct effect of nicotine dependence on intention to take measures to quit smoking. Smoke-free air laws appear to influence quitting intentions through the formation of positive attitudes about regulating smoking in public places and the perception of normative pressure to take measures to quit. Implications for smoke-free air policy campaigns and challenges in evaluating their effectiveness are discussed.

Health of adolescents and young adults: trends in achieving the 21 Critical National Health Objectives by 2010.

PURPOSE: The 21 Critical National Health Objectives (CNHOs) for Adolescents and Young Adults derived from Healthy People 2010 addressed the most significant threats to the health of individuals aged 10-24 years. This study assessed trends in the 21 CNHOs between 1991 and 2009, and from baseline years for which 2010 targets were established to 2009, and the extent to which targets were achieved. METHODS: For one CNHO (new HIV diagnoses), national data were not available. For CNHOs measured by census systems, the percentage of change in each health outcome was calculated between 1991 and 2009 and between baseline years and 2009. Any change ≥5% was considered as an improvement or deterioration. For CNHOs measured by national probability-based surveillance surveys, multivariate logistic regression was conducted using Stata Version 10.0 (StataCorp, College Station, TX) to calculate odds ratios for each outcome from 1991, and from baseline years to 2009, controlling for gender, race/ethnicity, and age or school grade-level. To calculate the percentage of targets being achieved, the difference between baseline data and 2009 data was divided by that between baseline data and target. RESULTS: Adolescents and young adults achieved two targets (rode with a driver who had drunk alcohol, physical fighting), improved for 12 CNHOs, made mixed progress by sub-objective for two, showed no progress in four, and regressed in achieving two (Chlamydia infections; overweight). Progress varied by demographic variables. CONCLUSION: Although encouraging trends were seen in young people's health, the United States achieved only two CNHOs. Attention is needed to improve the health and reduce disparities among young people.

Leisure-time physical activity and obesity in black adults in Indianapolis.

OBJECTIVE: To examine the relationship between the total volume of leisure-time physical activity (LTPA) and obesity among African American adults in Indianapolis. METHODS: Logistic regression analysis with 649 African American adults. RESULTS: The data show an inverse graded relationship between the total volume of LTPA and obesity for African American women, but not for men. CONCLUSIONS: African American women who accumulate a high volume of LTPA (ie, 300 minutes or more per week) are less likely to be obese. Further research is needed to investigate the gender difference in the effect of LTPA on obesity.