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Paragraphs for introduction to the chapter
Schools have more influence on the lives of youth than any other social institution except the family. In the United States, for approximately 190 days per year, 48 million youth attend the almost 110,000 elementary and secondary schools for about six hours of classroom time per day. More than 95% of all youth ages 5-17 are enrolled in school. Daily attendance averages 90%. During high school, national drop out rates average 12%; however, prior to high school, drop out is almost non-existent (NCES, 1993; National Education Commission on Time and Learning, 1994; NCES, 1994).
The goals of schools are consistent with the goals of health promotion. Because healthy children learn better than children with health problems do, to achieve their education mission, schools must help address the health needs of students. Furthermore, the underlying responsibility of schools to prepare youth to lead productive lives makes health promotion a central facet of the education mission. While schools alone cannot be expected to address the health and related social problems of youth, they can provide, through their climate and curriculum, a focal point for efforts to reduce health risk behaviors and improve the health status of youth (Kann et. al., 1995).
Increase to at least 30 percent the proportion of the Nation’s elementary, middle/junior, and senior high schools that require health education that follows the National Health Education Standards, uses effective up-to-date curricula, is provided by a qualified health education teacher, and emphasizes the six priority health risk behavior areas (behaviors that cause unintentional and intentional injuries; tobacco use; alcohol and other drug use; sexual behaviors; dietary patterns that cause disease; and inadequate physical activity).
Note the following operational definitions:
Effective curricula - curricula with scientific evidence of
effectiveness developed since 1990.
Qualified health education teacher - middle/junior and senior
high school teachers with a bachelor's degree in health education
or health and physical education, a graduate degree or 30 graduate
credits in health education or physical education, or certification
in health education or health and physical education.
Six priority health risk behavior areas - (1) behaviors that
cause unintentional and intentional injuries; (2) tobacco use;
(3) alcohol and other drug use; (4) sexual behaviors that cause
unintended pregnancies and sexually transmitted diseases; (5)
dietary patterns that cause disease; and (6) inadequate physical
activity.
Baseline data: Only available for parts of the proposed objective. In 1994, 53% of middle/junior and senior high schools had qualified health education teachers. In 1994, 47% of middle/junior and senior high schools provided instruction in the six-priority health risk behavior areas. Baseline data source: 1994 School Health Policies and Programs Study.
Health promotion has been included as one of the desired outcomes of formal education in the U.S. at least since 1918 when the Commission on the Reorganization of Secondary Education named health as the first of seven Cardinal Principles of Education (The Commission on the Reorganization of Secondary Education, 1918). In a recent report “Schools and Health: Our Nation’s Investment” the Institute of Medicine (1997) stated that students should receive the health-related education and services necessary for them to derive maximum benefit from their education and to enable them to become healthy, productive adults.
The School Health Education Study (Sliepcevich, 1964) conducted during the 1960s identified ten conceptual areas that have traditionally served as the basis of health education curriculum. More recently, CDC identified six categories of behaviors that are responsible for more than 70 percent of the mortality and morbidity among adolescents and thus should be the primary focus of school health education: (1) behaviors that cause unintentional and intentional injuries; (2) tobacco use; (3) alcohol and other drug use; (4) sexual behaviors that cause unintended pregnancies and sexually transmitted diseases; (5) dietary patterns that cause disease; and (6) inadequate physical activity (Kann, et.al., 1995). These behaviors are usually established during youth, persist into adulthood, are interrelated, and contribute simultaneously to poor health, education, and social outcomes.
The recently released National Health Education Standards (Joint Committee on National Health Education Standards, 1995) set the overarching goal of health education as the development of health literacy - the capacity to obtain, interpret, and understand basic health information and services and the competence to use such information and services to enhance health. Because these Standards are so new, few curricula have been redesigned or developed based on them, though this is one of the intended outcomes of the standards development process. Research has shown that for health education curricula to be successful in reducing priority health risk behaviors among adolescents effective strategies, considerable instructional time, and well-prepared teachers are required.
To attain this objective, states and school districts should support implementation of effective health education with appropriate policies, teacher training programs, provision of effective curricula, and regular assessment of progress. In addition, the role of the family, peers, and community at-large is critical to long term behavior change among adolescents.
The School Health Policies and Programs
Study 2000 will measure all eight components of the school health
program at the elementary, middle/junior, and senior high school
levels at the state, district, school, and classroom levels nationwide.
This study was first conducted in 1994. It will be repeated
in 2000 and at least one more time before 2010.
Data Source: School Health Policies and Programs Study 2000, CDC.
8.4B
Increase to at least 50% percent the proportion of the Nation’s elementary, middle/junior, and senior high schools that have a nurse-to-student ratio of at least 1:750.
Baseline data: In 1994, 28% of middle/junior and senior high schools had a nurse-to-student ratio of at least 1:750.
Baseline data source: 1994 School Health Policies and Programs Study.
The importance of providing health services to students in schools is widely accepted (Institute of Medicine, 1997). The provision of such services began over 100 years ago, with the purpose of controlling communicable disease and reducing absenteeism. Over the years, school health services have evolved to keep pace with changes in the health care, social, and educational systems in the United States (Lear, 1996). Current models of school health services reflect an understanding that children’s physical and mental health are linked to their abilities to succeed academically and socially in the school environment (National Health/Education Consortium, 1992).
Existing models of school health services span a wide range. In some schools, only basic needs such as emergency care are met (Snyder, 1991). At the other end of the spectrum are “full-service schools” that provide comprehensive primary health care, mental health counseling, social services, and educational counseling (Dryfoos, 1994). While the number of full-service schools is growing, only a fraction of schools provide primary health care (Institute of Medicine, 1997; National Nursing Coalition for School Health, 1995). Most commonly, school health services consist of basic care provided by registered nurses, sometimes with the assistance of health aides (Allensworth, 1994; Institute of Medicine, 1997).
School nurses are the traditional “backbone” of school health services and are often the only health care providers at the school site on a regular basis. The National Association of School Nurses recommends a ratio of one school nurse per 750 students.
The School Health Policies and Programs Study 2000 will measure all eight components of the school health program at the elementary, middle/junior, and senior high school levels at the state, district, school, and classroom levels nationwide. This study was first conducted in 1994. It will be repeated in 2000 and at least one more time before 2010.
Data Source: School Health Policies and Programs Study 2000, CDC
Increase to at least 12 percent the proportion of undergraduate students attending post-secondary institutions that receive information from their college or university on all six priority health risk behavior areas (behaviors that cause unintentional and intentional injuries; tobacco use; alcohol and other drug use; sexual behaviors; dietary patterns that cause disease; and inadequate physical activity).
Note the following operational definition:
Six priority health risk behavior areas - (1) behaviors that
cause unintentional and intentional injuries; (2) tobacco use;
(3) alcohol and other drug use; (4) sexual behaviors that cause
unintended pregnancies and sexually transmitted diseases; (5)
dietary patterns that cause disease; and (6) inadequate physical
activity.
Baseline data: In 1995, 6% of undergraduate students received information from their college or university on all six topics. The survey does not indicate in what form or how the data were received.
Baseline data source: 1995 National College Health Risk Behavior Survey.
More than 12 million students are currently enrolled in the nation’s 3,600 colleges and universities. Of these students, approximately 7.1 million are aged 18-24 years, comprising 57% of the college population. Of all persons aged 18-24 years in the United States, one fourth are currently either full- or part-time college students. Of all persons aged 20-24 years, more than half have attended college. (NCES, 1996; Bureau of the Census, 1996; Kominski et.al., 1994). Thus, colleges and universities are important settings for reducing important health-risk behaviors among many young adults.
Postsecondary institutions include 2- and 4-year community colleges, private colleges, and universities (CDC, 1997). Health education and health promotion activities can be conducted in these settings and reach the Nation’s future leaders, teachers, corporate executives, health professionals, and public health personnel. Personal involvement in a health promotion program can educate future leaders about the importance of health and engender a commitment to prevention that will benefit the future patients, students, and employees of today’s students.
Models of student health services range from small nurse-directed health centers in community colleges to comprehensive, full-service health care facilities with medical, psychological, psychiatric, and dental care; specialty services of various types, inpatient care, and a full range of health education and health promotion activities. Connections often exist between student health centers and medical, nursing, allied health, and public health programs elsewhere on campus.
CDC has identified six categories of behaviors that are responsible for more than 70 percent of the mortality and morbidity among young people and thus should be the primary focus of health education and health promotion activities conducted in post-secondary institutions: (1) behaviors that cause unintentional and intentional injuries; (2) tobacco use; (3) alcohol and other drug use; (4) sexual behaviors that cause unintended pregnancies and sexually transmitted diseases; (5) dietary patterns that cause disease; and (6) inadequate physical activity (Kann et. al., 1995). These behaviors are usually established during youth, persist into adulthood, are interrelated, and contribute simultaneously to poor health, education, and social outcomes.
Indeed, the 1995 National College Health Risk Behavior Survey (CDC, 1997) indicated that many college students engage in behaviors that place them at risk for serious health problems. Almost one third (29.0%) of college students were current cigarette smokers. One third (34.5%) reported episodic heavy drinking during the past month, 27.4% reported drinking alcohol and driving during the past month, and 30.5% of college students who had gone boating or swimming during the past 12 months had drunk alcohol while boating or swimming. One in five (20.4%) of female college student had been forced to have sexual intercourse during her lifetime. Only 29.6% of students who had had sexual intercourse during the past 3 months had used a condom at last sexual intercourse and 34.5% used birth control pills. About one in five (20.5%) of college students was overweight, 73.7% had failed to eat five or more servings of fruits and vegetables during the past day, and 21.8% had eaten three or more high-fat foods during the past day. Few college students had engaged in vigorous (37.6%) or moderate (19.5%) physical activity at recommended levels.
The National College Health Risk Behavior Survey provides information on the receipt of information on each of the six priority health risk behavior topics among nationally representative samples of undergraduate students attending post-secondary institutions. This survey was conducted in 1995 and is planned again for the next decade.
Data Source: National College Health Risk Behavior Survey, CDC
Allensworth, D.D. School health services: issues and challenges. In P. Cortese & K. Middleton (Eds.), The Comprehensive School Health Challenge: Promoting Health Through Education, vol. 1. Santa Cruz, Ca.: ETR Associates, 179-212, 1994.
Bureau of the Census. Statistical Abstract of the United States, 1996 (116th edition). Washington, DC: US Department of Commerce, 1996.
CDC. Youth Risk Behavior Surveillance: National College Health Risk Behavior Survey, United States, 1997. MMWR 46(SS-6), 1997.
Commission on the Reorganization of Secondary Education. Cardinal Principles of Secondary Education. Bulletin #35. Washington, DC: Bureau of Education, 1918.
Dryfoos, J.G. Full-service schools. San Francisco: Jossey-Bass, 1994.
Institute of Medicine. Schools and Health: Our Nation’s Investment. Washington, DC: National Academy Press, 1997.
Joint Committee on National Health Education Standards. National Health Education Standards: Achieving Health Literacy. Atlanta, GA: American Cancer Society, 1995.
Kann L, Collins JL, Pateman BC, Small ML, Ross JG, Kolbe LJ. The School Health Policies and Programs Study (SHPPS): Rationale for a Nationwide Status Report on School Health Programs. Journal of School Health 65(8):291-294, 1995.
Kominski R, Adams A. Educational Attainment in the United States: March 1993 and 1992. Washington, DC: US Bureau of the Census, 1994. (Current Population Reports no. P20-476).
Lear, J.G. School-based services and adolescent health: past, present, and future. Adolescent Medicine: State of the Art Reviews 7(2), 163-180, 1996.
National Education Commission on Time and Learning. Prisoners of Time. Washington, DC: National Education Commission on Time and Learning, 1994.
National Center for Education Statistics. Digest of Education Statistics, 1993. Washington, DC: US Department of Education, Office of Educational Research and Improvement, 1993.
National Center for Education Statistics. Dropout Rates in the United States: 1993. Washington, DC: US Department of Education, Office of Educational Research and Improvement, 1994.
National Center for Education Statistics.
Digest of Education Statistics, 1996. Washington, DC: US
Department of Education, Office of Educational Research and Improvement,
1996.
National Health/Education Consortium. The relationship of
health to learning: Healthy brain development. In H. Wallace,
K. Patrick, G. Parcel, & J. Igoe (Eds.), Principles and practices
of student health: vol. 2, School Health (pp. 262-272). Oakland,
Ca.: Third Party Publishing, 1992.
National Nursing Coalition for School Health. School health nursing services: exploring national issues and priorities. Journal of School Health, 65(9), 370-389, 1995.
Sliepcevich E. School Health Education Study: A Summary Report. Washington, DC: School Health Education Study, 1964.
Snyder, A. (ed.). Implementation Guide for the Standards of School Nursing Practice. Kent, OH: American School Health Association, 1991.
Draft of 2010 Objectives Ready for Internal
Review - March 1998
Secretary's Council Meeting -April 1998
Publication of Healthy People 2010 Draft -October 1998
Federal Register Notice of a Call for Public Comment on 2010
Draft -October 1998
Public Comment Period/Proposed Regional Meetings -October-December
1998
Healthy People 2000 Consortium Meeting -November 13, 1998,
Washington, DC
See the complete schedule at this web page:
http://web.health.gov/healthypeople/Guide/guide.htm#YEAR 2010 OBJECTIVES