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? ? Healthy Schools = Healthy Kids = Learning Better OR What is the relationship between school health policy and learning? Julia Dilley PhD MES Washington State - Healthy Schools Summit May 2008 Objectives Increase skills for: Using WA Healthy Youth Survey to describe “healthy students”

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slide1

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Healthy Schools = Healthy Kids = Learning BetterORWhat is the relationship between school health policy and learning?

Julia Dilley PhD MES

Washington State - Healthy Schools Summit

May 2008

objectives
Objectives

Increase skills for:

  • Using WA Healthy Youth Survey to describe “healthy students”
  • Using WA School Health Profile data to describe “healthy schools”
  • Describing association between academic achievement & health
  • Describing association between school health policies and student health
background
Background
  • From an ongoing project to merge Washington’s student-level health data and school-level policy data
    • Some results are preliminary
theoretical model
Theoretical Model

Students exhibit more healthy behaviors

Pro-health school policies, procedures & environments

School health programs

Students Learn Better

theoretical model5

Pro-health school policies, procedures & environments

School health programs

Students Learn Better

Theoretical Model

Students exhibit more healthy behaviors

What are important

health conditions?

Who is at risk?

healthy youth survey hys
Healthy Youth Survey (HYS)
  • Paper-based questionnaire given to 6th, 8th, 10th & 12th graders in fall of even years
  • Asks questions about
    • Risk & protective factors
    • Alcohol, drug & tobacco use
    • Health status
  • Next survey is Fall 2008:
    • Visit www.hys.wa.gov for materials, recruitment information, reports, link to online data analysis
    • Schools need to register by June 30 (it’s free)
health indicators of interest
Health Indicators of Interest
  • Smoking cigarettes
  • Using alcohol
  • Using marijuana
  • Obesity
  • Severe asthma
  • Poor nutrition: not eating breakfast
  • Poor nutrition: not enough fruit & veg
  • Poor nutrition: 2+ soda pop per day
  • Sedentary lifestyle: Insufficient exercise
  • Sedentary lifestyle: 3+ hours TV per day
  • Feeling unsafe at school
  • Mental distress/depression
  • Insufficient (<8 hours) sleep per night
health indicator trends
Health Indicator Trends
  • Most health status indicators are fairly stable
  • Smoking & marijuana have decreased in recent years
  • Obesity has increased in recent years
  • Local trends may be different – see your own reports
health disparities smoking
Health Disparities: Smoking

Source: 2006 Healthy Youth Survey, state sample only grades 8-10-12 combined.

health disparities smoking12
Health Disparities: Smoking

Source: 2006 Healthy Youth Survey, full dataset, 10th grade

health disparities feeling unsafe
Health Disparities: Feeling Unsafe

Source: 2006 Healthy Youth Survey, state sample only grades 8-10-12 combined.

health disparities feeling unsafe14
Health Disparities: Feeling Unsafe

Source: 2006 Healthy Youth Survey, full dataset, 10th grade

health disparities overweight
Health Disparities: Overweight

Source: 2006 Healthy Youth Survey, state sample only grades 8-10-12 combined.

health disparities overweight16
Health Disparities: Overweight

Source: 2006 Healthy Youth Survey, full dataset, 10th grade

summary how are different students at risk
Summary: how are different students at-risk?
  • Race/ethnicity
    • Asian students and white non-Hispanic students tend to have lowest risk for a variety of factors
    • Native American, Black, Latino and Pacific Islander/Hawaiian students tend to have higher risk
  • Socio-Economic Status
    • Students in lower income families tend to have greater health risks
theoretical model18

Students exhibit more healthy behaviors

School health programs

Students Learn Better

Theoretical Model

What is the status

of school health

policies in

Washington?

Pro-health school policies, procedures & environments

school health profiles survey
School Health Profiles Survey
  • Paper-based questionnaire given to principals & lead health teachers in secondary schools
  • Given in spring of even-numbered years (in the field now!)
  • Asks about health-related policies and environments
  • Reports & more information:

http://www.k12.wa.us/CoordinatedSchoolHealth/SchlHealthProfiles.aspx

school health policy indicators
School Health Policy Indicators
  • School Health Capacity
    • 52% have an advisory group
    • 65% have any health-related SIP goals/objectives (31% nutrition, 36% physical activity, 23% tobacco, 26% illness)
    • 59% have any staff wellness programs
school health policy indicators22
School Health Policy Indicators
  • Asthma
    • 53% “no idle zone” policy for buses
    • 81% obtain asthma action plans
  • Nutrition
    • 27% policy to offer fruit & vegetable options when foods offered
    • Nutrition standards: 76% for vending, 74% for school store, 32% for parties, 29% fundraising
    • Labeling healthy food options: 30% cafeteria, 55% vending, 30% school store
    • Access to unhealthy competitive foods: 49% before class, 50% at lunch, 36% other hours during school
school health policy indicators23
School Health Policy Indicators
  • Physical Activity
    • 32% required 4+ PE classes
    • 34% had staff who received training in fitness instruction
    • 50% promoted walking & biking to school
    • 38% have “safe route to school” partnerships
  • Tobacco
    • 89% posted “no-tobacco” signs
    • 87% enforced a “no-tobacco” zone near school property
    • 64% had supportive consequences
associations school characteristics and strong policies
Associations: School Characteristics and Strong Policies
  • Schools with advisory groups tend to have stronger health policies
  • Larger schools tend to have stronger health policies
  • We are exploring whether having health-related SIP goals/objectives improves health policies
  • Staff wellness programs appear correlated with some improved policies and student behaviors
theoretical model25

Students exhibit more healthy behaviors

Pro-health school policies, procedures & environments

School health programs

Students Learn Better

Theoretical Model

Alignment of health with schools’ educational mission is

critical

summarizing the research
Summarizing the Research
  • Building evidence base for associations
    • CDC DASH website: http://www.cdc.gov/HealthyYouth/health_and_academics/index.htm
    • California Study (Update 5) http://www.gettingresults.org/
    • Active Living Research summary: http://www.activelivingresearch.org/alr/alr/files/Active_Ed.pdf
    • UW SDRG study linked WASL scores with school-level HYS (Arthur & Brown, 2005)
  • One study estimated that up to one-quarter of minority achievement gap due to health disparities (Currie, 2005)
academic risk
Academic Risk
  • In HYS, self-reported as getting “mostly Cs, Ds, Fs”
    • 24% of 8th graders and 31% of 10th graders overall
academic risk race
Academic Risk & Race

Source: 2006 Healthy Youth Survey, state sample only grades 8-10-12 combined.

disparities in achievement math wasl
Disparities in Achievement: Math WASL

NOTE: on this graph “higher” is better

academic risk socio economic status
Academic Risk & Socio-economic Status

Source: 2006 Healthy Youth Survey, state sample only grades 8-10-12 combined.

increasing risks increasing academic challenges
Increasing Risks  Increasing Academic Challenges

2006 HYS: grades 8 and 10 combined

average health risks by race
Average # Health Risks by Race
  • White NH: 3.1
  • Asian: 3.0
  • Native American: 3.8
  • Black: 3.8
  • Latino: 3.8
  • Pac Islander/Native Hawaiian: 3.6
multivariate statistical models
Multivariate Statistical Models
  • We used a multivariate logistic regression model to simultaneously take all factors into account.
  • For those factors that are no longer significant, we can say that associations we originally observed can actually be attributed to other factors (those that remained significant).
  • For example, soda pop remains statistically significant in our full model – this means that for youth with all the same other factors (nutrition, overweight, exercise, safety, maternal education/SES, etc.) that drinking increasing numbers of soda pop per day is still is associated with increased academic risk.
which are most important
Which are most important?
  • Strongest associations
    • Smoking, severe asthma, marijuana, no breakfast, depression
  • Moderate associations
    • Obesity, soda pop, insufficient exercise, TV, alcohol, feeling unsafe at school
  • Weakest associations
    • Sufficient fruit & veg, not enough sleep
which health risks can we change with school based interventions and how
Which health risks can we change with school-based interventions, and how?
  • Would be good to have interventions with broad influence, that reach race/ethnic minority and low SES students equitably
  • Would be good to have interventions that can include families, but do not rely on them or place any burden on them – things that can become “how the school works” or “what is normal”

 Policy, Procedure, Systems

theoretical model41

Students exhibit more healthy behaviors

Pro-health school policies, procedures & environments

School health programs

Students Learn Better

Theoretical Model

This is currently the weakest link

what about individual interventions
What about Individual Interventions?
  • Individual interventions can change student health
  • Pros
    • Can be tailored to meet individual needs
  • Cons
    • Expensive/resource intensive to implement, difficult to sustain
    • May not always reach students in greatest need
    • Changing students one-by-one takes a long time
policy environment change interventions
Policy & Environment-change Interventions
  • Policy interventions don’t cause individual behavior change, but they support other efforts
    • If the school was a garden, policy would be the fertile (or barren) soil where healthy ideas to grow
  • Pros
    • Broad influence, for a variety of students
    • Once implemented, need for resources to maintain may be less
  • Cons
    • Policies can’t be only on paper, they need promotion, buy-in and enforcement
    • Engaging diverse families may be difficult, but could be very helpful for implementation
exploratory statistical models
Exploratory statistical models
  • We linked school policy data and student behavior data to describe changes in student behavior associated with changes in school policy
    • Reducing access to competitive foods was linked with decreases in student consumption of high-fat snacks and pop from school sources
    • Implementing more PE requirements increased student physical activity (this might be especially important for overweight students)
    • Lower SES schools had better PE participation, maybe due to fewer college-bound students seeking PE exemptions?
disparities in perception of support systems
Disparities in Perception of Support Systems

Source: 2006 Healthy Youth Survey

disparities in perceived enforcement
Disparities in Perceived Enforcement

Source: 2006 Healthy Youth Survey, 10th grade

possible interpretation
Possible Interpretation
  • The more individualized an intervention, the more critical cultural competence becomes
theoretical model51

Students exhibit more healthy behaviors

Pro-health school policies, procedures & environments

Students Learn Better

You are

here

Theoretical Model

School health programs

summarizing what we know
Summarizing what we know
  • There is a strong association between health risks and academic risks, probably healthy students learn better
    • it certainly couldn’t hurt to help students be healthier!
  • Health disparities may play an important role in minority & socio-economic achievement gaps
  • School policy interventions can have a modest but broad-based, sustainable influence on student health behaviors
which health factors to prioritize
Which Health Factors to Prioritize?
  • Consider
    • Prevalence of the health risk factor, number of students to influence
    • Strength of association, logical direction of association
    • Evidence for school-based interventions
    • Resources for interventions
    • Potential reach and sustainability of outcomes
    • Political/community buy-in and opportunities
    • Building comprehensive capacity to address health in schools
thank you
Thank you!

Keep watching the research…

Julia Dilley

julia.dilley@state.or.us

(360) 705-1358