Schools and Health Our Nation's Investment (1997) / Chapter Skim
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Appendix A
Appendix A
Pages 303-336
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Appendixes
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, another option that is complementary to universal health care and that seeks to target youth directly is comprehensive school health education (9, 10~. Developing health education efforts that are centered around and reach out from the school is a logical goal for national health, given that upwards of onethird of the 1990 health objectives can be potentially attained through the school (7, 11~.
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One conceptualizes comprehensive school health education as an educational package within larger population-based health promotion efforts that include community education, worksite wellness programs, and legislative efforts (12~. The other conceptualizes health education as part of a "Healthy Children Ready to Learn" initiative that is targeted to the family, rather than the school, and integrates health education with referrals to social services (13~.
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Alternatively, schools "house" and care for youth six to seven hours a day, potentially serving as a mini-community for youth. However, common wisdom states that these hours are not sufficient to deliver health education messages that will result in long-term behavior change, and that school programming augmented by complementary community programs and messages is necessary to "boost" the effects of school program to the point of changing youth health behavior.
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In addition to offsetting barriers to effectiveness, the inclusion of community efforts in school health education would likely offset barriers to the initiation of new health education programs and the institutionalization of current programs (33~. Community support in the form of positive mass media coverage or financial support could increase the probability that a school health referendum would pass or that a controversial program, such as AIDS prevention, would be adopted by parents.
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explain how a small critical mass of community leaders or innovators may influence youth and adults to adopt health programs; these theories translate to lobbying for education referenda and local policy change, as well as the use of mass media to complement school health education programs (38, 39~. Potential mechanisms for integrating community efforts with school health education, according to theory, are summarized in Table A-1.
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Ideally, these levels of services are reciprocal and synergistic in terms of their effectiveness; thus, inclusion of all four levels in a comprehensive school health education plan would be considered a strategic use of prevention services (40~. Level 1 is primary prevention or universal health education involving whole populations of youth in school settings.
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Teacher, parent or peer Smoking, leader trainer, materials drugs, distribution nutrition Complementary Drugs community education, mass media coverage Complementary Drugs community education, peer leaders Collateral health Reproductive services or referral health for youth, primary prevention programs would be expected to be a major focus of school health education. Some qualitative results of process evaluations suggest that primary prevention programs promote increases in student requests or self-referrals for other levels of programming (40~.
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The working definition of "community" was any health promotion or disease prevention intervention conducted outside of the school and representing potentially significant channels of influence and programming for youth. The community channels included parent programs; mass media programming, campaigns, and materials; community organization and training, including the use of councils, coalitions, and partnerships or the use of extra-school settings for education, such as Boys and Girls Clubs or health agencies; and policy change initiatives, including school and community (46-49~.
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, 1 study (57, 58) 4 long-term drug prevention studies (59-62)
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APPENDIX A 315 Outcomes Community Media Organization Health Policy Participation Behavior Standardized training, increased implementation Some effects on program use rates NS 2-15% net decreases or 20-67% net change in monthly smoking, smaller effects on monthly alcohol and marijuana use; 6-mot to 3-yr. effects; no longterm effects (30)
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4 health promotion 1 Education, studies (72-75) , 2 screening reviews studies (76, 77)
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Increased parent Decrease in participation in cigarette, alcohol, activities marijuana use Increased health NR services utilization, funding continued on next page
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SCHOOL + COMMUNITY 2 smoking prevention 1 studies (92, 93) 1 smoking prevention study (94)
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APPENDIX A 319 Outcomes Community Media Organization Health Policy Participation Behavior Community training, education, collateral clinic services Increased self- NR and daily health services utilization Coalitions for Effects on NR training, purchase distribution, decisions, media release of coverage; fund materials, mass raising and media coverage, lobbying for policy change, fund-raising training teachers not effective Education School + parent Smoking coverage decreased in duration of intervention Education Effects on media Effects on smoking use increased increased with with student + school + parent parent participation implementation varied Campaigns School program No effects implementation questionable Education distribution in clinics of universities Condom use varied by setting continued on next page
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2 1 health promotion 1 study (111) Education, SAPs Education Homework Helmet distribution Education Education SAPs, core team Involvement in community development process
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· . In community Police as trainers, task force Coverage, Task force, Product campaigns distribution of availability materials, community education Campaign Fitness increased drug use decreased, in all settings Delayed onset in 1 study; no overall effects High student, parent participation rates High dissemination Task force Involvement in core team Community organization 11% decrease in cholesterol, increase in nutrition and exercise; 8% difference in weekly smoking at 5-yr.
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Peer-led Homework, education education Education Education, Parent counseling reinforcement, education 1 Education and lobbying Education NOTE: NR = not reported; NS = not specific; blank spaces = no information or not evaluated. 50 hours of teacher-taught school health education in the 1980s (50)
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None of the studies reviewed emphasized mechanisms to link or interface with the community (78~. None reported using a systems or restructuring intervention as suggested in some comprehensive school health education models and none reported placing a special emphasis on cultural sensitivity (15, 79~.
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School ~ Community Programs State-of-the-art school health education should include one or more of the mechanisms shown in Table A-1 to promote cross-referrals, crosscommunication, and resource sharing with community agencies for general health, as well as specific prevention services (compare 88~. The mechanisms should also include community leaders and parents as participant or discussants in the health education process, particularly for such sensitive health areas as AIDS education (89~.
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School + community programs were the only programs to show any effects on parent participation and parent health behavior or any effects on program or materials dissemination and health service delivery in the community. Effects of school + community programs on nutrition and exercise appear to be somewhat larger than effects of school programs; differential effects on sexual risk behaviors are not clear.
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Given the consistency of positive findings of school + community programs on participation, dissemination, and youth and parent health behavior variables, the general answer would appear to be yes. However, communities show great variability in the structure and action plans of the coalition, council, core team, or task force component used to integrate health education with the
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A recent analysis of a school + community program for drug abuse prevention supports this finding (123~. Who would coordinate integrated school and community health education programs, and who would fund these programs?
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To the extent that knowledge is measured as an educational outcome in health education classes, comprehensive school programs and integrated school + community programs could be considered effective in improving educational achievement. However, no studies reported significant effects of a health program on grade point average, absenteeism, or drop out rates, which are considered overarching indices of educational achievement.
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First, the school + community studies reviewed here were based on a model of intensive community involvement that probably exceeds the realistic capacity, resources, and time of most schools and school systems. The integrated school + community health education program mentioned in general models at the beginning of this paper (e.g., 18)
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Health policy reform and comprehensive school health education: the need for an effective partnership. Journal of School Health 63~1~:33-37.
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1981. The contribution of school health education to community health promotion: What can we reasonably expect?
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1994. Comprehensive school health education programs: Innovative practices and issues in standard setting.
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. Health Education Quarterly 16~2~:229-244.
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Special issue: Community coalitions for health promotion. Health Education Research 8~3~:375-384.
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1993. A cardiovascular health education program for rural schools.
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1995. The potential benefits and costs of a comprehensive school health education program.
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