Health Profiles.qxd
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participation in school sports (37%), participation in other school activities (72%), ... §ion=53 www.aptv.org/FTR/Other/Health. Report.pdf.) One of the areas ...
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Marchina Toodle Alabama Department of Education Federal Programs, Coordinated School Health 50 North Ripley Street, Room 5348 Montgomery, AL 36130 mtoodle@alsde.edu (334) 242-1991
Henry N. Williford Auburn University Montgomery Department FSPE PO Box 244023 Montgomery, AL 36124 hwillifo@mail.aum.edu (334) 244-3548
This report has been made possible by a cooperative agreement with the Centers for Disease Control and Prevention, Division of Adolescent and School Health, the Alabama Department of Education, and Auburn University Montgomery
ALABAMA DEPARTMENT OF EDUCATION • JOSEPH B. MORTON, STATE SUPERINTENDENT OF EDUCATION • NOVEMBER 2007 No person shall be denied employment, be excluded from participation in, be denied the benefits of, or be subjected to discrimination in any program or activity on the basis of disability, sex, race, religion, national origin, color, or age. Ref: Sec. 1983, Civil Rights Act, 42 U.S.C.; Title VI and VII, Civil Rights Act of 1964; Rehabilitation Act of 1973, Sec. 504; Age Discrimination in Employment Act; Equal Pay Act of 1963; Title IX of the Education Amendment of 1972: Title IX Coordinator, P.O. Box 302101, Montgomery, Alabama 36130-2101 or call (334) 242-8444.
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2006 Alabama School Health Education Profiles Survey Results
BACKGROUND Profiles (SHEP) Survey assists state and local health a
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management activities; school health policies related to HIV/AIDS prevention, tobacco-use prevention, violence prevention, physical activity, and nutrition; food service; and family and community involvement in school health programs. Data from the SHEP can be used to improve school health programs. The SHEP Survey was developed by the Division of Adolescent and School Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, in collaboration with representatives of state, local, and territorial departments of health and education. The SHEP Survey consists of two questionnaires that were used to collect data—one for school principals and one for lead health education teachers. The two questionnaires were mailed to 346 regular secondary public schools with Grades 6-12 in Alabama during the spring of 2006. Usable questionnaires were received from 77% of principals and from 74% of teachers. Because the response rates for these surveys were greater than or equal to 70%, the results are weighted and are representative of all regular public secondary schools in Alabama with Grades 6-12. Results from the principal and lead health education teacher surveys are presented for the following types of schools in Alabama: •Senior high schools with a low grade of 9 or higher and a high grade of 10 or higher. •Middle schools with a high grade of 9 or lower. •schools with a low grade of 8 or less and a high grade of 10 or higher.Junior/senior high •All schools. The 2006 School Health Education Profiles are weighted data obtained from surveys of both principals and lead health education teachers. Results of the surveys represent all regular secondary schools in Alabama having Grades 6-12.
B A C K G R O U N D
Health Profile
I N T INTRODUCTIONR O D School Health Education Profiles (SHEP) The SHEP is a biennial survey conducted by state and local education and health agencies among middle/juniorU and senior high school principals and lead health education teachers.C status of the following: •aeh hhTt leHcSuPdEeoomiitnatreorns i rtqhuee nceumr raetnstSchoolnoetdnc tn.T •Physical education requirements.I •Asthma management activities. •Food service. •Competitive foods practices and policies.O •Family and community involvement in school health programs.N •and AIDS prevention, tobacco-use prevention, violence prevention, and physicalSchool health policies on HIV activity. The SHEP is used for the following: •Advocate for required health education. •Identify health education topics and skills that are taught. •Identify parent and community involvement in health education. •Identify topics for staff development. •Improve school health education programs and policies. •Determine how well schools address the health and safety needs of their students. Alabama has participated in the SHEP study since 1994. Sample: Selection Process and Description PRINCIPAL SURVEY DESCRIPTION All regular secondary public schools with Grades 6-12 were included in the sampling frame. Schools were sorted by estimated enrollment in the target grades within school level (senior high schools, middle schools, and junior/senior high schools combined) before sampling. Systematic equal probability sampling with a random start was used to select the schools for the survey. The principal or his/her designee was surveyed in each participating school. The response rate was 77% and included 260 out of 339 sampled eligible principals who returned questionnaires. All questionnaires were usable after data editing. The data were then weighted to make the data conform to known population distributions. The weighted results can be used to describe school health policies and practices of all regular secondary public schools in Alabama with Grades 6-12. LEAD HEALTH TEACHER DESCRIPTION The same format as the Principal Survey was used for the Lead Health Education Teacher Survey. The lead health education teacher was surveyed in each participating school. A 74% response rate included 252 out of 339 sampled eligible lead health education teachers that returned questionnaires. The data were then weighted to make the data conform to known population distributions. The weighted results can be used to describe school health policies and practices of all regular secondary public schools in Alabama with Grades 6-12. 2006 School Health Education Profiles Survey Results3
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In 2004, the State Superintendent of Education developed a Statewide Committee to Review the State
R E S U L T S O F P R I N C I P A L S U R V E Y
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Ninety-six percent of the high schools required newly hired health education teachers to be certified or have
RESULTS OF THE PRINCIPAL SURVEY REQUIRED HEALTH EDUCATION Fifty-twoan endorsement in health education. percent of middle school health education teachers have the The 2006 SHEP questionnaire asked principals about appropriate certification. the number of required health education courses offered at different grade levels. Both principals and health educators were asked whether health educationSCHOOL HEALTH COUNCIL was required at any grade, if schools used national, state, or local curriculum guidelines to guide Forty-nine percent of high schools and 38% of middle instruction, and the percentages of students exempt schools have a school health council that offers from health education classes by parents’ requests. guidance regarding the development of policies on health topics. The principal survey found that 98% of high schools and 72% of middle schools require health education. In Alabama, a one-half (.5) unit of health education isPHYSICAL EDUCATION required for graduation. Health education is moreSTNEMEIRQURE likely to be required in either the ninth or tenth grade. Alabama requires one unit of physical education as Health education is often taught in a combined part of theAlabama High School Graduation health and physical education course or in a course requirements. Ninety-seven percent of high schools such as science, social studies, or English. The and 98% of middle schools reported requiring physical results of the survey indicate that the majority of education in Grades 6-12. Ninety percent of high middle school students receive health education in a schools required one course while 80% of middle combined health and physical education course schools required two to three courses. (See Alabama (86%) and that health education is also taught in Physical Education Course of Study, http://www.alsde. areas such as science, social studies, or English. edu/html/sections/documents.asp?section=54&sort=25 The majority of students take one course of required &footer=sections.) health education; however, a number of students take two or more health education courses. The majority of multiple health education courses are taken inEXEMPTIONS FOR THE REQUIRED middle school.PHYSICAL EDUCATION COURSE The SHEP report found that students can be exempted from a required physical education course for many different reasons. In high school, students were exempted for enrollment in other courses (13%), participation in school sports (37%), participation in other school activities (72%), participation in community sports (1%), religious reasons (28%), long-term physical or medical disability (54%), and cognitive disability (17%). Middle school students were exempted for enrollment in other courses (2%), participation in school sports (2%), participation in other school activities (15%),
religious reasons (19%), long-term physical or medical disability (67%), and cognitive disability (15%).
CERTIFICATION OF HEALTH EDUCATION TEACHERS
COORDINATION OF HEALTH EDUCATION In high school, health education tends to be coordinated by the health education teacher (41%). In middle school, health education is often coordinated by a school administrator. In specific instances there are circumstances where health education is coordinated by district administrators, curriculum coordinators, and school nurses.
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In 2006, the following was issued by the State Superintendent of Education regarding waivers for students in Grades 9-12:Until funding is obtained for Grades K-8 physical education teachers, there will be no exception to the one required unit of physical education in Grades 9-12. Any Alabama public school system that has adequate certified physical education teachers in Grades K-8 may request of the State Superintendent of Education that the exemptions of the one credit of physical education in Grades 9-12 be applied as listed below: 1. May substitute physical activity based subjects (e.g., R.O.T.C., marching band, and athletics) and other subject areas under exceptional circumstances for physical education under the following conditions: (i) A plan which reflects collaboration with the physical education teacher at the school must be developed to ensure that students master the required content standards and benchmarks as outlined in theAlabama Course of Study: Physical Education. http://www.alsde.edu/ html/sections/documents.asp?section=54&sort =25&footer=sections (ii) The SDE Physical Fitness form verifying test results for exempted students as for all students must be submitted to the SDE. (iii) Such other conditions as prescribed by local boards of education. This subsection (f) becomes effective with the class entering the ninth grade in the fall of 2006.
of Health of America’s Youth With Particular Emphasis on Alabama’s Youth (State Health Review Committee Web Site) http://www.alsde.edu/html/boe resolutions2. _ asp?id=966. (See recommendations in Appendix A. http://www.alsde.edu/html/doc_download.asp?id=4108 §ion=53 www.aptv.org/FTR/Other/Health Report.pdf.) One of the areas that was addressed by the committee was the issue of waivers for required physical education. As a result of the recommendations by the committee, the State Superintendent of Education presented the following recommendation to the Alabama State Board of Education.The State Superintendent of Education will notify all superintendents and principals that effective for the 2005-2006 school years, all physical education waivers for students in Grades K-8 must have a current justification submitted to the State Department of Education (SDE) no later than August 15, 2005. Blanket waiver requests for large groups of students will be subject to close scrutiny. The 2005-2006 school year will serve as the pilot year to get to full implementation of the “no exceptions/no substitutions” policy of the Alabama State Board of Education except on a student-by-student basis that will require full justification to the State Superintendent of Education in any year in which a waiver is requested.
2. No other substitutions are authorized unless written authorization for such substitutions is secured from the State Superintendent of Education. REPEAT OF REQUIRED PHYSICAL EDUCATION COURSE If a student in high school fails a required physical education course he/she is required to retake the course (99%). In middle school (17%) are required to retake the course. In combined situations (middle/high school) 94% are required to retake the course. CERTIFIED PHYSICAL EDUCATION STAFF The majority of newly hired physical education teachers is required to be certified, licensed, or have an endorsement in physical education. One-hundred percent of the high school teachers were reported to meet the above guidelines, and 97% of the middle school teachers met the above guidelines.
INTRAMURAL AND AFTER-SCHOOL ACTIVITY With the emphasis on improvement of the health of Alabama school students, the State Health Review Committee developed the following recommendations: School district administrators need to develop a plan to increase physical activities before, during, and after the normal school day. The plan should include coordination and communication with teachers, civic organizations, PTAs, sports organizations, and wellness councils that share the common goal of developing activity opportunities and events for students. The plan should include working with the local government and the Alabama Department of Transportation to make infrastructure changes that encourage students to participate in physical activities. Examples may include improvements to public parks and playgrounds, creation of bike trails, and creation of safe routes to schools so that students will not be afraid to walk to school. It is recommended that schools offer organized activities such as competitions in various sports, clubs, self-directed activities, open gym, special events, field trips, instructional and practice opportunities, exercise classes, lunch time activities, intramurals, and Kids Walk-to-School programs. Work with the school staff to schedule times and facilities for these events. Due to the limitations of school budgets, it is suggested that fundraising activities, government grants, and business
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sponsorships be used as the primary source for funding for the activity programs. These recommendations were presented to and approved by the Alabama State Board of Education. The Department of Public Health is also promoting after-school programs. The Steps to a Healthier Alabama Program (2006-2007) has worked with public schools to start after-school programs. The programs emphasize the importance of good health, nutrition, and physical activity. The principal survey found that 40% of the high schools offered intramural activities and 51% of middle schools offered intramural activities. Only a small portion of schools offered transportation for students who participated in after-school intramural activities or sport clubs. Six percent of high schools and 15% of middle schools offered transportation. However, a large majority of the schools offered the school for use by students or outside agencies regarding sports teams, classes, or lessons (75% for high schools and 69% for middle schools). Only a small portion of the schools promote walking or biking to and from school (23% high school and 33% middle school). TOBACCO POLICY The principal survey indicated that schools offer some type of policy regarding prohibiting the use of tobacco. The policy addresses the use of cigarettes, smokeless tobacco, cigars, and pipes. In addition, the schools also have a tobacco prevention policy for faculty/staff during school-related activities. The policy also includes a tobacco use prevention policy that specifically prohibits the use of tobacco for visitors during any school-related activity. The policy includes tobacco use in the school buildings and outside on school grounds, including the parking lot; on school buses or other vehicles used to transport students; and at off-campus, school-sponsored events. While schools do have a policy regarding tobacco-use prevention, when asked if the policy was “ideal” only 58% of high schools reported an ideal policy with 65% of the middle schools reporting an ideal tobacco policy. When students are in violation of the smoking policy, the school can take a variety of actions. The following indicates the percentage of schools that always or most always take the following actions when students are caught smoking. For senior high schools, 93% of the schools inform the parents or guardians; 11% are referred to a school counselor; 100% are referred to a school administrator; 14% are encouraged, but not required, to participate in an assistance, education, or cessation program; 2% are required to participate in an
assistance, education, or cessation program; 3% are referred to legal authorities, while 28% are placed in detention and 14% not allowed to participate in extracurricular activities or interscholastic sports; 22% are given in-school suspension; 48% are suspended from high school; 1% are expelled from school; and 4% are reassigned to an alternative school. For middle school students, 98% of the schools inform the parents or guardians; 34% are referred to a school counselor; 99% are referred to a school administrator; 11% are encouraged, but not required to, participate in an assistance, education, or cessation program; 5% are required to participate in an assistance, education, or cessation program; 12% are referred to legal authorities, while 30% are placed in detention; 25% are not allowed to participate in extracurricular activities or interscholastic sports; 26% are given in-school suspension; 32% are suspended from middle school 2% are expelled from school; and 8% are reassigned to an alternative school. The majority (96%to 99%) of schools prohibit tobacco advertising in each of the following locations for both high school, middle school, and combined junior and senior high schools: in the school building; on the school grounds, including on the outside of the building, on playing fields, or other areas of the campus; on school buses or other vehicles used to transport students; and in school publications. The majority of schools, at all levels, prohibit tobacco advertising through sponsorship of school events (91% to 96%). Schools also prohibit students from wearing tobacco brand-name apparel or carrying merchandise with tobacco company names, logos, or cartoon characters on it (97% to 99%). The majority of schools also post signs marking a tobacco–free school zone that is a specified distance from school grounds where tobacco use is not allowed (78% to 80%).
LUNCH, SNACKS, AND BEVERAGES The State Health Review Committee was composed of two subcommittees. One addressed issues and policies regarding nutrition while the other addressed physical education/physical activity. The following are the recommendations provided by the subcommittees, including the State Superintendent of Education recommendations: Beginning with the 2005-2006 school year, every school shall review its offerings of foods in vending machines and develop a plan to begin phasing out low-nutritive foods sold in vending machines and school stores and phasing in high-nutritive foods. Each school should develop a plan with the guidance of the local superintendent or his/her designee that
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One initial in-service activity shall occur for personnel in each school system on the importance of nutrition and physical education with respect to prenatal, infant, adolescent, and adult lifestyles and lifespan, with new personnel being assigned to in-service activities during their first full year of employment. This shall begin with the 2006-2007 school year. In conjunction with the requirements of the Child Nutrition Reauthorization Act, each school will conduct evaluations using a nationally recognized, validated survey to identify strengths and weaknesses and prioritize changes as an action plan for improving student health. The assessment and planning steps will involve teachers, child nutrition staff, other school staff as appropriate, parents, students, and the community as part of the required wellness policy. The Principal Survey indicated that the majority of students had more than 20 minutes to eat lunch (80% to 81%). When asked if schools had adopted a policy stating that if food is served at student parties, at after-school or extended-day programs, or at concessions stands that fruits and vegetables would be among the foods offered, 33% to 41% of the schools at all levels did have such a policy. This was also addressed by the Statewide Committee on the Status of Youth Health. In addition, the committee addressed the purchase of snack foods or beverages from one or more vending machines at the school or at a school store, canteen, or snack bar. Ninety-one percent of high schools allowed the purchase of snack food from vending machines and 79% of middle schools allowed the purchase of snack food from vending machines. This table shows the percentage of schools in which students can purchase the snack foods or beverages from vending machines. Table 1. Purchase of Snack Foods Senior Jr/Sr Item High % Middle % High % Overall Chocolate candy 44 28 44 37 Other kinds of candy 54 33 46 43 Salty snacks not low in fat 59 40 63 53 Salty snacks low in fat 91 85 92 89 Fruits or vegetables, not juice 28 17 16 20 Low-fat cookies, crackers, cakes, pastries, or other low-fat baked goods 87 79 84 83 Soda pop or fruit drinks, not 100% juice 87 68 91 80 Sports drinks 98 92 95 95 100% fruit or vegetable juice 84 82 82 83 Bottled water 87 96 100 97 1% skim milk 45 39 31 38 2% whole milk(plain or flavored)44 39 28
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allows for participation by students, teachers, and parents. Each school’s strategic plan for improving the School Nutrition Environment Plan should be completed by April 1, 2006, and ready for implementation with the beginning of the 2006-2007 school year. A state review during the 2005-2006 school year of school/school system plans for healthy choices in vending machines and other recommendations shall occur with possible additional recommendations by the State Superintendent of Education in the spring of 2006 applicable to the 2006-2007 school year. Foods and beverages that are not to be approved for sale by the school’s committees are soda water/carbonated beverages that are not “diet” in nature, water ices (e.g., popsicles, and snow cones) as recommended by the Committee, chewing gum, and candies as recommended by the Committee. During the 2005-2006 school year, no more than 50 percent of beverage choices shall be carbonated and of those at least 50 percent will be low/no calorie soft drinks. Beginning July 1, 2006, schools may not use Child Nutrition Program (CNP) funds to purchase new fryers for the school breakfast/lunch programs. State staff in the CNP will work with local school system CNP employees to address modifications necessary in order to offer healthier school meals. Schools are encouraged to participate in school gardens, farm-to-school programs, farmer’s markets, and to purchase Alabama-grown fruits and vegetables whenever possible. No one on the school campus shall provide commercial access to “for sale” or “free” Foods and Beverages of Minimal Nutritional Value (FBMNV) as recommended by the committee. All fundraising activities that involve the selling of food during school hours, as students gather on the school campus before school begins, as students wait on transportation, or otherwise exit the school campus following school dismissal should reinforce food choices that promote good health, except when contracts have been or will be executed by August 8, 2005. This means all events outside the school day are not affected by this recommendation and booster clubs, etc., are free to select items for sale for specific fundraising and concession sales as they see fit as long as the activity does not conflict with this position.
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SCHOOL NURSE Ninety percent of high schools reported having a school nurse who provides for standard health services to the students and 92% of the middle schools reported providing a school nurse. MEDICATIONS AND SELF-ADMINISTRATION There are differences in the medications that schools allow students to carry and self- administer. The following table shows the results of the Principal Survey.
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A number of schools routinely conduct locker searches (65% to 68%), while a relatively smaller number of schools require students to wear school uniforms. The majority of uniforms are worn by middle school students (13% vs. 27%). Also, relatively few schools require students to wear identification badges (16% high school vs. 8% middle school). Both senior high and middle schools have implemented metal detectors including wands (38% high school vs. 39% middle school). Surveillance cameras are often used inside or outside the building (92% high school vs. 79% middle school). A number of schools use police, school resource officers, or security guards during the regular school day (73% senior high vs. 68% middle school). Table 4. Prevention Programs Offered Senior Jr/Sr Item High % Middle % High % Overall Peer mediation 42 39 34 38 Safe passage to school 10 11 10 11 Prevention of gang violence 30 46 26 36 Prevent bullying 55 81 60 68 Schools also have a variety of preventive programs. This table lists preventative programs and the percentage for each category. In addition, all schools have comprehensive plans to address crisis preparedness, response, and recovery in the event of a natural disaster or other emergency or crisis situation.
Table 2. Times Snack Foods Can Be Purchased Senior Jr/Sr Item High % Middle % High % Overall Before classes in the morning 59 15 33 33 During any school hours when meals are not being served 64 37 63 52 During school lunch periods 16 16 16 16 This table shows the percentage of time when students can purchase candy; snacks that are not low in fat; soda pops, sports drinks, or fruit drinks that are not 100% fruit juice; or 2% or whole milk. The table indicates that snack foods are primarily purchased at times other than during lunch periods. SCHOOL HEALTH INDEX The School Health Index (SHI) is a self-assessment and planning guide developed by the Centers for Disease Control and Prevention (CDC) that enables schools to perform the following: • Identify the strengths and weaknesses of their school health promotion policies and programs. • Develop an action plan for improving student health. • Involve teachers, parents, students, and the community in improving school policies, programs, and services. Information regarding the SHI can be found at http://apps.nccd.cdc.gov/shi/default.aspx. In Alabama, only a small number of schools use the SHI from the CDC to assess health and safety policies and programs. Table 3. Use of the School Health Index Senior Jr/Sr Item High % Middle % High % Overall Use of School Health Index 19 18 15 17 The Statewide Committee on the Health of Alabama Students recommended that tools such as the SHI be incorporated to improve the school environment. In addition, the Steps to a Healthier Alabama grant from CDC has influenced several schools to adopt the SHI. SAFETY AND SECURITY MEASURES All schools reported that visitors must report to the main office or reception area upon arrival. The majority of schools (96% to 98%) maintained a closed campus where students are not allowed to leave school during the school day, including during lunchtime. The majority also use staff or adult volunteers to monitor school halls during and between classes (95% to 96%).
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