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? ? Healthy Schools = Healthy Kids = Learning Better OR What is the ? ? Healthy Schools = Healthy Kids = Learning Better OR What is the relationship between school health policy and learning? Julia Dilley Ph. D MES Washington State - Healthy Schools Summit May 2008

Objectives Increase skills for: Ø Using WA Healthy Youth Survey to describe “healthy students” Objectives Increase skills for: Ø Using WA Healthy Youth Survey to describe “healthy students” Ø Using WA School Health Profile data to describe “healthy schools” Ø Describing association between academic achievement & health Ø Describing association between school health policies and student health 2

Background Ø From an ongoing project to merge Washington’s student-level health data and school-level Background Ø From an ongoing project to merge Washington’s student-level health data and school-level policy data l Some results are preliminary 3

Theoretical Model School health programs Pro-health school policies, procedures & environments Students exhibit more Theoretical Model School health programs Pro-health school policies, procedures & environments Students exhibit more healthy behaviors Students Learn Better 4

Theoretical Model School health programs Pro-health school policies, procedures & environments Students are important Theoretical Model School health programs Pro-health school policies, procedures & environments Students are important What Students exhibit more health conditions? Learn healthy Better behaviors Who is at risk? 5

Washington State’s Healthy Youth Survey 6 Washington State’s Healthy Youth Survey 6

Healthy Youth Survey (HYS) Paper-based questionnaire given to 6 th, 8 th, 10 th Healthy Youth Survey (HYS) Paper-based questionnaire given to 6 th, 8 th, 10 th & 12 th graders in fall of even years Ø Asks questions about Ø l l l Ø Risk & protective factors Alcohol, drug & tobacco use Health status Next survey is Fall 2008: l l 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) 7

Health Indicators of Interest 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. Health Indicators of Interest 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 12. 13. 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 8

Prevalence of Risk Factors 2006 WA Healthy Youth Survey 8 th grade 10 th Prevalence of Risk Factors 2006 WA Healthy Youth Survey 8 th grade 10 th grade Smoking 6% 14% Alcohol 17% 33% Marijuana 7% 17% Obesity 10% Severe asthma 0. 3% 0. 4% No breakfast 34% 39% Insufficient Fruit & Veg 71% 75% Soda pop 16% 17% Insufficient exercise 18% 25% Too much TV 31% 28% Feeling unsafe at school 18% 17% Mental distress 24% 28% 9

Health Indicator Trends Ø Most health status indicators are fairly stable Ø Smoking & Health Indicator Trends Ø Most health status indicators are fairly stable Ø Smoking & marijuana have decreased in recent years Ø Obesity has increased in recent years Ø Local trends may be different – see your own reports 10

Health Disparities: Smoking Source: 2006 Healthy Youth Survey, state sample only grades 8 -10 Health Disparities: Smoking Source: 2006 Healthy Youth Survey, state sample only grades 8 -10 -12 combined. 11

Health Disparities: Smoking Source: 2006 Healthy Youth Survey, full dataset, 10 th grade 12 Health Disparities: Smoking Source: 2006 Healthy Youth Survey, full dataset, 10 th grade 12

Health Disparities: Feeling Unsafe Source: 2006 Healthy Youth Survey, state sample only grades 8 Health Disparities: Feeling Unsafe Source: 2006 Healthy Youth Survey, state sample only grades 8 -10 -12 combined. 13

Health Disparities: Feeling Unsafe Source: 2006 Healthy Youth Survey, full dataset, 10 th grade Health Disparities: Feeling Unsafe Source: 2006 Healthy Youth Survey, full dataset, 10 th grade 14

Health Disparities: Overweight Source: 2006 Healthy Youth Survey, state sample only grades 8 -10 Health Disparities: Overweight Source: 2006 Healthy Youth Survey, state sample only grades 8 -10 -12 combined. 15

Health Disparities: Overweight Source: 2006 Healthy Youth Survey, full dataset, 10 th grade 16 Health Disparities: Overweight Source: 2006 Healthy Youth Survey, full dataset, 10 th grade 16

Summary: how are different students at-risk? Ø Race/ethnicity l l Asian students and white Summary: how are different students at-risk? Ø Race/ethnicity l l 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 Ø Socio-Economic Status l Students in lower income families tend to have greater health risks 17

Theoretical Model School health programs Pro-health school policies, procedures & environments Students is the Theoretical Model School health programs Pro-health school policies, procedures & environments Students is the status What exhibit more health of school Students Learn healthy policies in Better behaviors Washington? 18

Washington State School Health Profile Survey 19 Washington State School Health Profile Survey 19

School Health Profiles Survey Ø Paper-based questionnaire given to principals & lead health teachers School Health Profiles Survey Ø Paper-based questionnaire given to principals & lead health teachers in secondary schools Ø Given in spring of even-numbered years (in the field now!) Ø Asks about health-related policies and environments Ø Reports & more information: http: //www. k 12. wa. us/Coordinated. School. Health/Schl. Health. Profiles. aspx 20

School Health Policy Indicators Ø School Health Capacity l l l 52% have an School Health Policy Indicators Ø School Health Capacity l l l 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 21

School Health Policy Indicators Ø Asthma l l Ø 53% “no idle zone” policy School Health Policy Indicators Ø Asthma l l Ø 53% “no idle zone” policy for buses 81% obtain asthma action plans Nutrition l l 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 22

School Health Policy Indicators Ø Physical Activity l l Ø 32% required 4+ PE School Health Policy Indicators Ø Physical Activity l l Ø 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 l l l 89% posted “no-tobacco” signs 87% enforced a “no-tobacco” zone near school property 64% had supportive consequences 23

Associations: School Characteristics and Strong Policies Schools with advisory groups tend to have stronger Associations: School Characteristics and Strong Policies Schools with advisory groups tend to have stronger health policies Ø Larger schools tend to have stronger health policies Ø We are exploring whether having health-related SIP goals/objectives improves health policies Ø Staff wellness programs appear correlated with some improved policies and student behaviors Ø 24

Theoretical Model School health programs Pro-health school policies, procedures & environments Students exhibit more Theoretical Model School health programs Pro-health school policies, procedures & environments Students exhibit more healthy behaviors Students Learn Better Alignment of health with schools’ educational mission is critical 25

Student Health & Academic Achievement 26 Student Health & Academic Achievement 26

Summarizing the Research Ø Building evidence base for associations l l Ø CDC DASH Summarizing the Research Ø Building evidence base for associations l l Ø CDC DASH website: http: //www. cdc. gov/Healthy. Youth/health_and_academics/index. h tm California Study (Update 5) http: //www. gettingresults. org/ Active Living Research summary: http: //www. activelivingresearch. org/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) 27

Academic Risk Ø In HYS, self-reported as getting “mostly Cs, Ds, Fs” l 24% Academic Risk Ø In HYS, self-reported as getting “mostly Cs, Ds, Fs” l 24% of 8 th graders and 31% of 10 th graders overall 28

Academic Risk & Race Source: 2006 Healthy Youth Survey, state sample only grades 8 Academic Risk & Race Source: 2006 Healthy Youth Survey, state sample only grades 8 -10 -12 combined. 29

Disparities in Achievement: Math WASL NOTE: on this graph “higher” is better 30 Disparities in Achievement: Math WASL NOTE: on this graph “higher” is better 30

Academic Risk & Socio-economic Status Source: 2006 Healthy Youth Survey, state sample only grades Academic Risk & Socio-economic Status Source: 2006 Healthy Youth Survey, state sample only grades 8 -10 -12 combined. 31

Academic Risk by Specific Health Indicators: 8 th graders Source: 2006 Healthy Youth Survey Academic Risk by Specific Health Indicators: 8 th graders Source: 2006 Healthy Youth Survey 32

Academic Risk by Specific Health Indicators: 8 th graders Source: 2006 Healthy Youth Survey Academic Risk by Specific Health Indicators: 8 th graders Source: 2006 Healthy Youth Survey 33

Which comes first? 34 Which comes first? 34

Increasing Risks Increasing Academic Challenges 2006 HYS: grades 8 and 10 combined 35 Increasing Risks Increasing Academic Challenges 2006 HYS: grades 8 and 10 combined 35

Average # Health Risks by Race White NH: 3. 1 l Asian: 3. 0 Average # Health Risks by Race White NH: 3. 1 l Asian: 3. 0 l Native American: 3. 8 l Black: 3. 8 l Latino: 3. 8 l Pac Islander/Native Hawaiian: 3. 6 l 36

Increasing Risks & Race 37 Increasing Risks & Race 37

Multivariate Statistical Models Ø We used a multivariate logistic regression model to simultaneously take Multivariate Statistical Models Ø We used a multivariate logistic regression model to simultaneously take all factors into account. Ø 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). Ø 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. 38

Which are most important? Ø Strongest associations l Smoking, severe asthma, marijuana, no breakfast, Which are most important? Ø Strongest associations l Smoking, severe asthma, marijuana, no breakfast, depression Ø Moderate associations l Obesity, soda pop, insufficient exercise, TV, alcohol, feeling unsafe at school Ø Weakest associations l Sufficient fruit & veg, not enough sleep 39

Which health risks can we change with school-based interventions, and how? Would be good 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 Ø 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 Ø 40

Theoretical Model School health programs Pro-health school policies, procedures & environments Students exhibit more Theoretical Model School health programs Pro-health school policies, procedures & environments Students exhibit more healthy behaviors Students Learn Better This is currently the weakest link 41

What about Individual Interventions? Ø Individual interventions can change student health Ø Pros l What about Individual Interventions? Ø Individual interventions can change student health Ø Pros l Can be tailored to meet individual needs Ø Cons l l l 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 42

Policy & Environment-change Interventions Ø Policy interventions don’t cause individual behavior change, but they Policy & Environment-change Interventions Ø Policy interventions don’t cause individual behavior change, but they support other efforts l Ø Pros l l Ø If the school was a garden, policy would be the fertile (or barren) soil where healthy ideas to grow Broad influence, for a variety of students Once implemented, need for resources to maintain may be less Cons l l 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 43

School Policy & Nutrition 44 School Policy & Nutrition 44

School Policy & Smoking Risk 45 School Policy & Smoking Risk 45

School Policy & Physical Activity 46 School Policy & Physical Activity 46

Exploratory statistical models Ø We linked school policy data and student behavior data to Exploratory statistical models Ø We linked school policy data and student behavior data to describe changes in student behavior associated with changes in school policy l l l 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? 47

Disparities in Perception of Support Systems Source: 2006 Healthy Youth Survey 48 Disparities in Perception of Support Systems Source: 2006 Healthy Youth Survey 48

Disparities in Perceived Enforcement Source: 2006 Healthy Youth Survey, 10 th grade 49 Disparities in Perceived Enforcement Source: 2006 Healthy Youth Survey, 10 th grade 49

Possible Interpretation Ø The more individualized an intervention, the more critical cultural competence becomes Possible Interpretation Ø The more individualized an intervention, the more critical cultural competence becomes 50

Theoretical Model You are here School health programs Pro-health school policies, procedures & environments Theoretical Model You are here School health programs Pro-health school policies, procedures & environments Students exhibit more healthy behaviors Students Learn Better 51

So now what? ? ? 52 So now what? ? ? 52

Summarizing what we know Ø There is a strong association between health risks and Summarizing what we know Ø There is a strong association between health risks and academic risks, probably healthy students learn better l it certainly couldn’t hurt to help students be healthier! Health disparities may play an important role in minority & socio-economic achievement gaps Ø School policy interventions can have a modest but broad-based, sustainable influence on student health behaviors Ø 53

Which Health Factors to Prioritize? Ø Consider l l l l Prevalence of the Which Health Factors to Prioritize? Ø Consider l l l l 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 54 54

Thank you! Keep watching the research… Julia Dilley julia. dilley@state. or. us (360) 705 Thank you! Keep watching the research… Julia Dilley julia. [email protected] or. us (360) 705 -1358 55