Transcript Slide 1

?
?
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”
 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
2
Background
 From
an ongoing project to merge
Washington’s student-level health data
and school-level policy data

Some results are preliminary
3
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
What are important
Students
exhibit
health conditions?
Learn
more
Better
healthy
Who is at risk?
behaviors
5
Washington State’s
Healthy Youth Survey
6
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)
7
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
8th grade
10th grade
Smoking
6%
14%
Alcohol
17%
33%
Marijuana
7%
17%
Obesity
10%
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%
Insufficient sleep
43%
65%
9
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
10
Smoked Cigarettes in Past Month
Health Disparities: Smoking
Cigarette Smoking by Race/Ethnicity
30%
*
19.5%
20%
14.4%
13.4%
11.6%
13.0%
**
10%
6.6%
0%
White,
nonHispanic
Asian
Native
American
Black/
Af.Amer.
Source: 2006 Healthy Youth Survey, state sample only grades 8-10-12 combined.
Hispanic/ Nativ.Haw /
Latino
Pac Isl.
11
Health Disparities: Smoking
Maternal Education and Smoking
30
% 10th graders
21.7
20
16.4
smoking
10.8
10
0
< HS
HS graduate
Source: 2006 Healthy Youth Survey, full dataset, 10th grade
College +
12
Health Disparities: Feeling Unsafe
Feel Unsafe at School by Race/Ethnicity
*
25.0%
Feel Unsafe at School
30%
20%
17.1%
*
29.5%
*
26.6%
*
23.6%
Hispanic/
Latino
Nativ.Haw /
Pac Isl.
19.1%
10%
0%
White, nonHispanic
Asian
Native
American
Black/
Af.Amer.
Source: 2006 Healthy Youth Survey, state sample only grades 8-10-12 combined.
13
Health Disparities: Feeling Unsafe
Maternal Education and Feeling Unsafe at School
100
81.7
80
% 10th graders
80
76.1
60
40
20
0
< HS
HS graduate
Source: 2006 Healthy Youth Survey, full dataset, 10th grade
College +
14
Health Disparities: Overweight
Overweight by Race/Ethnicity
Overweight by BMI
30%
*
20%
15.9%
10%
9.4%
*
*
16.9%
14.3%
13.8%
Black/
Af.Amer.
Hispanic/
Latino
**
6.9%
0%
White, nonHispanic
Asian
Native
American
Source: 2006 Healthy Youth Survey, state sample only grades 8-10-12 combined.
Nativ.Haw /
Pac Isl.
15
Health Disparities: Overweight
Maternal Education and Overweight
% 10th graders
30
20
13.9
11.2
8.7
10
0
< HS
HS graduate
Source: 2006 Healthy Youth Survey, full dataset, 10th grade
College +
16
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
17
Theoretical Model
School
health
programs
Pro-health
school policies,
procedures &
environments
Students
What is the status
Students
exhibit
of school health
Learn
more
policies in Better
healthy
Washington?
behaviors
18
Washington State
School Health Profile Survey
19
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
20
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
21
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
22
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
23
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
24
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
Summarizing the Research

Building evidence base for associations





CDC DASH website:
http://www.cdc.gov/HealthyYouth/health_and_academics/index.h
tm
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)
27
Academic Risk
HYS, self-reported as getting “mostly
Cs, Ds, Fs”
 In

24% of 8th graders and 31% of 10th graders
overall
28
Academic Risk & Race
Academic Risk by Race/Ethnicity
*
Academic Risk
60%
47.1%
*
42.8%
*
40.1%
40%
27.2%
*
32.1%
**
16.6%
20%
0%
White, nonHispanic
Asian
Native
American
Black/ Af.Amer.
Hispanic/
Latino
Nativ.Haw/ Pac
Isl.
Source: 2006 Healthy Youth Survey, state sample only grades 8-10-12 combined.
29
Disparities in Achievement:
Math WASL
Percent of Students in Grade 10 Meeting Standard in 1999 and 2006
by Ethnicity
100.0
90.0
80.0
70.0
59.9
56.7
60.0
50.0
38.1
37.3
40.0
31.0
20.0
25.5
23.3
30.0
14.3
9.5
1999
2006
11.6
10.0
0.0
American Indian
Asian/Pacific
Islander
Black
Hispanic
White
NOTE: on this graph “higher” is better
30
Academic Risk & Socio-economic
Status
Academic Risk by Maternal Education
50%
Academic Risk
40.3%
40%
30.1%
30%
19.5%
20%
10%
0%
no HS
HS/GED
Some college or more
Source: 2006 Healthy Youth Survey, state sample only grades 8-10-12 combined.
31
Academic Risk by Specific Health
Indicators: 8th graders
80
% Academic Risk
60
40
20
0
Cigarette
Smoking
Alcohol Use
Marijuana
Use
Obesity
Without risk factor
Source: 2006 Healthy Youth Survey
Severe
Asthma
Not Eating
Breakfast
Insufficient
Fruit & Veg
With risk factor
32
Academic Risk by Specific Health
Indicators: 8th graders
80
% Academic Risk
60
40
20
0
2+ Soda
Pop/Day
Insufficient
Exercise
3+ Hours
TV/Day
Feels Unsafe
at School
Without risk factor
Source: 2006 Healthy Youth Survey
Depression
<8 Hours
Sleep/Night
With risk factor
33
Which comes first?
34
Increasing Risks  Increasing
Academic Challenges
2006 HYS: grades 8 and 10 combined
35
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
36
Increasing Risks & Race
120
100
Native Amer
Asian
Pac Isl
Latino
White NH
Black
80
60
40
20
0
0
1
2
3
4
5
6
7
8
9
10 11+
37
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.
38
Which are most important?
 Strongest

Smoking, severe asthma, marijuana, no
breakfast, depression
 Moderate

associations
Obesity, soda pop, insufficient exercise, TV,
alcohol, feeling unsafe at school
 Weakest

associations
associations
Sufficient fruit & veg, not enough sleep
39
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
40
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?
 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
42
Policy & Environment-change
Interventions

Policy interventions don’t cause individual
behavior change, but they support other efforts


Pros



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


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
Trend in 5-a-day and unhealthy vending
100
80
% 8th grade
meeting 5-a-day
60
% schools with
unhealthy opt
40
20
0
2002
2004
2006
year
44
School Policy & Smoking Risk
Trend in Susceptibility to Smoking &
Supportive Policy Consequences
100
80
% 10th grade
susceptible to
smoking
60
40
20
0
2002
2004
2006
% schools w ith 10th
grade w ith
supportive
consequences
year
45
School Policy & Physical Activity
Trend in exercise and requiring PE
80
70
60
50
% 10th grade getting
sufficient exercise
40
30
20
10
0
% schools w ith 10th
grade requiring 4+ PE
classes
2002
2004
2006
year
46
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?
47
Disparities in Perception of
Support Systems
Percent who say school provides a
counselor for students
Access to ATOD Counselor by Race/Ethnicity
80%
70.0%
*
64.9%
60%
*
60.7%
*
58.6%
*
*
62.9%
64.2%
40%
20%
0%
White, nonHispanic
Source: 2006 Healthy Youth Survey
Asian
Native American Black/African Hispanic/Latino
Native
American
Hawaiian/Pacific
Islander
48
Disparities in Perceived
Enforcement
No Tobacco Rules Always
Enforced
Policy Enforcement by Race/Ethnicity
60%
40%
21.9%
20%
0%
White, nonHispanic
**
*
18.7%
Asian
Source: 2006 Healthy Youth Survey, 10th grade
22.4%
*
18.0%
22.7%
18.9%
Native American Black/ Af.Amer. Hispanic/ Latino Nativ.Haw / Pac
Isl.
49
Possible Interpretation
 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
Students
exhibit
more
healthy
behaviors
Students
Learn
Better
51
So now what???
52
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
53
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
54
Thank you!
Keep watching the research…
Julia Dilley
[email protected]
(360) 705-1358
55