Category Archives: School Health
It’s no secret that kids perform better in school when they are healthy and feel motivated to learn. But not all kids have access to the quality health care that can help them get healthy, stay healthy or treat any chronic health conditions they have. That’s where school-based health centers come in.
School-based health centers are partnerships between schools and community health organizations. They help students get the preventive care they need—including flu shots, annual physicals, dental exams, vision exams and mental health counseling—right where they spend most of their daytime hours: On school grounds. There are currently more than 2,000 school-based health centers across the country. Besides removing barriers to health care that many families face, school-based health centers help reduce inappropriate visits to emergency departments by up to 57 percent, research has found. They also help lower Medicaid expenditures, decrease student absences from school and do a better job of getting students with mental health issues the services they need.
Moreover, with growing recognition that health disparities affect academic achievement, school-based health clinics help close the gap by providing crucial access to health care for students who might not otherwise get it. A study by researchers at the University of Washington, Seattle, found that high school students who used school-based health centers experienced greater academic improvements over the course of five semesters than students who didn’t use these centers; the effect was especially pronounced among those who took advantage of mental-health services. Another study found that high school students who were moderate users of school-based health centers had a 33 percent lower dropout rate in an urban setting that has a high dropout rate.
The exact services offered by these centers vary by community. At Santa Maria High School in Santa Maria, Calif., the health center’s offerings include crisis intervention sessions; a grief group for students dealing with loss; and ongoing opportunities for students to build important social skills and skills that will help them maintain a healthy lifestyle. In Oakland, Calif., the Native American Health Center offered at a middle school and a high school provides medical care, dental care, mental health services and a peer health education program in one setting. At the Maranacook Health Center in central Maine, kids can get support for chronic health problems (such as asthma, diabetes, or seizures), medications they need, counseling or other mental-health evaluations and services.
The ultimate goal behind these centers is for all children to enjoy and benefit from good health and school success.
“Children and adolescents are at the heart of the mission,” said John Schlitt, president of the School-Based Health Alliance, based in Washington, D.C. But the “scope of the health center’s influence extends beyond the clinic walls to the entire school, its inhabitants, climate, curriculum, and policies. The school is transformed as a hub for community health improvement.”
Most parents send their children off to school expecting they’ll have their minds enriched and expanded—they don’t expect that their kids’ health to be jeopardized.
But the reality is that the environmental conditions in aging or deteriorating school facilities can harm kids’ health and compromise their ability to learn. This is partly because children may be exposed to a variety of environmental hazards—such as lead, asbestos, molds, radon and volatile organic compounds—as well as toxic chemicals and pesticides at school. Half of U.S. schools have problems with indoor air quality, according to the Environmental Protection Agency (EPA), and research suggests that the poorest children in the poorest neighborhoods have schools that are in the worst condition.
Sixty percent of kids suffer health and learning problems that stem from the conditions of their schools, according to the Coalition for Healthier Schools’ Towards Healthy Schools 2015 report. Children are especially vulnerable because they’re smaller; their organs are still developing; they spend more time on the ground; and they breathe more air and drink more water per pound of body weight than do adults, according to the EPA. They also may not be able to identify obvious hazards and move away from them.
Reducing environmental risks in schools offers significant payoffs in multiple domains. Improving indoor air quality can reduce asthma attacks by nearly 40 percent and upper respiratory infections by more than 50 percent, according to the 2006 report Greening America’s Schools: Costs and Benefits. What’s more, a study weighing the costs and benefits of developing green schools for Washington State estimated a 15 percent reduction in absenteeism and a 5 percent increase in test scores, according to the Towards Healthy Schools 2015 report.
“A healthy school has a building that promotes health and learning—it will be clean, dry, and quiet. It will have good control of dust and particulate matter. It will provide good ventilation and good air quality,” said Claire Barnett, founder and executive director of the Healthy Schools Network Inc., a non-profit organization dedicated to children’s environmental health and safety in schools. “This also assumes there’s no lead in the pipes, no PCBs in lighting or other old building materials, and no routine spraying of pesticides indoors or out. It shouldn’t be hard to have a building that meets these standards but it is. Parents shouldn’t take it for granted that a school facility is healthy.”
The start of the school year also means a return to team sports. There’s no question that playing a team sport provides clear benefits for kids, including the opportunity to develop physical fitness and other healthy habits, good sportsmanship, self-esteem and self-discipline. Kids who play sports are also less likely to engage in risky behaviors such as smoking or substance abuse.
But there is a potential dark side: An increased risk of sports-related injuries, with concussions at the top of the list of current concerns. Each year nearly 250,000 kids go to emergency departments for suspected sports-related concussions and there’s growing recognition that continuing to play with a concussion can lead to long-term effects on the brain, especially for kids. Girls also now have a higher rate of sports-related concussions than do boys, according to the Children’s Safety Network.
Because of all of these reasons there’s a major push underway to prevent concussions in all youth sports, not just in football, since concussions also commonly occur in girls’ and boys’ soccer, lacrosse, basketball and other sports, according to the American Academy of Pediatrics. In May, the White House hosted the first-ever Healthy Kids & Safe Sports Concussion Summit to promote and expand research on sports-related concussions among kids and raise awareness of steps that can be taken to help prevent, identify and respond to concussions in young athletes.
Meanwhile, the U.S. Centers for Disease Control and Prevention (CDC) launched the Heads Up: Concussion in High School Sports initiative to help coaches, athletes and parents take steps to prevent concussions and respond appropriately if they occur. Among the prevention measures being introduced are modifications to protective gear (including new helmet technology for various sports), rule changes (such as limits on heading drills in soccer practices and tackling drills in football), identifying athletes who are at risk (by looking for genetic markers of risk) and educating everyone involved with youth sports about the dangers of concussions.
There are also stricter guidelines about when it’s appropriate for athletes to return to play after a concussion, based on their physical and cognitive symptoms; concussion history; and adherence to a step-by-step process for returning to the field or court. The CDC now recommends that coaches and parents consider whether their league or school should conduct baseline testing—a pre-season exam to assess an athlete’s balance and brain function—so that if a concussion is suspected to have occurred, the baseline results can help establish the extent of the head injury.
“Players, coaches and parents are demanding that we find a way to reduce concussion risk in sports,” said Michael Sims, head athletic trainer for football at Baylor University and a board member of the National Operating Committee on Standards for Athletic Equipment. “But equipment can’t do it alone. It’s critical that safe play and return to play practices are enforced.”
With research indicating that fewer children are walking or biking to school than in decades past—and with the childhood obesity epidemic in full swing—health experts have been brainstorming solutions that would address both issues. In recent years, a simple but effective concept has been gaining traction at the grass-roots level: Why not organize a “Walking School Bus”—a group of kids who walk to school with one or more adults, so that kids can get exercise on their way to and from school?
A Walking School Bus is “just like a regular school bus, but without the walls and seats, and instead of wheels, we use our feet,” explained LeeAnne Fergason, education director for the Bicycle Transportation Alliance in Portland, Ore., which has a thriving Walking School Bus program. Other communities around the country that have well-established Walking School Bus programs include Chapel Hill, N.C.; Sacramento, Calif.; Burlington, Vt.; Columbia, Mo.; and Duluth, Ga. In the Fall of 2014, many more schools—including Grand View Elementary in Manhattan Beach, Calif.; Greenacres Elementary in Scarsdale, N.Y.; Madison Elementary in Redondo Beach, Calif.; and several elementary schools in Spokane, Wash.—will be joining the trend.
Created by the National Center for Safe Routes to School, these programs help kids sneak some extra physical activity into their day while also addressing parents’ concerns about getting their kids to school safely. It can be as simple as a few neighborhood families taking turns walking their kids to school. Or it can be more elaborate, with prearranged routes, timetables and stops along the way to pick up more “passengers”; with this model, there’s usually an adult “driver” at the front and an adult “conductor” bringing up the rear. A variation on this theme, the bicycle train, in which two or more adults accompany and supervise kids as they ride their bikes to school, has also become popular.
Viewed as a way to fight childhood obesity, improve school attendance rates and ensure that kids get to school safely, the Walking School Bus concept is garnering positive reviews from public health experts. In July 2013, Michelle Obama voiced her support of these programs in her remarks to mayors gathered at the White House.
“I've heard more and more of this kind of walking school bus happening all over the country—so that kids can get exercise on the way to school, kind of like we did when we were growing up," she said. “It’s about people all across this country coming together to take action to support the health of our kids.”
Besides providing an opportunity for movement, the Walking School Bus also allows kids to socialize with their peers, gain a bit of independence and learn important road safety skills. All of these benefits are also important for children’s health and wellbeing.
U.S. Surgeon General Issues ‘Call to Action’ Warning on Tanning and Skin Cancer
The U.S. Surgeon General has released the office’s first Call to Action on the dangers of tanning as it relates to skin cancer, which the Surgeon General called a “major public health problem.” The Call to Action is designed to increase awareness of skin cancer and presents five strategic goals to support its prevention:
- Increase opportunities for sun protection in outdoor settings
- Provide individuals with the information they need to make informed, healthy choices about ultraviolet (UV) radiation exposure
- Promote policies that advance the national goal of preventing skin cancer
- Reduce harms from indoor tanning
- Strengthen research, surveillance, monitoring, and evaluation related to skin cancer prevention
Skin cancer is the most common type of cancer in the United States, with nearly 5 million people treated for all types combined annually at a cost of $8.1 billion. Melanoma is responsible for the most deaths and 90 percent of melanomas are estimated to be the result of UV exposure. Read more on cancer.
NIH, 23andMe Partner to Expand Researcher Access to Genetic Disease Data
The National Institutes of Health (NIH) has entered into a $1.4 million, two-year deal with home genetics startup 23andMe to open up the company’s stores of genetic data to external researchers. The grant will enable the creation of survey tools and other methods to help researchers access information on thousands of diseases and traits for more than 400,000 people who have use 23andMe’s services. “23andMe is building a platform to connect researchers and consumers that will enable discoveries to happen faster,” said Anne Wojcicki, co-founder and CEO of 23andMe, in a release. “This grant from the NIH recognizes the ability of 23andMe to create a unique, web-based platform that engages consumers and enables researchers from around the world to make genetic discoveries.” Read more on research.
Study: Students Increasingly Accepting Healthier School Lunches
Despite initial pushback from students wary of revised school lunch policies implemented to provide heathier meals in 2012, a nationally representative sample of 557 U.S. public elementary schools found that approximately 70 percent of respondents said that students liked the new lunches by the second half of the school year. Researchers also found that school meal sales were up for disadvantaged students, who are more likely than their peers to experience a lack of proper nutrition. Read more on school health.
County Health Rankings & Roadmaps — Transforming Public Schools in Baltimore: Q&A with Robert English
Years of research shows that school facilities in poor condition—including faulty heating and cooling systems, poor indoor air quality, and deficient science labs—significantly reduce academic achievement and graduation rates. On the other hand, new and renovated school buildings that are equipped with modern science labs; art and music resources; and other amenities lead to improved educational outcomes. Research has also shown that when students attend high-quality schools they are more likely to be engaged in school and have higher attendance, test scores and graduation rates.
The public schools in Baltimore, Md., have the lowest graduation rates and oldest facilities in the state. A recent report described 85 percent of Baltimore’s 162 public school buildings as being in either poor or very poor condition.
While graduation rates in Baltimore public schools have increased significantly in recent years, thanks to better funding and other academic-focused efforts, Baltimoreans United in Leadership Development (BUILD) aims to further improve the graduation rate, educational outcomes, overall health and economic prosperity of Baltimore residents. The goal is to integrate the rebuilding and renovation of every city school into the district’s education reform efforts. BUILD and its partners, ACLU of Maryland and Child First, want to change state and city policies to support school construction and renovation.
BUILD is the recipient of a County Health Rankings & Roadmaps community health grant to educate and engage parents, school leaders, and leaders from other sectors such as business, the community and faith leaders about the need for updated schools to get the best education outcomes for Baltimore’s students. NewPublicHealth recently spoke with Robert English, BUILD’s lead organizer, about the group’s recent successful efforts.
>>How healthy is your county? Join the live webcast event on March 26 to celebrate the launch of the 2014 County Health Rankings and to spotlight communities taking action to build a culture of health across America.
NPH: What’s the link between improving the school infrastructure and improving the graduation rates?
English: A leading indicator of students graduating from high school is that they feel safe and challenged in their schools. We’ve talked to thousands of students and families in Baltimore City and by the time students here in Baltimore get into the 9th grade and 10th grade, they have often lost interest in high school and many of them have said that it’s because of the facilities. We didn’t have science labs in many cases or other core components of a quality education to send kids to college.
This campaign is about building the 21st century learning environments that can prepare young people not only to graduate, but to go to college. For BUILD this is not a bricks-and-mortar campaign—this is about providing the educational space where every child has an opportunity to learn, and then secondly this is about bringing people together around creating high expectations for students. We’ve continued to organize in the schools that are in year one through year three of school construction, and the constituency we are building will be here to hold our schools accountable to providing real results.
For some kids, getting ready to head back to school takes more than a new backpack and a sharpened pencil. In an effort to reduce the deaths and harassment that some Chicago kids faced on their way to and from school, the city has enhanced a program called “Safe Passage,” which trains city workers to help children get to school safely. Last year there were 600 workers in the program, and this year that number has been doubled.
“The whole city is with you, shoulder to shoulder, doing our part to make sure every child in every neighborhood is safe on the way to and from school and has academic success once they get there,” said Mayor Rahm Emanuel in a meeting with Safe Passage workers late last month.
The program currently serves 91 schools. Over the last two years crime on Safe Passage routes was down 20 percent and incidents among students were down 27 percent the schools.
Training for Safe Passage workers includes work on how to build relationships, anticipate issues before they occur and strategies for de-escalating situations. Training continues throughout the school year.
Stationing workers is actually part of a much larger strategy in Chicago for improving school safety, which has included trimming trees and removing weeds to make areas easier to see and safer; installing safe passage signs; removing graffiti; and repairing broken sidewalks and street lights. The city has also conducted community education training about the Safe Passage program. Parents along the Safe Passage routes got school specific information before the term began. See safe passage routes here.
CDC: U.S. School Districts Seeing Improvements in Multiple Health Policies
U.S. school districts are seeing continued improvements in measures related to nutritional policies, physical education and tobacco policies, according to the U.S. Centers for Disease Control and Prevention (CDC). The findings are part of the 2012 School Health Policies and Practices Study, a periodic national survey assessing school health policies and practices at the state, district, school, and classroom levels. "Schools play a critical role in the health and well-being of our youth," said CDC Director Tom Frieden, MD, MPH. "Good news for students and parents – more students have access to healthy food, better physical fitness activities through initiatives such as ‘Let’s Move,’ and campuses that are completely tobacco free."
Among the key findings:
- The percentage of school districts that allowed soft drink companies to advertise soft drinks on school grounds decreased from 46.6 percent in 2006 to 33.5 percent in 2012.
- Between 2006 and 2012, the percentage of districts that required schools to prohibit junk food in vending machines increased from 29.8 percent to 43.4 percent.
- The percentage of school districts that required elementary schools to teach physical education increased from 82.6 percent in 2000 to 93.6 percent in 2012.
- The percentage of districts with policies that prohibited all tobacco use during any school-related activity increased from 46.7 percent in 2000 to 67.5 percent in 2012.
Read more on school health.
Poor Oral Health Linked to Increased Risk for Oral HPV Infection
Poor oral health is associated with increased risk of the oral human papillomavirus (HPV) infection responsible for as many as 80 percent of oropharyngeal cancers, according to a new study in the journal Cancer Prevention Research. Researchers found that people who reported poor oral health had a 56 percent higher prevalence oral HPV, people with gum disease had a 51 percent higher prevalence and people with dental problems had a 28 percent higher prevalence. “The good news is, this risk factor is modifiable—by maintaining good oral hygiene and good oral health, one can prevent HPV infection and subsequent HPV-related cancers.” said Thanh Cong Bui, MD, postdoctoral research fellow at the University of Texas School of Public Health. Other factors also increased the risk, such as being male, smoking tobacco or using marijuana. Read more on cancer.
Study: Hospital Pediatric Readmission Rates Not an Effective Measure of Quality of Care
Hospital readmission rates for children are not necessarily an effective measurement of the quality of care, according to a new study in the journal Pediatrics. "As a national way of assessing and tracking hospital quality, pediatric readmissions and revisits, at least for specific diagnoses, are not useful to families trying to find a good hospital, nor to the hospitals trying to improve their pediatric care," study author Naomi Bardach, MD, an assistant professor of pediatrics at the University of California, San Francisco, Benioff Children's Hospital. "Measuring and reporting them publicly would waste limited hospital and health care resources." After analyzing 30- and 60-day readmission rates for seven common pediatric conditions, researchers found that at 30 days readmission for mood disorders was most common, at 7.6 percent, followed by 6.1 percent for epilepsy and 6 percent for dehydration. Readmission rates for asthma, pneumonia, appendicitis and skin infections were all below 5 percent. Bardach said the low rates leave “little space for a hospital to be identified as having better performance.” Further study could improve the way readmission rates are utilized to assess the quality of pediatric care. Read more on pediatrics.
Jane Brody is the Personal Health columnist for The New York Times. She joined the newspaper in 1965 as a specialist in medicine and biology after receiving degrees in biochemistry and writing for multiple college newspapers, as well as for the Minneapolis Tribune. With her column she has seen and reported on almost 50 years in the evolution of personal and community health.
NewPublicHealth recently spoke with Brody about her take on the state of community health—and what we can all do to improve it.
NewPublicHealth: Over the years, what efforts have you seen that you think have been most effective at improving community health?
Jane Brody: Well, I think one of the most exciting things that’s happened in New York City, and possibly in other cities as well, is getting better food to people who live in food deserts. For example, collecting food that would otherwise be wasted and bringing it to communities where people get free food that is healthy, fresh, and they even have demonstrations of recipes. In fact, I got one of my favorite recipes—it’s a green bean frittata—from one of their demonstrations that I attended just to see how it all worked out.
We’ve also, as you’ve no doubt heard, been putting in all of these bike lanes and we now have introduced the Bike Share Program, which is not inexpensive, but it does at least give more people an opportunity to get off their butts and get out of their cars and maybe even not even use public transportation in some cases, but to get some exercise to and from work, which is wonderful. I remember during one of the transit strikes that we had in New York City, I rode my bicycle from Brooklyn to Times Square where I work, over the bridges and stuff, and it was just wonderful because I got my exercise in at the same time as I got to work and I didn’t have to spend an extra hour exercising. There have been improvements. We have, of course, public pools that are only open in the summer, but in summer is better than no public pools and nobody has to pay anything for a public pool, which is really great.
A community needs assessment of a Chinese-American community in New York City several years ago found multiple barriers to physical activity for children and teens including parents unable to supervise kids at play because of long work hours, unsafe neighborhoods, limited knowledge or access to existing programs, financial hardship, inadequate support for physical activity in schools, limited time due to competing priorities such as academics, and too much time in front of video games, computer screens and television. To increase exercise time and options and help to reduce obesity rates among Chinese-American youth, public health professionals from the Charles B. Wang Community Health Center sought out funding from the New York State Department of Health and Mental Hygiene to create the Chinatown JUMP (Joining Urban Partners for More Physical Activity) program.
>>Read more on New York's Health Improvement Plan, which sets out a plan for similar community health assessments and cross-sectoral collaborations in response to these findings.
Chinatown JUMP currently works with eight afterschool programs to incorporate daily physical activity into the curriculum of these academic programs, blending activity with learning. Program goals include:
- Promote healthier and fit children by educating them and their families about the correlation between exercise and staying healthy.
- Increase staff capacity to support students’ healthier lifestyle through training and technical assistance.
- Establish an afterschool culture that supports physical activity as well as academic achievement.
The program works hard to incorporate parents’ support and involvement as well. Participating students in iMove receive a community resource guide with information about free and low-cost recreational centers and public spaces in the neighborhood to share with their parents. Parents are also invited to workshops on the importance of physical activity and healthy eating habits.
NewPublicHealth recently spoke with Susan Yee, Associate Director of Programs at the Charles B. Wang Community Health Center, about Chinatown JUMP.
NewPublicHealth: What is the Chinatown JUMP program and what do you think sets it apart from other programs with similar goals?
Susan Yee: Chinatown JUMP’s goal is to try to improve opportunities for more physical activity in the Manhattan Chinatown area in order to create sustainable changes within the community.