Missouri School Health Profiles: 2016 Key Findings Missouri Department of Health and Senior Services Randall W. Williams, MD, FACOG, Director AN EQUAL OPPORTUNITY/AFFIRMATIVE ACTION EMPLOYER Services provided on a nondiscriminatory basis. Table of Contents The School Health Profiles………………………………………………......................... 3 The 2016 School Health Profiles Key Findings …………………………..……………… 3 School Health Coordination and Leadership…………………………………………….. 4 School Health Program Assessment and Planning………………………………………. 4 School Health Policies and Practices: Tobacco-use Prevention………………………………………………………….. 6 Nutrition………………………………………………………………………….. 7 Parent and Family Education and Engagement………………………………….. 9 Opportunities for Physical Activity outside of Physical Education……………… 9 Health Services…………………………………………………………………… 10 HIV Prevention and Sexual Orientation………………………………………….. 11 Curriculum and Instruction: Health Education………………………………………………………………… 12 Physical Education………………………………………………………………. 14 HIV, other STDs and Pregnancy Prevention…………………………………….. 15 Professional Development……………………………………………………………….. 16 Acknowledgements………………………………………………………………………. 18 The Department of Elementary and Secondary Education does not discriminate on the basis of race, color, religion, gender, gender identity, sexual orientation, national origin, age, veteran status, mental or physical disability, or any other basis prohibited by statute in its programs and activities. Inquiries related to department programs and to the location of services, activities, and facilities that are accessible by persons with disabilities may be directed to the Jefferson State Office Building, Director of Civil Rights Compliance and MOA Coordinator (Title VI/Title VII/Title IX/504/ADA/ADAAA/Age Act/GINA/USDA Title VI), 5th Floor, 205 Jefferson Street, P.O. Box 480, Jefferson City, MO 65102-0480; telephone number 573-526-4757 or TTY 800-735-2966; email [email protected] 2 The School Health Profiles The School Health Profiles survey has been conducted every even-numbered year since 1994 by the Missouri Department of Elementary & Secondary Education (DESE) in collaboration with the U.S. Centers for Disease Control and Prevention (CDC). School buildings with any of the grades six through 12 in which grade six is not the highest grade in the building are randomly selected to participate. Two different questionnaires are sent to the building principal – one for the principal and another for the person designated as the lead health education teacher. The principal survey addresses school health policies and programs while the teacher survey focuses on health-related curriculum and instruction. Both surveys were developed by the CDC. In 2016, 381 secondary schools were randomly selected to participate, from which 294 principals (77 percent) and 283 lead health education teachers (74 percent) completed questionnaires. The response rates were sufficient to generalize results to regular and charter public secondary schools each year the survey has been conducted in Missouri. A special thank you is extended to the principals and teachers for completing the questionnaires, and to the staff at DESE who administered the survey. Without their cooperation, this important information would not be available. The 2016 School Health Profiles Key Findings This report highlights changes in School Health Profiles (SHP) results over several years that the survey has been conducted in Missouri. Different years of data are reported due to questions being added throughout the years. Trends are identified in key indicators that provide important information about the state of school health programs and policies in Missouri public secondary schools. The intent is to raise awareness about areas where efforts may be improved to support the health of students. In summary, the 2016 SHP found an increase in the percentage of secondary schools that:  Used the School Health Index (SHI) to assess injury and violence prevention  Recommended new or revised health and safety policies and activities to school administrators  Prohibited tobacco use by students, staff, and visitors on school property, and at off-site events  Prohibited less nutritious foods and beverages from being sold for fundraising purposes  Identified “safe spaces” where LGBTQ youth can receive support  Provided curricula about HIV, STD, and pregnancy prevention relevant to LGBTQ youth  The lead health teacher received training in interactive teaching methods and encouraging family involvement The 2016 SHP revealed a decline in the percentage of secondary schools that:  Made arrangements with organizations or health care professionals off school grounds to provide students with tobacco cessation  Provided services or referrals for HIV testing, pregnancy testing, provisioning of condoms or other contraceptives, or prenatal care  Provided health education teachers with several resources, including goals, objectives and expected outcomes, a written curriculum or an assessment plan for health education  Taught the importance of using a condom with another contraceptive  The lead health education teacher received professional development in awareness and mental health, nutrition and dietary behavior, and tobacco-use prevention 3 School Health Coordination and Leadership The percentage of schools that had a school health advisory council or other group providing guidance on school health issues: 2008: 78.2 2014: 55.9 2016: 63.7 Among the secondary schools that had a school health advisory group, the percentage of schools that did any of the following activities during the past year: 2012 2014 2016 Identified student health needs using relevant data 67.2 74.0 72.9 Recommended new or revised health and safety 69.8 73.8 78.1* policies and activities to school administrators Sought funding or leveraged resources to support 53.6 54.0 55.6 health and safety priorities for students and staff Communicated the importance of health and safety 81.9 79.1 89.2 policies and activities to administrators, parents, teachers or community members Reviewed health-related curricula or materials 79.0 70.1 84.5 Why these findings are important “Impacting long-term health risks is not a simple task relegated exclusively to schools. Planning and implementing activities directed toward child and adolescent health needs, as well as school employees, requires that many people be involved. Collaborative efforts among family, community, and schools are the most effective approaches for both prevention and intervention.” - Missouri Coordinated School Health Coalition Key Resources School Health Advisory Council Guide. Missouri Coordinated School Health Coalition publication. August 2017. Available at http://www.healthykidsmo.org/resources/docs/SHAC/SHAC_Guide.pdf A Guide for Incorporating Health & Wellness into School Improvement Plans. National Association of Chronic Disease Directors. 2016. Available at https://c.ymcdn.com/sites/chronicdisease.site- ym.com/resource/resmgr/school_health/NACDD_SIP_Guide_2016.pdf The Whole School, Whole Community, Whole Child Model: A Guide to Implementation. National Association of Chronic Disease Directors. 2017. Available at: http://www.ashaweb.org/wp- content/uploads/2017/10/NACDD_WSCC_Guide_Final.pdf School Health Program Assessment and Planning There was a significant upward trend from 2008 to 2016 in the percentage of Missouri secondary schools that had ever used the School Health Index or another self-assessment tool to assess injury and violence prevention. ____________________________ *Statistically significant trend 4 Percentage of schools that had assessed: 2008 2010 2012 2014 2016 Physical activity 59.2 50.3 43.9 48.8 55.0 Nutrition 59.0 47.0 44.4 46.5 55.8 Tobacco-use prevention 54.3 45.4 42.8 40.0 51.4 Asthma 37.4 31.7 29.8 32.7 34.2 Injury and violence prevention 38.5 39.2 40.7 40.7 44.4* The percentage of Missouri secondary schools that had a School Improvement Plan that included health-related objectives on each of the following topics: 2010 2012 2014 2016 Health education 49.9 41.4 44.9 46.6 Health services 47.9 40.9 45.4 44.2 Mental health and social services 38.8 38.1 42.1 Healthy and safe school environment 74.2 67.9 65.6 Family and community involvement 76.8 70.9 69.2 Faculty and staff health promotion 42.9 36.7 40.7 Physical education and physical activity 51.1 42.8 N/A Physical education 47.1 44.7 Physical activity 40.5 35.6 Nutrition services and available foods 44.7 42.4 N/A School meal program 42.3 38.8 Food and beverages available at school outside the school meal program 35.1 32.8 Counseling, psychological, and social services 53.7 Physical environment 61.7 Social and emotional climate 66 Family engagement 70.9 Community involvement 75.3 Employee wellness 40.8 Why these findings are important Conducting an assessment of school health programs and policies is essential for identifying areas to address in a school improvement plan. School improvement plans provide school staff and advisory groups with direction for improving programs and activities, and increases motivation when planned improvements are accomplished. Key Resources The School Health Index (SHI): Self-Assessment & Planning Guide 2017. U.S. Centers for Disease Control and Prevention Division of Adolescent and School Health. Available at http://www.cdc.gov/healthyyouth/shi/index.htm ____________________________ *Statistically significant trend 5 School Health Index Training Manuals available at: https://www.cdc.gov/healthyschools/shi/training/index.htm Training Tools for Healthy Schools e-Learning Series available at: https://www.cdc.gov/healthyschools/professional_development/e-learning/shi.html School Health Policies and Practices Tobacco-use Prevention The percentage of secondary schools that had adopted a policy prohibiting tobacco use remained statistically unchanged from 2004 to 2016. Among schools that had adopted a policy, the percentage that prohibit tobacco use by students, staff and visitors increased significantly from 2004 to 2016. Percentage of schools that: 2004 2006 2008 2010 2012 2014 2016 Adopted a policy prohibiting tobacco use 97.4 98.3 99.7 96.7 99.0 96.8 96.9 Prohibit tobacco use by students, staff and 26.8 24.0 33.1 33.0 42.4 45.2 43.0 visitors on school property and at off-site school events, among schools with policies From 2008 to 2016, there was a significant upward trend in the percentage of secondary schools that provided cessation services for faculty and staff. Percentage of schools that offer cessation services for: 2008 2010 2012 2014 2016 Faculty and staff 15.7 14.5 15.6 18.9 20.5* Students 19.3 16.7 11.4 17.9 14.2 During the same period, there were significant changes in the percentages of schools that arranged for tobacco cessation. This percentage increased for faculty and staff, but decreased for students. Percentage of schools that arrange cessation for: 2008 2010 2012 2014 2016 Faculty and staff 20.2 22.8 23.2 25.4 24.2* Students 25.4 23.6 21.6 19.4 20.1* Why these findings are important Eliminating tobacco use on school property and at off-campus events reduces exposure to secondhand smoke as well as decreasing role modeling of use for young people. Schools that provide for tobacco cessation services for students and staff produce an immediate health benefit and are among the most cost effective preventive services available. Key Resources A school tobacco policy index is available at https://cphss.wustl.edu/Products/ProductsDocuments/CPPW_SchoolTobaccoPolicyIndex.pdf Tobacco use prevention and cessation resources available at https://www.cdc.gov/healthyschools/tobacco/publications.htm ____________________________ *Statistically significant trend 6 Nutrition There was no significant change in the percentage of secondary schools that prohibit advertisements for candy, fast food restaurants, or soft drinks in buildings, publications and vehicles from 2008 – 2016. Percentage of schools prohibiting advertising: 2008 2010 2012 2014 2016 In school building 54.5 53.2 48.0 57.5 56.3 On school grounds 46.6 45.0 41.7 48.6 46.7 In school publications 55.7 50.7 46.5 56.0 50.6 On school buses or other vehicles 64.5 61.4 58.4 66.8 61.4 The percentage of secondary schools in which students could purchase snack foods or beverages from one or more vending machines at the school or at a school store, canteen or snack bar declined significantly from 2004 to 2016. 2004-90.2 2006-87.1 2008-83.6 2010-75.2 2012-79.5 2014-68.9 2016-63.6* There were several significant downward trends in the types of snacks, candy, or non-nutritious drinks schools offered to students, from 2004 - 2016. Percentage of schools allowing students to purchase: 2004 2006 2008 2010 2012 2014 2016 Chocolate candy 61.8 50.8 31.3 33.2 38.3 30.8 10.4* Other kinds of candy 64.1 54.9 36.4 37.5 39.9 34.0 16.2* Salty snacks not low in fat (e.g., regular potato chips) 68.4 60.9 38.9 38.7 41.4 36.8 18.7* 2% or whole milk (plain or flavored) 50.2 47.3 37.2 33.3 28.7 17.1* Soda pop or fruit drinks that are not 100% juice 74.2 54.9 43.8 46.0 36.2 23.1* Sports drinks (e.g., Gatorade) 76.2 75.6 63.9 65.8 56.0 47.3* Foods or beverages containing caffeine 47.9 38.4 39.8 31.9 26.3* Fruits (not fruit juice) 33.9 31.0 34.9 26.6 23.6 Non-fried vegetables (not vegetable juice) 25.0 21.0 23.3 20.0 15.2* Crackers, pastries and other baked goods not low in fat 42.7 41.9 43.3 34.1 16.3* Ice cream or frozen yogurt not low in fat 26.3 18.3 20.5 17.4 9.3* Water ices or frozen slushes that do not contain juice 19.7 14.7 17.5 11.9 9.1* Low sodium or “no salt added” pretzels, chips, crackers 43.4 43.4 Nonfat or 1% (low fat) milk (plain) 40.7 31.9* Energy drinks (e.g., Red Bull, Monster) 3.6 1.4 Bottled water 64.7 61.1 100% fruit or vegetable juice 43.5 40.6 ___________________________ *Statistically significant trend 7 There were several significant upward trends in health-related activities conducted by schools from 2008 – 2016: The percentage of secondary schools that had done any of the following in the current school year: 2008 2010 2012 2014 2016 Priced nutritious foods lower than less nutritious foods 11.4 7.2 8.9 14.2 11.0 Asked students, families and staff for food preferences 55.5 48.4 46.8 44.2 46.4 Informed students or families of nutritional content of foods 47.6 44.1 52.3 54.3 56.0* Conducted taste tests for food preferences for nutritious items 20.5 17.2 24.2 28.2 33.4* Allowed students to visit the cafeteria to learn about nutrition 17.9 18.7 17.5 22.1 20.3 Served locally or regionally grown foods in cafeteria or classes 32 32.4 36.9 Planted a school food or vegetable garden 14.3 24.5 27.7 Placed fruits and vegetables near the cafeteria cashier for easy access 60.8 68.7 65.2 Used attractive displays for fruits and vegetables in the cafeteria 50.6 60.8 63.6 Offered a self-serve salad bar to students 53.4 55.1 58.2 Labeled healthful foods with appealing names 28.8 36.9 33.3 Encouraged students to drink plain water 71.7 76.4 Prohibited staff from giving students food or food coupons as rewards 23.5 25.7 Prohibited less nutritious foods and beverages to be sold for fundraising 25.9 42.2* There was no significant change in the percentage of secondary schools that always or almost always offered fruits or non-fried vegetables at school celebrations when foods or beverages were offered from 2008 – 2016. 2008 - 29.0 2010 – 23.9 2012 - 19.0 2014 – 28.7 2016 – 24.7 Why these findings are important When providing foods and beverages for students, schools have an obligation to offer that which is nutritious. Good nutrition contributes to students’ ability to learn. The statistically significant downward trends in the types of snacks, candy, or non-nutritious drinks schools offered to students shows that Missouri schools are complying with USDA’s Smart Snacks in School regulation that was implemented in School Year 2014-2015. Additionally, foods and beverages high in calories and low in nutritional value contribute to obesity, which is a growing concern in Missouri. Key Resources School wellness resources and wellness policy resources available from the Department of Education Food and Nutrition Services at https://dese.mo.gov/financial-admin-services/food-nutrition- services/wellness Team Nutrition is an initiative of the USDA Food and Nutrition Service to support the Child Nutrition Programs. Information available at: https://www.fns.usda.gov/tn/team-nutrition The Smart Snacks in School regulation and information on the nutrition requirements that all foods sold in school are required to meet can be found at https://dese.mo.gov/financial-admin-services/food- nutrition-services/smart-snacks __________________________ *Statistically significant trend 8 Parent and Family Education and Engagement The percentage of secondary schools that during the current school year provided parents and families with health information designed to increase parent and family knowledge in these topics did not significantly change from 2008 – 2016: 2008 2010 2012 2014 2016 HIV, STD, or teen pregnancy prevention 30.6 25.7 14.4 21.6 19.7 Tobacco-use prevention 37.2 32.9 23.0 25.2 23.1 Physical activity 44.1 46.8 38.0 40.6 38.2 Nutrition and healthy eating 45.6 46.7 35.5 40.9 31.5 Asthma 21.1 24.5 22.8 23.6 22.6 Why these findings are important “School efforts to promote health among students have been shown to be more successful when parents are involved.” - Strategies for Involving Parents in School Health. Centers for Disease Control and Prevention. Key Resources Parent Engagement: Strategies for Involving Parents in School Health. CDC. Available at: http://www.cdc.gov/healthyyouth/protective/pdf/parent_engagement_strategies.pdf Parents for Healthy Schools. Available at: https://www.cdc.gov/healthyschools/parentengagement/parentsforhealthyschools.htm Opportunities for Physical Activity outside of Physical Education Class There have been no significant trends in the opportunities for physical education outside of the classroom, from 2008 – 2016. The percentage of all secondary schools that: 2008 2010 2012 2014 2016 Offer intramural sports or physical activity clubs 58.8 62.8 51.8 54.2 61.4 Offer interscholastic sports 90.0 79.7 88.9 Have physical activity breaks in classrooms other than PE 37.7 42.6 39.9 Have a joint use agreement for shared use of school or community physical activity facilities 60.8 56.0 58.4 Why these findings are important Schools play a critical role in improving the physical activity behaviors of children and adolescents. Because students may not attend physical education classes daily, students need opportunities to be physically active before, during or after school. Schools can create environments that are supportive of physical activity by implementing policies and practices. Key Resources Comprehensive School Physical Activity Programs: Helping All Students Achieve 60 Minutes of Physical Activity Each Day. American Alliance for Health, Physical Education, Recreation and Dance (AAHPERD). Available at: https://www.shapeamerica.org//advocacy/positionstatements/pa/upload/Comprehensive-School- Physical-Activity-programs-2013.pdf 9 The Association Between School-Based Physical Activity, Including Physical Education, and Academic Performance. U.S. Department of Health & Human Services (HHS) and the Centers for Disease Control and Prevention (CDC). Available at: http://www.cdc.gov/healthyyouth/health_and_academics/pdf/pa-pe_paper.pdf School Health Guidelines and the Morbidity and Mortality Weekly Report (MMWR) can be found at: https://www.cdc.gov/healthyschools/npao/strategies.htm Strategies for Recess in Schools. U.S. Department of Health & Human Services (HHS) and the Centers for Disease Control and Prevention (CDC). Available at: https://www.cdc.gov/healthyschools/physicalactivity/pdf/2016_12_16_SchoolRecessStrategies_508.pdf Health Services The percentage of secondary schools that had a full-time registered nurse who provided health services to students did not change significantly from 2008 to 2016. 2008-79.0 2010-75.8 2012-73.9 2014-75.2 2016- 75.7 The percentage of secondary schools that linked parents and families to health services and programs in the community did not change significantly from 2014 – 2016: 2014: 70.2 2016: 65.9 From 2014 – 2016, there were several significant decreases in the percentage of secondary schools that either provided services or referred students to health professionals not on school property for: Provided services Provided referral 2012 2014 2016 2012 2014 2016 HIV testing 4.1 4.0 0 47.7 45.0 27.6* Pregnancy testing 3.9 4.4 0.3* 51.1 48.9 29.8* Provision of condoms 1.7 2.1 0 33.0 30.4 21.8* Provision of contraceptives other than condoms 1.4 1.0 0 33.5 30.6 21.3 Prenatal care 6.7 6.1 0.6* 53.5 45.4 29.3* Human papillomavirus (HPV) vaccine administration 1.3 2.9 1.5 40.9 40.5 34.0 __________________________ *Statistically significant trend 10