Oregon School Health Education Profile Report 2002

Kara Stebbins, MPH

Ginny Ehrlich, MPH, MS

For more information, contact Ginny Ehrlich, Oregon Department of Education

(503) 378-3600 x2711

This report has been made possible by a cooperative agreement with the Centers for Disease Control and Prevention, Division of Adolescent and School Health.

September, 2003

Susan Castillo, Superintendent of Public Instruction

HEALTHY KIDS LEARN BETTER

Table of Contents

Acknowledgements …………………………………………………………… / 2
Executive Summary ………………………………………………….……….. / 3
Introduction …………………………………………………………………… / 9
Methods ……………………………………………………………………….. / 10
RESULTS
A. Extent of health education ……………………………………………… / 13
B. Content of health education ……………………………………….……. / 17
C. Extent and content of physical education/activity programs……………. / 22
D. Extent of asthma education and management activities ……………….. / 25
E. Extent and content of tobacco education ……………………….………. / 28
F. Extent and content of HIV education …………………………………… / 31
G. Coordination and collaboration among school health partners ………… / 33
H. Professional and staff development …………………………………... / 38
I. School policies related to health and safety ………………….…………. / 44
J. Highlights of changes over time………………………………………… / 52
Limitations and Conclusions ………………………………………………….. / 59
References …………………………………………………………………….. / 61
Appendices:
1: Frequencies for Core Principal and Health Educator Surveys …………. / 62
2: Frequencies for Supplemental Principal Survey……………………….. / 89
3: Frequencies for Supplemental Health Educator Survey….……………. / 97
4: Frequencies for Supplemental Health Services Survey……………..…. / 103
5: Frequencies for Supplemental Mental Health Services Survey………... / 113
6: Treatment of Missing Data ……………………………………………… / 119

Acknowledgements

The authors of this report wish to acknowledge many individuals who made the administration, analysis and report for the 2002 School Health Education Profile possible.

Special thanks go to Carol Elkins and Tamara Kuenzi of the Oregon Department of Education who spent countless hours compiling and accounting for survey instruments. Additionally, these individuals were responsible for follow up procedures used to increase overall participation rates.

Andrew Osborn spent many hours on survey administration and data preparation. Gratitude goes out as well to Romila Tandingan of DHS-HS for providing feedback on the written report. David Dowler provided consultation on his work on the 2000 SHEP Report, on which this report is based, which assisted greatly with the development of the current version.

Finally, particular thanks go to all the participating principals and lead health educators who took the time to complete and return the surveys.

Executive Summary

This report outlines findings from the latest School Health and Education Profile (SHEP), administered in the Spring of 2002.

I. Methods

The SHEP is a biannual questionnaire that is sent to a representative sample of Oregon schools containing grades six through twelve. One questionnaire goes to school principals, and another goes to lead health educators. Questionnaires were mailed to 366 Oregon schools in the Spring of 2002. One school was found to be ineligible, for a total of 365 eligible schools. Completed surveys were received from 183 principals (50% response rate) and 152 health educators (42% response rate). In general, these response rates are too low to consider the survey results representative of all Oregon schools. Comparisons between 2002 results and those of earlier surveys are presented when differences are greater than 5%, but should be viewed with caution because of differences in methodologies between years.

This report analyzes responses from the core modules in Oregon’s SHEP survey. SHEP also includes supplemental modules. The appendices provide summary level data for some of those supplemental modules.

II. Findings

A. Extent of health education

Over 97% of the schools had required health education in at least one grade. Less health education was required in high school grades than in middle school grades, less health education was required with each increasing grade of high school, and less health education was required for high schools in 2002 than in 2000. There was a slight trend toward more required health education for middle schools from 2000 to 2002. It is likely that much of the required health education material was taught in classes other than dedicated health education classes, although the percent has decreased from 2000 to 2002, especially for middle schools. Middle schools still remain more likely than high schools to teach required health education material as part of another course. Very few students were exempted from required health education because of a parental request.


B. Content of health education

Most schools taught health education in a comprehensive manner: 14 of the 17 crucial health topics were each taught in at least 80% of schools, and the average percent of schools teaching each of those 17 crucial topics increased from 84% to 89% from 2000 to 2002. Alcohol and other drug prevention, HIV/AIDS prevention, tobacco use prevention, physical activity and fitness, and nutrition and diets were each taught in at least 97% of schools. Teaching about the topic of nutrition and diets increased from 88% of schools in 2000 to 97% in 2002. The average percent of schools teaching each of a list of key health skills rose from 85% to 90% from 2000 to 2002. Skills each taught by more than 90% of the schools were resisting peer pressure, decision-making, communication, and analysis of media messages. Teaching analysis of media messages increased from 82% in 2000 to 93% in 2002. The three most common topics of nutrition instruction were the benefits of healthy eating, accepting body size differences, and aiming for a healthy weight. The vast majority of schools reported using group discussion and cooperative learning in health education courses. Use of the internet increased from 76% to 87% from 2000 to 2002. Use of pledges and contracts as a teaching method increased from 49% of schools in 2000 to 58% in 2002. Overall, schools reported low use of research-based, effective curricula for health education, and those that did rarely implemented them in their entirety.

C. Extent and content of physical education/activity programs

Physical education was required in at least one grade for 98% of schools, although some schools allowed exemptions (22%) or did not require a passing grade (46%). Ninety percent or more of the schools taught about the benefits of physical activity and addressed issues such as endurance, strength, flexibility, body composition, and the dangers of performance-enhancing drugs. Seventy percent or fewer schools taught about physical activity opportunities in the community, how to overcome barriers to physical activity, or how to make and monitor individualized physical activity plans. The vast majority (95%) of schools provided facilities for community-sponsored physical activity, and almost two-thirds (65%) provided intramural or club-based physical activities.

D. Extent of asthma education and management activities

Only 27% of schools taught asthma awareness to all students in at least one grade. A few more schools provided education to students with asthma and school staff about managing the condition (39% and 38% respectively). Ninety-five percent of schools encouraged full participation in physical education and physical activity when students with asthma are doing well, but fewer (81%) provided modified physical education/activities as needed. The majority (91%) of schools allowed students to self-carry inhalers. Eighty-one percent of schools identified and tracked all students with asthma, but only 31% tracked absences which are asthma-related. Half of schools obtained and used Asthma Action Plans for their students with asthma. One-quarter of schools provided intensive case management for students with asthma who are absent 10 days or more per year. Only 10% of schools provided a full-time registered nurse, all day every day.

E. Extent and content of tobacco education

It should first be noted that all schools with Measure 44 school-based tobacco prevention grants were included in the sample for both 2000 and 2002. These schools are required to deliver instruction each year at grades 5 – 9, which may inflate the results for tobacco prevention-related SHEP questions. Ninety-seven percent of schools reported trying to increase knowledge on tobacco use prevention in a required health education course– up from 88% in 2000. However for 12th graders, the percent decreased from 59% in 2000 to 35% in 2002. Tobacco use prevention was taught most frequently at the middle school level. Fifteen out of 17 selected tobacco prevention topics were each taught in at least 80% of schools. The most common topics were those related to long and short-term effects of tobacco use and the benefits of not using tobacco. Overall, schools reported low use of research-based, effective curricula for tobacco prevention health education, and those that did rarely implemented them in their entirety.

F. Extent and content of HIV education

A variety of HIV prevention topics were each taught in at least 80% of schools. Over 94% of schools taught about how HIV is transmitted, abstinence as a method of preventing HIV infection, how HIV affects the human body, and the influence of alcohol/drugs on risk behavior. Seventy-eight percent of schools taught about condom efficacy (and this is an increase over 70% in 2000), but only 42% of schools taught correct condom use (essentially unchanged from 40% in 2000).

G. Coordination and collaboration among school health partners

Just 13% of schools used a district health coordinator. Therefore, 87% did not have a full-time health coordinator, but rather someone who coordinated health in addition to other primary responsibilities. Similar to 2000, only a minority of schools had a health advisory council. Health educators often worked with other school staff (such as PE teachers, counselors, health services staff) and community partners. They were less likely to work with food services staff. The percent of schools reported to be working with community partners increased from 46% in 2000 to 63% in 2002. There was an increase from 2000 to 2002 in the percent of schools involving families through providing information on the health education program (68% to 83%) and inviting families to attend classes (44% to 55%). Schools were about twice as likely to have referral services for students to receive tobacco cessation services than for faculty and staff. About half of the schools had the school climate and safety initiatives of bullying-prevention and of peer-mediation, while fewer had a gang-violence prevention program. The percent of schools with bullying and gang violence prevention programs increased from 2000 to 2002.

H. Professional and staff development

Ninety-four percent of schools require a newly hired physical education teacher to be certified, licensed, or endorsed by the state in physical education. Only 19% of health educators had a sole emphasis in health education in their pre-service training, but another 44% had dual training in physical and health education. The remaining health educators had no formal training in the discipline. Fifty-three percent of health educators had taught health education for 10 or more years, a decrease from 62% in 2000. Health educators attended an average of 7.8 staff development events over the past 2 years—an average of 5.5 staff development topics and an average of 2.3 instructional methods topics. Health educators most often received training in CPR and first aid. Less than half received training on teaching students of various cultural backgrounds. Health educators most desired additional staff development in violence prevention, suicide prevention, and teaching skills for behavior change. In addition, there were large discrepancies between received and desired staff development for the topics of death and dying, emotional and mental health, and encouraging family or community involvement.

I. School policies related to health and safety

Fourteen percent of schools allowed physical education teachers to punish students with increased physical activity, while 8% allowed other teachers to punish students by denying them the opportunity for physical activity through participation in a physical education class. Nearly all schools had a policy prohibiting tobacco use, with an increase in the number of policies covering a broader range of tobacco products and tobacco users compared to 2000. Most policies for students and faculty/staff prohibited smoking in specific locations in and around the school, as well as at off campus, school-sponsored events. Sixty-five percent of schools posted signs specifying the school as a comprehensive tobacco-free zone (an increase from 54% in 2000). The large majority of schools also reported prohibition of all tobacco product advertising at school, including on student clothing and possessions. The most common way to address a student caught smoking was to refer him/her to a school administrator or to inform the parents or guardians. There was essentially no change from 2000 to 2002 in the percent of schools responding to an offense by requiring or encouraging participation in tobacco education or cessation programs. Most schools (85%) had a written policy protecting students and staff with HIV/AIDS. There was an increase in the percent of schools reporting students had 20 or more minutes to eat lunch, from 60% in 2000 to 83% in 2002. Less than 10% of schools reported that they or their district have a policy stating that fruits or vegetables will be offered at school settings such as student parties, after-school programs, staff meetings, parents-meetings, or concession stands. Implementation of a list of safety and security measures varied across schools participating in the survey. The most common safety and security measures implemented were requiring visitors to report to main office (100%), monitoring school halls (89%), and having a closed campus (i.e., students not allowed to leave during the day) (66%). Four security measures increased from 2000 to 2002: hall monitoring, having a police officer or guard on-site, routine checks of backpacks, desks and lockers, and prohibition of backpacks. Nearly all schools (97%) had a written plan for responding to a violent incidence.

J. Highlights of changes over time

From the 2000 SHEP to the 2002 SHEP, the extent of health education required for 6-8 graders increased, while the extent of health education required for 9-12 graders decreased. The average percent of schools teaching crucial health education topics, essential skills, and tobacco prevention topics all increased. Teaching also increased for specific topics of nutrition and diets, analysis of media messages and condom efficacy (not use). The percent of schools with policies prohibiting all tobacco products increased for both students and faculty. There was an increase in the posting of tobacco free zones. Use of suspension or detention as a response to student tobacco use increased, while encouraging or requiring that the student attend education or cessation program remained unchanged. More health education staff worked with community members, provided families with information on the health education program, and invited parents to class. Staff desire for training around the topic of family and community involvement also increased. Any changes in the percent of schools receiving training were in the direction of an increase in training. Behavior change was the only topic which schools increased desire for training despite a parallel increase in receipt of training. There was an increase in the percent of schools with programs for bullying and gang violence prevention, as well as an increase in schools reporting security policies such as hall monitoring, police/security guards on site, checking lockers and backpacks or even prohibiting backpacks.