Supporting Health and Wellness in High Schools
Margaret Stetsko
Master of Science in Education Program
Northwestern University
August 2006
Table of Contents
Rationale……………………………………………………………….……...3
Research Project Question Development………………….…..…..…….…3
Literature Review…………………………………………………..….…..…5
Data Collection………………………………………………………..…….27
Ethics Statement……………………………………………………..….…..29
Data Analysis and Interpretation…………………………….…..…….....30
Figure 1.1 – Q-Sort Prompt Ranking……………………..…...……31
Figure 1.2 – I get bored or tired during class……………...... ….…41
Figure 1.3 – I like to sit in class and listen………………...... …..…41
Figure 2.1 – I feel stupid when I am playing sports….………..…49
Figure 2.2 – I use Math everyday……………………...... 50
Figure 2.3 – I like the way I feel when I am active…….….….…..50
Conclusion…………….…………………………………………....….…...56
References……….……………………………………….….……….…..…63
Appendix A……………………………………..………….……………....67
Appendix B………………………………………………………………....69
.
Appendix C………………………………………………………………....84
Appendix D…………………………………………………….…………..86
Appendix E…………………………………………………….…………...88
Rationale
I first began to think about researching school involvement in student health while watching a national news report on the obesity epidemic in America. The reporter outlined several of the problems that excess weight and inactivity can have on a person’s health. The program also outlined some ways that people can make positive changes to their lives. I immediately began to think about how to best educate Americans on making positive health decisions. I believe that educating youth is the best place to start for encouraging healthy habits, and I believe that schools are one of the best places for that education. I believe that the health issues in America that are related to diet and exercise are partially a cultural issue. People’s habits in this culture are not likely to change without sufficient education and motivation.
Research Project Question Development
My project did not begin with the topic of promoting student health. Initially, I was interested in researching the International Baccalaureate (IB) program and the IB degree. I have always been passionate about teaching a world-wide perspective to students, and I thought that researching the IB program was ideal for determining how to encourage students to take an international perspective towards their education. While I am still very interested in this topic, the research began to become difficult in determining exactly what my question was. I knew that I was interested in international education, but I could not determine exactly what I wanted to find out, or how the IB programs in the United States had implications regarding the IB programs overseas.
I probably would have stuck with my original topic if I had not been inspired by the news program I saw on the obesity epidemic. Health and physical fitness has played an important role in my life, and it has taken me a long time to get to the point where I feel as though I have adequate knowledge and motivation for being the healthiest that I can be. I also worry about the health of those around me, and struggle with the best way to encourage positive changes in my loved ones’ lives without being hurtful. That is part of the reason I think healthy habits are best if learned at a young age – unhealthy habits are hard to break.
One of the most difficult issues with choosing this topic was that I had to determine a researchable question. I knew that I wanted to look at how schools can help encourage good habits, but I also knew that it would be hard to determine what constitutes a habit. There is no way to know whether a person will continue to act the way they do in their youth. Furthermore, there are difficulties in defining health, as there are many components tied to health. Physical fitness and nutrition were the two areas that were most important to me, but these two areas are still very broad when looking at a variety of issues in schools that could affect student behavior. I knew from the start that I did not want to limit my study to physical education and health classes alone, as I see those as places that provide information, but do not necessarily provide an environment for forming habits outside the classroom. That is how I got the idea to look at health and physical education in classrooms outside of health and physical education.
Moving the focus of my question to places outside of physical education and health classes widened my project, but I believe that is an important component. In fact, I wanted my project to look at places in the school outside of all classrooms. While this provided potential problems in having too wide of a topic, I thought that it was extremely important. As I stated in my Rationale section of this project, I believe that the health problems in America are partially cultural. I also believe that schools are a sub-culture in America. Students are profoundly affected by the entire environment in which they learn, not just by the classroom. I wanted to consider the entire school environment in my research.
For a while, my project question focused on just lessons in the classroom, and I wanted to look specifically at Math. However, as I actually began to collect data, I never stopped looking at the school-wide environment. I realized as I collected data that the larger environment had never left my point of interest. Therefore, I settled on the following question for my research project: “What changes can be made in high school classrooms and the high school environment in order to promote student health?”
Literature Review
Introduction
Students learn far more than math, science, reading, literature and language in schools. Students learn how to take care of themselves. Schools provide an education on life, not just academic subjects. One example of this extension of education is health and general well being. Schools provide not only the curriculum for health and physical education, but also an environment in which students can make decisions based on what they learn in those subjects. Given the amount of time that children and adolescents spend at school, it is possible that they are learning more of their health habits in school than they learn at home.
America is facing a health crisis. The evidence that our country is in need of change is abundant. Medical costs are increasing rapidly as more people with diseases stemming from obesity are in need of treatment. More specifically, the health problems related to obesity are beginning at younger ages. In a Congressional Subcommittee on Education Reform, U.S. House Representative Michael N. Castle cited a report by the National Institute for Health Care Management stating that the number of overweight and obese young Americans doubled between 1990 and 2000 (2004). Researchers are pessimistic. Given the current trends, the outlook does not look good for the future of America’s health. Through the domain of the American health crisis, this project aims to look at how current health trends in America directly impact children and adolescents.
In analyzing the effect that our culture has on children and adolescent health, the school environment plays a key role in determining the future of these issues and the degree to which health trends will impact today’s youth. A school with soda machines, candy machines, french fries and nachos for lunch might dissuade students from making health choices. If teachers and administrators emphasize the importance of math tests or AP credits over the importance of daily physical activity, students are less likely to make health their priority. While health is ultimately up to the individual, a school environment might influence students to make positive choices based on the opportunities surrounding them. The second domain of this project is school environment. This project will look at examples of existing school health programs, and will consider the role that educators and the school environment might play in addressing national health issues.
Currently, many schools across the nation are restructuring their Physical Education courses. These positive changes in physical education curriculum are gaining a lot of media attention, especially in light of this American health crisis. Still, the burden of teaching a healthy life is typically left in the hands of the health educators and the physical educators. By doing this, educators are suggesting that the disciplines of health are only meant for health subject courses. Education researchers have explored the effects of combining curriculum in other academic areas. For example, students study Economics in History, Calculus in Physics, and Literature in Foreign Language. Therefore, the final domain of this project is integrated curriculum, as the goals for physical health could be a priority for all educators.
It should be noted that the contents of health and physical education are broad. Therefore, this project will focus primarily on nutrition and physical activity. There are many additional topics for adolescent health, such as alcohol and drug use, sexual health, social and emotional health, and so on. This project will also limit the discussion of nutrition education in terms of making healthy food choices, but will not address the complexities of issues such as anorexia and bulimia in teenagers. Furthermore, a great deal of the research on these topics does not differentiate between primary and secondary education, and often generalizes findings to both populations. While the main concern of this project is education in a secondary setting, research on programs in primary education is included. The primary education programs may serve as guidelines and a frame of reference for what may or may not work for adolescent programs.
The American health crisis
Health statistics regarding Americans and recent trends in obesity are startling. For the first time in our Nation’s history, some states are reporting over 20% of the adult population as obese. The medical definition of obese is based on a person’s Body Mass Index (BMI), which is a number determined by calculating weight in kilograms divided by the square of height in meters. A BMI of 18.5 up to 25 commonly refers to a healthy weight, a BMI between 25 and 30 refers to overweight and a BMI of 30 or higher refers to obese (The Endocrine Society, 2006, Obesity Basics section, chart). For most people, being 30 pounds over the recommended weight range for your height constitutes obesity. A limitation in using the BMI as an indicator of health is that is does not account for increased muscle mass (Taras and Potts-Datema, 2005). In addition, some researchers use a more limited weight range when discussing children’s health issues because children’s weight ranges are actually smaller than adult weight ranges. The BMI does not reflect this smaller overall weight range. Despite a few inconsistencies of this measurement, the BMI is a relatively reliable indicator of a person’s health in relation to their weight.
The effects of excess weight reach far. People who are overweight or obese often suffer a number of related health problems. According to the Surgeon General, one out of every eight deaths in America is caused by an illness directly related to overweight and obesity (Surgeon General, 2003, paragraph 5). In fact, obesity contributes to the number-one cause of death in our nation: heart disease. Excess weight is also linked to diabetes, some cancers, sexual health problems, sleep apnea, asthma, depression and a variety of social issues. (Taras and Potts-Datema, 2005).
Our nation’s weight problems are also taking a major toll on our economy. According to a study sponsored by the Centers for Disease Control and Prevention (CDC), obesity-related medical expenditures in the United States reached $75 billion in 2003 (U.S Congress, 2004). One example of a costly weight-related disease is diabetes. In a recent report, the surgeon general suggests that excess weight has led to an increased number of people living with Type II diabetes, since this disease is often caused by excess weight. People with Type II diabetes also suffer additional health problems, such as eye diseases, cardiovascular problems, kidney failure, and early death. Given the number of people living with diabetes and its associated medical problems, each year, this condition costs America an estimated $132 billion (U.S. Congress, 2004).
There are trends in childhood and adolescent health that suggest that the situation may become even worse. According to the CDC, childhood and adolescent obesity rates (ages 6-19) have increased 4-fold in the past two decades (Taras & Potts-Datema, 2005). For the first time ever noted, people are developing Type II diabetes in their youth. According to Dr. Kenneth Cooper, an expert in health and physical fitness, “The Baylor College of Medicine has even reported that children who develop Type II diabetes before 14 years of age may be shortening their life span by 17 to 27 years” (U.S. Congress, 2004). Given the current costs of treating adults with obesity-related illnesses, our country can expect those costs to increase as this generation of youth reaches adulthood.
Despite the negative impact of overweight lifestyles, the damage is not always permanent. According to the American Obesity Association (AOA), “Weight loss of about 10% of body weight, for persons with overweight or obesity, can improve some obesity-related medical conditions including diabetes and hypertension.” (AOA, 2006, paragraph 1). While the current trends are pessimistic, change is still possible. This health crisis is capturing the attention of the media and therefore becoming perceptible to Americans. In addition, the federal government is on board and is working to make changes for the benefit of the American health and economy. Between the Childhood Obesity Prevention Act, the Child Nutrition bill, the School Nutrition Association, Child Nutrition and WIC Reauthorization Act of 2004, the involvement of the U.S. Department of Agriculture, the National Alliance for Nutrition and Activity, the U.S. Department of Health & Human Services, the Centers for Disease Control and Prevention, and any of the hundreds more organizations dedicated to this cause, the government is actively searching for solutions to cure the American obesity epidemic.
Part of the problem of addressing this issue is pinpointing what exactly needs to change. Experts debate whether the biggest problem in our culture is poor diet, or whether the biggest problem is a lack of physical activity. Medical experts now know more than ever about the combination of genetic, social, metabolic, and environmental factors that play a role in a person’s weight. Still, the issue frequently returns to the fact that many people are eating too much and moving too little. An article by the Associated Press (2006) recently stated that some experts are blaming soda and sugar-sweetened beverages for weight gain, as a study found that one of every five calories in the average American diet is liquid. “The nation’s single biggest ‘food’ is soda, and nutrition experts have long demonized it” (Associated Press, 2006). The soda blame is only one theory, however, and many schools have recently begun to ban the soda machines all together. Other theories include an increased consumption of fast food, larger portion sizes and families who fail to make time to sit down and eat meals at home.
There are some areas in which our nation has had success in terms of nutrition health. The U.S. Food and Drug Administration has recently mandated that all nutrition information includes a breakdown of fats, including how much trans fat is in the food. Trans fat is often included in packaged foods in order to increase their shelf life. Trans fat, along with saturated fat, is known to raise low-density lipoprotein (LDL) cholesterol levels, which contributes to health problems such as cardiovascular disease. The government is making an effort to get more information out to people regarding the food they are consuming. However, these efforts will have little effect if people are not also learning the importance of nutrition labels and also learning how to read those labels. Part of the reason that current health trends are continuing to decline is that the major information providers of our country, particularly schools and the media, may not be providing adequate information or positive influence.
Lack of physical activity could be an equal or greater contributor to America’s health problems. This generation appears to be more sedentary than ever. According to the CDC, two out of three Americans are not active at recommended levels (CDC, 2006, paragraph 1). Furthermore, a study by the University of Hong Kong and the Department of Health found that being inactive could be more hazardous for a person’s health than smoking (News Target, 2006, paragraph 1). According to this study, 20% of all deaths of people older than 35 were a result of a lack of physical activity. Some research is also suggesting that physical activity might be more significant than weight in terms of a person’s health. In a study published by the Annals of Epidemiology, Carlos J. Crespo, Dr.P.H., associate professor of social and preventive medicine in the University at Buffalo's School of Medicine and Biomedical Sciences, states,
Our findings confirm that, independent of other known risk factors, such as hypertension, high cholesterol and smoking, physical activity exerts positive health benefits independent of body weight. The benefit may derive from the fact that regular moderate physical activity, no matter how much you weigh, appears to stimulate the immune system, improve insulin sensitivity and increase bone density, among other positive effects. These findings send a strong message that everyone should strive to be active in some way (Senior Journal, 2006, paragraph 5).