How School-Healthy is California?

School health programs and policies may be one of the most efficient ways to prevent or reduce health-risk behaviors among students, which in turn, can prevent serious health problems. The Centers for Disease Control and Prevention (CDC) has issued science-based guidelines that identify policies and practices schools can implement to improve critical student health-risk behaviors. In addition, CDC has released tools designed to help schools implement effective health promotion and safety policies and practices identified in its guidelines.

To understand the extent to which effective school health policies and practices are being implemented in schools, monitoring is critical.  To accomplish this, CDC has implemented the School Health Profiles (Profiles) surveillance system (www.cdc.gov/schoolhealthprofiles). Profiles is a system of surveys that collects data every even-numbered year (e.g., 2010, 2012) from school staff in representative samples of secondary schools in states and other jurisdictions. After each Profiles cycle, CDC creates a detailed report of state results for each participating state, as well as a report that compiles state results. While this information helps state agencies understand how their state compares with others on specific school health policies and practices, it does not provide states with a simple understanding of how multiple components of their school health program efforts are reflected in school practices and how those efforts compare with those of other states.

In a recent article, Nancy D. Brener, Howell Wechsler, and Tim McManus use data from the School Health Profiles surveys conducted in 2010 to rank-order states based on the percentage of schools within each state that engaged in 12 key practices related to a healthy school environment and health education. Forty-nine states participated in Profiles in 2010 and met the criteria for inclusion in the healthy school environment analysis. California ranked 20^th, meaning that the healthy school environment was the 20^th best among these 49 states. The state was above the median across these 49 states in the percentage of schools that offer intramural sports and the percentage of schools that prohibit all tobacco use at all times in all locations, but was below the median in the percentage of schools with a full-time registered nurse.

Forty-seven states met the criteria for inclusion in the health education analysis, and California’s rank in that analysis was 17^th. The state was above the median across these 47 states in the percentage of schools with a written curriculum that covers all eight National Health Education Standards and the percentage of schools that teach key HIV, STD, and pregnancy prevention topics in both middle school and high school, but was below the median in the percentage of schools that teach key nutrition topics and tobacco-use prevention topics.

States with the lowest rankings tended to be in the west and Midwest, so California is a notable exception to this trend. This finding allows California to promote the strengths of their school health policies and practices in certain areas; other states may want to emulate these policies and practices. Other areas, however, are still in need of improvement. For example, only 21.8% of secondary schools in California had a full-time registered nurse, well below the median across states of 43.9%. Policy makers in California should consider targeting their efforts toward this and other critical areas of school health noted in this study to help improve student health.

The full study is in Brener, N., Wechsler, H., and McManus, T., “How School Healthy is Your State? A State-by-State Comparison of School Health Practices Related to a Healthy School Environment and Health Education” in the Journal of School Health, October 2013, vol. 83, no. 10, pp. 743-749.