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The general science of infection prevention and control can be applied to and adapted for a variety of settings, including kindergarten through grade 12 (K-12). Strategies can be implemented in the classroom and whole school environment to prevent a wide array of illnesses caused by both bacteria and viruses. This science brief presents findings from a review of research studies focused on school- based strategies to prevent and control respiratory and gastrointestinal infections. The studies reviewed in this brief informed and supported development of the Guidance for Preventing Spread of Infections in K-12 Schools. Previous literature reviews have been published about infection prevention in schools, and most have focused on single intervention strategies such as hand washing, cleaning and disinfection, or contact tracing. Additionally, Centers for Disease Control and Prevention (CDC) has evidence-based guidance, including the respiratory virus guidance that was taken into consideration when developing this brief. This science brief adds to existing literature by describing the current state of science for a comprehensive set of strategies to prevent spread of respiratory and gastrointestinal infections in K-12 settings.

The Centers for Disease Control and Prevention established School Health Profiles (Profiles) in 1996 to monitor school health policies and practices in secondary schools in states and school districts across the United States. Profiles is a system of surveys conducted biennially in even-numbered years and provides data on the following topics: health education requirements and content, physical education and activity, safe and supportive environments, health services, and school health coordination. In March 2020, the COVID-19 pandemic forced schools across the United States to close, interrupting Profiles administration. Data collection, originally planned for January-June, was extended in several states and local agencies through December 2020. The 2020 Profiles marks the first routine surveillance assessment of school health programs since the pandemic. Further, for the first time in system history, the 2020 Profiles report includes nationwide estimates in addition to state and district data. Profiles surveys are conducted by education and health agencies among middle and high school principals and lead health education teachers. This report describes Profiles methods, showcases results from the 2020 Profiles, summarizes changes over time, and reveals both strengths and weaknesses in school health programs nationwide. These data can be used to compare results across jurisdictions, plan and monitor programs, identify professional development needs, and support health-related policies and legislation.

Inclusive physical education and physical activity programs in schools provide equal opportunities for all students, including those with disabilities. All students, regardless of ability, should get the recommended 60 minutes or more of daily physical activity. Schools can help them meet this recommendation. This brief is for state education and health leaders. It defines inclusion, identifies relevant federal policies, describes the current status of inclusion in the United States, and suggests six actions state leaders can take to promote inclusion in physical education and physical activity at the district and school levels.

The Centers for Disease Control and Prevention's (CDC) Youth Risk Behavior Surveillance System (YRBS) has a long history of providing representative data on the nation's high school students. These assessments are crucial to CDC's mission of identifying health behaviors and experiences; understanding the determinants and co-occurrence of risks; and utilizing data to promote healthier and safer adolescence for the nation's youth through effective school and community programs, policies, and approaches. Although adolescents are in good health overall, clear risks remain. For example, while the proportion of high school students who are sexually active has steadily declined, half of the 20 million new STDs reported each year were among young people, between the ages of 15 and 24.2 Further, young people aged 13-24 account for 21% all new HIV diagnoses in the United States, with most occurring among 20-24 year olds. Although most high school students are increasingly making better decisions about their health, this report identifies subgroups who are at an increased risk for HIV, STDs, and teen pregnancy. The CDC looks forward to working with partners in public health and education to develop strategies to address the disparities highlighted in this report. Improving the health of adolescents and, subsequently, their health in adulthood will require our collective action at the family, school, and community levels. The CDC hopes this report will serve as a helpful resource to monitor its progress going forward.

Less than one-third of children and adolescents in the United States are meeting the recommendation from the "2008 Physical Activity Guidelines for Americans" to get 60 minutes or more of physical activity each day. Schools can help students meet this national recommendation because close to 60 million children and adolescents attend school. Schools have also shown that they are capable of helping students get up to 20 to 60 minutes of physical activity during the school day. This finding underscores that schools are the most strategic and practical place for students to learn about and practice being physically active. The Whole School, Whole Community, Whole Child model can help schools strategically identify and promote policies, practices, and programs that increase physical education and physical activity. Within the context of this model, schools can develop, implement, and evaluate a Comprehensive School Physical Activity Program. This program involves coordination across multiple components, including: (1) Physical education as the foundation; (2) Physical activity during the school day (recess and classroom physical activity); (3) Physical activity before and after school; (4) Family and community engagement; and (5) Staff involvement. This report describes strategies for promoting and planning classroom physical activity. It also provides a list of practical resources to help school staff implement the strategies identified. [The writing team for this report includes: Brittany H. Chen, Mary Juergens, Kelly Hughes, Lina Jew, Kate Holmes, and Shannon L. Michael. This document was prepared in collaboration with Springboard to Active Schools, an initiative of the National Network of Public Health Institutes (NNPHI) and Health Resources in Action (HRiA) through a cooperative agreement.]

This report provides results from the School Health Policies and Practices Study (SHPPS) conducted in 2016. Following a detailed Methods section, 2016 results are presented in a series of 90 tables organized around the components of the Whole School, Whole Community, Whole Child (WSCC) model. Tables 1.1 through 6.9 provide the percentage of districts with certain policies and practices in place. Results are shown separately by school level (elementary school, middle school, and high school) if the questions were asked separately by school level. For each variable, the prevalence estimate is shown along with a 95% confidence interval. Tables 7.1 through 7.6 then provide the results of trend analyses examining changes over time in selected school health policies and practices. Table 8.1 provides results for the 7 Healthy People 2020 objectives and sub-objectives monitored by SHPPS 2016. Following the Results section is a Discussion section that highlights the key findings of the report.

This report provides results from the School Health Policies and Practices Study (SHPPS) conducted in 2014. Following a detailed Methods section, 2014 results are presented in a series of 168 tables organized around the 10 components of the Whole School, Whole Community, Whole Child (WSCC) model. Tables 1.1 through 10.4 provide the percentage of schools or classes with certain policies and practices in place; these results are shown separately for each school level--elementary school, middle school, and high school. For each variable, the prevalence estimate is shown along with a 95% confidence interval. Tables 11.1 through 11.12 then provide the results of trend analyses examining changes over time in selected school health policies and practices. Table 12.1 provides results for the 56 Healthy People 2020 objectives and sub-objectives monitored by SHPPS 2014. Following the Results section is a Discussion section that highlights the key findings of the report.

The School Health Policies and Practices Study (SHPPS) is a national survey periodically conducted to assess school health policies and practices at the state, district, school, and classroom levels. SHPPS 2014 assessed the characteristics of selected components of the Whole School, Whole Community, Whole Child model: (1) health education; (2) physical education and physical activity; (3) nutrition environment and services; (4) health services; (5) counseling, psychological, and social services; (6) social and emotional climate; (7) physical environment; and (8) employee wellness; (9) family engagement; and (10) community involvement. This report presents the trends of SHPPS findings over the years 2000, 2006, and 2014.

This report provides an overview of the 2014 School Health Policies and Practices Study (SHPPS). SHPPS is a national survey periodically conducted to assess school health policies and practices at the state, district, school, and classroom levels. The 2014 study collected data at the school and classroom levels only. SHPPS assesses the characteristics of selected components of the Whole School, Whole Community, Whole Child model: (1) health education; (2) physical education and physical activity; (3) nutrition environment and services; (4) health services; (5) counseling, psychological, and social services; (6) social and emotional climate; (7) physical environment; (8) employee wellness; (9) family engagement; and (10) community involvement.

All forms of violence, including youth violence, suicidal behavior, child maltreatment, sexual violence, intimate partner violence, and elder abuse, negatively affect the health and well-being of this country. Youth violence, in particular, is a significant public health problem. Many young people and communities view the grim facts about youth violence as unavoidable and have accepted youth violence as a societal reality. However, the truth is that youth violence is not inevitable. Youth violence is preventable. The past investment into monitoring, understanding, and preventing youth violence is paying off and proving that youth violence can be stopped before it occurs. the Centers for Disease Control and Prevention (CDC) and the larger field of youth violence prevention researchers and practitioners have performed decades of work on youth violence and how it can be prevented. From systematic surveillance, rigorous research on modifiable factors that predict violence, evaluation of prevention strategies, and the strengthening of the capacity of communities to use approaches that work, a great deal has been learned about how to prevent youth violence. To help communities take advantage of the available knowledge, CDC has developed "Preventing Youth Violence: Opportunities for Action." This resource summarizes what is currently known about youth violence--the health consequences, trends, disparities, causes, costs, and prevention strategies. It outlines important strategies for youth violence prevention that are based on strong evidence and experience. It includes examples of specific programs and activities that have been found to be effective. These evidence-based youth violence prevention strategies focus on reducing the factors that put young people at risk for violence and bolstering the factors that strengthen their positive development and buffer against violence. Everyone has a role to play in preventing youth violence. "Preventing Youth Violence: Opportunities for Action" provides information and action steps that can help public health and other community leaders work with partners to prevent youth violence. This resource also describes actions that young people, families, caregivers, adults who work with youth, and other community members can take to reduce youth violence. "Development of 'Preventing Youth Violence: Opportunities for Action'" is appended.

Students feel more connected to their school when they believe that the adults and other students at school not only care about how well they are learning, but also care about them as individuals. Young people who feel connected to school are more likely to succeed academically and make healthy choices. All school staff, including teachers, principals, counselors, social workers, nurses, aides, librarians, coaches, nutrition personnel, and others, can have an important and positive influence on students' lives. The time, interest, attention, and emotional support they give students can help them learn and stay healthy. This fact sheet provides guidance for fostering school connectedness and creating a more welcoming and supportive school environment for all students. (Lists 5 resources.)

School connectedness is the belief held by students that the adults and peers in their school care about their learning as well as about them as individuals. Students who feel connected to school are more likely to have a number of positive health and academic outcomes. This fact sheet answers questions about school connectedness and identifies strategies school districts and administrators can use to foster it among their students. (Lists 5 resources.)

Efforts to improve child and adolescent health typically have featured interventions designed to address specific health risk behaviors, such as tobacco use, alcohol and drug use, violence, gang involvement, and early sexual initiation. However, results from a growing number of studies suggest that greater health impact might be achieved by also enhancing protective factors that help children and adolescents avoid multiple behaviors that place them at risk for adverse health and educational outcomes. Enhancing protective factors also might buffer children and adolescents from the potentially harmful effects of negative situations and events, such exposure to violence. Protective factors include personal characteristics such as a positive view of one's future; life conditions such as frequent parental presence in the home at key times (e.g., after school, at dinner time); and behaviors such as active participation in school activities. School connectedness is a particularly promising protective factor. This publication defines and describes the components of school connectedness and identifies specific actions that schools can take to increase school connectedness. The six strategies outlined in this publication provide a framework for increasing students' connectedness to school. In combination with evidence-based health promotion programs, strategies such as these can help schools have the greatest impact on the health and education outcomes of their students.

The mission of the Division of Adolescent and School Health (DASH) is to prevent the most serious health risks among children, adolescents, and young adults. Its goal is to prevent unintentional injuries and violence by enabling the nation's schools to address safety through coordinated school health programs. It attempts to achieve this goal through implementation of the following strategies: (1) data collection and analysis; (2) science-based guidance; (3) funding to nongovernmental organizations for programs and policy development; (4) technical assistance; and (5) integration with other federal efforts. This publication highlights specific DASH initiatives corresponding to each of these strategies.

This publication offers concrete suggestions for schools working to improve the health and school attendance of students with asthma. The Centers for Disease Control and Prevention (CDC) has identified six strategies for schools and districts to consider when addressing asthma within a coordinated school health program. The six strategies detailed herein are: (1) Establish management and support systems for asthma-friendly schools; (2) Provide appropriate school health and mental health services for students with asthma; (3) Provide asthma education and awareness programs for students and school staff; (4) Provide a safe and healthy school environment to reduce asthma triggers; (5) Provide safe, enjoyable physical education and activity opportunities for students with asthma; and (6) Coordinate school, family, and community efforts to better manage asthma symptoms and reduce school absences among students with asthma. This revised edition includes a list of resources covering each of the six strategies.

This report offers a composite review of methods used to prevent tobacco use. The report evaluates five approaches currently used to reduce tobacco consumption: educational, clinical, regulatory, economic, and comprehensive approaches. The report explains these approaches in terms of the larger context of tobacco control and provides a vision for the future of tobacco use prevention and control based on available tools and resources. The report contains special sections on the management of nicotine addiction, regulatory efforts such as advertising, economic interventions, comprehensive programs, global efforts, and elimination of health disputes. (Contains 25 tables, 6 figures, and over 1,000 references.) (JDM)

This publication presents best practices to help states assess options for comprehensive tobacco control programs and to evaluate their local funding priorities. It draws on best practices determined by evidence-based analyses of excise tax-funded tobacco control programs in California and Massachusetts and by the Centers for Disease Control and Prevention's involvement in providing technical assistance in the planning of comprehensive tobacco control programs in other states with excise tax-funded programs (Oregon and Maine) and in the four states that individually settled lawsuits with tobacco companies (Florida, Minnesota, Mississippi, and Texas). Section A, "Components of Comprehensive Tobacco Control Programs," focuses on (1) "Community Programs to Reduce Tobacco Use," (2)"Chronic Disease Programs to Reduce the Burden of Tobacco-Related Diseases," (3) "School Programs," (4) "Enforcement," (5) "Statewide Programs," (6) "Counter-Marketing, " (7) "Cessation Programs," (8) "Surveillance and Evaluation," and (9) "Administration and Management." Section B presents "Funding Model for All 50 States." Section C offers "Recommended Program Element Budgets, by State." An appendix presents information on the efficacy of comprehensive tobacco control programs in California and Massachusetts. (SM)

Smoking is the leading cause of preventable death in the United States and certain racial and ethnic minority groups are at higher risk for using tobacco. This is the first Surgeon General's report to focus on tobacco use among these four racial and ethnic minority groups. It provides a single, comprehensive source of data on each group's pattern of tobacco use and presents information on national and regional efforts to curtail consumption of tobacco products. Preventing health problems related to tobacco use among these individuals will be integral to achieving the Healthy People 2000 objectives. Following the introduction in Chapter 1, Chapter 2 illustrates how patterns of tobacco use differ among the groups. Chapter 3 compares the groups in terms of the incidence and prevalence of death rates for diseases commonly associated with tobacco use. Chapter 4 analyzes the smoking-related health status of these groups to determine if there is a differential risk for tobacco addiction. Chapter 5 discusses tobacco control and education efforts among members of the four ethnic minority groups. (Contains 43 references.) (JDM)

This report presents findings from a spring 1997 survey of all middle-school students (grades 6-8) enrolled in schools funded by the Bureau of Indian Affairs (BIA). The Centers for Disease Control Youth Risk Behavior Survey (YRBS) was completed by 6,990 students in 115 of the 122 BIA-funded middle schools; the overall response rate was 74 percent. The self-administered Middle School YRBS is a 55-item questionnaire that assesses the prevalence of six categories of behaviors that contribute substantially to death, illness, and social problems among U.S. youth and adults: (1) unintentional and intentional injuries; (2) tobacco use; (3) alcohol and other drug use; (4) sexual behaviors that contribute to unintended pregnancy and sexually transmitted disease, including HIV infection; (5) dietary behaviors; and (6) physical activity. Findings in each category are detailed in narrative and chart form and compared to national and high school findings. Some findings include: (1) less seat belt use among males, less use of helmets among males, 37 percent of all students took a gun to school, 64 percent engaged in a fight, and one-third had considered suicide; (2) over 78 percent had tried cigarette smoking; (3) three in five had used alcohol, and 51 percent had used marijuana; (4) 20 percent had sexual intercourse; (5) 23 percent thought of themselves as overweight; and (6) 69 percent participated in vigorous physical activity. A chart shows ages of initiation for various survey activities. Tables break down findings by sex and grade. Suggestions are offered for the role of schools in addressing the risk behaviors examined in this survey. (SAS)

The "School Health Index" is a self-assessment and planning guide that will enable schools to: (1) identify the strengths and weaknesses of school policies and programs for promoting health and safety; (2) develop an action plan for improving student health and safety, and (3) involve teachers, parents, students, and the community in improving school policies, programs, and services. Results from using the "School Health Index" can help include health promotion activities in overall School Improvement Plans. There is growing recognition of the relationship between health and academic performance, and completing the "School Health Index" can become one of any school's important Leave No Child Behind educational reform activities. The self-assessment process allows members of the school community to come together and discuss what each school is doing to promote good health. More specifically, assessing the extent to which schools implement the kinds of policies and practices recommended by the Centers for Disease Control and Prevention (CDC) in its research based guidelines for school health and safety programs (see the Resources section for information on how to obtain these guidelines). After completing the self-assessment process, schools will be asked to identify recommended actions to improve performance in areas that received low scores. Then guidance will be provided for prioritizing the various recommendations. This step will help administrators to decide on a handful of actions to be implemented this year. Finally, completion of the School Health Improvement Plan will guide steps in planning the implementation of recommended actions. Completing the "School Health Index" is an important first step toward improving schools' health promotion policies and practices. Each school can then act to implement their own School Health Improvement Plan and develop an ongoing process for monitoring progress and reviewing recommendations for change. the "School Health Index" focuses on how schools can promote: (1) physical activity; (2) healthy eating; (3) a tobacco free lifestyle; and (4) a wide range of safety-related behaviors. These topics were chosen because CDC has developed guidelines for schools on addressing each of them and because these health behaviors can play a critical role in preventing the leading causes of death, disability, and illness. Fact Sheets are appended. [Document also prepared by the Division of Nutrition and Physical Activity, Office on Smoking and Health, Division of Unintentional Injury Prevention, and Division of Violence Prevention. Prepared in collaboration with Steven H. Kelder.]

This packet of materials is Phase 1 of a toolkit designed to enlighten education leaders about the need for HIV prevention for youth, especially in communities of color. One element of the toolkit is a VHS videotape that features a brief message from former Surgeon General, Dr. David Satcher. The toolkit also includes a copy of a letter sent to constituents about the toolkit and a series of fact sheets on the current state of HIV/AIDS in Communities of Color. "HIV/AIDS and African Americans"; "HIV/AIDS and Minority Women;""HIV/AIDS and Hispanics"; "HIV/AIDS and Adolescents and Young Adults"; "HIV/AIDS and American Indians/Alaska Natives"; "HIV/AIDS and Asian Americans/Pacific Islanders"; "HIV/AIDS and the Caribbean" (Puerto Rico and the U.S. Virgin Islands); and "HIV/AIDS and the United States." Appended is a sample op-editorial column, "Youth AIDS Prevention Requires a 'Community Classroom'" (David Satcher). (SM)

This document presents an update of a fact book first published by the Public Health Service in 1969. It deals with the medical, social, and economic aspects of cigarette smoking and identifies cigarette smoking as the chief preventable cause of death in the United States. The first section, Smoking, Tobacco & Health, examines trends in cigarette smoking for the years 1900 through 1985 and corresponding statistics on lung cancer deaths; discusses the popularity and addictiveness of cigarettes; and looks at who smokes and why, teenagers and smoking, and former smokers. A section on smoking and health compares life expectancies of male smokers and nonsmokers. Cigarette smoking and its relationship to cancer, heart disease, and chronic lung disease are examined. The constituents of cigarettes are identified and the introduction of low-tar and low-nicotine cigarettes is discussed. Also included are discussions of women and smoking; smoking and the workplace; pipes, cigars, and smokeless tobacco; and passive smoking. A section on cigarette manufacturing and marketing looks at cigarette marketing, cigarette advertising, and cigarette taxes. Other sections discuss the growing of tobacco and the cigarette trade worldwide. (NB)

Parents want their child to do well in school. They also want their child to be healthy and avoid behaviors that are risky or harmful. Through their guidance and support, parents can have great influence on their child's health and learning. But they also have important allies in this effort--the caring adults in their child's school. Research shows that students who feel a genuine sense of belonging at school are more likely to do well in school, stay in school, and make healthy choices. This sense of belonging is often described as school "connectedness." Connected students believe their parents, teachers, school staff, and other students in their school care about them and about how well they are learning. This brief paper discusses the importance of a child's connection to school and lists some actions parents can take, at home and at school, to help their child become more connected to his or her school. (Lists 5 resources.)

The ultimate goal of the work of violence prevention is to stop violence before it begins. The Centers for Disease Control (CDC) uses a four-level social-ecological model (SEM) to better understand and prevent violence. The four levels are: (1) Individual; (2) Relationship; (3) Community; and (4) Societal. This model considers the complex interplay between individual, relationship, community, and societal factors. It allows the CDC to understand the range of factors that put people at risk for violence or protect them from experiencing or perpetrating violence. The overlapping rings in the model illustrate how factors at one level influence factors at another level. Besides helping to clarify these factors, the model also suggests that in order to prevent violence, it is necessary to act across multiple levels of the model at the same time. This approach is more likely to sustain prevention efforts over time than any single intervention.