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It is of fundamental importance that the Basic Health Units (BHU) are distributed equally in relation to educational institutions to increase the possibility of greater effectiveness of the actions of the School Health Program (SHP). The objective of the study was to outline a spatial overview of the implementation of the program in Sergipe, observing whether the principle of equitable distribution of actions was being adhered to. It involved a cross-sectional study in which the municipalities that joined the SHP were surveyed and mapping of BHU and public schools was elaborated, observing the occurrence of equity in their distribution via geolocation; and the mean and median distances between health and education equipment were estimated. The results revealed that 1,436 (84.52%) of public schools were participants in the SHP. The mapping and estimation of distance indicated evidence of inequity of actions in schools located in rural areas and peripheral areas of urban regions. In addition, flaws were detected in the geolocation information of the BHUs throughout the state, which can contribute to non-resolutive decision-making, due to the unrealistic view of the distribution of the BHU.

School-age children experience sensory processing challenges, especially among children living with intellectual and developmental disabilities. As the modern classroom strives to be an inclusive environment, more schools are adopting measures to provide sensory processing support. School nurses can be at the forefront to spearhead this initiative and are well-positioned to promote support and inclusivity for students through increased education for this population, including their peers. This article explores a collaboration between local school health services and a college of nursing to provide school-age children the opportunity to learn about the challenges faced by children living with sensory processing challenges.

Background: The purpose of this study was to assess the effects of the Bienestar/NEEMA Coordinated School Health Program (BN CSHP) on cardiorespiratory fitness (CRF) of preschool children., Methods: A cluster randomized trial was conducted of preschools in South Texas. Of 48 eligible schools, 28 were randomly assigned (14 intervention, 14 control). Family demographics and household health characteristics were collected from parents and CRF from children. Generalized linear mixed model (GLMM) was used to analyze the data., Results: Family demographics, household health characteristics, and children's weight, obesity prevalence, and sedentary activity of the control group were similar to the intervention group at baseline. After adjusting for covariates, the number of laps ran by children in the control group increased by 23% (CI: -5% to 60%) per each data collection period compared with 53% (CI: 7% to 119%) in the intervention group., Implications for School Health Policy, Practice, and Equity: State mandates, parent engagement, and funding are key for designing effective health and Physical Education (PE) programs., Conclusion: Children in the BN CSHP, compared to those in the control group, had a significantly higher increase in their CRF. This finding is important because of the health benefits of CRF in children., Clinicaltrials: gov Identifier: NCT05501392., (© 2024, American School Health Association.)

Lesbian, gay, and bisexual (LGB) adolescents are often at higher risk than their heterosexual peers for adverse sexual health, violence, mental health, and substance use outcomes. Schools are a vital resource for enhancing protective behaviors and reducing risk behaviors. Sixteen school districts selected schools to implement a sexual health program (exposed) or usual programming (unexposed). We analyzed LGB student health outcomes using 2015 and 2017 Youth Risk Behavior Surveys. Analyses compared LGB student health outcomes by exposure status across time points using a multilevel approach. Program exposure was associated with decreased odds of ever having sex, ever testing for HIV, and using effective hormonal birth control, and an increased odds of condom use. There were no significant findings among secondary violence, mental health, and substance use outcomes. This evaluation highlights the potential for schools to reduce sexual risk behaviors among LGB youth, and opportunities to improve access to health services.

This study aims to evaluate the implementation and describe the actions developed in the School Health Program (PSE) by primary care health teams that joined the Brazilian National Program for Improvement of Access and Quality of Basic Care (PMAQ-AB), in 2012, 2014, and 2018. The participation of the teams in school health activities increased throughout the three evaluation cycles, with the expansion of clinical evaluation, health promotion, and disease prevention actions. In cycle II, 24% of the teams performed the seven clinical evaluation actions, 18% performed the six promotion and prevention actions. However, 6.3% of the teams did not perform any clinical evaluation action and 8.8% did not perform health actions of promotion or prevention. In cycle III, more than 90% of the teams participated in the PSE, 84% of the health teams reported a combined planning for actions in schools, and more than 60% of the teams held joint meetings with the schools. PSE was institutionalized in all regions of the country, being more developed in municipalities with 10,000 to 30,000 inhabitants, lower Municipal Human Development Index (HDI-M) level, and greater coverage of the Family Health Strategy (FHS). Despite the positive evolution, the predominance of clinical evaluation actions in relation to health promotion actions and the proportion of teams that still have limitations in the combined efforts between health and education suggest a certain distancing from the PSE guidelines. To advance the implementation of the PSE, it is necessary to train health and education professionals; deepen intersectoral connection; expand the implementation of information and communication technologies; and maintain policies that allow the evaluation of the PSE, in order to support its development.

Our objective was to estimate the prevalence of depression and to determine whether high-risk health behaviors were associated with it among school-going adolescents, thereby assessing the need to integrate mental health services with the school health program. We conducted a cross-sectional study among 260 adolescents in schools of Bhavnagar city (western India) during January-October 2017. To assess depression, Beck Depression Inventory-II (BDI-II) was used and high-risk health behaviors were assessed by the Youth Risk Behavior Surveillance System (YRBSS) tool. Multivariable logistic regression analysis was performed to assess whether high-risk health behaviors were independent predictors of depression. The prevalence of depression was found to be 43%. Among high-risk health behaviors, adolescents carrying a sharp weapon to the school was the lowest (4%) and not eating breakfast was the highest (88%). On multiple logistic regression, feeling unsafe at school, self-perception regarding overweight, being a female, not living with both parents in the same house, being unhappy with school performance, having illness/seriously injured, and immediate family member being seriously ill/injured were found to be the significant predictors of depression among the adolescents. There is a need to address mental health issues like depression and high-risk health behaviors under the school health program through screening interventions., (© 2021 Wiley Periodicals LLC.)

Background: Improving the academic achievement of youth in the United States is an area of interest and a critical indicator of the future success of the youth. The purpose of this study was to examine the impact of a comprehensive school physical activity and healthy eating program on 5th-grade students' academic achievement, specifically reading and math., Methods: Overall, 628 (intervention: 377, 54% girls; comparison: 251, 49% girls) 5th-grade children participated across the 6 schools in a year-long comprehensive health intervention, completing curriculum-based academic achievement measures at 2 time-points., Results: Results showed that even after controlling for class clustering, age, sex, race, and T1 reading and math variables, students' T2 reading and math achievement were significantly higher in the intervention group than the comparison group., Conclusions: Comprehensive health programming can enhance the health and academic achievement of youth., (© 2021, American School Health Association.)

Objective: To describe the School Health Program (PSE) eye health action in Brazil, based on the PSE actions monitoring system., Methods: This was a descriptive cross-sectional study using data from the Primary Health Care Information System from 2014 to 2019., Results: data on 153,073 PSE eye health action activities and 5,697,109 participants were found. Activities increased by 65.1% in the period from 2014 to 2019. The average number of actions carried out in participating schools was 4.35 (95%CI 4.00;4.70). National average coverage of the action was 8.32% (95%CI 6.31;10.33) in the period. In 2019, 15,325 students were identified as having vision changes., Conclusion: We found that PSE eye health interventions have grown over the years in Brazil as a whole, therefore contributing to the prevention of visual impairment and blindness in Brazilian students.

Objectives: to compare health promotion actions carried out by Family Health teams in Ceará, linked to the School Health Program., Methods: a cross-sectional study involving the first and second cycles of an external assessment of 910 and 1,626 teams from 184 municipalities, which joined the Brazilian National Program for Improvement of Access and Quality of Primary Care. Eight clinical assessment and seven health promotion indicators were assessed, together with health professionals working in schools., Results: the interviewees were nurses (95.6% and 98.3%). Between the cycles, there was an increase in clinical assessment (78.7% and 91.3%), health promotion and disease prevention (82.5% and 89.3%) and survey of students for follow-up (41.4% and 66.4%) in schools., Conclusions: health actions at school advanced between cycles, with nurses as protagonists in school health, which can reduce vulnerabilities in children and adolescents and qualify Primary Care.

There is growing evidence supporting the effectiveness of a comprehensive school health program. However, implementation in developing countries is a challenge. Furthermore, the available information on the association between a comprehensive school health program and students' academic attainment is limited. In Kenya, a project to verify the effects of a comprehensive school health program was carried out in Mbita sub-county, Homa Bay County from September 2012 to August 2017. This study aimed to clarify the improvement of school health during the project years and the association between school health and students' academic attainment. Primary schools in Mbita sub-county were selected as study sites. We assessed 44 schools' scores on a school health checklist developed from the Kenyan Comprehensive School Health Program, the students' mean score on the Kenya Certificate of Primary Education (KCPE), and absenteeism during the project years (2013-16). The mean school health checklist score (n = 44 schools) was 135.6 in 2013, 169.9 in 2014, 158.2 in 2015 and 181.3 in 2016. The difference of the mean score between 2013 and 2016 was significant. In addition, correlation analysis showed a significant association between mean KCPE score in the project years and school health checklist score (Pearson's coefficient was 0.43, p = 0.004). The results of this study suggest improvements of school health by the implementation of the Kenyan Comprehensive School Health Program and students' academic attainment., (© The Author(s) 2020. Published by Oxford University Press. All rights reserved. For permissions, please email: journals.permissions@oup.com.)

The Kenyan government established the Kenyan Comprehensive School Health Program (KCSHP) on the basis of Kenyan National School Health Policy. A KCSHP pilot project was carried out in eight primary schools in Mbita Sub-County of Homa Bay County in the Nyanza Region from 2012 to 2017. This pilot project provided health facilities and support for evaluation with a school health checklist, and organized teacher training on health education, a child health club, and school-based health check-ups. The present study aimed to examine the appropriateness and reliability of the strategy of the second KCSHP pilot project in Kenya. We analyzed data from self-administered questionnaires targeted at pupils in seventh-grade in the eight primary schools. The questionnaire consisted of questions on health-related knowledge, attitudes and practices, self-evaluated physical and mental health status, self-awareness of health control, subjective happiness, recognition on the importance of learning about health in school, absenteeism, and sense of school belongingness. The project contributed to improving health-related knowledge, attitudes and practices, self-evaluated health status, sense of school belongingness, recognition on the importance of learning about health in school, self-awareness of health control, and absenteeism. On the contrary, subjective happiness did not improve significantly.

Objectives: to describe the structure used in the School Health Program and analyze the association between its material resources and the actions carried out., Methods: cross-sectional, quantitative, analytical, and normative study. A normative instrument of the program was applied to collect data from May to July 2017 with 105 Family Health Strategy professionals. Data were organized and analyzed using descriptive and inferential statistics on IBM SPSS Statistics 22.0 software., Results: financial resources were made available with low periodicity; the most used human resources were dentists; the most frequent infrastructure resource was the school; the most frequently used materials were those related to administrative support (legal-size paper and pen) and clinical resources (fluoride, toothbrush, and toothpaste). An association was identified between resources and anthropometric assessment activities and vaccination status., Conclusions: the program structure showed reduced financial resources and priority participation of human resources from the health sector, and the actions were carried out by using the school infrastructure and administrative and clinical materials.

Background: The study evaluates children in schools that participate in the School Health Program in the Northern region of Brazil with the objective of assessing whether their schools interfered in the development of overweight/obesity and how individual and school environment variables behave according to contextual analysis., Methods: The analyses were carried out with 1036 children from 25 municipal public schools in Northern Brazil that participated in the School Health Program. We evaluated both individual characteristics and scholar environment through univariate and multivariate logistic regressions to identify which of these factors were related to overweight/obesity as well as the effect of varying such associations., Results: The considered individuals had an median age of 8 years, being 54.9% female and 27.8% presenting overweight/obesity. In multivariate logistic regression, the overweight/obesity variance in schools was 0.386 (individual variables) and 0.102 (individual and school variables), explaining 23.7% of the variation, reduction of ICC and MOR. The Akaike Information Criterion between the models was reduced and the likelihood ratio indicated better adequacy of the latter model. The investigated children had a greater chance of developing overweight/obesity when they performed 2+ sedentary activities/day, depending on school location as well as whether or not candies were sold in the school surroundings. On the other hand, a lower chance of developing overweight/obesity was identified in children that ate 5+ meals/day and practiced dance at school., Conclusion: We observed that the variables inherent to both individuals and schools favored the development of overweight/obesity in children. It is relevant that scholar curriculums incorporate healthy eating interventions and encourage body practices associated with policies that restrain the sale of ultra-processed food in schools as well as the development of intersectoral actions between education and health to control childhood obesity.

The aim of this study was to evaluate the influence of the Brazilian School Health Program (SHP) on dental clinical disorders such as caries, gingivitis, and dental trauma as well as on the oral-health-related quality of life (OHRQoL) of adolescents in Nova Friburgo, RJ, Brazil. The study consisted of a non-probabilistic (convenience) sample comprising 319 12-year-old adolescents, both participants and non-participants of the SHP, for at least two years. Socio-demographic and OHRQoL questionnaires (CPQ11-14, the Child Perceptions Questionnaire) were applied as well as clinical examinations for caries, periodontal disease, and dental trauma following the World Health Organization (WHO) criteria by calibrated researchers. Mann-Whitney, chi-square tests, and multiple logistic regression models were used for the data analysis. Statistically significant differences were observed between the groups covered and not covered by the SHP for gingivitis (p = 0.0373) and OHRQoL on the social welfare subscale (p = 0.0265) and total scale (p = 0.0449) of CPQ11-14. Multivariate analysis showed that female adolescents were 1.74 times more likely to present a lower OHRQoL (OR = 1.74, 95%IC = 1.10-2.77, p = 0.0183) than males. In addition, non-SHP subjects were 1.56 times more likely to have poor OHRQoL (OR = 1.56, 95%IC = 0.94-2.59, p = 0.0873) than program participants. In conclusion, SHP positively influenced the OHRQoL of adolescents. However, follow-up studies are needed to verify the continued effectiveness of this Brazilian SHP in improving the oral health levels and quality of life of adolescents.

Background: The reasons for the mixed evidence of the effectiveness of school-based physical activity programs can be many, including implementation challenges. Studying program implementation can potentially contribute to enhancing effectiveness, the design of future interventions, improved implementation, and the interpretation of outcomes., Methods: For this process evaluation, individual interviews were conducted with 16 teachers who had implemented the program "Active All Year Round" in a fifth-grade school class (students aged 9-11 y) in 2017. Through systematic text condensation feasibility and barriers of program implementation, perceived program reach and the programs' influence on social cohesion were identified and discussed., Results: Teachers described the program as very feasible to implement and identified very few implementation barriers, the most prominent being time constrains. Perceived program reach was very high, and teachers reported that those students who are less confident when it comes to physical activity did not have differential participation than those feeling more confident about physical activity. Finally, the program was perceived to positively affect social cohesion in class., Conclusions: Active All Year Round is a standardized, flexible, and easily implemented program in Danish schools. Future studies are needed to study implementation from a student's perspective and/or students' role in and experiences with competition-based health programs.

Background: Children from disadvantaged backgrounds are more apt to experience lower availability of nutritious foods, lack opportunities to exercise, and lack access to recreational facilities, and thus, are more likely to be obese and at greater risk for developing chronic diseases. We review school health education programs' impact on physical activity behaviors among disadvantaged students., Methods: The inclusion criteria of the study were articles: published in English with full text between 2011 and 2017; focused on school health education programs for disadvantaged school-aged students; assessed programs including a physical activity component; examined school-aged children and adolescents' physical activity behaviors; and assessed programs with comparison groups., Results: There were 13 studies matching inclusion criteria in this review. The results of this review indicated that school-based health education programs which included culturally appropriate physical activity, parent involvement, and enhanced student motivation and choice of activities appeared to increase physical activity levels among disadvantaged school-aged students. Health education programs should also emphasize behavioral change skills, such as goal setting and self-motivation, to positively impact on students' physical activity behaviors., Conclusions: School-based health education programs may help increase access to physical activity among disadvantaged populations., (© 2019, American School Health Association.)

Background and Objectives: School health programs are frequently attempted in low- and/or middle-income countries; however, programmatic scope and reach is limited by human resource constraints. We sought to determine if trained community members could implement a school health program that improved outcomes in rural primary schools in India., Methods: This was a mixed-methods, stepped-wedge, cluster-controlled study of schools pragmatically assigned to receive a multicomponent, comprehensive school health program delivered by lay field-workers., Results: All students in 22 primary schools (9 government schools and 13 low-cost private schools) participated in this study. A total of 3033 student-years were included in the analysis (2100 student-years in the intervention period and 933 student-years in the control period). Qualitative feedback was collected from 38 teachers, 49 parents, and 4 field-workers. In low-cost private schools, the diarrhea incidence was lower in students receiving the intervention (incidence rate ratio 0.58; 95% confidence interval [CI] 0.47 to 0.71; P < .001). There was no difference in diarrhea incidence for students in government schools (incidence rate ratio 0.87; 95% CI 0.68 to 1.12; P = .29). Health-knowledge acquisition was higher in intervention schools (mean difference 12.6%; 95% CI 8.8 to 16.4; P < .001) and similar in both school types. Intervention coverage rates were high (mean 93.9%; SD 2.0%), and performance assessment scores indicated fidelity (mean 3.45; SD 0.69). Stakeholders revealed favorable perceptions of the field-workers and high levels of perceived impact., Conclusions: Lay field-worker-led school health programs offer a promising alternative for improving school health delivery in resource-constrained settings., Competing Interests: POTENTIAL CONFLICT OF INTEREST: Dr Matergia and Ms Matergia serve as directors for Broadleaf Health and Education Alliance, which funded the development and implementation of the intervention; Dr Matergia is also a former employee of the implementing agency, Darjeeling Ladenla Road Prerna, where he led the initial design of the Comprehensive Health and Hygiene Improvement Program; Ms Giri and Ms Thapa are current employees of Darjeeling Ladenla Road Prerna; and Mr Ferrarone, Ms Khan, and Dr Simões have indicated they have no potential conflicts of interest to disclose., (Copyright © 2019 by the American Academy of Pediatrics.)

Obesity among children is highly prevalent and can lead to risk factors for chronic disease in adulthood. Key organizations have called on schools to play a larger role by increasing children's physical activity and nutrition by adopting an overall culture of health. This study examined the impact of a socioecological theory driven school-wide nutrition and physical activity intervention on 5th graders' central adiposity and obesity level. In 2015-2016, in the Midwest region of U.S., four treatment and two control schools, including 628 (377 treatment) 5th grade children participated in an eight-month intervention. Children in the treatment schools participated in a comprehensive healthy school transformation program consisting of six components. Waist-to-Height Ratio (WHtR) and Body Mass Index (BMI) was calculated and used as the measure of obesity. ANCOVA revealed a significant difference in WHtR among treatment and control groups at time two (T2) F MI (1,6148.14) = 4.43, p = .035, R 2  = 0.64, R 2 Treament  = 0.01, with no significant differences based on age, sex, and race. Additionally, the ANCOVA for BMI revealed a marginally significant lower BMI among the treatment than comparison group students F MI (1, 614) = 3.575, p = .059, R 2  = -0.23, 95%CI upper boundary: -0.03). The healthy school intervention led to significant differences in obesity levels, regardless of age, sex, or race, across the 8-month program between 5th grade children in treatment and non-treatment schools. This supports the ability of schoolwide programs to significantly and positively impact student health and chronic disease prevention.diff  = -0.23, 95%CI upper boundary: -0.03). The healthy school intervention led to significant differences in obesity levels, regardless of age, sex, or race, across the 8-month program between 5th grade children in treatment and non-treatment schools. This supports the ability of schoolwide programs to significantly and positively impact student health and chronic disease prevention., (Copyright © 2018 Elsevier Inc. All rights reserved.)

This study evaluated the implementation of the School Health Program (PSE in Portuguese) in the city of Belo Horizonte, Minas Gerais State, Brazil, the mechanisms favoring inter-sector action, and municipal administrators' perceptions concerning inter-sector collaboration. A case study was developed with document search and the application of an online questionnaire. The document search analyzed federal and municipal legislation on the PSE published in the Federal Register and Municipal Register and news on the program published in the Municipal Register. A semi-structured online questionnaire was completed by 30 municipal administrators. Content analysis was used on the qualitative data from the document search and questionnaire. The quantitative data were interpreted by descriptive analysis using Stata v. 13. Integrative mechanisms were identified in the federal and municipal provisions and in the unique PSE model adopted by the city. These mechanisms can potentially promote permanent linkage between health and education. However, the study with municipal administrators showed limited use of these mechanisms and the predominance of a sector-based logic in the program. There was evident difficulty in developing inter-sector collaboration in the program's activities. The potentialities of inter-sector action identified in the official documents and described in the institutional news failed to reverberate in either the administrators' practices or the impact on the schools' territories.

Objective: To analyze the association between experience and professional training in the School Health Program., Method: Descriptive, inferential, quantitative and normative study. The data were collected from May to July 2017 through a questionnaire based in the School Health Program, with the participation of professionals from the Family Health Strategy., Results: 105 professionals participated in the study. The average time working in the Family Health Strategy and in the School Health Program is 12.1 and 7.2 years, respectively. 94.3% of the professionals feel qualified to perform the activities of the School Health Program, although only 30.5% have participated in training. There is statistical association between experience and professional training., Conclusion: The professionals who conduct activities in the School Health Program undergo few training processes, but feel qualified to carry out the activities proposed.

Objective: to understand the introduction of the School Health Program in the city of Cascavel, Paraná State, as opposed to the report of nurses., Method: a qualitative study with fifteen participants. The data were collected from April to August 2015, through semi-structured interviews, analyzed by content analysis and thematic modality., Results: the category "Introduction process" of the School Health Program integrates the subcategories "Identified health problems" and the "Challenges of intersectoriality". The program was implemented quickly, with a fragile training of professionals to perform in the phases that compose it. Structural conditions of schools, human and material resources, and emerging intersectoral interaction were identified obstacles. The integration of the health, school, and family constitutes the program's potentiality., Final Considerations: it is understood that the actions of the program were based on health assessments of students, and it is necessary for professionals and managers to discuss and analyze the obstacles identified to achieve all the proposed objectives.

Objective: to describe the experience in the municipality of Itapevi-SP, Brazil, within the framework of School Health Program and school meals related to overweight prevention., Methods: this cross-sectional study comprised 21 public schools of the first cycle of Primary School who adhered to the School Health Program; the diagnoses, based on 2014 data, included the students' nutritional status, qualitative analysis of school meals, and inclusion of themes related to nutrition and physical activities in curricular and extracurricular activities., Results: overweight was present in 30.6% of the 7,017 students; ultra-processed foods represented 68.4% of the breakfast and afternoon snacks, whilst unprocessed and minimally processed foods were more present in lunch meals (92.4%); themes related to nutrition and the practice of physical activities were present in the curricular activities of 14 schools., Conclusion: the assessment of the actions of the School Health Program and school meals shows the need for adjustments on school menus.

Objective To analyze the context of health promotion with adolescents in the health and education interface focusing on the actions of the Brazilian School Health Program. Qualitative study conducted in 2015 with professionals working in the Regional Executive Coordination IV, in Fortaleza, Ceará. The data obtained in the interview were processed in the ALCESTE program. 17 health professionals and 22 education professionals participated in the study. The organization of spontaneous demand causes disharmony in the scheduled visits and health actions in the school. The difficulties in the implementation of the School Health Program were demonstrated by the lack of knowledge, the lack of planning among the sectors and the different demarcations in the territory. The professionals' lack of knowledge regarding the program and the lack of action planning confirm the disarticulation of the education and health sectors, although they indicate the possibilities of this inter-sectoral practice.

Objective: The purpose of this study was to evaluate the effectiveness of environmental activities in a school-based health program among 6th grade students (N = 2315)., Methods: Students enrolled in Project Healthy Schools, a school-based health program designed to reduce childhood obesity and improve cardiovascular health, completed a health questionnaire on recent lifestyle choices including diet, physical activity, and sedentary behaviors. Baseline and follow-up data were compared between students who received educational lessons and students who received educational lessons and additional activities in the schools' environment. We calculated descriptive and one-way ANOVA statistics., Results: Students at schools with educational lessons and environmental activities reported more fruit intake (p = .046), fewer sugary beverages (p = .054) and servings of fatty/sugary foods (p = .002), and more moderate physical activity (p = .009) compared to students with educational lessons only. No beneficial effect was observed in decreasing TV viewing time. Mobile device time increased in both groups., Conclusions: The present study suggests school-based health programs combining educational lessons and additional environmental activities may improve diet and physical activity in middle school children to a greater degree than educational lessons alone.

Objective: Understand teachers' perception of a school health program and its relationship with health education activities developed at school., Methodology: Descriptive qualitative study, in which interviews with 10 teachers at a public school in the city of Barbalha, Ceará, Brazil were conducted. Data were analyzed in thematic categories., Results: Teachers perceived the School Health Program as welfare, without integration between teachers and health professionals, and being of no interest to teenagers. Educational activities at school and their relationship to the program were perceived as clinical evaluations that were not integrated into the actions already developed at school., Conclusion: A weakness was found in the lack of integration of actions performed by different agents. Therefore, there is a need for a closer relationship between them in order to optimize efforts to promote school health.

Case-control studies evaluating the factors associated with childhood obesity are scarce in Brazil. We aimed to analyze the factors associated with obesity in Brazilian schoolchildren enrolled in the School Health Program.A case-control study was conducted on 80 schoolchildren aged 7 to 9 years, 40 of them obese and 40 of normal weight according to the cut-off points established by the World Health Organization (2007). Weight, height and waist circumference were obtained. Socioeconomic, demographic, health, eating behavior and lifestyle data were collected by applying a questionnaire to the person responsible and by determining his/her nutritional status. A binary unconditional logistic regression model (univariate and multivariate) was used for data analysis. The prevalence of obesity was 7.21%. The final model showed that duration of breast-feeding ≥ 6 months of age (OR 5.3; 95% CI: 1.3-22.1), excess weight of the person responsible (OR 7.1; 95% CI: 1.2-40.2), a sedentary level of physical activity (OR 4.1; 95% CI: 1.1- 15.5), and fast chewing (OR 7.4; 95% CI: 2.1-26.9) were significantly associated with childhood obesity. The factors associated with obesity in schoolchildren were duration of breast-feeding ≥ 6 months, persons responsible with excess weight, and sedentary children who chew fast. The present study contributes information to be used for the health actions planned by the School Health Program., (Copyright AULA MEDICA EDICIONES 2014. Published by AULA MEDICA. All rights reserved.)

This article describes the design, implementation, and evaluative findings of the HEROES (Healthy, Energetic, Ready, Outstanding, Enthusiastic, Schools) Initiative, a school-based multilevel childhood obesity prevention intervention. Based on the Centers for Disease Control and Prevention's recommended coordinated school health approach, the HEROES Initiative works to alleviate the burden of childhood obesity in Southern Indiana, Northwestern Kentucky, and Southeastern Illinois in the United States. Process evaluation was conducted with the 17 participating schools in spring 2012 based on interviews with school personnel and observation of the school environment. Findings showed that despite some variability, schools were generally able to implement the intervention with fidelity. School-level outcome evaluation was also based on observation of the school environment, and revealed that schools had implemented a number of new practices to encourage physical activity and healthy eating. Assessment of student-level outcomes was based on professionally collected physiological measurements and self-reported behavioral data collected over an 18-month period of time, last collected in spring 2012. Findings demonstrated that the HEROES Initiative has been successful in reducing the percentage of overweight children in participating schools and healthfully modifying their dietary, physical activity, and sedentary behaviors. Strategies that have facilitated success and challenges related to the intervention are discussed.

Background: Underserved children, particularly girls and those in urban communities, do not meet the recommended physical activity guidelines (>60min of daily physical activity), and this behavior can lead to obesity. The school years are known to be a critical period in the life course for shaping attitudes and behaviors. Children look to schools for much of their access to physical activity. Thus, through the provision of appropriate physical activity programs, schools have the power to influence apt physical activity choices, especially for underserved children where disparities in obesity-related outcomes exist., Objectives: To evaluate the impact of a nurse directed, coordinated, culturally sensitive, school-based, family-centered lifestyle program on activity behaviors and body mass index., Design, Settings and Participants: This was a parallel group, randomized controlled trial utilizing a community-based participatory research approach, through a partnership with a University and 5 community schools. Participants included 251 children ages 8-12 from elementary schools in urban, low-income neighborhoods in Los Angeles, USA., Methods: The intervention included Kids N Fitness(©), a 6-week program which met weekly to provide 45min of structured physical activity and a 45min nutrition education class for parents and children. Intervention sites also participated in school-wide wellness activities, including health and counseling services, staff professional development in health promotion, parental education newsletters, and wellness policies for the provision of healthy foods at the school. The Child and Adolescent Trial for Cardiovascular Health School Physical Activity and Nutrition Student Questionnaire measured physical activity behavior, including: daily physical activity, participation in team sports, attending physical education class, and TV viewing/computer game playing. Anthropometric measures included height, weight, body mass index, resting blood pressure, and waist circumference. Measures were collected at baseline, completion of the intervention phase (4 months), and 12 months post-intervention., Results: Significant results for students in the intervention, included for boys decreases in TV viewing; and girls increases in daily physical activity, physical education class attendance, and decreases in body mass index z-scores from baseline to the 12 month follow-up., Conclusions: Our study shows the value of utilizing nurses to implement a culturally sensitive, coordinated, intervention to decrease disparities in activity and TV viewing among underserved girls and boys., (Copyright © 2012. Published by Elsevier Ltd.)

This work reports the experience of implementation of the School Health Program (PSE) by a team from the Family Health Strategy (FHS) in a public school in Fortaleza-CE, Brazil. The activities included conference about the deployment of the PSE with teachers and members of the FHS, workshops with students, clinical and dental assessment for adolescents and delivery of Booklets of Adolescent Health. The implementation of the PSE allowed health professionals to perceive their social role as educators and provided adolescents a greater contact with the staff from FHS. The rapprochement between the school and the FHS is crucial to help teenagers to transform scientific knowledge into healthy behaviors.

Background: A complementary ecological model of the coordinated school health program (CSHP) reflecting 20 years of evolved changes is proposed. Ecology refers to the complex interrelationship between intrapersonal factors, interpersonal processes and primary groups, institutional factors, community factors, and public policy., Methods: Public health and child development theories that incorporate the influence of personal and social environments on health behavior, along with models that incorporate the influence of ecology, were consulted., Results: Concepts from several models were combined with the 8 components of CSHP to formulate an ecological model involving 6 program and services components in an inner circle surrounded by 4 concentric rings representing the healthy school environment, essential structures of CSHP, local school district governance, and family and community involvement., Conclusion: This complementary ecological model is intended to serve as an additional conceptual approach to CSHP practice, evaluation, and research, and should prove especially useful to practitioners and researchers who already have a fundamental understanding of CSHP.

The study was conducted to determine whether there is a relationship between the Coordinated School Health Program (CSHP) and student academic performance. Data were collected from schools and the community for three reports for 50 states and the District of Columbia (DC). The School Health Policies and Programs Survey (SHPPS), the National Assessment of Educational Progress (NAEP), and the U.S. Census 2000 Profile were used to study the relationships among three parameters: (a) The intervention called a CSHP: (b) Student achievement; and (c) Rate of poverty in each state. A stepwise regression analysis was conducted, controlling for poverty using state-level data. Components of a CSHP had statistically significant relationships with academic achievement. Students in states with policies promoting students' health demonstrated higher academic scores and higher rates of high school completion.

Background: Although models such as the coordinated school health program (CSHP) are widely available to address student health needs, school professionals have been unconvinced that scarce resources should be allocated to improving student health. Concern that attention may be diverted from meeting academic accountability goals is often seen as a reason not to attend to student health. Despite continuing calls for the study of multicomponent health programs in relation to educational achievement, the understanding of the extent to which adherence to the characteristics of CSHP contributes to or compromises academic outcomes over time remains incomplete., Methods: A retrospective study was conducted of CSHP implementation across 158 public schools in Delaware, serving grades K-12. Using a doubly multivariate design, this study examined 3 levels of CSHP implementation across 5 school-level academic indicators for 3 years. Indicators included school performance, school progress, and aggregated student performance in 3 content areas--reading, mathematics, and writing. Data for the years prior to, during, and following implementation of CSHP were analyzed., Results: Multivariate main effects of year by implementation level were detected. CSHP schools with high levels of implementation had better school-level performance and progress ratings. CSHP implementation did not have an effect on reading, math, and writing indicators, though all groups showed significant improvements over time in these areas., Conclusions: Results of this study suggest that quality implementation of CSHP does not adversely impact school-level academic indicators over time. Moreover, findings suggest a better fit with school-wide accountability indicators than with specific content-based achievement indicators.

After successful pilot projects, Zhejiang Province, China, decided to systematically scale-up health promoting schools (HPS) over the entire province of 47 million. This study describes the interventions and self-reported changes in attitudes, knowledge and behavior during the first phase of scaling-up. Group interviews were conducted with a sample of 191 participants (school administrators, teachers, students and parents) from nine schools with a total of approximately 15 200 students. Grounded theory guided data analysis. Schools implemented all HPS components (school health policy, physical school environment, psychosocial school environment, health education, health services, nutrition services, counseling/mental health, physical exercise, health promotion for staff and outreach to families and communities), adapted to local circumstances. Participants reported a range of changes in attitudes (paying more attention to health, attaining better 'psychological quality' and confidence, forming friendships between teachers and students and feeling more relaxed), knowledge and concepts (increasing knowledge about various health issues, developing a broader concept of health and gaining better understanding about the HPS concept) and behavior (actively participating, increasing physical activity, improving sanitary habits, reducing or quitting smoking, eating more nutritiously, increasing safety behavior, sustaining less injuries and improving parent-child communication). This qualitative study shows the feasibility and efficacy of implementing HPS in Zhejiang Province, China.

A complementary ecological model of the coordinated school health program (CSHP) reflecting 20 years of evolved changes is proposed. Ecology refers to the complex interrelationship among intrapersonal factors, interpersonal processes and primary groups, institutional factors, community factors, and public policy. Public health and child development theories that incorporate the influence of personal and social environments on health behavior, along with models that incorporate the influence of ecology, were consulted. Concepts from several models were combined with the eight components of CSHP to formulate an ecological model involving six program and services components in an inner circle surrounded by four concentric rings representing the healthy school environment, essential structures of CSHP, local school district governance, and family and community involvement. This complementary ecological model is intended to serve as an additional conceptual approach to CSHP practice, evaluation, and research, and should prove especially useful to practitioners and researchers who already have a fundamental understanding of CSHP.

Background: Coordinated school health programs (CSHPs) bring together educational and community resources in the school environment. This method is particularly important in rural areas like Kansas, where resources and trained health professionals are in short supply. Rural Stafford County, Kansas, struggles with health professional shortages and a low-income, high-need population., Methods: In 2001, Stafford County's Unified School District 349 began a multiyear CSHP development process, which required adaptations for implementation in a rural area. First, a CSHP team was formed of community and administrative stakeholders as well as school system representatives. Next, the CSHP team assessed school district demographics so the program framework could be targeted to health needs. During a yearlong planning phase, the CSHP team determined 4 priority areas for program development, as limited staff and funds precluded developing programs in all 8 traditional CSHP areas. Program activities were tailored to the population demographics and available resources., Results: Program outcomes were supported by School Health Index (SHI) data. Of the 8 CSHP focus areas, the SHI found high scores in 3 of the Stafford CSHP's priority areas: Health Services; Psychological, Counseling, and Social Services; and Physical Education. The fourth Stafford CSHP priority area, Nutrition Services, scored similarly to the less prioritized areas., Conclusions: The process by which the Stafford school district modified and implemented CSHP methods can serve as a model for CSHPs in other rural, high-need areas.

As the need for Coordinated School Health Programs (CSHP) increases, so does recognition of the importance for advocating with local school boards for their support. Identifying the diversified make up of school board members and implementing effective strategies to advocate for coordinated school health can help facilitate the successful inclusion of such a program. With increasing emphasis placed on standardized testing and the "basic" curriculum, school board members need to become aware of specific benefits a CSHP can provide their district. With the relationship between health status and academic achievement confirmed in scientific research, school boards may begin paying more attention to providing high-quality health services and health instruction for students. This article presents items to consider and steps to take before, during, and after addressing a local school board for their support in implementing a CSHP.

Although research indicates that school meal programs contribute to improved academic performance and healthier eating behaviors for students who participate, fewer than 60% of students choose the National School Lunch Program or School Breakfast Program. School meal programs have a difficult time competing with foods that are marketed to young people through sophisticated advertising campaigns. Youth's preferences for fast foods, soft drinks, and salty snacks; mixed messages sent by school personnel; school food preparation and serving space limitations; inadequate meal periods; and lack of education standards for school foodservice directors challenge school meal programs as well. A coordinated school health program offers a framework for meeting these challenges and provides children and adolescents with the knowledge and skills necessary for healthful eating. This article identifies challenges facing school foodservice directors in delivering healthful meals and acquaints dietetics professionals with the coordinated school health program to be used as a tool for addressing unhealthful weight gain and promoting healthful eating.

The Florida Department of Education, with CDC funding, designed the Florida Coordinated School Health Program Pilot Schools Project (PSP) to encourage innovative approaches to promote coordinated school health programs (CSHP) in Florida schools. Each of eight pilot schools received $15,000 in project funding, three years of technical assistance including on-site and off-site assistance, a project office resource center, mailings of resource materials, needs assessment and evaluation assistance, and three PSP Summer Institutes. Project evaluators created a context evaluation, approaching each school independently as a "case study" to measure the school's progress in meeting goals established at baseline. Data were collected using the How Healthy is Your School? needs assessment instrument, a School Health Portfolio constructed by each school team, a Pilot Schools Project Team Member Survey instrument, midcourse team interviews, final team interviews, and performance indicator data obtained from pilot and control schools. The PSP posed two fundamental questions: "Can financial resources, professional training, and technical assistance enable individual schools to create and sustain a coordinated school health program?" and "What outcomes reasonably can one expect from a coordinated school health program, assuming programs receive adequate support over time?" First, activities at the eight schools confirmed that a coordinated school health programs can be established and sustained. Program strength and sustainability depend on long-term resources, qualified personnel, and administrative support. Second, though coordinated school health programs may improve school performance indicators, the PSP yielded insufficient evidence to support that belief. Future projects should include robust measurement and evaluation designs, thereby producing conclusive evidence about the influence of a coordinated school health program on such outcomes.

Client or customer satisfaction surveys assess the perceived quality of programs, products, services, and employee performance. Such assessments prove beneficial for evaluation and planning purposes. This survey examined the satisfaction of clients using the programs, services, and technical assistance provided through the Coordinated School Health Program Office (CSHPO) in the Florida Department of Education. Using the 42-item Client Satisfaction Survey, data were collected in summer 1999 from 300 of 574 clients (52.3%) who attended training sessions or sought technical assistance from CSHPO during 1996-1999. More than two-thirds (67.2%) of clients rated the training program as "very good" or "excellent" at increasing their understanding about the concept of a coordinated school health program. Overall, 69.7% of clients rated the training programs they attended as "very good" or "excellent." Resource materials and staff effectiveness rated positively as well. Findings confirmed client satisfaction with CSHPO's training programs, technical assistance, and staff. Information obtained through the client satisfaction survey can be used by CSHPO to assist in future program planning and resource allocations.

A process evaluation of a school health program designed to improve students' health and educational success is presented. The program included a pediatric nurse practitioner and two nurses placed in three high-risk, urban intervention schools. It is a part of a larger multidimensional pilot intervention project (The Children First Plan). Implemented services and the implementation process are described. Key components for a successful implementation included obtaining buy-in, learning the school culture, defining roles, and keeping a sense of humor. Collaborative efforts among the nursing team, other children-first plan providers, and the school staff improved service delivery. Lack of communication was the primary barrier. In addition, differing philosophies among systems (education, social services, health), problems with referral and feedback, and lack of appropriate providers hampered service delivery. Recommendations for continued program improvement and replication projects are provided.

Obesity has become one of this country's most significant nutritional diseases. The prevalence of childhood and adolescent obesity has steadily increased over the past 20 years. The risk of developing health problems increases as the obese child becomes an obese adolescent and adult. The 1997 Youth Risk Behavior Survey reports adolescents participate in behaviors that put them at risk for obesity. The recognition of these unhealthy behaviors among our youth has led to the need for early intervention. The Coordinated School Health Program is a mechanism to address adolescent obesity at the school-age level. This program includes an organized set of policies, procedures, and activities intended to protect and promote the health and well-being of students and staff. The eight components of a Coordinated School Health Program (CSHP) include school health services, a healthy school environment, comprehensive school health education, counseling and guidance, physical education, food service, worksite health promotion, and the integration of school and community. This paper describes integration of prevention and treatment strategies for adolescent obesity for each of the eight components of a CSHP.

The present article reports on the trajectory of the Primary School Health Care Program (PROASE) at the municipality of Ribeirão Preto and describes some reflections about this proposal.

Educators and clinicians are continually searching for innovative methodologies that promote positive health behaviors, that are age and developmentally appropriate, and that are fun. Puppetry meets these criteria. Puppetry is a creative learning methodology that stimulates learning through play. Various types of puppets are identified and a summary of the ways in which puppets may be used in a coordinated school health program to enhance positive health behaviors is presented. While many individuals attest to the value of using puppets, research should be conducted to assess effectiveness of puppetry on health knowledge, attitudes, skills, and behaviors.

This article presents findings from the first phase of a comprehensive evaluation plan for the school health program in Nebraska public schools. The evaluation utilized the Targeting Outcomes of Programs (TOP) framework to gather parents' perspectives about the benefits of the school health program, and a ranking of important health activities and role providers. A survey was distributed to 1,200 parents randomly selected from 60 school districts. Of these, 450 (38%) were returned: 96% supported funding of health programs; 88% believed families benefited from school health; 92% viewed the health programs as "essential" to the educational mission; 64% preferred a ratio of 1 nurse/500 students; and 89% believed all students needed access to a professional school nurse. The nurse was the only clearly defined role in the health program and had activities rated as "extremely important." Results were reported to the Nebraska legislature for support of state funding for school health nursing.