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An increasing number of schools obtained a Healthy School certificate, yet little is known about factors, characteristics, and processes, i.e. conditions, influencing the effectiveness of the Healthy School program. Therefore, a mixed methods evaluation study will be conducted on three levels: the student, the school, and the region. The research questions are focused on: 1) conditions for student outcomes, 2) conditions for implementation in schools, and 3) conditions for regional support. For the evaluation, the school and region are considered complex adaptive systems. Conditions for intended outcomes on student lifestyle, health, and academic achievement will be examined using a combination of existing datasets including school codes. Based on student outcomes, best and worst performing schools will be selected for predominantly qualitative analysis to further explain differences. To get insight into conditions for implementation in schools and regional support in nine regions, the degree of implementation will be determined with a questionnaire to select schools for predominantly qualitative analysis. Combined, this study will not only provide insight into the current situation on the three levels, but also explain differences between regions, schools, and students. Consequently, it will be possible to provide concrete advice to strengthen implementation of the Healthy School program. [ABSTRACT FROM AUTHOR]

BackgroundPublic health interventions that target children's physical, mental, and emotional health will enhance their ability to learn and grow. Although more complex, school initiatives that address multiple ecological levels and take a holistic view may be more effective and likely to lead to lasting change.AimsThis article presents the framework of Commit to Be Fit (C2BF) as an example of how schools can integrate multi-level and holistic approaches for health. This innovative school-based intervention includes activities addressing individual, home, school, and community to create a culture of wellness. We describe the implementation of C2BF and its basis in ecological models and give examples of activities across three components: cafeteria, classroom, and community. We discuss challenges and note that leadership engagement and alignment were critical elements for C2BF's success thus far.DiscussionC2BF uses a school-based multi-level approach to creating a culture of wellness and holistic health for students, teachers, and community members. C2BF is unique compared to other school-based programming and includes activities that address all eight domains posited for program sustainability within public health. Built to be flexible and adaptive, C2BF was able to successfully pivot during the COVID pandemic and also follow new science.ConclusionC2BF and other multi-level holistic approaches are more likely to achieve long-term change by utilizing strategies across the multiple levels of the ecological model to improve health and wellbeing.

Th is article outlines the current state of theoretical knowledge about mentalization, which appears to be essential for eff ective practice in the teaching profession. Mentalization is the capacity to understand and make sense of our own and others' actions by recognising and giving meaning to intentional mental states, including needs, thoughts, feelings, beliefs, and motivations. It is the understanding of the background of the behaviour – the understanding of the mental states that have led to a certain behaviour. Thanks to mentalization theory, we are now able to think and discuss in more detail what happens between and within people as they interact in diff erent social contexts such as schools. Th ese skills are useful for teachers as they work with children, whose metalizing skills are still developing. At the same time, in their practice, teachers often encounter children who come to school with disruptive behaviours, insecure attachment styles, and negative internal working models of relationships that make the healthy development of mentalizing skills diffi cult. Th is article highlights the importance of mentalization in educational contexts and provides a framework for interventions aimed at increasing mentalization skills among teachers, parents, and students. Empirical evidence has shown that the implementation of mentalization-based programmes in schools can lead to signifi cant improvements in teacher resilience, as well as a reduction of aggressive behaviour among students and an improvement of their academic performance.

The purpose of this study was to determine the management of healthy elementary schools in terms of planning aspects. This study uses a mixing method approach by using a concurrent embedded design or a combination of quantitative qualitative models. Data collection techniques were carried out by interviews, participant observation, documentation, and questionnaires. The validity of the questionnaire used expert judgment while the validity of the data used triangulation and informant review techniques. Data analysis for the qualitative approach uses an interactive analysis model and the quantitative approach uses descriptive statistics. The results showed that the healthy school planning model is systemic-collaborative, namely by involving stakeholders to collaborate involving students in compiling habituation activities/activities that are integrated with socio-cultural values in the classroom and build awareness of the school community. [ABSTRACT FROM AUTHOR]

Objective: Digital platforms for prevention and health promotion (PHP) are now, more than ever, available for use by school professionals, including teachers. However, little is known about what motivates them to use such platforms. A scoping review (ScR) was conducted to identify conditions that promote use by school professionals, including teachers, of PHP digital platforms at schools. Methods: For our ScR, we accessed ERIC, Sociological Abstracts, MEDLINE, PubMed, and Web of Science databases (period 2000-2018) in 3 sectors: education, health, online technologies. For each study, we prepared and validated a summary sheet. Contents dealing with conditions for use were subjected to open coding, grouped into categories, and synthesized. Results: Of the 3639 articles captured, 17 studies were selected. Five conditions emerged: (1) ensuring that the digital platform becomes a reference for PHP activity in schools; (2) that the resources needed for its uptake are mobilized; (3) that it is user-friendly; (4) that the digital platform engages the participation of everyone involved; and (5) that it is linked to existing programs in the school. Conclusion: These results can guide the activities deployed in schools for optimal implementation of PHP programs from digital platforms. [ABSTRACT FROM AUTHOR]

Copyright of TSG: Tijdschrift Voor Gezondheidswetenschappen is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

The school is a privileged space for the promotion of health. In Colombia the Healthy School Strategy is developed as an integrating tool for health policies in the school environment. Objective: the study seeks to evaluate the implementation of the healthy school strategy in the rural context of the Municipality of Ibagué. Materials and Methods: the evaluation of the implementation was carried out through the construction of a logical model and the definition of evaluative criteria in relation to healthy environments, public policies and plans for the healthy school, social participation, empowerment and education for health. A total of 93 rural schools were evaluated and the information was raised through questionnaires to those responsible for the schools and through interviews with health managers. Results: health and environmental problems were identified in the schools associated with lack of rurality, lack of articulation of the health and educational sector, low social participation and education focused on disease prevention. Conclusions: promoting healthy school environments in rural areas requires a national and local legal framework that guarantees state, intersectoral action, effective participation of the education sector, health renewal and that promotes political, social and administrative interests and wills. [ABSTRACT FROM AUTHOR]

In British Columbia (BC), Canada, a school district effort was launched to focus on mental wellbeing in middle and senior secondary schools. The initiative "Got Health?" was intended to help students take the lead, through action research, in program development and delivery of information. The purpose of this action research project was to evaluate, assess, and report student and staff perceptions of "Got Health?" Particular focus lay with student and staff thoughts concerning the inspiration, benefits, and challenges of the student-led mental health initiative across multiple and diverse schools. Focus group interviews were conducted involving student and teacher members of "Got Health?" teams. Results revealed that the majority of participants believed a positive change occurred in their school environments, which included a favourable impact on the mental wellbeing messages shared throughout their school communities. This suggests that a student-led inquiry approach can be an effective means of promoting mental wellbeing in school settings. [ABSTRACT FROM AUTHOR]

Background: Public health interventions that target children's physical, mental, and emotional health will enhance their ability to learn and grow. Although more complex, school initiatives that address multiple ecological levels and take a holistic view may be more effective and likely to lead to lasting change., Aims: This article presents the framework of Commit to Be Fit (C2BF) as an example of how schools can integrate multi-level and holistic approaches for health. This innovative school-based intervention includes activities addressing individual, home, school, and community to create a culture of wellness. We describe the implementation of C2BF and its basis in ecological models and give examples of activities across three components: cafeteria, classroom, and community. We discuss challenges and note that leadership engagement and alignment were critical elements for C2BF's success thus far., Discussion: C2BF uses a school-based multi-level approach to creating a culture of wellness and holistic health for students, teachers, and community members. C2BF is unique compared to other school-based programming and includes activities that address all eight domains posited for program sustainability within public health. Built to be flexible and adaptive, C2BF was able to successfully pivot during the COVID pandemic and also follow new science., Conclusion: C2BF and other multi-level holistic approaches are more likely to achieve long-term change by utilizing strategies across the multiple levels of the ecological model to improve health and wellbeing., Competing Interests: HJ, JT, and AB are RCPS employees who received at least partial salary support from the PATH Foundation through the C2BF grant. SG is the RCPS superintendent and received no compensation from PATH. HJ, JT, AB, and SG were not involved in data analyses outside of the participatory analysis in the Enhanced Force Field Analysis. LW, AR, and DP were contracted by the PATH Foundation to provide evaluation support for C2BF. KD and ME are employees of the PATH Foundation but did not have a role in the evaluation design, data collection, analysis, or interpretation of the findings that were the basis for this publication, and their support as C2BF program officers was critical to its implementation and success; however, their roles in this publication were limited to providing feedback on the final draft. The remaining authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2023 Redelfs, Smith, Merrill, Grimsley, Jenkins, Tederick, Butler, Dueck, Eastham Thomas, Perez and Whigham.)

Contemporary health educators in schools are responsible for promoting the health of individual students, as well as a healthy school environment. The ongoing push for increasing device use in schools, which is underpinned by the information and communications technology (ICT) capability requirements of the new Australian Curriculum, can potentially lead to health risks for students that may not be well understood by students, schools and families. Widespread increasing implementation of ICT may outpace supporting research into risks. While schools tend to focus on cyber safety in relation to risks from ICT use, limited consideration is given to the other potential health risks of sustained screen time, despite the robust and growing body of research linking sustained screen time to a range of health issues. This paper outlines a crucial practical role for health educators in mitigating health risk to students from increasing screen time in schools and at home. Schools need to communicate the importance of balance in screen time, leading by example and fostering protective partnerships with students, their families and broader community support mechanisms. [ABSTRACT FROM PUBLISHER]

Background and context: Schools in Australia and internationally are increasingly adopting a Bring Your Own Device (BYOD) approach to teaching and learning. The review: While discussion of a BYOD approach has taken place, there is a dearth of consideration of the potential impact of BYOD policy on student health. Implementation of a BYOD policy may have implications for increased sedentary behaviour, as well as spinal and postural health. Increased use of devices at home to complete homework may also have implications for sleep duration, which in turn may impact upon a range of physical and cognitive issues. BYOD implementation may also increase student vulnerability to cyberbullying. These and other health issues are discussed. Recommendations: Schools may find it helpful to adopt a risk analysis approach informed by social cognitive theory, with an emphasis on the provision of knowledge and the fostering of self-efficacy in order to safeguard against potential health risks. As this issue has significance for researchers in both health promotion and education, an interdisciplinary approach should be taken. [ABSTRACT FROM AUTHOR]

The enthusiasm regarding the school as a place for mental health promotion is powered by a large body of research demonstrating the links between mental health and well-being, academic success and future life opportunities. Despite on-going commitment to mental well-being in the U.K., statistics suggest mental health issues are increasing among children and young people. This small-scale qualitative-exploratory study, undertaken in two primary schools in North Wales, reports on how school practitioners perceive, promote and support the mental health and well-being of pupils. The paper highlights a reluctance by practitioners to address mental health topics due to fear of stigma and a desire to protect children. Issues linked to funding, skills and training, together with over-stretched specialist agencies, are making it difficult for school practitioners to support pupils. There is a pressing need for appropriate training opportunities in order for practitioners to be knowledgeable and to feel confident to discuss mental health with children and young people. Schools have a significant role in supporting children's mental well-being and reducing the stigma attached to mental illness but only if this important topic is not regarded as an 'elephant in the room'. [ABSTRACT FROM AUTHOR]

ABSTRACT BACKGROUND Collaborative partnerships are an essential means to concomitantly improve both education outcomes and health outcomes among K-12 students. METHODS We describe examples of contemporaneous, interactive, and evolving partnerships that have been implemented, respectively, by a national governmental health organization, national nongovernmental education and health organizations, a state governmental education organization, and a local nongovernmental health organization that serves partner schools. RESULTS Each of these partnerships strategically built operational infrastructures that enabled partners to efficiently combine their resources to improve student education and health. CONCLUSIONS To implement a Whole School, Whole Community, Whole Child Framework, we need to purposefully strengthen, expand, and interconnect national, state, and local collaborative partnerships and supporting infrastructures that concomitantly can improve both education and health. [ABSTRACT FROM AUTHOR]

Expanding school health promotion. Outcomes and reach of a school health support program in primary education To stimulate school health promotion in Dutch primary schools, a support program was developed involving financial incentives and professional support that schools can apply for. Since 2012, this program has been organized four times. All Dutch schools could subscribe for two options: (1) tailored advice on health promotion by a 'healthy school advisor', often working for a local Municipal Health Service, or (2) financial support for health activities. This article provides the results of the initial round of support initiatives from the perspective of healthy school advisors and participating schools. Furthermore it describes the reach of the support program in a series of three rounds. [ABSTRACT FROM AUTHOR]

Purpose – Intersectoral collaboration is often a prerequisite for effective interventions in public health. The purpose of this paper is to assess the facilitating and hindering conditions regarding intersectoral collaboration between health authorities, public health services (PHSs), public services stakeholders (PPSs) and the education sector in comprehensive school health promotion (CSHP) in the Netherlands. Design/methodology/approach – CSHP collaborations in five Dutch regions were studied using a questionnaire based on the DIagnosis of Sustainable Collaboration (DISC) model, focusing on: change management; perceptions, intentions and actions of collaborating parties; project organization; and factors in the wider context. Univariate and multivariate analyses with bootstrapping were applied to 106 respondents (62 percent response). Findings – A similar pattern of facilitating and hindering conditions emerged for the five regions, showing positive perceptions, but fewer positive intentions and actions. An overall favorable internal and external context for collaboration was found, but limited by bureaucratic procedures and prioritizing stakeholders’ own organizational goals. Change management was rarely applied. Some differences between sectors emerged, with greatest support for collaboration found among the coordinating organizations (PHSs) and least support among the financing organization (municipalities). Research limitations/implications – The generalization of the findings is limited to the initial formation stage of collaboration, and may be affected by selection bias, small sample size and possible impact of interdepartmental collaboration within organizations. Practical implications – The authors recommend establishing stronger change management to facilitate translation of positive perceptions into intentions and actions, and coordination of divergent organizational structures and orientations among collaborating parties. Originality/value – The results show that it is valuable for collaborating parties to conduct DISC analyses to improve intersectoral collaboration in CSHP. [ABSTRACT FROM AUTHOR]

Purpose -- The purpose of this paper is to evaluate the evidence base of the Food Dudes healthy eating programme, specifically the short- and long-term effectiveness of the intervention for consumption of fruit and vegetables both at school and at home and displacement of unhealthy snack consumption. Design/methodology/approach - Articles were identified using Academic Search Complete, PsycARTICLES, Medline and PubMed databases keywords for the period January 1995 to August 2013. Articles were included if they reported an empirical evaluation of the Food Dudes programme aimed at children aged between 4-11 years. Articles were included regardless of geographical location and publication type (i.e. published and "grey" literature). Findings -- Six articles were included for review. Findings indicated that the programme was moderately effective in the short term; however, the long-term effectiveness of the programme is unknown. The ability of the programme to generalise to the home setting and to displace unhealthy snack foods also requires further investigation. Originality/value -- This is the first independent review of the Food Dudes programme. In light of the extensive roll out of the Food Dudes programme, an appraisal of the evidence surrounding the programme is timely. The review highlights that sustaining fruit and vegetable intake cannot be achieved through behaviour-based interventions alone and the long-term maintenance of fruit and vegetable consumption requires more than the implementation of an intervention found to be effective in a controlled research environment. [ABSTRACT FROM AUTHOR]

Purpose - The purpose of this paper is to describe the development of new interactive, bi-lingual Sex and Relationships Education (SRE) resources called Tyfu i Fyny/Growing Up, suitable for students aged between five and 12 years. It also discusses the evidence used to support the development of the resources, the support provided for teachers and parents and an initial evaluation following their use. Design/methodology/approach - Tyfu i Fyny/Growing Up are interactive bi-lingual (Welsh and English) SRE teaching resources for primary schools suitable for students aged five to 12 years. These resources comprise of two components, an interactive electronic web-based programme and a floor mat illustrating a naked boy and girl. The electronic web-based programme is used to introduce puberty changes, loving relationships, conception, pregnancy and birth and is suitable for students aged nine to 12 years. The floor mat is suitable to be used with students aged between five and 12 years. Teaching activities can include naming body parts, discussing gender differences, personal safety, distinguishing between appropriate and inappropriate touching, discussing puberty changes and other health promotion activities as well as delivering aspects of the National Curriculum for Wales. Findings - The results from the initial evaluation undertaken with year six students and teachers demonstrates how the resources have impacted on the teaching and learning experiences of primary teachers and students. It also demonstrates how the teacher training sessions and using the Tyfu i Fyny/Growing Up resources have increased teachers' confidence in delivering SRE. Practical implications - The learning experiences of students and their enjoyment of using the Tyfu i Fyny/Growing Up resources were significantly high. The implementation of teacher training improved teaching practice and increased teachers' confidence in the subject. The resources have facilitated the delivery of effective whole school comprehensive SRE programmes for primary schools. These factors confirm the value of the investment given to their development. The resources could easily be customised in line with diverse ethnic, cultural, linguistic and religious requirements. Originality/value - This paper demonstrates how the Tyfu i Fyny/Growing Up interactive SRE resources have influenced the teaching and learning experiences of primary school teachers and students. [ABSTRACT FROM AUTHOR]

Abstract Purpose - The purpose of this paper is to study the effectiveness of the international volunteer programme's dance4life (D4L) in Russia. The programme aims to address taboos, stigma, discrimination, HIV/AIDS prevention and the promotion of sexual reproductive health and rights (SRHR) and a healthy lifestyle among adolescents. The programme uses an "edutainment" model that involves young people through music, dance and youth icons. Educated volunteers provide schoolchildren with comprehensive information on SRHR and demonstrate the practical application of life and leadership skills. The programme ends with a celebration event. Design/methodology/approach - Qualitative and quantitative methods were used. Only those who got as far as stage three of the process, 20 per cent of those who begun, were sampled. The qualitative research involved youth aged 13-19 (20 interviews, six focus groups), teachers (eight interviews), volunteer team members (eight interviews) and programme managers in four project regions and in Moscow (five interviews). In the quantitative research 105 respondents took part, of whom 48 per cent were 13-16 years old, 44 per cent were 17-19 years old and 8 per cent were 20-23 years old. Both boys and girls were included in the sample. Findings - Young people's participation in D4L had a significant positive impact on perceptions of SRHR and knowledge levels, changed some misconceptions about HIV/AIDS and helped develop social and healthy lifestyle skills. The programme contributed to the growth of voluntary activity and the organizational skills of participants. Teachers' perceptions of SRHR changed positively after their participation in the programme. Research limitations/implications - The fact that the sample is only those who completed all stages of the programme, 20 per cent of the overall population who began it, is clearly a source of bias. The size of the quantitative research sample (n = 105) does not allow disaggregation of data by region nor by gender: this limitation was minimized by choosing four regions with relatively comparable socio-economic status, and through quota sampling in equal proportions for boys and girls. This is the first time such a study has been conducted, so it is not possible to draw conclusions about the long-term impact of the programme. Practical implications - The short implementation period allows for the dissemination of information and training to large numbers despite limited funding. Social implications - The D4L approach provides information on SRHR to youth, which arouses their interest, and is perceived as relevant and important. Programme participants use this information themselves and share it with their friends, parents and other adults. Originality/value - The D4L programme is unique in Russia: there is no regular sexual education in Russian schools. School programmes are rarely evaluated with the methods used in this study. [ABSTRACT FROM AUTHOR]

Many companies nowadays consider schools to be an important setting for marketing to children. However, important concerns can be raised from a health promotion perspective about the potential negative impact of commercial activities on the health and well-being of pupils. As this discussion paper will demonstrate, some commercial activities raise concerns in relation to physical health and obesity, not only by potentially undermining formal curriculum messages, but also through the active promotion of specific products, particularly those high in fat, sugar or salt. Nonetheless, the issues raised by commercial activities are not solely limited to effects on physical health. By allowing commercial activities, schools risk instilling in pupils consumer-orientated values. This is significant as such values have been linked to the development of poor health and well-being. Furthermore, the presence in schools of commercial activities will also militate against informed decision-making and be disempowering. There is also evidence that business-sponsored teaching materials can contain biased and misleading information. The potential negative impacts of commercial activities are inconsistent with goals in relation to the promotion of health and the principles of health-promoting schools. [ABSTRACT FROM PUBLISHER]

Current research in education shows that "experiential learning," a theory developed by Jean Piaget that places value on the primacy of authentic experiences, is an effective educational method that leads to meaningful and long-lasting learning. Experiential environment-based learning, which promotes inquiry-based observation and analysis, has been shown to advance retained knowledge, increase engagement and enthusiasm for learning, while providing an antidote to society's increasing detachment from nature and cultural obsession with technology. This paper posits nature not as a subject to learn about, but as a tool to learn with. Rather than relying on occasional outdoor excursions, as the current pedagogy suggests, classrooms should provide direct interaction with natural phenomena in order for students to develop a deep understanding of traditional subject matter, while reflecting on the directness and complexity of their experiences. Despite many positive trends in outdoor curriculum and school design such as "green schools" and "healthy schools," which focus primarily on a checklist of prescriptive items, contemporary classrooms often do not reflect important current directions in educational philosophy. Throughout the 20th century, two factors have shifted away from learning experientially with the natural environment: buildings have become less connected to the natural world due to increased security and the prevalence of air conditioning, and curricula has become more concerned with memorization than with experience. To what extent are classrooms, currently and historically, designed as reflections of current educational philosophy? This paper provides a survey of well-designed classrooms, classrooms that support experiential learning by design. [ABSTRACT FROM AUTHOR]

Copyright of TSG: Tijdschrift Voor Gezondheidswetenschappen is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

This project examined 23 teachers’ involvement in a curricular project to integrate physical activity into the school day. The teachers represented all grade levels and worked in schools that served Native American students in the United States. Interviews occurred twice during the year-long project. Data were analyzed via constant comparison. Teachers’ willingness to engage was influenced positively by caring about students and their own personal wellness history. Their engagement was impeded by institutional factors of scheduling and assessment pressures. The results provide insights into how teachers might be persuaded to and prepared for the implementation of similar programs in new locations. [Copyright &y& Elsevier]

This article provides a critical analysis of recent policy initiatives associated with 'Healthy Schools'. Its specific focus is upon evaluation research conducted by the authors at the School of Education, University of Leicester. The evaluation team investigated healthy school programmes in two Midlands authorities as they related to anticipated accreditation for the National Healthy School Standard (NHSS). Analysis is of findings that sought to identify the most effective approaches for supporting schools and colleges to achieve healthy school status. A specific focus is upon schools' capacity, and those of the health and educational professionals with whom they work, to meet the myriad expectations that are part of the standard. The 'Healthy School' is seen as a critical case where connections between health and education are expected to mirror government department interests in 'joined-up' thinking, evaluation strategies and concerns about accountability and performance among schools and local authorities. This is illustrated in the language of the NHSS, where healthy schools are assumed to provide settings for promoting children's and young people's health through the curriculum, the school environment, and in partnership with parents, governors and local stakeholder communities drawn from education, health, social and community services. Curricular themes of citizenship and personal social and health education are being pulled together to provide a revised non-statutory curriculum for Personal, Social and Health Education (PSHE) and, by September 2002, a new curriculum framework for citizenship. What are the prospects for such an ambitious linking of rhetoric and practice? The article identifies key aspects of the healthy schools challenge, namely the need to ascertain ways in which its development can be simultaneously extended yet sufficiently inclusive to meet the multiple interests of a healthy and educated citizenry, and of schools in which that challenge is supposed to be met. Yet the article also sounds warnings of a standard that, with limited resources and prioritization, might drown under the weight of its own inclusiveness. The concluding counterpoint is an illustrative case-study of effective practice that pre-dates yet anticipates proposed curriculum changes. [ABSTRACT FROM AUTHOR]

The objective of this study was to establish and investigate a taxonomy of school health among high school students in Ontario, Canada. Data analyzed were based on 3358 9th-12th graders attending 103 high schools who participated in the 2011 Ontario Student Drug Use and Health Survey. Based on 10 health-related indicators, multilevel latent class analysis was used to extract 4 student-level latent classes and 3 school-level latent classes. Unhealthy schools (19% of schools) had the lowest proportion of healthy students (39%) and the highest proportion of substance-using (31%) and unhealthy (18%) students. Healthy schools (66%) contained the highest proportion of healthy students (56%) and smaller proportions of substance-using (22%) and unhealthy students (8%). Distressed schools (15%) were similar to healthy schools in terms of the proportions of healthy and unhealthy students. Distressed schools, however, were characterized by having the largest proportion of distressed students (35%) and the lowest proportion of substance-using students (4%). Meaningful categories of schools with respect to healthy environments can be identified and these categories could be used for focusing interventions and evaluating school health programs.