A Four Year Comparison A Four Year Comparison of the School Health of the School Health

EducationEducation ProfileProfile Presented byPresented by

Sandra OwenSandra Owen

Clinical FacultyClinical Faculty

Georgia State UniversityGeorgia State University

DescriptionDescriptionSchool Health Education ProfileSchool Health Education Profile

Developed by the Division of Adolescent Developed by the Division of Adolescent and School Health, C.D.C. and School Health, C.D.C.

• PrincipalsPrincipals examine health examine health education and HIV prevention education and HIV prevention education from an administrative education from an administrative perspective perspective

• Health Education TeachersHealth Education Teachers examine health education from an examine health education from an instructional perspectiveinstructional perspective

Sample DescriptionSample Description

Three comparable samples were Three comparable samples were randomly drawn from the randomly drawn from the

population of Georgia public, population of Georgia public, middle and secondary schools. middle and secondary schools.

Response rates includedResponse rates included : : 71%(1994), 60%(1996), 71%(1994), 60%(1996),

82%(1998)82%(1998)

Grade Level Sample Grade Level Sample DistributionDistribution 1994 1996 1994 1996 19981998Grade 6 122 133 174Grade 7 133 138 185Grade 8 122 127 176Grade 9 103 103 142Grade 10 105 98 139Grade 11 102 94 137Grade 12 100 92 137

Percent Distribution for Percent Distribution for Middle and Secondary Middle and Secondary

SchoolsSchools• Middle SchoolMiddle School

includes: includes: • 1994(53%) 1994(53%)

1996(56%) 1996(56%) 1998(60%)1998(60%)

• High SchoolHigh School includes: includes: 1994(41%) 1994(41%) 1996(41%) 1996(41%) 1998(45%)1998(45%)

Plan for Data Analysis and Plan for Data Analysis and InterpretationInterpretation

• Calculate percent Calculate percent change comparing change comparing 1994 data to 1998 1994 data to 1998 datadata

• Item selection Item selection criteria 1.State criteria 1.State required 2.Health required 2.Health Knowledge Knowledge 3.Health Skills 3.Health Skills 4.Parent Involved 4.Parent Involved

Status of Health Education Course (6-12th Grades)

60%

99% 100%

17% 16%6%

0%

20%

40%

60%

80%

100%

1994 1996 1998

Year

Pe

rce

nt

Required HealthCourse

No SeparateCourse

Percent Change for Status of Health Education Course

67%

-65%-80%

-60%

-40%

-20%

0%

20%

40%

60%

80%

Pe

rce

nt Required Health

Course

No SeparateCourse

PrincipalPrincipal ResponseResponse

Schools report full complianceSchools report full compliancewith state health instructionwith state health instructionrequirement and maintain requirement and maintain compliance over two years. A compliance over two years. A shift to providing health as ashift to providing health as aseparate course is exhibited.separate course is exhibited.

Placement of Health Education Course

0%

50%

100%

6th 7th 8th 9th 10th 11th 12th

Grade Level

Perc

ent

1994

1996

1998

PrincipalPrincipalResponseResponse

Percent Change in Placement of Health Course

-50%

0%

50%

100%

6th 7th 8th 9th 10th 11th 12th

Grade Level

Perc

ent

Percent Change in Placement of Health Course

-50%

0%

50%

100%

6th 7th 8th 9th 10th 11th 12th

Grade Level

Perc

ent

An upward shift in grade An upward shift in grade level placement of healthlevel placement of healtheducation appearseducation appears between eleventh andbetween eleventh andtwelfth grades.twelfth grades.

Issues Impacting Health Education

0%

50%

100%

Percent

1994

1996

1998

1994 32% 24% 57% 8% 46%

1996 26% 70% 62% 6% 46%

1998 40% 69% 76% 1% 32%

No Exempt No Council No Peer Ed. No Coord. Heal.Coord.

-100% -50% 0% 50% 100% 150% 200%

No Exempt

No Council

No Peer Ed.

No Coord.

Heal.Coord.

Percent Change in Issues Impacting Health Education

-100% -50% 0% 50% 100% 150% 200%

No Exempt

No Council

No Peer Ed.

No Coord.

Heal.Coord.

Percent Change in Issues Impacting Health Education

PrincipalPrincipalResponseResponse

A substantial reduction in A substantial reduction in the number of functioningthe number of functioningbuilding-level Advisorybuilding-level AdvisoryCouncils has the potentialCouncils has the potentialfor impacting healthfor impacting healtheducationeducation

Trends in Support of Inservice Education

0%

20%

40%

60%

80%

100%

Sch/Dis. Stipend Substitute Reimburse

Inservice support

Perc

ent

1994

1996

1998

PrincipaPrincipal l ResponsResponsee

-50% 0% 50% 100%

Sch/Dis.

Stipend

Substitute

Reimburse

Percent Change in Factors Supporting Inservice Education

-50% 0% 50% 100%

Sch/Dis.

Stipend

Substitute

Reimburse

Percent Change in Factors Supporting Inservice Education

In-service training has In-service training has shifted away from the schoolshifted away from the schooland outside the district. Thisand outside the district. Thishas been supported by costhas been supported by costreimbursement andreimbursement andprovision of substitutes. provision of substitutes.

Parental Feedback About Health Education

38%41%31%

60%52%

56%

0%0%2%0%

10%20%30%40%50%60%70%

1994 1996 1998

None

Positive

Negative

PrincipPrincipalalResponResponsese

23%

-7%

-100%

-100%

-50%

0%

50%

None Positive Negative

Change in Parent Feedback About Health Education

23%

-7%

-100%

-100%

-50%

0%

50%

None Positive Negative

Change in Parent Feedback About Health Education

The majority of parent The majority of parent feedback principals receive feedback principals receive about health educationabout health educationcontinues to be positive. continues to be positive.

HIV Education Across Grade Levels

0%

20%

40%

60%

80%

100%

120%

6 7 8 9 10 11 12

Grade Level

Pe

rce

nt

1994

1996

1998

Percent Change of Grade Level Inclusion of HIV Education

-100%

0%

100%

200%

300%

400%

6 7 8 9 10 11 12

Grade Level

Pe

rce

nt

PrincipalPrincipalResponseResponse

The inclusion of HIV The inclusion of HIV education has substantiallyeducation has substantiallyincreased across all high schoolincreased across all high schoolgrade levels.grade levels.

Inclusion of HIV Education Across the Curriculum

0%

20%

40%

60%

80%

100%

1994 1996 1998

Year

Pe

rce

nt

Health

Science

Family Life

9%

67% 64%

0%

20%

40%

60%

80%

% Change

Percent Change of HIV Education Inclusion

Health

Science

Family Life

9%

67% 64%

0%

20%

40%

60%

80%

% Change

Percent Change of HIV Education Inclusion

Health

Science

Family Life

PrincipalPrincipalResponseResponse

With the steady increase With the steady increase in HIV education withinin HIV education withinHealth, there is a Health, there is a substantialsubstantialincrease in HIV educationincrease in HIV educationintegrated into Science integrated into Science and and Family Living.Family Living.

School-Based HIV Policy

0%

20%

40%

60%

80%

100%

1994 1996 1998

HIV Policy

Worksite Safety

TeacherTraining

0%

20%

40%

60%

80%

HIV Policy WorksiteSafety

TeacherTraining

Percent Change for Major Components of HIV

Prevention/Intervention

0%

20%

40%

60%

80%

HIV Policy WorksiteSafety

TeacherTraining

Percent Change for Major Components of HIV

Prevention/Intervention

PrincipalPrincipalResponseResponse

A substantial number ofA substantial number ofschools have implementedschools have implementedan HIV policy including the an HIV policy including the provision for work-siteprovision for work-sitesafety. safety.

Summary of Principal Summary of Principal ResponsesResponses

• Full complianceFull compliance with with state requirement state requirement for health educationfor health education

• Upward shiftUpward shift in in grade placement of grade placement of specific health specific health course (11th & 12th)course (11th & 12th)

• Substantial decreaseSubstantial decrease in operating in operating Advisory Councils at Advisory Councils at the school levelthe school level

Summary of Principal Summary of Principal ResponsesResponses

ContinuedContinued• DecreaseDecrease in schools in schools allowing to exempt allowing to exempt healthhealth

• In-service In-service shift awayshift away from school and out from school and out of districtof district

• InfusionInfusion of HIV of HIV education across education across grade levels and grade levels and courses courses

• IncreaseIncrease in HIV in HIV Policy Policy implementationimplementation

Health Teacher ResponsesHealth Teacher ResponsesSpecific to:Specific to:

• Planning and Planning and implementing implementing health educationhealth education

• In-service education In-service education • Factors influencing Factors influencing

the quality of HIV the quality of HIV educationeducation

• Joint health Joint health education activitieseducation activities

Materials Required to Plan and ImplementHealth Instruction at the School Level

0%

50%

100%

150%

State District School Commercial

1994

1996

1998

HealthHealthTeacher Teacher ResponseResponse

-50%

0%

50%

100%

150%

State District School Commercial

Percent Change in Required Materials

-50%

0%

50%

100%

150%

State District School Commercial

Percent Change in Required Materials

Full Full compliancecomplianceto state to state guideguide

Shift to Shift to using school using school guide more guide more and and commercial commercial materials materials lessless

Health Knowledge Emphasis

0% 20% 40% 60% 80% 100%

AOD

HIV

Injury

Suicide

Tobacco

1998

1996

1994

27%37%

32%46%

31%

0%

50%

AOD HIV Injury Suicide Tobacco

Percent Change in Knowledge Emphasis of Health Risk Behaviors

27%37%

32%46%

31%

0%

50%

AOD HIV Injury Suicide Tobacco

Percent Change in Knowledge Emphasis of Health Risk Behaviors

Health Health TeacherTeacherResponseResponse

Substantial increases in Substantial increases in knowledge emphasis ofknowledge emphasis ofmajor health risk major health risk behaviorsbehaviors

Discussion of suicide and Discussion of suicide and HIV had greatest change. HIV had greatest change.

Emphasis on Developing Health Skills

0%20%40%60%80%

100%120%

Decision Goal Set MediaAnaly.

Resist StressMan.

1996

1998

0% 1% 2% 3% 4% 5%

Decision

Goal Set

Media Analy.

Resist

Stress Man.

Percent Change in Health Skill Emphasis

0% 1% 2% 3% 4% 5%

Decision

Goal Set

Media Analy.

Resist

Stress Man.

Percent Change in Health Skill Emphasis

Health Health TeacherTeacherResponseResponse

High levels of health High levels of health literacyliteracyskill inclusion is apparentskill inclusion is apparent

Greatest change was noted Greatest change was noted for for inclusion of resistance to inclusion of resistance to socialsocialpressure and media pressure and media analysis.analysis.

Typical HIV EducationHealth Course

0% 50% 100% 150%

Abstinence

Cond.Effic.

HIV Test

Needle Sh.

Transmiss.

1998

1996

1994

Health Health Teacher Teacher ResponsResponsee

0% 20% 40% 60% 80%

Abstinence

Condom

HIV Test

Needle

Transmiss.

Percent Change in Specific HIV Education

0% 20% 40% 60% 80%

Abstinence

Condom

HIV Test

Needle

Transmiss.

Percent Change in Specific HIV EducationIncreased emphasis onIncreased emphasis on

HIV testing HIV testing

All major HIV educationAll major HIV educationareas experienced areas experienced a positive changea positive change

0%

10%

20%

30%

1994 1996 1998Expand

Teacher Response to Parent Feedback on HIV Education

Expand

Limit

-60%

-40%

-20%

0%

20%

40%

60%

Expand Limit

A Shift From Limiting to Expanding HIV Education as a Result of

Parent Feedback

-60%

-40%

-20%

0%

20%

40%

60%

Expand Limit

A Shift From Limiting to Expanding HIV Education as a Result of

Parent Feedback

Health Teacher Health Teacher ResponseResponse

Health Teachers Health Teachers response to a shift inresponse to a shift inparent feedbackparent feedback forforHIV educationHIV education

Factors Teachers Say Make HIV Education Difficult

0% 10% 20% 30% 40%

Community

Materials

Parents

Time

Training

1998

1996

1994

10%

8%

-21%

62%

0%

-40% -20% 0% 20% 40% 60% 80%

Community

Materials

Parents

Time

Training

Percent Change in Factors Making HIV Education Difficult for

Teachers

10%

8%

-21%

62%

0%

-40% -20% 0% 20% 40% 60% 80%

Community

Materials

Parents

Time

Training

Percent Change in Factors Making HIV Education Difficult for

Teachers

Health Teacher Health Teacher ResponseResponse

Concern about negativeConcern about negativefeedback from parentsfeedback from parentsis substantially lessis substantially less

Issue of time demandIssue of time demandhad the greatest change had the greatest change

141%

160%

82%

11%

0% 50% 100% 150% 200%

Community

Counselor

P.E.

Teachers

Percent Change of Joint Health Activities

141%

160%

82%

11%

0% 50% 100% 150% 200%

Community

Counselor

P.E.

Teachers

Percent Change of Joint Health Activities

HealthHealthTeacher Teacher ResponseResponse

P.E. teacher mostP.E. teacher mostoften involved often involved

Counselors and Counselors and the communitythe communityhave become have become involved involved

Joint Health Activities

0% 20% 40% 60% 80%

Community

Counselor

P.E.

Teachers

1998

1996

1996

Teachers' Report of Inservice Education

0% 20% 40% 60%

AOD

HIV

Injury

Suicide

Violence

1998

1996

1994

-3%

-38%

-18%

0%

158%

-50% 0% 50% 100% 150% 200%

AOD

HIV

Injury

Suicide

Violence

Percent Change in Type Inservice Received

-3%

-38%

-18%

0%

158%

-50% 0% 50% 100% 150% 200%

AOD

HIV

Injury

Suicide

Violence

Percent Change in Type Inservice Received

Health Health TeacherTeacher ResponseResponse

Suicide preventionSuicide preventioneducation is stilleducation is still minimalminimal

Violence had the Violence had the greatest attentiongreatest attention

HIV training was HIV training was reducedreduced

0%

10%

20%

30%

40%

50%

60%

70%

Health/PE Health Science

Primary Position for Teachers of Health

1996

1998

13%

0%

-18%

-20%

-10%

0%

10%

20%

Health/PE Health Science

Percent Change of Primary Position of Health Teachers

13%

0%

-18%

-20%

-10%

0%

10%

20%

Health/PE Health Science

Percent Change of Primary Position of Health Teachers

Health Teacher Health Teacher ResponseResponse

Science teachers are lessScience teachers are less likely to teach healthlikely to teach health Health/ physical educationHealth/ physical educationteachers are most likelyteachers are most likelyto teach health.to teach health.

Summary of Health Teacher Summary of Health Teacher ResponsesResponses

• Shift away from commercial Shift away from commercial materialsmaterials

• Substantial inclusion of Substantial inclusion of health risk behavior health risk behavior knowledge, particularly HIV knowledge, particularly HIV and suicideand suicide

• Inclusion of health skills Inclusion of health skills especially resistance to especially resistance to social pressure and media social pressure and media analysisanalysis

• Emphasis on HIV testingEmphasis on HIV testing

Summary of Health Teacher ResponsesSummary of Health Teacher Responses ContinuedContinued

Parent feedback is lessParent feedback is lesslikely to limit and more likely tolikely to limit and more likely toexpand HIV educationexpand HIV education

Time demand is the greatestTime demand is the greatestdifficulty experienced by healthdifficulty experienced by health teachersteachers

Counselors are more often includedCounselors are more often includedin joint health activitiesin joint health activities

Suicide prevention educationSuicide prevention educationremains a teacher voiced needremains a teacher voiced need