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BACKGROUND: As summarized in this article, the widespread implementation of modern school health education (SHE) could become one of the most effective means available to improve the well-being of people in the United States and in other nations. However, the development and evolution of SHE largely remains unorganized, underdeveloped, and neglected by health and education agencies, policymakers, and the public. METHODS: Essential to the development of any scientific discipline, scientists today use the word ontology to refer to efforts to organize knowledge in particular domains. A useful working definition of a scientific ontology is an explicit, formal specification of a shared conceptualization-a systematic set of shared terms and an explication of their interrelationships. Nine interdependent questions are outlined to help guide the development of an initial, broad, and actionable scientific ontology for SHE. RESULTS: Whether and how we respond to these questions arguably will determine the future of SHE research, policy, practice, and equity in the United States. CONCLUSIONS: An initial ontology might help conceptualize, inform, and facilitate more systematic and strategic local, state, national, and international deliberations and actions to improve SHE.

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BACKGROUND: Adapting existing health programs for synchronous remote implementation has the potential to support vulnerable youth during the COVID 19 pandemic and beyond. METHODS: The Stanford Youth Diabetes Coaches Program (SYDCP), a school-based health promotion and coaching skills program, was adapted for remote implementation and offered to adolescents from low-income communities in the US: an urban site in San Jose, CA and rural sites in Lawrence County, MO, and Central Valley, CA. Participants completed online pre- and post- surveys. Analysis included paired T-tests, linear regression, and qualitative coding. RESULTS: Of 156 enrolled students, 100 completed pre- and post-surveys. Of those: 84% female; 40% Hispanic; 37% White; 28% Asian; 3% African American; 30% other race. With T-tests and regression models, the following measures showed statistically significant improvements after program participation: health knowledge, patient activation, health understanding and communication, consumption of fruits and vegetables, psychosocial assets of self-esteem, self-efficacy, problem-solving, and ability to reduce stress. Technology barriers were frequently reported at Lawrence County site. 96% participants reported making a lifestyle change after program participation. CONCLUSIONS: Remote implementation of health promotion programs for vulnerable youth in diverse settings has potential to support adoption of healthy behaviors, enhance patient activation levels, and improve psychosocial assets.

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Background: School Health Instruction (SHI) comprises of series of formal, well-planned, and organized learning whereby information concerning knowledge, habits, attitudes, practices, and conducts are given pertaining to the health of an individual or members of the school community. A well-structured and implemented SHI forms the basis for a healthy health promotion. Aim: The study aimed at assessing the implementation of SHI among primary schools in a Local Government Area, Southwest, Nigeria. Subjects and Methods: A cross-sectional descriptive study was carried out among 67 private and public schools in a Local Government Area of Ekiti State using a standardized checklist and direct observation. Data were analyzed using SPSS version 25. Results: The ratio of teachers to pupils was 1:16 in public schools and 1:10 in private schools. More public-school teachers (93.8%) compared to private school teachers (28.9) had education-related qualifications (P < 0.0001). All public schools adhered to the recommended three periods per week on health education while the frequency of adherence varied in private schools. About half of the private school teachers and 60.4% of the public school teachers have had in-service training on general health and health promotion. Direct teaching by a subject teacher was carried out by 11.9% of the schools while 49.3% had supplemental teaching aids. The scope of health education was uniform among all the schools. Only 46.3% of the schools attained the recommended minimum acceptable score on SHI. Conclusion: School health instruction was poorly implemented in the study location. There is a need to scale up SHI and monitor its implementation in the study location. These efforts should be supported by all stakeholders and backed with adequate oversight function by regulatory authorities, provision of in-service training, and teaching aids for teachers.

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BACKGROUND: There is evidence of school-level variability in children's active behaviors. This study investigated the associations between school environments, policies and practices, and children's physical activity (PA) and active school transportation (AST), in a school ecology context. METHODS: We recruited children (N = 1699, age = 10.2 ± 1.0 years, 55.0% girls) in 37 schools from 3 diverse regions of Canada. We then collected data using questionnaires (child, parent) and pedometers. In each school, an official completed a School Health Environment Survey. Multilevel regression models were used to examine associations with children's daily steps, and frequency and volume (frequency*distance) of AST. RESULTS: Between-school variation ranged from 4.7% to 22.2% demonstrating that school environments are associated with children's active behaviors. None of the school environment variables were significantly associated with children's PA or frequency of AST. Nevertheless, their inclusion improved the PA model. Children's volume of AST increased in schools that reported more initiatives to promote AST. CONCLUSIONS: Our findings suggest that multiple components are needed to effectively promote active behaviors in children. Schools should determine the areas in which they can improve and assess the feasibility of implementing measures to make their school environments, policies, and practices more conducive to PA and AST.

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BACKGROUND: Most children do not eat enough fruits and vegetables (FV). Schools are a critical setting for supporting children to consume FV. To fill a gap in available materials, a classroom curriculum was developed and evaluated to determine impacts on student FV-related knowledge, attitudes, and behaviors. METHODS: A pre-/post-intervention survey was administered to 4th-6th grade students in 3 intervention and one comparison schools. Post-intervention student focus groups, parent/guardian surveys, and teacher surveys provided complementary information. RESULTS: Intervention students had a significantly greater increase in total FV intake, fruit intake, and 100% juice consumption, and preference for several types of FV relative to comparison group students. Students, teachers, and parents reported overall high levels of satisfaction with the curriculum. CONCLUSIONS: The Harvest of the Month curriculum is effective at increasing fruit intake among a low-income, diverse student population in grades 4-6, is acceptable to students, teachers, and parents, and is feasible to implement. Findings suggest this impact is the result of changes in preferences, skills, and motivation but not self-efficacy or perceived social norms. Some tailoring of the curriculum may be needed to increase its appropriateness for 6th-grade students, increase the impact on vegetable intake, and limit intake of juice.

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BACKGROUND: The relationship between health and learning generally goes without question in developed countries, and has a philosophic, economic, and statutory basis. Historically, school health and school health education have evolved in response to addressing the public health needs of the times. Health literacy skills are more important now than ever. Living in an ongoing COVID-19 global pandemic reminds us of the vital role of being in control of our health, wherein health literacy plays a "life or death" role in our daily lives. METHODS: Considering the evolution of school health education, we examine the significance of health literacy in our society and schools in contemporary times. RESULTS: We must take a critical look at a place for education for health literacy and why it should be an innovative path in adaptive, reimagined, and revitalized schools. CONCLUSIONS: It is time to rebrand school health in general, and school health education specifically. Improved health literacy is an asset leading to greater opportunities for health and life-long learning.

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BACKGROUND: Childhood is a critical period for developing food-related skills and knowledge, known as food literacy (FL). Schools may be an important setting for interventions aiming to improve FL in children. This systematic scoping review aimed to characterize food literacy interventions in elementary schools. METHODS: Databases (PubMed, Web of Science, and EBSCO) were searched for FL interventions in elementary schools (students aged 4-12 years). Studies were assessed according to design, duration, theoretical underpinning, and ascertainment of FL outcome(s). Interventions were assessed according to FL competencies (functional, interactive, and critical). RESULTS: After exclusions, 116 studies were eligible for review, including 105 original interventions. Interventions ranged from 45 minutes to 4 years. Social cognitive theory was the most referenced theory and common interventions included; classroom lessons, games, school gardens, food preparation, and cooking classes. Most studies measured FL outcomes quantitatively (96%, N = 111). All studies addressed functional FL (N = 116), while 77% (N = 89) addressed interactive FL and 28% (N = 32) addressed critical FL. CONCLUSIONS: This first international review of FL programs in elementary schools found great heterogeneity in school-based FL intervention design and measurement of FL. Few interventions addressed critical FL, which should be a focus for future interventions.

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BACKGROUND: Food literacy, a sub-area of health literacy, is achieving attention in schools, academia, research, health care, businesses, and governments worldwide. Against the current COVID-19 pandemic backdrop, the relevance of food literacy's interconnected attributes such as nutritional knowledge, food skills, and food environment is gaining traction. Enhancing health and food literacy in the K-12 school environment are important empowerment tools with the potential to reduce health inequalities as vulnerable people are at risk of limited health literacy. METHODS: We aim to clarify the meaning of food literacy and its relationship to health literacy and other factors influencing eating behavior. RESULTS: We offer a proposed conceptual model depicting connections between relevant theories and constructs in the field of health and nutrition. Concrete actions are offered that contemporary schools can take guided by the utility of the model. CONCLUSIONS: This visual can help guide schools' multidimensional health and food literacy efforts while considering the realities of the current COVID-19 pandemic context and beyond. This model will provide an overarching reference for schools to consider key constructs to support practice, research, policy, and intervention efforts to advance their health and food literacy agendas.

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BACKGROUND: School Health Instructions (SHI) entail the instructional aspect of school health programme, which provides a classroom opportunity for inculcating healthy habits into the school- age child. OBJECTIVE: To assess the status of implementation of school health instruction in primary schools in Gwagwalada Area Council of the Federal Capital Territory, Nigeria. METHODS: A cross-sectional descriptive study of 146 primary schools in the Gwagwalada Area Council of the Nigerian Federal capital was carried out to assess the implementation of SHI with respect to the contents, methods of delivery and teachers preparation for health teaching using an evaluation checklist for SHI. RESULTS: Of 146 schools, 115(78.8%) schools attained the minimum acceptable score of 27. Of the 40 public and 106 private schools, 27(67.5%) public and 88(83.0%) private schools attained the acceptable minimum score of 27. There was a statistically significant difference between the mean scores attained cumulatively in the various components of the school health instruction by the public and private schools (t=2.721, p= 0.008). Public schools had significantly more teachers with education-related qualifications than private schools (p<0.001). Teachings on HIV/ AIDS, safety education and community health were undertaken by 95.9%, 93.2% and 95.2% schools respectively. Only 5(3.4%) schools followed the recommendation of giving health instruction at least thrice a week. CONCLUSION: Implementation of SHI was adequate in the study area, with a better performance among the private schools.

CONTEXTE: L'enseignement de la santé à l'école (SHI) comprend l'aspect pédagogique du programme de santé scolaire, qui offre en classe la possibilité d'inculquer des habitudes saines à l'enfant d'âge scolaire. OBJECTIF: Évaluer l'état de la mise en œuvre de l'enseignement de la santé scolaire dans les écoles primaires du Conseil régional de Gwagwalada du territoire de la capitale fédérale, Nigéria. MÉTHODES: Une étude descriptive transversale de 146 écoles primaires du Conseil régional de Gwagwalada de la capitale fédérale nigériane a été menée pour évaluer la mise en œuvre de l'AMS en ce qui concerne le contenu, les méthodes de prestation et la préparation des enseignants à l'enseignement de la santé en utilisant une liste de contrôle SHI. RÉSULTATS: Cent quinze (78,8%) écoles composées de 27 (67,5%) écoles publiques et 88 (83,0%) écoles privées ont atteint le score minimum acceptable de 27, avec une différence statistiquement significative entre les scores moyens des deux catégories d'écoles (t = 2,721, p = 0,008). Les écoles publiques avaient beaucoup plus d'enseignants avec des qualifications liées à l'éducation que les écoles privées (p <0,001). Des enseignements sur le VIH / SIDA, l'éducation à la sécurité et la santé communautaire ont été dispensés respectivement par 95,9%, 93,2% et 95,2% des écoles. Seulement 5 écoles (3,4%) ont suivi la recommandation de donner des cours de santé au moins trois fois par semaine. CONCLUSION: La mise en œuvre de SHI a été adéquate dans la zone d'étude, avec une meilleure performance parmi les écoles privées. MOTS CLÉS: Enseignement de la santé à l'école, école primaire, privé, public, Conseil régional de Gwagwalada, Territoire fédéral de Capital, Nigéria.

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BACKGROUND: In this study, we examined nutrition-related topics among adolescent students attending schools with different Indices of Community Socio-Educational Advantage (ICSEA). METHOD: Participating students (N = 206) from 5 schools in Western Australia completed a paper-based questionnaire on nutrition-related topics. Frequencies and independent chi-square tests were used to identify differences between sexes and school ICSEA. RESULTS: Of the participating students, 75% were interested in learning about 8 of 16 topics. We found statistically significant differences by sex (p < .01) for "Eating the right foods for preventing illness and disease," "Eating the right food for being active" among girls, and "Reducing food waste" among boys. We also noted differences by school ICSEA. CONCLUSION: Acknowledging sex and socioeducational differences in teaching and learning may help teachers to engage adolescent students in nutrition education.

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BACKGROUND: Many youth engage in risky sexual behaviors that are associated with adverse sexual health outcomes. Lesbian, gay, bisexual, transgender, and questioning/queer (LGBTQ) youth are disproportionately affected. Comprehensive sex education is instrumental to minimize these outcomes; however, each state varies in the topics taught. METHODS: This paper is a comprehensive review of all 50 states and the District of Columbia's policies, including laws and education standards, for LGBTQ inclusive material in school-based sex education for youth in K-12. RESULTS: Overall, 48 states have policies that mandate sex education in the public schools. This review describes policy differences relevant to students who identify as LGBTQ, by comparing required topics, parental/guardian permission, LGBTQ inclusion, and normative language requirements. CONCUSIONS: There is a lack of uniformity and presence of discrimination in school-based sex education policies in the United States, particularly related to LGBTQ topics. Therefore, young people, especially LGBTQ students, face geographical barriers to accessing sexual health information and schools are limited in implementing curriculum essential for students to optimize sexual health outcomes. State policymakers, school administrators, child health advocates, and parents should work to eliminate barriers for comprehensive sex education.

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BACKGROUND: Consistent with the Whole School, Whole Community, Whole Child Approach, food education encompasses nutritional status, culture, community, environment, and society. Unifying standards are needed to support food education integration in K-12 curricula. Pilot Light, a Chicago-based nonprofit, sought to generate such standards. This study reports a formative evaluation research process that led to the development of Food Education Standards (FES). METHODS: Nine FES were drafted within the context of the National Health Education Standards. The 2-day Pilot Light Food Education Summit convened 26 experts and community members to review draft FES. A facilitated, consensus-building process generated refined FES and K-12 competencies. Drawing on Summit outcomes and expert feedback, a team of teachers subsequently drafted final FES. Summit participants completed pre- and post-Summit surveys to assess changes in food education priorities. RESULTS: The initial 9 FES were refined to 7. Comparison data indicated shifts in endorsed priorities for food education, moving from prioritizing specific knowledge, such as "categorizing food into food groups," toward "students having a conscious decision-making process around food." CONCLUSIONS: Developed with input from experts across multidisciplinary fields, the evidence-based Pilot Light FES can be feasibly implemented in multiple subjects across all school types and community socio-demographic levels.

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BACKGROUND: Bystander cardiopulmonary resuscitation (CPR) initiated before medical help arrives saves lives. Hands-Only CPR keeps the blood flowing to the brain and other organs, increasing a person's chance of survival. METHODS: A literature review identified Hands-Only CPR as the preferred method of CPR performed in the community setting. Many states have passed legislation making CPR education a high school graduation requirement. RESULTS: School nurses can play a pivotal role as school districts address these new CPR requirements. The school nurse involvement in these newly mandated CPR training requirements can support student success and improve the health of communities. CONCLUSIONS: School nurses need to use these newly mandated CPR training requirements as an opportunity to showcase the profession of nursing to ensure the school nurse remains present in our schools.

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BACKGROUND: Physical education (PE) can provide opportunities to engage in daily moderate-to-vigorous physical activity (MVPA), but MVPA levels in many classes are low. This study examines MVPA during middle school PE lessons before and after receiving the SPARK (Sports, Play, and Active Recreation for Kids) program. METHODS: Sixteen schools were enrolled in the study. PE teachers at eight schools received the intervention. PE lessons at all schools (N = 561) were observed over 2 years. Hierarchical linear regression models examined the effect of the intervention on the amount and consistency of MVPA and sedentary behavior. RESULTS: An average of 13.7% of observed class time was spent in MVPA (approximately 5 minutes of a 60-minute class), compared to 27.5% of time spent sedentary. There was no evidence that the curriculum resulted in increased MVPA or consistent MVPA, or that it decreased sedentary behavior. Findings also suggested that contextual factors may contribute to physical activity levels in PE. CONCLUSIONS: Mixed evaluation findings of the SPARK middle school curriculum demonstrate that an out-of-the-box curriculum does not have the same results in all contexts. Implications for school health are described based upon findings. Further research is needed to identify effective strategies to increase MVPA for adolescents both in and outside of PE.

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BACKGROUND: Studies have examined relationships between teacher characteristics and student achievement in courses such as math and science. This study is among the first to examine effects of teacher characteristics on student knowledge in a health course. METHODS: Student (N = 6143) pretest and posttest data were linked to teacher (N = 67) data. Changes in student knowledge scores from pre- to postcourse were explored using mixed-effects linear models. Teacher characteristics included professional development (PD) attendance, having a dedicated classroom, certification type, educational background, years' experience, and athletic coaching status. RESULTS: Teacher characteristics associated with greater student knowledge gains included: being certified to teach health versus not certified (p < .001), having a dedicated classroom versus no classroom (p = .017), and for middle school teachers, having attended ≥3 PD sessions versus ≤2 (p = .023). Less knowledge gain was associated with teachers that coached versus noncoaches (p = .040) and having a health degree versus no health degree (p = .049). Post hoc analyses revealed the negative effect of health degree was only significant among coaches (p = .026). CONCLUSIONS: Findings suggest opportunities for maximizing student knowledge gains through tailored selection of health teachers and provision of appropriate teaching support.

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BACKGROUND: Measurement of nutrition knowledge is common in interventions targeting dietary modifications in a school-based setting. Previous research has noted a general lack of disclosure regarding the details and psychometric properties of nutrition knowledge tools, which makes uptake of previously used instruments extremely difficult. METHODS: Our systematic literature review sought to identify interventions measuring nutrition knowledge in school settings to students aged 9 to 18. Studies were categorized according to content subject and relevant descriptive characteristics and psychometric properties were extracted. RESULTS: Following the initial screening of 16,868 articles, 308 papers were evaluated for eligibility. Sixty-seven studies consistent with the inclusion criteria were included in the review. A minority of studies reported analysis of validity (31.3%) and/or reliability (40.3%), and 73.1% of studies had at least one unknown relevant descriptive characteristic. The majority (68.7%) of studies were custom developed, of which only 13 reproduced the tool in the publication. CONCLUSION: Overall, there was an alarming lack of reporting across studies, both in terms of the description of knowledge tools as well as their psychometric properties. These omissions make the selection of appropriate instruments for use in novel contexts difficult, and highlight the need for greater disclosure and pre-intervention testing.

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BACKGROUND: Elementary teachers have the potential to influence children's eating habits. This study examined teacher views and practices regarding nutrition education. METHODS: An online survey was administered to K-6 teachers (N = 628) in 55 public elementary schools in a large city in the western United States. Three indices were created based on responses. Indices included: (1) attitudes and beliefs about nutrition education; (2) self-efficacy regarding nutrition education; and (3) personal health behaviors. Relationships between indices, classroom practices, and teacher characteristics were tested. Teacher comments were categorized into themes. RESULTS: Most teachers agreed they can make a difference in the eating behaviors of their students (68%). Correlations between hours of nutrition taught and teachers' attitudes and beliefs (r = .37, p < .01), nutrition self-efficacy (r = .38, p < .01), and personal health practices (r = .15, p < .01) were weak, yet statistically significant. Number of years teaching was inversely related to frequency of food rewards (r = -119, p < .01). Few teachers (21%) agreed they have support to teach nutrition in the classroom. CONCLUSION: Teachers understand the importance of nutrition education but provision is limited by competing demands. Teachers suggest tailored nutrition materials, qualified nutrition personnel, and school stakeholder support to promote nutrition education.

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BACKGROUND: Youth living with disabilities are at risk of experiencing poor health outcomes. Coordinated school health programs have an opportunity to help youth with disabilities and their families through health education, health services, and community engagement. The World Health Organization developed the International Classification of Functioning, Disability, and Health (ICF) as a framework to analyze factors related to health conditions. We used the ICF to examine parental perceptions of health and function among students with disabilities living in rural and urban areas. METHODS: We surveyed parents (N = 71) using the parent-report versions of the Pediatric Outcomes Data Collection Instrument and Child Health and Illness Profile. From this group, parents were asked to volunteer to participate in in-depth, individual interviews (N = 18). The interviews were audio-recorded and transcribed verbatim. Researchers used the ICF linking rules to analyze and code the transcriptions. Emergent themes were assigned numerical ICF codes. RESULTS: There were more similarities than differences among rural and urban families. Children living with disabilities face significant environmental barriers regardless of context. CONCLUSIONS: Schools can facilitate education to improve the quality of life of parents and families of children with disabilities. School authorities should consider the many environmental barriers both urban and rural these families face in the community. The ICF can be used as a framework for program planning for community-based, health education for this population.

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BACKGROUND: Teen Prevention Education Program (PEP) is a school-wide, peer-led comprehensive sexuality education program currently implemented in more than 50 schools across 2 states. Many teen pregnancy prevention researchers and practitioners view peer-led programs as a promising approach for reducing teen pregnancy and associated sexual risk behaviors. However, prior research on the effectiveness of these programs indicates mixed results. METHODS: We randomly assigned schools to implement Teen PEP immediately (intervention group) or on a delayed schedule (comparison group) and used propensity score matching to improve the comparability of the study groups. We surveyed students at baseline and about 6 months after the program ended. RESULTS: Teen PEP did not significantly impact rates of sexual activity or unprotected sex; however, the program led to improvements in exposure to information about sexual health topics and knowledge of preventing pregnancy and transmission of sexually transmitted infections. CONCLUSIONS: Teen PEP succeeded in accomplishing some of its most proximal goals, increasing students' access to information and knowledge. However, we found little evidence that the program affects sexual risk-taking within 6 months of its conclusion. Future research will examine the program's longer-term impacts on sexual risk behaviors.

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The reciprocal relationship between health and education has garnered increased attention among public health professionals. The evidence is clear that the level of an individual's education is related to health outcomes in adulthood and that healthier children are more likely to be academically successful than those with health issues. Unpacking and examining various aspects of this relationship is the focus of my 2017 SOHE Presidential Address. The three specific purposes of the presentation are to (a) understand the reciprocal relationship between education and health, (b) understand the characteristics of quality schools and quality school health education, and (c) to review strategies designed to activate school improvement as a public health strategy. In order to examine the relationship, I will address the relationship of social determinants and social justice to the quality of education with special attention to the impact of poverty. In addition, I will present possible reasons behind the linkage of higher educational attainment to better health outcomes, and the impact of health challenges on academic success for school-age children and youth. Finally, I will present characteristics of quality schools including considerations related to quality school health education programs. I conclude the presentation by presenting 11 specific actions for school improvement for consideration by SOPHE members and other public health professionals.

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