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The COVID-19 pandemic has had far reaching effects on school communities, which will continue to affect the teaching profession for years to come. As K-12 teachers worked to meet the educational, social, emotional and health needs of students and families, their personal well-being was taxed. It is critical to understand the experiences of K-12 teachers during the COVID-19 pandemic and to leverage this understanding to develop effective strategies for supporting K-12 teachers in the future. This research leveraged data from the School Staff Health and Wellness Study to examine teachers’ well-being and career outlook during the COVID-19 pandemic. The central hypothesis was ‘adverse work environment factors during the COVID-19 pandemic would have significant effects on teachers’ well-being and future career plans.’ In the first study, the association between K-12 teachers’ satisfaction with their technological training and their well-being during Fall 2020 was evaluated. Following a mixed methods design, ANCOVA tests were used to compare means of scores on validated measures of stress, anxiety, depression, well-being and sleep among teachers who were satisfied with their technology training, unsatisfied with their training and who did not receive technology training. To complement quantitative analyses, content analysis was conducted to understand the breadth of responsibilities teachers assumed in Fall 2020. Participants’ responses to the following open-ended question were analyzed: “When preparing to teach in Fall 2020, what else did you have to do?” The majority (88%) of participants reported having to learn new technology yet approximately half (54%) felt unsatisfied with the training they received. When compared with teachers who were unsatisfied with their technology training, those who were satisfied with their training were less anxious, depressed, stressed, had lower sleep disturbance, and scored higher on measures of well-being. The second study focused on evaluating the association between teachers’ work environment and plans to continue teaching. A multivariable logistic regression model was fit to data describing teachers’ working conditions and future career plans. Results suggest that 27% of teachers were considering leaving the profession in Fall 2020. The following five factors were associated with teachers considering leaving their profession: low satisfaction with COVID-19 related decision making (aOR=2.50), poor mental health (aOR=2.31), lower levels of supervisor support (aOR=1.88), significant job duty changes (aOR= 1.51), and greater fear that a household member would contract COVID-19 (aOR=1.37). In the third study, trends in teachers’ well-being throughout the COVID-19 era were evaluated. Longitudinal analysis of teachers’ scores on validated measures of stress, anxiety, depression, well-being, and sleep disturbance was undertaken. Findings indicate that from Fall 2020 to Spring 2022, average anxiety, depression, stress and sleep disturbance decreased among teachers as overall well-being scores improved. Access to supervisor support and normalization of working hours to pre-pandemic levels were associated with improved well-being. Concurrently, the percentage of teachers who were teaching remotely dropped from 30% to 1% respectively. Concurrently, approximately 20% of teachers reported “poor” mental health. From Fall 2020 to Spring 2022, the percentage of teachers who endorsed plans to continue teaching fell from 73% to 67%. In conclusion, this dissertation aimed to enhance understanding of the impacts of the COVID-19 pandemic on K-12 teachers’ well-being and career plans. Ultimately the goal of this work is to guide policies and interventions to foster resilient and supportive school communities. Understanding the experiences of K-12 teachers during the COVID-19 pandemic is critical to effectively supporting members of school communities amid future challenging circumstances.

Medical emergencies occur every day in school settings across America. School nurses have a vital role in providing care for individuals experiencing a medical emergency and leading a multidisciplinary team during a medical emergency event. Since incidences of medical emergencies are commonplace, it is standard to have protocols and guidelines for these events. To address this concern, an evidence-based practice project was implemented in a rural school district in North Georgia. The pilot project was developed and implemented to assess the effectiveness of implementing a “Medical Emergency Chain of Command Protocol.” The protocol was developed to improve the effectiveness and efficiency of multidisciplinary communication during a medical emergency in the school setting. The Health Service Department team members were given a preimplementation and postimplementation assessment to evaluate the protocol’s effectiveness and a preeducational and posteducational survey to assess the effectiveness of an educational in-service to improve the team member’s knowledge about using a chain of command. The pilot study was conducted over a 60-day implementation period. After thorough data collection and analysis were completed, the results showed that implementation of a medical emergency chain of command protocol in the school setting positively impacts multidisciplinary communication during and after a medical emergency event in the school setting.

The Centers for Disease Control and Prevention (CDC) recommends the Whole School, Whole Community, Whole Child (WSCC) Model, developed jointly with the Association for Supervision and Curriculum Development, as a multi-level approach designed to improve students’ health. The model has been used to inform HIV, STDs, and pregnancy prevention programs, but not specifically for childhood obesity. This study aims to determine the degree schools are implementing the six modules of the WSCC model that align with theoretical obesity prevention programs and each module’s relationship to obesity in Ohio middle school students aged 14-16.

The school nurse (SN) is often the sole health care expert in the school setting, providing for the physical and socio-emotional needs of others. SN may be exposed to reports of trauma, a widespread and costly public health issue. This study sought to explore the experience of the SN when exposed to reports of trauma from those in their care. Seven N.J. certified school nurses participated in two online interviews via Microsoft Teams, spaced one to two weeks apart between June 2021 and September 2021. Interviews were recorded & transcribed verbatim and thematic analysis applied. This study found that SN receive reports of trauma to varying degrees, with those in high-poverty urban settings relaying more frequent exposure than those in suburban settings. The SN identified the health office as a safe haven where students are welcome, accepted as they are, can share concerns, and seek comfort from their ailments.SN reported challenges working within the school model, and experienced obstacles to receiving reports of trauma including a lack of school-based collaboration, a lack of understanding of the SN role, and SN workload. In the eye of the storm, while receiving traumatic reports, SN focus on immediate needs. Later, while mitigating the aftermath, they process the experience and apply coping strategies, such as self-care and social support, to restore and replenish. While weathering the storm, they share concern and frustration, but acknowledge that they can only do so much. The SN in this study did not demonstrate secondary trauma but instead shared stories of resilience. Effects of the COVID-19 pandemic on the SN receipt of reports of trauma were explored. Further research is needed regarding the role of the SN, SN workload, and their experience in receiving reports of trauma.

This dissertation consists of two studies. Study One investigated the relationship between workload, mindfulness, and psychological detachment for preservice teachers. Study Two investigated the joint effects of psychological detachment and social support on preservice teachers’ health and professional engagement.Study One AbstractBackground: Work recovery researchers have called for studies that investigate mindfulness as an ancillary moderator of the stressor-detachment model. Purpose: This study investigated the relationship between workload, mindfulness, and psychological detachment for preservice teachers. Method: Preservice teachers completed an online survey of work experiences and well-being. To answer the research questions, data from a subsample (n = 175) were analyzed with hierarchical linear and logistic regression models. Results: Participants perceived their workloads to be lighter when they did not live at home with family (p = .036). Those in serious relationships were 1.87 times more likely than those who were not in serious relationships to spend more than 21 non-school hours on teaching-related work each week (p = .046). Mindfulness was lower for preservice teachers at Northeastern schools compared to all other regions (p = .018). Having a heavier workload decreased preservice teachers’ psychological detachment (p < .001), but mindfulness did not moderate the relationship (p > .05). Discussion: This study provides evidence of differences in preservice teacher workload and mindfulness based on familial commitments and geographic location. Findings also suggest higher workloads have a negative impact on detachment capacity, but mindfulness does not moderate this relationship. Further research is needed to inform effective stress reduction and stress management interventions for early career teachers. Study Two AbstractBackground: Psychological detachment and social support seem to be competing buffers of the stressor-strain relationship but may jointly affect worker well-being. Purpose: This study investigated the effects of psychological detachment and social support on preservice teachers’ health and professional engagement. Method: Preservice teachers completed an online survey of work experiences and well-being. To answer the research questions, data from a subsample (n = 235) were analyzed with descriptive statistics, nonparametric correlations, and hierarchical linear regression models. Results: Participants reported better-than-average general health and professional engagement. However, they also spent an average of 15.60 of the past 30 days in poor health, 5.36 of which were due to poor physical health and 10.24 of which were due to poor mental health. In addition, they experienced health-related activity limitation during 5.95 of the past 30 days. Professional engagement was negatively correlated with days of poor mental health (p < .01) and total unhealthy days (p < .05). Psychological detachment was a statistically significant predictor of activity limitation (p = .039) and engagement (p < .001). Social support and the detachment-support interaction term were not statistically significant predictors for health or engagement (all p > .05). Discussion: This study offers foundational insights into preservice teachers’ health and professional engagement and provides evidence of a relationship between detachment, health, and engagement. Additional research is needed to identify effective strategies for enhancing preservice teachers’ career commitment and well-being.

Abstract: Lifestyle behaviours, including diet, physical activity, sleep, and sedentary behaviour, have been shown to be associated both with health outcomes, including childhood obesity, and academic achievement in children and youth. The improvement of these lifestyle behaviours to prevent chronic disease is an important public health priority. In addition, academic success for children is an important target for public health as educational attainment is a key social determinant of health and supports good health across the lifespan. Schools are an ideal place to implement initiatives to improve children’s lifestyle behaviours. However, further evidence is needed to justify that investments in children’s healthy lifestyle behaviours are also investments in academic success, and that health promotion in school environments does not detract from, but instead complements, the mandate of schools. The aim of this thesis is to investigate the relationship of diet, physical activity, sleep, screen usage, and body weight status with academic achievement. This aim was addressed through four research objectives, aligned into five research questions. The objectives consisted of assessing the relationship between lifestyle behaviour recommendations and academic achievement taking into consideration socioeconomic factors, assessing the independent and combined importance of meeting recommendations for lifestyle behaviours, and discussing considerations for the assessment of the relationship between physical activity and academic achievement. To achieve these objectives, I employed data from three, population-based surveys of children and youth from Alberta, Nova Scotia, and Canada-wide. Two of these surveys were linked to standardized exam performance while the Canadian survey had students self-report their academic achievement. I found that adherence to established recommendations for a healthy diet, particularly for sugar intake, physical activity, screen usage, and sleep were positively and strongly associated with better academic achievement. Children who met recommendations for free sugar intake scored almost 4% better on their academic exams compared to children who did not. In Nova Scotian children, the combined effects of adhering to all of these guidelines had a stronger association with academic achievement than the whole of their individual effects. Students who met the highest number of healthy lifestyle behaviour recommendations had up to three times the odds of meeting expectations on their exams compared to children who met the lowest number. This thesis generated novel evidence to demonstrate that adherence to healthy lifestyle behaviour recommendations are strongly associated with better academic achievement in children and early adolescents, regardless of body weight status or soecioeconomic status. This thesis generates three key recommendations for public health. First, free sugars intake among children is a key health promotion target to both improve the health of children and improve their academic achievement. Based on my findings, if all children in Alberta met the recommendations for free sugars intake, 1.4% more students would meet the Acceptable Standard on standardized exams in Language Arts, and 0.3% more would meet it in Math. In addition, 0.5% more students would meet the Excellence Standard in both Language Arts and Math. Currently, Alberta Education is committed to increasing the number of children who meet each of these standards by 0.2% each year for the next three years. Working towards the reduction of free sugars intake of Albertan students would easily meet these institutional goals with added health benefit. Secondly, this thesis demonstrates the importance of the promotion and adherence to healthy lifestyle behaviour guidelines for children. I also recommend the inclusion of free sugars guidelines in the next version of Canada’s Food Guide to complement existing Canadian guidelines for diet, physical activity, sleep, and screen usage. Third, the evidence from this thesis demonstrates that school-based health promotion to improve the lifestyle behaviours of children will benefit the academic success of all children regardless of their socioeconomic or body weight status. I recommend the broader implementation and evaluation of effective school-based health promotion initiatives in Canada. In particular, further implementation of initiatives taking a Comprehensive School Health approach and rigorous evaluation of their impact on students’ academic achievement is merited given the compelling evidence generated by this thesis.

Abstract: School health policies establish nutrition standards for schools and provide guidelines for the operation of a health-focused school environment. Little research has been conducted to understand implementation of school nutrition policies, and even fewer studies have assessed policy implementation in Aboriginal schools. Historical, cultural, and societal differences between Aboriginal and non-Aboriginal schools may play an important role in the adoption and implementation of health and wellness policies and practices in First Nation communities. The present thesis utilized a community-based participatory research approach to generate a school staff-focused perspective of school nutrition policy implementation in a First Nation community school in Alberta. The research was an evidence-based process evaluation that aimed to understand policy implementation strategies by investigating staff perceived facilitators and barriers of policy implementation, as well as the relationship between staff eating habits and policy implementation. A concurrent triangulation mixed methods approach utilized results of a quantitative survey and qualitative interviews to understand school staff perceptions. Themes derived from the qualitative interviews were woven and integrated with the statistical frequencies derived from a quantitative survey; subsequently a comprehensive set of findings was presented to the community school research committee for review and interpretation. Significant enabling factors for policy implementation were found to be the school environment, administrative and personnel support for the school nutrition policy, and preceding foundational health programming. An innovative facilitator of policy implementation was the identification of the school as a role model for First Nation community members, for example in leading health initiatives, providing a place for nutritious food and physical activity opportunities, and as a health resource for all community members. The health behaviours of school staff played a role in policy adoption. Staff members who self-rated their diets as above average were more likely to agree with policy tenets and to perceive fewer barriers to school nutrition policy implementation. Barriers to school nutrition policy implementation such as inconsistent policy implementation by staff and parents’ lack of awareness of policy can be respectively addressed by increased staff nutrition education opportunities and improved communication avenues with families of students. An unanticipated barrier was a perceived discordance between the foods served at First Nation cultural events such as bannock or wild game and federally derived policy nutrition standards such as those of Canada’s Food Guide that emphasize a low-fat diet. Staff members spoke to the perceived conflict between public health initiatives to promote appreciation for Aboriginal traditional foods with public health messaging that also encouraged Canadians to reduce saturated fat intake, which would be present in traditional foods such as wild game. In conclusion, staff’s personal healthy practices, perceptions of the school nutrition policy and support for the policy were significant influencing factors for the adoption and implementation of school nutrition policy, and therefore are also important factors for student, family, and community health. The conclusions presented encourage consideration of First Nation wellness perspectives in policy development, and inclusion of traditional foods and cultural activities as part of a First Nation school nutrition policy.

Introduction Decreasing chronic absenteeism is one of the Hawaiʻi State Department of Education (HIDOE) Strategic Plan’s primary target goals as attendance is a prominent indicator of academic success. Some of HIDOE’s schools have over a 30% chronic absenteeism rate. School-based health initiatives can help address this critical issue. National guidelines recommend one school nurse per 750 children in the public school system. Hawaiʻi DOE schools serve over 180,000 students for which there are only eight nurses on campuses throughout the state. The evidence is clear that school based health services are effective, but there is a lack of research on which models are best in improving academic outcomes and fiscal solvency. Business planning is an essential element to success. The purpose of this project was to design a business model to inform sustainable development of a school based health services program for the Waianae Nanakuli Complex Area located at Nānāikapono Elementary School in order to decrease health related absenteeism and early dismissal rates, and over time lead to improved student academic outcomes. The logic model was used as the conceptual framework. Methods The three main activities of this project included a needs assessment, business planning, and evaluation of the resulting business plan. Once completed, the business plan was evaluated utilizing quantitative and qualitative methods by community healthcare experts selected by the core project team. Target goal was an evaluation score of >80%. Results The business plan contains ten sections, including a comprehensive financial analysis. Evaluation of the business plan draft resulted in an aggregate score of 86%. Results were compiled, reviewed and applicable changes made. The final draft of the plan, which met our criteria for success, is included in the results section. Discussion The School Based Health Services Program model designed can be expanded to reach an entire HIDOE complex area, serving 70% more children and adolescents than a standalone clinic, while increasing fiscal sustainability. The business plan will be used to guide expansion to the remaining HIDOE complex areas contributing to the effort to keep Hawaiʻi’s keiki healthy and ready to learn.

School based health clinics provide medical services and healthcare to students within the school setting. Research suggests that students who use school based health clinic services perform better academically in school by improving their attendance, health status, and addressing their medical needs. This retrospective study explored the relationship between school based health clinics and academic performance in elementary school-aged children. Academic performance was measured using students’ final grades, New Jersey Assessment of Skills and Knowledge (NJ ASK), and Language Arts Literacy (LAL) scores. Students were tracked longitudinally from grades 3-5 comparing students who used an onsite school based health clinic versus those who did not use an onsite school based health clinic. Results explore relationships between school based health clinic users versus school based health clinic non-users as well as differences between school based health clinic users and non-users. These findings suggest that having an onsite school based health clinic may improve academic performance in elementary school-aged children.

Purpose. The purpose of this study was to evaluate the impact of the Institutes for Higher Education (IHE) Academy, a professional conference intended to train school health education faculty in the use of online resources available through the Centers for Disease Control (CDC), and to facilitate the integration of these resources into school health teacher preparation programs. Methods. This was a mixed methods study with two data collection phases. The quantitative phase involved the use of an online survey designed to determine the number of changes made within participants’ school health teacher preparation programs. All school health faculty members who attended an IHE Academy were recruited via e-mail to participate (N = 151). After three rounds of reminder e-mails, an acceptable participation rate was reached (68%). Descriptive statistics were used to analyze survey data. In the qualitative phase, all participants who completed the online survey were recruited to participate in a follow-up phone interview (n = 103). The follow-up interview was tailored for each participant based upon their survey responses, and was designed to elicit examples of program changes made as a result of attendance at the IHE Academy, as well as benefits and barriers to change. A total of 54 interviews were conducted and recorded. Recorded interviews were transcribed and coded. An inter-rater coded 15% of the transcripts to ensure inter-rater reliability. Qualitative data was triangulated with each participant’s survey data. Results. The majority of IHE Academy attendees made significant changes to their teacher preparation programs, and subsequently trained an estimated 2,800 pre-service school health educators in the use of the CDC’s online tools and resources. Through participant outreach, more than 7,000 school health faculty and in-service K-12 health educators were also trained.Conclusions. The IHE Academy is an effective and sustainable approach to improving the quality of K-12 school health education.Recommendations. To further improve the effectiveness of the IHE Academy, program planners should recruit increased numbers of school health graduate students who plan to work in teacher preparation in order to increase their return on investment. Program planners should also consider mandating participation in an online community that could provide guidance and continuing support for IHE Academy attendees.

As the percentage of school children with chronic conditions such as diabetes continues to rise, funding for school nurses to keep those students healthy and safe is decreasing. This dissertation includes three studies: (1) a systematic review of the literature on the role and impact of American elementary school nurses, (2) a focus group study that further examined the role of Kentucky school nurses and described their reaction to a new regulation that necessitates delegation of diabetes-related nursing tasks to unlicensed assistive personnel (UAP), and (3) a quantitative study that examined Kentucky school nurses’ past behaviors and future intentions regarding the delegation of diabetes-related tasks. A systematic review of the literature revealed that activities of school nurses can be conceptualized into four major areas: (a) health promotion and disease prevention; (b) triage and treatment of acute issues (e.g., injuries and infectious diseases); (c) management of chronic conditions; and (d) psychosocial support. School nursing activities are associated with increased attendance, higher quality schools, and cost savings. Focus groups in three regions of Kentucky found that Kentucky school nurses fulfill the same major roles as their counterparts across the nation, and face similar challenges such as lack of time, limited resources, language barriers, and communication issues with families. School nurse participants described their biggest impact on students as identifying and addressing students’ physical and psychosocial barriers to learning. While recent legislation was passed in Kentucky necessitating the delegation of insulin administration to UAP, school nurses had not experienced many changes at the time of the focus groups. However, some nurses said that their districts were not planning to delegate insulin administration and intended to keep a nurse in every school. Others appreciated the prospect of having more trained staff in schools to recognize signs of distress in chronically ill students. A statewide survey of 111 Kentucky school nurses indicated that nurses’ past delegation behaviors and future intentions related to delegation are rooted in the level of skilled decision-making that must occur and the risk to the student if the wrong decision is made. Unfortunately, school nurses’ intentions to delegate higher-stakes tasks (e.g. carbohydrate counting, insulin dose verification, and insulin administration) were significantly stronger than their support for (attitude related to) delegation of those tasks, which is disconcerting both for the safety of students as well as for the liability retained by delegating nurses. This disparity between support and intentions indicated that school nurses anticipate that they will have to delegate certain tasks to UAP despite their discomfort with delegating them, most likely due to high workload and lack of resources. Additional studies should be undertaken to determine the impact of legislative changes on the delivery of school health services in Kentucky and other states, particularly once school districts and nurses have had adequate time to adjust to new laws. Such studies should investigate to whom nurses are delegating health services, what tasks are being delegated, and the extent and process of training that UAP receive. Future surveys should utilize perceived behavioral control items that assess situational control (e.g. policy, workload) over delegation rather than, or in addition to, efficacy of individual skills required for delegation of nursing tasks. Researchers must further explore the discrepancies between attitude and intentions; that is, why are nurses planning to delegate tasks to UAP if they do not support the delegation of those tasks? Kentucky school nurses are champions of health promotion for children, not only in their provision of health services and health education, but also in the area of school health policy. School nurses should train UAP so that more school staff can recognize signs of distress in students with diabetes, but at the same time should continue to advocate and seek funding for a nurse in every school with the help of the Every Student Succeeds Act.

Study One Abstract:Background: Steroid use is an increasing health issue among adolescents. Purpose: This study investigated steroid use among 9th through 12th grade students in the Greater Cincinnati area. Methods: A total of 38,414 students completed the PRIDE Questionnaire, which examined steroid use and other drug use. Results: A total of 2.6% of students reported using steroids in the past year. Steroid use (past year) was significantly most common among males, juniors/seniors, African American adolescents, and Hispanic adolescents. Parent and school factors were significantly associated with past year steroid use, while sport participation was not significantly related. Having high levels of parental rule setting regarding substance use were associated with decreased odds for past year steroid use. Similarly, adolescents at schools with clear/consistent rules and enforcement regarding substance use were at decreased odds for past year steroid use. Such findings varied based on sex, grade level, race, and ethnicity. Students who reported that teachers frequently discuss the dangers of substance use were at an increased risk for past year steroid use. Discussion: Several risk and protective factors for steroid use were identified and as such should be addressed in prevention programs. Initiatives to reduce risk of steroid use should incorporate parental and school factors. Special attention is warranted for Hispanic and African American adolescents. Further examination of the potential relationship between context of sport participation and adolescent steroid use is needed.Study Two Abstract: Background: School violence, school victimization and suicidal ideation are serious public health concerns among adolescents. Purpose: The present pilot study investigated the association between adolescent steroid use and school violence, school violent victimization and suicidal ideation. Methods: A secondary data analysis of the 2014 PRIDE Questionnaire was performed based on information collected from 38,414 high school adolescents from the Greater Cincinnati area. Results: Results indicated higher than average rates of school violence (32%), school violent victimization (29%), and suicidal ideation (32%). Logistic regression analyses indicated that steroid use was directly related to school violence, school violent victimization and suicidal ideation in the previous year. Additionally, adolescents who were male, Freshman/Sophomore, and in a minority group were at greatest risk for engagement in school violence. African American, Hispanic and younger adolescents were at increased odds for school violent victimization. Minority students and females were at greatest risk for suicidal ideation. Discussion: Findings from this study may be beneficial to health professionals, schools and prevention specialists and could be used when developing comprehensive prevention efforts for adolescents.

Abstract: Canadian school jurisdictions have adopted health promotion policies and guidelines as part of a broader comprehensive strategy to address childhood obesity, but there is limited research that has investigated how these “naturally occurring” population level interventions have influenced changes in school environments and student behaviours. Following the dissemination of various policies and initiatives related to health promotion in schools, the Province of Nova Scotia (NS) offered a case for research inquiry to describe how recent provincial policies were implemented. The purpose of this research was to provide contextual understanding of the adoption, implementation and impact of health promotion policies and practices in NS. Quantitative research was employed to describe provincial trends in children’s nutrition behaviour and weight status and to assess school practices across NS schools. Qualitative methods provided context on the processes that influenced implementation using a case study approach. From the quantitative analysis, although there were some improvements in diet quality, energy intake and healthy beverage consumption of children over time, there was no significant effect observed on body weight. Furthermore, schools reported greater adoption of curriculum-related practices, rather than practices that could foster comprehensive (i.e. holistic) approaches to school health. Contextual information from the qualitative case studies provided critical insight to understanding policy, organizational and individual outcomes. Schools that were stimulated by jurisdictional vision and provided with relevant resources and support exhibited processes that facilitated adoption of health promotion policies. Commitment, leadership and a supportive school culture was also found to be important to help schools overcome barriers to implementation. Overall, the contextual focus of this research provided a comprehensive account of health promotion policy implementation to advance the effectiveness and dissemination of population-level interventions in schools. Considering the multifaceted behavioural and social structural influences of obesity, illuminating this context in population-level interventions is critical to improve implementation and the overall impact on population-level weight status. Fostering collaboration between health and education sectors and establishing a broad system for support is essential to develop an understanding of the mutual benefit between health and learning and to progress the adoption, implementation and sustainability of school health initiatives.

Public health policies profoundly shape individuals' embodied sense of self as well as the organization of resources by discursively constructing identities, knowledge, power and risk. For health and organizational communication scholars, understanding how policy discourses are developed, legitimized, and implemented are salient concerns. I engage these issues through a case study of the Deerfield Local School District's School Health Advisory Committee (SHAC). Formed in response to federal policy mandates, the SHAC's mission is to improve the district’s health environment. Specifically, I investigated how the committee communicatively organized resources for health amidst local exigencies and material conditions. I employed interpretive research strategies including participant-observation, in-depth interviews, and document analysis to collect discourse from SHAC members and stakeholders. Additionally, I gathered insights from students served by the Deerfield SHAC using participatory sketching. I analyzed the data using poststructural feminist and narrative theories. My interpretation of the discourses centered around five themes: participants' definitions of health, the paradoxes of committee membership, members' narrative sense-making of resistance and power, the absence of particular stakeholders' voices in SHAC narratives, and narrative challenges for sustainable organizing. My analysis of the SHAC's discourse highlighted how members legitimized the committee’s organizing practices by framing parents from a deficit-oriented perspective, and shifting attention away from social determinants of health. I describe how assumptions about stakeholders’ values and health literacy were further invoked in narratives that naturalized the exclusion of specific voices, such as parents and children, from the SHAC. Then, I narrate the tensions between symbolic-material concerns that emerged from SHAC meetings and conversations with members about the committee's practices. Finally, I outline practical implications for the SHAC and describe the study's limitations and areas for future research.

The purpose of this study was to identify the factors that significantly influence the attitudes and perceptions of high school health education teachers relative to HIV prevention instruction. Despite a steady decrease in the number of diagnosed cases each year, HIV/AIDS continues to rank as one of the leading causes of illness and death in the United States. Individuals between the ages of 13 and 19 years are particularly vulnerable for HIV transmission, as evidenced by the steady increase in the number of reported infections in this age group over the past decade. Underlying this trend is a growing lack of awareness, a decreasing perception of vulnerability and a general lack of accurate knowledge regarding HIV/AIDS among adolescents and young adults in the United States. The CDC, along with a number of researchers in sexuality education, recommends that education about HIV prevention is most appropriate and effective when executed within the context of a comprehensive school health education program that establishes a foundation for understanding the relationships between personal behavior and health. While the CDC’s 2006 School Health Policies and Practices study indicates that 31 states require instruction in HIV prevention, research indicates that there is great variability between states and individual districts in the provision of the requirements for the certification, licensure, and training in sexuality education of the teachers providing that instruction. The population of interest in this study was high school health education teachers in public school systems in the United States. A systematic random sample of 800 high school health education teachers representing states with mandates requiring instruction in HIV prevention and states with no such requirements was selected from a list of public high schools derived from the Common Core of Data (CCD) of the United States Department of Education’s National Center for Educational Statistics database. An a priori power analysis, for external validity of the results, suggested a sample size of 374 completed surveys based on a 5% sampling error and 50/50 split in responses for a population of 11,250 schools. Sample size was determined based on alpha at .05, the effect size at .20 and 90% power. Based on response rates of studies with similar populations, a total of 800 surveys were sent to lead health education teachers in the selected high schools. Seventy-nine surveys were undeliverable, leaving a potential sample size of 721. A total of 362 high school health education teachers (50%) responded. While there is almost complete agreement (99%) among respondents in this study that HIV prevention instruction is needed, the results of this study indicate that there is significant variance in outcome expectations, efficacy expectations, perceived barriers and benefits, and attitudes of high school health education teachers about teaching HIV prevention. The factors in this study that emerged as most significantly influencing the attitudes and perceptions of high school health education teachers about teaching HIV prevention were related primarily to teacher preparation and training and the number of years of experience teachers had teaching health education. The presence of a state mandate requiring HIV prevention instruction was significantly associated with higher efficacy expectations and more perceived benefits by high school health education teachers, but did not appear to have significant influence in relation to practices in the classroom. Characteristics of high school health education teachers that were significantly related to attitudes, perceptions and instructional practices included the age, gender and race/ethnicity of the instructor. The findings of this study are consistent with and affirm findings from previous studies that have emphasized the significance of teacher preparation and training relative to teachers’ perceptions, attitudes, perceived benefits and barriers, and efficacy and outcome expectations, which ultimately influence student outcomes. Findings from this study also indicate the need to further investigate certain teacher characteristics, such as race/ethnicity, age, experience level, and gender to determine the extent that those variables may influence curricular content and instruction.

The mission of schools and the mission of health promotion are interdependent. The promotion of positive health behaviors and the adoption of basic health knowledge and health skills are fundamental public-education outcomes. Healthy children are ready to learn, and being healthy requires education and practice. By embedding the eight components of Coordinated School Health (CSH) into the notion of a school, schools can provide the structure, systems and environment which support children’s health and learning. A broad-stroke assessment of a school’s current health programs and health services will demonstrate this connection between learning and health. Foregrounding the connection that exists between health and learning will reinforce the need for a school to coordinate a health-promoting framework to enhance student learning.The purpose of this study was to conduct an asset and needs assessment of health programs and services; implement or improve programs, services or policies which would enhance CSH; and evaluate the process of the assessment and implementation, in one elementary school. This study was only the beginning of an ongoing, multi-year process of assessment, implementation and evaluation moving this school toward complete and comprehensive CSH. Using CSH as the “gold standard,” Participatory Action Research (PAR) provided a holistic approach for assessment and built both relationships and collaboration among the school’s stakeholders for sustainable change. The participants were students, teachers, staff, parents, volunteers and the school board. The determination of which assessment tools to use and how to interpret and utilize data were shared decisions among all participants. Over the course of one school year, the study moved through three distinct, yet overlapping and cyclical phases—assessment, implementation, evaluation. The participants selected the School Health Index (SHI) as the tool with which to initiate the assessment. Conducting the SHI and understanding CSH “gave the structure” upon which to build services and to reinforce the school's existing policies. The school environment and the student needs are now grounded by CSH, and its Wellness Council is empowered and ready to implement changes for students’ health and achievement.This study found that the holistic, comprehensive nature of CSH was reinforced through the process of assessment, implementation and evaluation with involvement from multiple stakeholders. The participants' experience replicated what others have previously found: Support from the principal and the school board must first be secured and then nurtured throughout the process; a “champion” for school health is essential to a successful CSH initiative; the champion may be a member of the outside community or may be a formal health coordinator. Additional lessons from this study which other schools may also apply include: Invite all stakeholders and work for full participation; conduct a whole-school assessment of health initiatives; connect the students’ health needs to the school’s mission; keep a record of meetings, programs and ideas; reflect on the process of each meeting or program; conduct formative and summative evaluation; take action based on these reflections and evaluations; and finally, publicize and celebrate accomplishments.

Background: This study analyzes local wellness policies of 176 Georgia public school systems. The purpose of the study was to analyze potential relationships between demographic characteristics of Georgia school systems and compliance with the Child Nutrition and WIC Reauthorization Act of 2004, as well as the strength of wellness policy goals in the areas of nutrition, physical activity, and other school-based activities. Methods: Demographic data from the Georgia Department of Education were used as independent variables. Compliance ratings and the strength of wellness policy goals were derived from an evaluation tool developed by a research team at Georgia State University’s Institute of Public Health as part of a project contracted by the Georgia Department of Education. Analysis was conducted using Pearson’s correlation (two-tailed), crosstabulation, and linear regression. Results: Statistically significant positive associations were found between academic performance and strength of overall wellness policy goals (p < .05), as well as goals in the areas of nutrition education and other school-based activities (p < .01). Economic status of the student population was found to be positively associated with the strength of nutrition education goals (p < .05). No statistically significant associations were identified between demographic characteristics of school systems and physical activity goals. No associations were identified between involving community stakeholders in wellness policy development and having more comprehensive wellness policy goals. Conclusions: This study found statistically significant evidence of districts with stronger academic performance having more comprehensive overall wellness policy goals and stronger goals specifically in the areas of nutrition education and other school-based activities goals. Findings should assist the Georgia Department of Education in allocating its limited resources to help school systems improve wellness in public schools throughout Georgia. Recommendations are made to strengthen federal and state policy regarding school wellness, to conduct more research regarding the influence of community involvement on school wellness, and to provide guidance to local school systems having less resources and lower student academic performance in order to ensure health disparities are not further exacerbated.

Background: HIV is increasingly prevalent among youth in the US. Objective: To assess the impact of HIV/AIDS education on health-risk behaviors associated with HIV infection in the state of Georgia. Methods: Descriptive analyses of the 2005 Georgia Student Health Survey were conducted by cross-tabulating the presence of HIV/AIDS education and each of the health-risk behaviors of interest. In addition, a survey with a sample of metro Atlanta health educators that assessed ASK US was conducted and analyzed. Results: The percentage of Georgia high school students that had ever been taught about AIDS or HIV infection in school was 91.8% (n = 1,547).The only self-reported risk factor that appeared to have a relationship with HIV/AIDS education was binge drinking (p = 0.0060). Results of the health educator survey demonstrated that ASK US is a good HIV/AIDS education tool. Conclusions: Although HIV/AIDS education is widespread, the prevalence of various health-risk behaviors remain high and, therefore, different models of HIV/AIDS education may be called for.

Since the inception of the 1974 Education for all Handicapped Children legislation, the number of students referred and placed in special education has been steadily rising. The largest increase is in the learning disabilities category. With the reauthorization of the Individuals with Disabilities Education Improvement Act of 2004 and the federal requirements for schools under the No Child Left Behind law, schools are required to take a closer look at their rising special education numbers and identify alternative solutions for children's needs other than a certain placement in special education. There are different levels of variables that influence a teacher's decision to refer a student to special education. This study aimed to understand the mesosystem school variables that influence this process. Using two scales, the Organizational Health Inventory for Elementary Schools (OHI-E) and the Collective Efficacy Scale (CE-Scale) this study used purposive sampling to survey ten elementary school faculties in a large suburban district in Virginia. LD prevalence rates were collected for all elementary schools in the district. Data was analyzed to answer the following questions: (a) How does school organizational health correlate with the number of students referred to special education in a given school? (b) How does collective teacher efficacy correlate to the number of students referred for special education services? The overall return rate for the survey was 87% with 490 teacher surveys completed. Teachers did not have many teaching years in their buildings. Teachers with twelve or more teaching years experience were more likely to refer students to special education. Collective teacher efficacy scores were correlated to school health scores but not to LD prevalence rates. Higher institutional integrity was seen in smaller schools. Title I schools did not correlate with higher LD prevalence rates. Two variables predicted referrals to special education; years teaching in combination with teacher efficacy resulted in greater referrals to special education. The findings of this study may aid educational leaders in making sound changes within school environments to affect the school's LD prevalence rate, addressing particularly teacher efficacy and referral habits of more experienced teachers.

การศึกษาครั้งนี้เป็นกรณีศึกษาเกี่ยวกับ 1) บทบาทปัจจุบันและบทบาทที่คาดหวังของผู้เกี่ยวข้อง ในการดำเนินงานอนามัยโรงเรียน ได้แก่ โรงเรียน ผู้ปกครอง ศูนย์สุขภาพชุมชน และองค์กรปกครอง ส่วนท้องถิ่น 2) องค์ประกอบของผู้มีส่วนเกี่ยวข้องในการดำเนินงานอนามัยโรงเรียน 3) กิจกรรมการ ดำเนินงานอนามัยโรงเรียน และ 4) ปัญหาอุปสรรคในการดำเนินงานอนามัยโรงเรียน กลุ่มตัวอย่างคือ ผู้บริหารโรงเรียน ครูอนามัยโรงเรียน ผู้ปกครอง เจ้าหน้าที่สาธารณสุข และเจ้าหน้าที่องค์กรปกครอง ส่วนท้องถิ่นในพื้นที่อำเภอบางปะอิน จังหวัดพระนครศรีอยุธยา เก็บข้อมูลโดยการสนทนากลุ่ม วิเคราะห์ ข้อมูลส่วนบุคคลโดยใช้สถิติบรรยาย และวิเคราะห์ข้อมูลจากการสนทนากลุ่มโดยการวิเคราะห์เชิงเนื้อหา ผลการศึกษาพบว่า บทบาทที่คาดหวังของผู้บริหารโรงเรียน ครูอนามัยโรงเรียน ผู้ปกครอง เจ้าหน้าที่ สาธารณสุข และเจ้าหน้าที่องค์กรปกครองส่วนท้องถิ่นในการดำเนินงานอนามัยโรงเรียน สูงกว่าบทบาท ที่ปฏิบัติจริงในปัจจุบัน ผู้บริหารโรงเรียน/ครูอนามัยโรงเรียน เจ้าหน้าที่สาธารณสุข แต่ละคนรับรู้งาน อนามัยโรงเรียนไม่ครบทุกกิจกรรม เมื่อรวบรวมคำตอบของทุกคนจากทุกฝ่าย จึงครอบคลุมครบทุก กิจกรรม แต่ก็ยังปฏิบัติได้ไม่ครบถ้วน ส่วนผู้ปกครองและเจ้าหน้าที่องค์กรปกครองส่วนท้องถิ่นรับรู้งาน อนามัยโรงเรียนไม่ครบทุกกิจกรรมเช่นกัน กลุ่มตัวอย่างมีความคิดเห็นว่า ผู้มีส่วนเกี่ยวข้องกับงาน อนามัยโรงเรียนควรประกอบด้วย ผู้บริหารโรงเรียน ครูอนามัยโรงเรียน ครูทุกคนในโรงเรียน ผู้ปกครอง เจ้าหน้าที่สาธารณสุข เจ้าหน้าที่องค์กรปกครองส่วนท้องถิ่น นักเรียน ชุมชน วัด และสำนักงานการประถมศึกษา ปัญหาและอุปสรรคในการดำเนินงานอนามัยโรงเรียนคือ ขาดงบประมาณ ผู้มีส่วนเกี่ยวข้องขาดความรู้ ขาดการประสานงาน ขาดความร่วมมือ ขาดการประเมินผลการดำเนินงาน ครูอนามัยโรงเรียนและ เจ้าหน้าที่สาธารณสุขมีภาระงานมากจนไม่สามารถดำเนินงานอนามัยโรงเรียนได้อย่างมีประสิทธิภาพ ตามที่ถูกคาดหวัง ผลการศึกษามีข้อเสนอแนะ ดังนี้ 1) ควรมีการประชุม เพื่อทำข้อตกลงร่วมกันเกี่ยวกับ บทบาทในการดำเนินงานอนามัยโรงเรียนเพื่อให้เกิดการประสานความร่วมมือของทุกภาคส่วนอย่างมี ประสิทธิภาพ 2) ครูทุกคนในโรงเรียน ตลอดจนนักเรียนและผู้ปกครองควรมีส่วนร่วมในงานอนามัยโรงเรียน และ 3) นำข้อมูลจากการศึกษาไปประกอบในการพัฒนารูปแบบการดำเนินงานอนามัยโรงเรียนที่พึงประสงค์ ให้เหมาะสมกับบริบทของพื้นที่