Holistic health promotion for adolescent girls in an alternative school setting: Lessons learned

IntroductionTeens in alternative school programs engage in more risky health behaviors (Grunbaum, Lowry, & Kann, 2001) and are at greater risk of obesity (Sherlock, 2011) than teens in mainstream schools. Because healthy students are able to learn better than unhealthy students (Basch, 2011), these health disparities only exacerbate the academic disadvantage that students in alternative schools already experience. Good health supports academic success (Basch, 2011).Meta-analytic evidence suggests that school-based health education programs can reduce obesity and increase positive health behaviors among adolescents (Stice, Shaw, & Marti, 2006). However, almost no studies have assessed healthy lifestyle programs in alternative school set-tings. Alternative schools pose particular challenges and opportunities for health promotion. Studies of other health-related programs such as HIV prevention in alternative schools have shown low levels of success (O'Hara, Messick, Fichtner, & Parris, 1996) and documented a greater number of barriers to implementation compared to mainstream school settings, such as poor attendance rates (Sherlock, 2011) and environmental limitations (Wisner, 2013).Alternative schools-or alternative education programs-provide individualized services for youth who struggle to succeed in traditional schools and who may be at risk for academic failure (Foley & Pang, 2006). Although there is a great need for health promotion in alternative schools, these settings are often overlooked as potential research or program implementation sites for many reasons including the geographic dispersion of students, complicated consent procedures when many students are in foster care, short-term alternative school placements and attrition, and chronic attendance problems (Kubik, Lytle, & Fulkerson, 2004). In fact, many students are referred to alternative schools precisely because of truancy or school anxiety problems that interfere with attendance.In addition, a meta-analytic review of barriers and facilitators for successful implementation of general school-based mental health programs in regular schools found that barriers included low parent engagement, unwieldy logistics, and poor support from administrations and teachers (Langley, Nadeem, Kataoka, Stein, & Jaycox, 2010). Facilitators to successful implementation included having adequate funding, professional support, and positive perceptions of the program (Langley et al., 2010). In a qualitative description study, administrative staff in Minnesota reported that inconsistent student attendance would interfere with the feasibility of conducting health research in alternative school settings (Kubik et al., 2004). However, key informants also identified potential facilitators: attention to building trust and rapport with students, avoiding stereotypical assumptions about students at alternative schools, and minimizing demands on staff time (Kubik et al., 2004).It is increasingly clear that healthy behaviors (e.g., nutrition, exercise, sleep, and positive coping) enable academic success and that compromised health and coping among students at alternative schools can interfere with their academic progress. Nevertheless, few health intervention studies have explored how to best reach this population. To address this gap in the literature, the authors conducted a study to examine the feasibility and acceptability of implementing a holistic healthy lifestyle and body image program among adolescent girls in an alternative school setting. To overcome some of the implementation barriers noted above and to ensure relevance to a challenging population, we incorporated community-based participatory research elements into all phases of the project, as described below.MethodsRecruitment and Sample DemographicsRecruitment Procedure. This study was conducted in a small alternative school setting, designed to serve students in grades six to twelve who struggle to succeed in mainstream schools due to social and behavioral difficulties. …