How School Healthy Is Your State? A State-by-State Comparison of School Health Practices Related to a Healthy School Environment and Health Education

In the United States, more than 55 million young people are enrolled in elementary and secondary schools.1 Because young people attend school about 6 hours a day approximately 180 days/year, schools are in a unique position to help improve the health status of children and adolescents. School health programs and policies may be one of the most efficient ways to prevent or reduce health-risk behaviors among students, which in turn, can prevent serious health problems.2 The Centers for Disease Control and Prevention (CDC) has issued science-based guidelines documents that identify policies and practices schools can implement to improve critical student health-risk behaviors.3–7 In addition, CDC has released tools designed to help schools implement effective health promotion and safety policies and practices identified in its guidelines.8–10 To understand the extent to which effective school health policies and practices are being implemented in schools, it is critical to monitor them. To accomplish this, CDC collaborated with state and local education and health agencies to develop and implement the School Health Profiles (Profiles) surveillance system.11 Profiles is a system of surveys that collects data from school staff in representative samples of schools in states, territories, large urban school districts, and tribes. Results provide useful information not only for the nation as a whole, but also for individual jurisdictions. Specifically, education and health agencies use Profiles data to describe school health policies and practices in their jurisdictions, identify professional development needs, plan and monitor programmatic efforts, support health-related policies and legislation, seek funding, and garner support for future surveys.12 Profiles data also are used as a primary measure of accountability for state and local education agency programs that are funded by CDC to reduce the prevalence of health-risk behaviors among students by increasing the proportion of schools that implement science-based school health policies and practices. CDC scientists have worked closely with leading school health experts to identify key school health policies and practices recommended by CDC guidelines and implementation tools that can be monitored through surveys of school staff such as Profiles. The scope of the surveys was kept somewhat narrow to limit their length, thereby reducing respondent burden and enhancing the chances of obtaining a high response rate. Therefore, Profiles does not measure all possible aspects of school health programs, but instead, focuses on specific areas that agencies are funded by CDC to address, including health education; promotion of physical activity, healthy eating, tobacco-use prevention, and sexual health; the prevention of human immunodeficiency virus (HIV) and acquired immunodeficiency syndrome (AIDS); asthma management; and family and community involvement in school health programs. Beginning in 1994, Profiles surveys have been conducted every even-numbered year. After each Profiles cycle, CDC creates a detailed report of results for each participating state, territory, large urban school district, and tribe. In addition, CDC publishes a compilation report for each cycle’s data. These reports contain complete results from every jurisdiction that had response rates of 70% or greater and documentation that enabled their data to be weighted. For the 2010 cycle, this report contained 193 pages, including 48 tables.13 Each table provides the percentage of secondary schools in each jurisdiction with a particular school health policy or practice in place. Minimum, maximum, and median percentages also are provided. This information helps state, territorial, and local agencies and tribal governments understand how their jurisdiction compares with others on specific school health policies and practices. The purpose of this study was to develop, for the first time, composite measures of critical Profiles results and use them to rate each state with weighted data on their overall performance in getting schools to implement effective health policies and practices. This rating provides states with a simpler understanding of the strength of multiple components of their school health program efforts and how their efforts compare with those of other states. State agencies can use this information to promote overall program strengths and advocate for resources to address weaknesses. On the national level, such information helps guide technical assistance to particular states or regions of the country. This analysis focused on 2 of 3 traditional components of school health: healthy environment and health education. The third traditional component, health services,14 was not included. Although the Profiles surveys contain a few items related to health services, they do not cover it in sufficient depth to warrant having it as its own component. Rather, the items related to health services have been incorporated into healthy environment.