Journal health of promotion

Journal health of promotion

The role of the Federal Government in promoting health through the schools: report from the Division of Adolescent and School Health, Center for Disease Control

Source: Journal of School Health. 62.4 (Apr. 1992): p135. From Gale Education, Religion and Humanities Lite Package.

Document Type: Transcript

Full Text: 

Statement of Lloyd J. Kolbe, PhD, Director, Division of Adolescent and School Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control, Public Health Service, U.S. Department of Health and Human Services, before the Subcommittee on Oversight of Government Management, Committee on Governmental Affairs, U.S. Senate, November 14, 1991.

Dr. William Roper, Director of the Centers for disease Control, established three priorities for CDC: 1) strengthen the public health infrastructure, 2) emphasize prevention of health problems, and 3) improve child health. We believe comprehensive school health education programs are vitally important to the health and educational achievement of our children. Let me explain why.

Much of the mortality and morbidity suffered today by Americans, young and old alike, is preventable. All of us pay the resulting social and economic costs. Among young people ages 1-24, almost 70% of all deaths are due to four causes: motor vehicle crashes cause 33% of all deaths; other unintentional injuries (formerly called accidents) cause 15%; homicides cause 10%; and suicides cause 10%.

These preventable deaths result from a small number of behaviors usually established during childhood and adolescence. For example, about one-half of all deaths from motor vehicle crashes could be prevented if those involved wore seatbelts. Further, about one-half of all deaths from motor vehicle crashes among teen-agers involved a teen-age driver using alcohol or drugs. Alcohol and drug use contribute enormously to other unintentional injuries as well, and to injuries intentionally inflicted, including homicide and suicide. Thus, though alcohol and drug use may not be listed among the leading causes of mortality and morbidity, these behaviors are certainly major contributors.

Similarly, sexual behavior established during youth often contributes to significant disease, social problems, and now -- since the advent of the HIV epidemic -- death. One million teen-age females become pregnant each year. Five of six pregnancies among 15-to-19 year olds in the U.S. are unintended. In addition, every year 3 million U.S. teen-agers are infected with a sexually transmitted disease. The number of reported AIDS cases in the U.S. among adolescent females ages 13-19 increased a startling 71% from September 1989 to September 1990. AIDS has become the sixth leading cause of death for 15-to-24 year olds. Nearly 20% of AIDS cases have been reported among persons ages 20 to 29. Because of the lengthy period between infection with the human immunodeficiency virus (HIV) and the onset of AIDS, we know a significant proportion of persons acquired the infection in their teen-age years, and those infections result from risk behaviors practiced by teen-agers.

Two health problems are most likely to plague our youth as adults: cardiovascular disease and cancer. Almost 60% of deaths in the U.S. are attributable to these two causes. Three behaviors contribute substantially to these diseases: tobacco use, improper diet (such as excessive consumption of fat), and inadequate physical activity. Patterns for these three behaviors usually are established during youth and continue into adulthood.

CDC INITIATIVES IN SCHOOL HEALTH

CDC is committed to enabling the nation's young people to avoid the risk behaviors described above and the health problems they cause. As evidence of this commitment, in 1988 CDC created a Division of Adolescent and School Health which now employs more than 50 staff to identify priority health risks among youth, monitor prevalence of these risks, support and implement national programs to prevent these risks, and evaluate the impact of national programs.

Preventing HIV Infection

During the past three years, this Division established a coordinated national system involving eight components specifically designed to help young people avoid behaviors that result in human immunodeficiency virus (HIV) infection. The eight components are 1) epidemiological surveillance program; 2) national organizations; 3) state and city departments of education; 4) materials development and dissemination; 5) training and demonstration centers; 6) colleges and universities; 7) youth in highrisk situations; and 8) evaluation. These components enable CDC to work collaboratively with other federal agencies and with many national, state, and local education and health agencies in the public and private sectors. Agencies that serve youth, especially health and education agencies, must work together to be effective in preventing health risks.

Though these components currently exist to prevent categorical risks for HIV infection, they can be used as a model for preventing other important categorical health risks as well. The first component of our national system involves an epidemiological surveillance program to periodically assess prevalence of youth risk behaviors that cause the most mortality and morbidity. These behaviors fall into six broad areas: 1) sexual behaviors that result in HIV infection, other sexually transmitted diseases, and unintended pregnancy; 2) drug and alcohol use; 3) tobacco use; 4) dietary patterns that contribute to disease; 5) insufficient physical activity; and 6) behaviors that result in unintentional and intentional injuries. CDC periodically conducts national surveys of these risk behaviors and also helps interested states and 16 large cities monitor prevalence of these risk behaviors among their high school students.

In addition to risk behaviors, CDC also monitors the extent to which the nation's schools provide health education to prevent risk behaviors in each of the six categorical areas, as part of a planned and sequential, kindergarten through grade 12, comprehensive school health education program. CDC works with several national education organizations to implement this part of the surveillance system.

CDC collaborated with representatives from more than 18 other federal agencies to develop this surveillance program. These agencies are located in the Department of Health and Human Services, Department of Education, Department of Agriculture, Department of Transportation, and Department of Justice. CDC continues to work with these agencies to monitor and report on 26 relevant National Health Objectives for the Year 2000, the Public Health Service Illicit Drug Demand Reduction Plan, and National Education Goal Six concerning safe, disciplined, and drug-free schools.

The second component consists of 23 national organizations and the Indian Health Service. CDC provides fiscal and technical support for these agencies to help schools, and other agencies that serve youth, implement effective HIV education within comprehensive school health education programs. For example, CDC funds and works closely with the National Congress of Parents and Teachers, National Association of State Boards of Education, Council of Chief State School Officers, American Association of School Administrators, and many others. The third component consists of every state, four territorial, and the 16 large city departments of education, supported by CDC, to help schools implement programs to prevent HIV infection and other important health problems. These departments of education work directly with CDC, and with the national organizations described above to: 1) develop HIV prevention policies, curricula, and education materials; 2) train teachers to implement HIV education; and, 3) assess the extent to which schools provide HIV education and the extent to which students engage in behaviors that result in HIV infection and other related health problems.

The fourth component facilitates development and dissemination of HIV education materials for youth. As one part of this component, CDC, in collaboration with other federal agencies and 12 national education and health organizations, developed and disseminated "Guidelines for Effective School Health Education to Prevent the Spread of AIDS." CDC currently is working with various federal agencies and national organizations to develop "Guidelines for Effective School Policies and Programs to Prevent Tobacco Use," and "Guidelines for Effective School Nutrition Education," respectively. CDC disseminates information about HIV education materials through the electronic Combined Health Information Database, and through an electronic Comprehensive Health Education Network.

The fifth component includes three national training and demonstration centers that help state and local officials learn how to implement state-of-the-art HIV education programs in their respective states and cities. This component also includes centers in 24 states that train teachers to implement comprehensive school health education curricula that include HIV education.

The sixth component enables the nation's colleges and universities to prevent HIV infection among their students. In each of five states, CDC supports a lead university that provides technical assistance and training to enable other colleges and universities throughout the state to develop HIV prevention education programs.

The seventh component helps local health departments that serve the nation's largest cities to prevent HIV infection among runaway and homeless youth, migrant youth, juvenile offenders, and other youth in high-risk situations. CDC implemented this component in consultation with the Administration for Children and Families and the Office of Substance Abuse Prevention.

The eighth component evaluates, and consequently improves, efforts described to prevent risks for HIV infection among youth. CDC is conducting research to evaluate the extent to which schools are implementing HIV education, and the extent to which students consequently reduce behaviors that result in HIV infection.

The existing eight components of this national system can be used as a model to prevent risks for important health problems other than HIV. These risks often are inter-related. For example, the same behaviors that cause HIV infection also cause other serious sexually transmitted diseases and unintended pregnancies. These sexual behaviors often are influenced by alcohol and drug use. Alcohol and drug use, in turn, are associated with unintentional injuries that result, for example, from motor vehicle crashes, as well as with intentional injuries, including homicide and suicide. Likewise, we cannot provide effective HIV prevention education without comprehensively addressing these other behaviors that increase the risk of HIV infection. Similarly, tobacco use, diet, and physical activity are inter-related. These risks and consequent health problems also significantly impede the educational achievement of our youth and contribute greatly to our accumulating health care costs.

Additional Initiatives

CDC conducts other programs and activities that influence the health of our young during infancy, preschool years, childhood, and adolescence. Many of these activities are conducted in collaboration with schools. For example, CDC monitors health risks (such as tobacco, alcohol, and drug use) that cause infant deaths, birth defects, developmental disabilities, and low-birth-weight babies. Since 1963, CDC has provided grants to state and local health departments to support childhood immunizations programs. Through these programs about 8.7 million children are immunized each year. CDC supports childhood lead poisoning prevention programs in 15 states and cities. CDC also is developing model health standards for day care centers. CDC has published guidelines (in collaboration with teachers, parents, community leaders, and law enforcement officials) for the control and prevention of suicide clusters. CDC also is developing guidelines for youth violence prevention programs.

To combat the alarming incidence of sexually transmitted diseases among youth, CDC provides fiscal and technical support to help state and local health departments prevent, diagnose, and treat sexually transmitted diseases. State and local health departments work with departments of education to help schools implement sexually transmitted diseases prevention education programs.

CONCLUSION

CDC is committed to working closely with the nation's schools to help implement planned and sequential, kindergarten through grade 12, comprehensive health education programs. To be effective, these programs must focus on preventing risk behaviors in each of the six areas: tobacco use, drug and alcohol use, diet, physical activity, sexual behaviors, and behaviors that result in unintentional and intentional injuries. However, these categorical efforts should be planned, implemented, and coordinated within a more comprehensive framework. Further, if efforts to prevent these health risks among youth are to be effective and efficient, we must combine the health expertise and health resources of health agencies with the necessary organizational capacity and policies of education agencies. Neither health nor education agencies can do the job alone. Both need each other.

Schools can do much more than implement comprehensive school health education to improve the health of our youth, and their consequent educational achievement. As stated in Healthy People 2000: National Health Promotion and Disease Prevention Objectives:

Other aspects of the school environment can also  be important to school health. State and local health  departments can work with schools to provide a  multidimensional program of school health that  may include health education, school-linked or school-based health services designed to prevent,  detect, and address health problems, a healthy and  safe school environment, physical education,  psychological assessment and counseling to promote  child development and emotional health, school site  health promotion for faculty and staff, and integrated school and community health promotion efforts.

Many agencies actively support school health programs. The U.S. Department of Education awards grants to support comprehensive school health education demonstration programs. Secretary Sullivan's School Readiness Initiative will help schools improve the health of youth. The Ad Hoc Committee on Health Promotion Through the Schools serves a useful function by convening federal agency representatives every other month to discuss school health programs. Several states and cities are implementing innovative approaches. But much more needs to be done. It only can be done if public and private sector health and education agencies at the national, state, and local levels work together.

IMPLICATIONS OF NURSING
 Identification of priority health risks among youth, monitor the prevalence of support, risk and implement national programs to prevent this risk, and evaluate the impact of national programs.
            CDC doing other programs and activities that affect health during young infants, preschool years, children and adolescents. Much of this activity is done in collaboration with the school. For example, CDC monitors health risks (such as tobacco, alcohol, and drug use) that cause infant mortality, birth defects, developmental disabilities, and low birth weight infants.
            And to do with nursing itself, journaling is more specific in the treatment and prevention of a risk to the continuity of human life deases more controlled.
To be effective, these programs should focus on prevention of risky behaviors in each of six areas: the use of tobacco, drugs and alcohol, diet, physical activity, sexual behavior, and behaviors that result in unintentional injuries and intentional. However, categorical efforts should be planned, implemented and coordinated in a more comprehensive framework. Furthermore, if efforts to prevent health risks among youth should be effective and efficient, we must combine the expertise and resources of health health health agencies with the necessary organizational capacity and policy institutions. Both health and educational institutions can do the job alone.

Source Citation

"The role of the Federal Government in promoting health through the schools: report from the Division of Adolescent and School Health, Center for Disease Control." Journal of School Health 62.4 (1992): 135+. Gale Education, Religion and Humanities Lite Package. Web. 9 Nov. 2011.

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