Comprehensive School Health Project : Gwinnett County Schools

                                                      Data Analysis and Interpretation

                                                              Discussion of Sample:

Data was collected over a three year period at 48 elementary, 16 middle, and 14 high schools. Descriptive data analysis was conducted at a group level. Some data was described at elementary, middle, and high school stratifications. Selected variables comprised a variety of assessments including personal health, personal improvement, and comprehensive school health. Additional data was collected from students to describe youth risk behaviors, youth perceptions of risk, and youth health education interests. The purpose of the project was to first document change in health status of school personnel then document change toward a more comprehensive school health program at participating schools, and to subsequently influence a change in youth risk behavior.

Sub-sample compatibility:

Schools identified different school personnel to participate each year in project training sessions. Two completely different groups of individuals participated in the first two years of training All schools were represented each year. Fifty two percent (52%) of the school personnel attending third year training had participated in the project at their school for two consecutive years.

To ensure that these three groups were similar in health related risk at pre-assessment, comparison of data from the personal health assessment was compared among the first, second, and third year school personnel groups. A mean of the first two groups on four selected variables was calculated and a standard deviation identified between the mean of these first two groups and the third group. This data is described in Table 1.

TABLE 1: SAMPLE COMPATIBILITY

            Item                 Group 1                Group 2                   Mean                Group 3         sd. 

High Blood Pressure

            31%   

            20%

            26%

            26%

.0

Family History of Chronic Disease

            79%

            77%

            78%

            77%

.7

Suicide Ideation

             3%

             1%

             2%

             1%

.7

Heavy Drinker

             4%

             3%

             4%

             3%

.71

 

                              Project Impact on Health Status of Participating School Personnel:

The measure of individual impact was calculated from pre-post health assessment scores of all three school personnel groups. A mean of the first and second group pre-test scores was calculated. A mean of the first, second and third group post-test scores was subtracted from the mean of the pre-test scores. Percent change was then calculated to measure positive or negative impact. Data is described in Table 2. All numbers in Table 2 represent percentage. Year one and year two pre- test samples were 300 and 309; year one, two and three post-test samples were 157, 167, and 150.

TABLE 2: MEASURE OF PERCENT CHANGE IN PERSONAL HEALTH ASSESSMENT

       Item              1Pre 1Pst 2Pre 2Pst 3Pst MPe Mpt  %Ch

No Blood Pressure check

 8

 6

 9

 5

 2

 9

 4

50%

No self-exam

66

74

74

73

75

70

74

-6%

Smoke cigarettes

16

 5

 6

 5

 3

11

 4

64%

No aerobic exercise or recreation

66

62

62

61

61

64

61

 5%

Poor food choices

33

34

35

33

26

34

31

 9%

15% or more overweight

32

34

29

31

25

31

30

 3%

30% or more overweight

17

15

14

13

15

16

14

13%

Don't wear seat belt

27

 5

 8

 5

 3

18

 4

78%

Drive while drinking or using drugs

14

 8

10

10

 8

12

 9

25%

Feel highly stressed

47

55

54

55

57

51

56

-10%

Not enough sleep

49

50

58

51

47

54

49

 9%

Anxiety interferes with performance

72

69

75

69

65

74

68

 8%

Depression

52

36

46

37

33

49

35

29%

 

Participants at pre-assessment rated higher for health risk behaviors including :

            (1) not participating in enough exercise (pre=64,post=61);

            (2) not having enough sleep (pre=54, post=49);

            (3) anxious to degree which effects performance (pre=74,post=68); and

            (4) feeling depressed (pre=49,post=35).

Factors 1-3 tend to produce factor 4 outcome (depression). A moderate effect on participants' report of feelings of depression (29% change) was documented at post-assessment. Even though participants seem to be reducing feelings of depression by getting more sleep and coping better with anxiety, their level of external stress has increased. Participants may be more aware of their personal stressors, and as they become more skilled in applying coping strategies, it is predicted that they will experience less stress.

Participants at post-assessment demonstrated greatest behavior change in:

Wearing seat belt                                  78%

Reducing cigarette smoking                    64%

Regular blood pressure checks               50%

Less feeling of depression                      29%

Less driving and drinking                        25%

Reduction in those 30% or                     13%

more overweight

Participant Report of Factors Effecting Goal Achievement:

(Pearson correlation coefficient of the pre-assessment group was .66; post-assessment group was .5)

            All three groups (1995- 1997) selected improving fitness/activity level as their number one             improvement goal;

            65% reported achieving half or more of their goal with 10% fully achieving their goal;

            All three groups identified self-motivation and determination as the main factor helping them          to reach their goal (.47, moderate participant correlation) followed by knowledge/skill and     support of family/friends;

            All three groups identified work/professional responsibilities as the main barrier to achieving          their goal (.49, moderate participant correlation) followed by family obligations.

                                                  Description of Wellness Conferences:

All conferences were conducted during the summer of 1995, 1996, and 1997. The first two conferences promoted personal health assessment with instruction relevant to skill development and application to promote personal health behavior change. The third conference encouraged participants to use previously learned health knowledge and skills in addressing student health compromising behaviors.

Comparison of top nine training workshops with the six major areas of change identified in Table 2:

Out of thirty two (32) workshops presented by the project in the first two years, nine (9) received evaluation scores of 80% or above by participants. These top nine (listed alphabetically) include:

                        CPR Certification

                        Health and Humor

                        Journaling:A method of coping

                         Laughter for Life

                        Mental Health:Coping with anxiety, stress, and depression

                        Project Adventure: Trust,cooperation,support

                        Roadmap to Financial Wellness:Reducing Money Stress and Anxiety

                        SAFE: General Safety Issues

                        Walking Wellness:Exercise, Weight Management

The top six behavior changes can be related to the top nine workshops suggesting that school personnel participants became more aware of methods for promoting personal wellness.

                        78%     Wearing seat belt (safety issues)

                        64%     Avoiding smoking  (cardiovascular risk factor; CPR training)

                        50%     Checking blood pressure regularly (cardiovascular risk factor; CPR training)

                        29%     Reducing depression (mental health, humor, journaling, trust, support)

                        25%     Avoiding combining driving with alcohol and/or other drug use (safety issues)

                        13%     Reducing obesity (walking wellness, anxiety reduction, mental health)

                                          Project Impact on Comprehensive School Health:

Project impact on comprehensive school health was measured by use of a standard school assessment instrument completed by a committee of project participants at each school. One form per school was submitted for analysis. Unit of analysis was conducted at the elementary, middle, and high school levels. Pre-assessment and post-assessment scores represent the grand mean of scores from schools within each group (elementary, middle, high school). The pre-assessment was completed in year one and the post-assessment in year three. Pre and post scores were calculated on percent of positive and negative responses on a total of 125 items. Positive responses included ratings 1 or 2 while negative responses included ratings 4 or 5 on a likert scale of 1-5 with 1 being most positive, 3 being neutral, and 5 being most negative. Percent change was calculated for pre\post test scores. Table 3 demonstrates this data. Additionally, percent change was calculated for each of the nine sub-sections of the instrument.

TABLE 3: PROJECT IMPACT ON SCHOOL AS MEASURED BY PERCENT CHANGE ON                          SCHOOL ASSESSMENT

   Grade Level                 Pre-assess     Post-assess      % Change

   Elementary

   N=44

  (pre & post)

77 (positive)

23 (negative)

75 (positive)

25 (negative)

   -3%

   Middle

   N pre  = 13

   N post = 16

67 (positive)

33 (negative)

71 (positive)

29 (negative)

    6%

   High School

   N pre  = 11

   N post = 14

67 (positive)

33 (negative)

73 (positive)

27 (negative)

    9%

 

Impact on Elementary Level: 92% Response Rate Pre and post scores represent percent of positive scores.     

            Sub-Sections                                         Pre                               Post                  % Change

            School Site Health                                 33                                 44                     33%

            School Health Environment                    82                                 91                     11%

            Coordination with Community                 62                                 63                     2%

            CARE Team support                             56                                 56                     0%

            School Physical Education                      94                                 94                     0%

            Counseling                                            80                                 80                     0%

            School Health Services                          87                                 81                     -7%

            School Health Instruction                       74                                 68                     -8%

            School Nutrition                                    67                                 56                     -16%

Interpretation of Elementary level data: The high percent change in school-site health (promotion of faculty wellness) is a predicted outcome of the project's major emphasis of faculty wellness. An additional change was identified in the school health environment suggesting an extension of a specific faculty focus to a more general school environment focus.

School system emphasis on reading skills, extensive curriculum changes, and renewed emphasis on testing during the second and third years of the project appears to have diverted school attention away from issues of school nutrition, school health services, and school health instruction. Project staff believe that prevention and support services were not changed at the elementary school level because elementary level educators continue to perceive children at low risk. An increased utilization of available community resources will promote a more effective comprehensive school health program at the elementary level.

 

Impact on Middle School Level: 91% Response Rate

 

            Sub-Sections                                         Pre                               Post                  % Change

            School Health Services                          62                                 75                     21%

            School Health Environment                    73                                 86                     18%

            School Health Instruction                       89                                 95                     7%

            CARE Team support                             56                                 56                     0%

            School Physical Education                      79                                 79                     0%

            School-site health                                  44                                 44                     0%

            Coordination with community                 50                                 50                     0%

            Counseling                                            73                                 73                     0%

            School nutrition                                     33                                 22                     -33%

 

Interpretation of Middle School level data:  Middle schools tended to be less teacher focused and more student focused in their school health programs when compared with elementary schools. Middle schools demonstrated similar emphasis on school health services and school health environment. This is consistent with project emphasis on the increase in social/health risk behaviors among middle school students and the need to provide prevention/intervention services within a supportive school environment. The increase in health instruction demonstrates the project emphasis on promoting self-efficacy (health risk reduction skills) among middle school students. Further attention needs to be given to the utilization of and coordination with community health resources, CARE team programs, and school-based counseling services. The school nutrition program needs to be evaluated for its level of involvement within the comprehensive school health program at the middle school level.  

Impact on High Schools: 90% Response Rate

            Sub-Sections                                         Pre                               Post                  % Change

            Coordination with community                 50                                 75                     50%

            School nutrition                                     33                                 44                     33%

            School-site health                                  44                                 56                     27%

            CARE team support                              56                                 67                     20%

            School health services                            62                                 69                     11%

            School health environment                      73                                 73                     0%

            School physical education                       79                                 79                     0%

            Counseling                                            73                                 73                     0%

            School health instruction                         89                                 84                     -6%                 

 

Interpretation: High school personnel tend to perceive the CARE team as a vehicle to more effectively prevent/intervene health compromising behaviors and therefore participate in a higher degree of coordination with community health resources. As did the elementary and middle level, the high school level demonstrates support for and inclusion of a school site wellness approach for school personnel.     

                         General Discussion of Project Impact on Comprehensive School Health:

When comparing impact among elementary, middle, and high school levels, the following statements can be made:

            1. All three levels ranked school site health as most important;

            2. Negative impact on school health instruction was noted for both elementary and high school when attention was 
               diverted away from school-site health (school personnel) to curriculum health inclusion;

            3. Middle school level demonstrated a 7% positive change in health instruction validating earlier assumptions that middle
                school faculty tend to be more student focused in their comprehensive approach to school health making them more
                partial to apply risk and protective factors to their health instruction;

            4. At the elementary and high school level, it is important to equally emphasize school-site health/wellness and classroom
                 health instruction (an equal faculty and student focus) in order to provide an effective program.   

                                      Third Year (1997) Conference Participant Perceptions

Attendance:

            Elementary: 217 (64%)

            Middle:      71 (21%)

            High:        50 (15%)

Participant Demographics:

            Administrators ( 56% represented middle school level)

            Counseling/social work (56% represented elementary level)

            Food Service/clinic/secretary (67% represented elementary level)

            Para professionals (96% represented elementary level)

            Special education ( 63% represented elementary level)

            Teachers (58 % represented elementary level, 27% represented middle school level, and

            14% represented high school level)

Note: Since youth risk behaviors tend to increase during middle school, having a majority of middle school administrators attending the third year conference potentiated the possible impact of anticipated conference outcomes at the local school level.

Years Experience of Participants:

            70% represented school personnel who had participated in the conferences both years

                        52% had participated for 2 years

                        18% had participated for 1 year

            30% represented school personnel who were participating for the first time

Participant Report of Further Use of Conference Information :

A. 93% reported that they shared information gained from the conferences with their students; this is a 79% increase from pre to post assessment within a two year period

            Participants reported sharing nutrition information (59%), fitness strategies/skills (43%), and stress
            management/relaxation (38%) with their students (.33, minor participant correlation)

            Classroom activities was the main method for sharing information with their

            students ; this is a 57% increase from pre to post assessment within a two year period

            Three resources participants identified to continue improving health education for their students: (.66, high participant
             correlation)

            Audio-visual resources this is a 231% increase from pre to post

            Guest speakers this is a 59% increase from pre to post

            Health education internet addresses (35%)

 B. 93% reported that they shared information gained from the conference with their faculty; this a 34% increase from pre to
      post

           Participants reported that they shared information on stress management/relaxation (54%), nutrition information skills
           (50%), and fitness strategies/skills (45%) [.5, moderate participant correlation]

            Note: These three areas are congruent with the participant health improvement goals.

            Participants reported that their most frequent method for sharing this information with their faculty was through informal
            conversation ( .53, moderate participant correlation)

            Two resources participants identified to continue improving the health and wellness of faculty/staff; (.7, high participant
            correlation)                          

            Guest speakers this is a 44% increase from pre to post

            Staff development (39%)

Participant Perceptions:

Health Related Factors WhichImpact Student Learning:  

All three levels [elementary (41%), middle (36%), and high (40%)] perceived physical activity as the most important health factor that can impact student learning;

All three levels [(elementary (19%), middle (31%), and high (31%)] perceived volunteerism and community involvement as the second most important health factor that can impact student learning; 

Student Benefit of Physical Activity and Volunteerism/Community Involvement:

All three levels identify mental, physical, and social well-being as the number one benefit of both factors;

All three levels identify increased academic success as the second benefit of both factors;

Middle school level identified internal assets (self-efficacy skills) as another benefit of both physical activity and volunteerism/community involvement; 

High school level identified sense of purpose in future as another benefit of both physical activity and volunteerism/community involvement.

Analysis of the Student Interest Survey (Health)

Students representing eight (57%) of fourteen Gwinnett County High schools completed a student interest survey (Health specific) developed by Sandra Owen, SANO Consulting. Through the use of a four item student questionnaire and a simple matrix, health lesson topics can be identified which are of interest, relevance, and age/stage appropriate. Such a process in planning health lessons increases students' motivation toward health and wellness and promotes their participation in class activities.

Three categories emerge from student responses to the survey.

            1. Category One includes health content areas that students rate as high interest and importance and about which they
                already know a lot. Topics which fall into this category are best used  as booster lessons.

            2. Category Two includes health content areas which students rate as low interest and importance and about which
                they know very little. Usually topics in this category are not ge/stage appropriate and should be taught at a more
                appropriate time. However, some topics may represent health risks for which the student does not feel vulnerable.
                The teacher must use judgement in this category to select health risk behavior topics for which the
                students fail to perceive as harmful to them. These topics are best used as regular health lessons.

            3. Category Three includes health content which students rate as high interest and importance and about which they
                know little. This category forms the initial basis for health lesson development.

TABLE 4: STUDENT INTEREST MATRIX

Health Topic

Interest

Importance

Knowledge

Category

Alcohol and other drugs (1)

 57 (1)

   54 (1)

  a lot

category 1    

Internal assets (2)

 90 (2)

  119 (3)

  little

category 3

Sex activity (3)

 94 (3)

  75 (2)

  little

category 3

Suicide (4)

115 (4)

 121 (4)

  little

category 3

Car Safety (5)

129 (5)

 142 (6)

  lot

category 1

Tobacco (6)

136 (6)

 140 (5)

  little

category 2

Dificits (7)

164 (8)

 143 (7)

  little

category 2

External assests(8) 

151 (7)

 150 (9)

  little

category 2

Nutrition (9)

166 (9)

 146 (8)

   little

category 2

Physical Activity (10)

246 (10)

 178 (10)

   little

category 2

Interpretation of Table 4:Student Interest Matrix

            Category One Topics : Possible booster lessons

                        Alcohol and Other Drugs

                        Driving Safety

            Category Two : Possible lessons for a more appropriate time

                        Deficits

                        External Assets

            Category Two: Possible lessons specific to risk behaviors for which the student does not feel
            vulnerable.These can follow the initial health lessons.

                        Tobacco use

                        Nutrition: Eating Disorders

                        Physical Activity for a Life-time

            Category Three: Initial health lessons

                        Risk and Protective factors for Suicide

                        Internal Assets (pro-social behavior)

                        Sexual activity

                        Youth Risk as Determined by Survey and Self-Report

High school youth participating in the Gwinnett Co. program self-reported the following risk and protective factors:

                  Protective                                                   Risk

Attitudes towards risk-taking are low (.56 of 3)   Socially active (2.2 of 3)

Positive view towards school (1.45 of 3)             Sex with 3 or more partners (10%)                    

Negative attitude towards drug use (3.29 of 4)    13% pregnant; 52% report they don't know much about sex

Parent social support (6.18 of 9)            

Moderate level of physical activity (57%)

56% report regular religious attendance             

 

Low involvement in delinquency (1.42 of 5)                    

Risk areas identified in the Youth Risk Survey appear to be similar to the areas students identified in the Interest Survey. The Category Three topics relate to the risk factors identified for this group (Internal assets and sexual activity). The inclusion of physical activity (from category two) as an add-on lesson is important for this group.  

By combining the results of student self-report from both the Youth Risk Survey and the Student Interest Survey, curriculum planners will be more effective in developing the sequence of health lessons for this high school group. Student interest is central to knowledge construction and motivation toward behavior which acts upon such knowledge.

                                                            Gwinnett County Schools

                Description of Comprehensive School Health Program/ Wellness Conference Impact

                                                           January 1995 - June 1997

                                         Funded through the U.S. Department of Education  

                                                               Report Prepared by:

                                                                 Sandra Lee Owen

                                                        SANO Educational Consulting

                                                                 Project Directors:

                                                                 Suzanne Brighton

                                          Safe/Drug-Free Schools, CARE Team Consultant

                                                                      Christi Kay
               
                                                CoOrdinator, Health and Physical Education