hronic

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hronic

isease

otes &

eports

otes &

eports

National Center for Chronic Disease Prevention and Health Promotion

Volume 14 • Number 1 • Winter 2001

Special Focus:

School Health

Inside

Reducing the Burden of Chronic Disease:

•

Commentary............. 2

•

Coordinated School

Promoting Healthy Behaviors Among Youth

Health Programs

Make a Difference .... 6

•

Secretaries Send Youth

Physical Activity Report

to the White House . 10

•

Reaching and Protecting

Young People .......... 14

•

Asthma: 10 Million

School Days Lost

Each Year ................. 18

•

Michigan Gets Moving

With PE Curriculum 19

•

Utah’s Unique

Approach to School

Health ...................... 20

•

Gold Medal School

Project Guides Health

Policies .................... 21

•

Healthier Smiles:

Children’s Oral

Health ...................... 22

•

Study Will Strengthen

School Health Policies

and Programs .......... 24

n February, the top TV show

Survivor

activity and fruit and vegetable consump-

•

How States Are Using

reached more than 29 million

tion and reduce tobacco use among youth,

YRBSS Data ............. 26

viewers in one night—a huge audi-

we would be well on our way to a healthier

•

CDC Supports

ence—yet, every school day, our nation’s

future in this nation,” said Lloyd Kolbe,

International School

Health Activities ...... 31

teachers beat that rating, reaching 53

PhD, Director, Division of Adolescent and

million children, each with a survival

School Health, NCCDPHP, CDC.

•

Media Campaign

Planned.................... 32

challenge. Taught to make healthy choices,

Risk Behaviors Lead to Major

these children improve their chances, not

•

cdnotes .................... 32

Chronic Diseases

only to survive, but to thrive into healthy

adult and senior years. CDC recognizes the

Cardiovascular disease, cancer, and diabe-

U.S. DEPARTMENT

school years as an ideal opportunity to

OF HEALTH AND

tes, which cause more than 70% of all

reduce the impact of chronic disease and

HUMAN SERVICES

deaths in the United States, are rooted in

Centers for Disease

risky behaviors by promoting healthy

Control and Prevention

lifestyles. “If we could increase physical

O NTI NU E D

PA G E

Fall 2000

Special Focus:

Cancer

Commentary

Schools Could Help Prevent

Lloyd J. Kolbe, PhD

Cardiovascular Disease,

Director, Division of Adolescent

and School Health

National Center for Chronic Disease

Cancer, and Diabetes

Prevention and Health Promotion

Centers for Disease Control and Prevention

n every state of our nation, cardiovascular disease

and implement effective policies and programs to

(CVD), cancer, and diabetes are responsible for

prevent health problems. These strategies are 1)

about two-thirds of all deaths, widespread ill-

monitoring critical health events and school policies

nesses, enormous health care costs, and extensive

and programs to reduce those events;

human suffering. Much of the morbidity and mortal-

2) synthesizing and applying research to improve

ity from these three diseases results from four risk

school policies and programs; 3) enabling constituents

factors that usually are established during youth:

to help schools implement effective policies and

tobacco use, unhealthy diet, inadequate physical

programs and 4) conducting evaluation research to

activity, and obesity. Once these often interrelated risk

improve policies and programs. CDC will use these

factors become established during childhood, they are

strategies to enable the nation’s schools to simulta-

difficult to modify during adulthood. Unfortunately,

neously prevent risks for CVD, cancer, and diabetes,

by the time they graduate from high school, 40% of

especially among populations with a disproportionate

our nation’s students smoke cigarettes, 73% don’t eat

burden of these diseases—notably, African Americans,

enough fruits and vegetables, 43% don’t engage

Hispanics, and Native Americans.

regularly in vigorous physical activity, and 25% of our

In this issue of

Chronic Disease Notes & Reports

, you

children and adolescents already are overweight or at

will read about some current efforts, including the

risk of overweight.

groundbreaking

President’s Report on Physical Activity

; a

Each generation of Americans attends school for 13

youth media campaign that will target middle school

of the most formative years of their lives. Carefully

youth with health messages; and school health activi-

designed and coordinated school health programs—

ties in Michigan and Utah. Also, we will share how

including school health education, school food

the coordinated school health programs model works.

service, and school physical education—could reduce

Improving the education and health of all children

these risk factors among the 53 million young people

within our own communities and across the globe—

who attend school each year, especially if school

and especially disadvantaged children—will present

programs are integrated with related community

opportunities and challenges. Purposeful and focused

efforts.

collaborations among public and private national,

A wide range of public and private national, state,

state, and local health and education agencies could

and local agencies are interested in working with

enable the nation’s 117,000 schools to establish the

schools to reduce one or another of these risk factors

kinds of polices and programs that would significantly

separately. During the past decade, CDC has institu-

reduce the burden of chronic diseases among future

tionalized four strategies that can help schools and

generations of Americans.

these agencies efficiently and collaboratively identify

cdnr

Special Focus:

School Health Programs

Promoting Healthy Behaviors

Top 10 Physical Activity, Nutrition,

Among Youth

and Tobacco-Use Prevention Priorities

O NTINU E D

F R O M

PA G E

for Schools

risk factors that are usually established

during youth: tobacco use, unhealthy diet,

1. Assess school’s physical activity, nutrition, and tobacco-

inadequate physical activity, and obesity.

use prevention programs and plan for improvement

Once poor health habits are adopted, they

(i.e., use CDC’s

School Health Index

are difficult to change. Data show that

2. Review and improve school’s physical activity, nutrition,

many young people are already at risk for

and tobacco-use prevention policies (i.e., use the

serious chronic diseases and premature

National Association of State Boards of Education’s

Fit,

death: 70% of high school students have

Healthy, and Ready to Learn

tried smoking at least once, 71% do not

3. Use research-based health education curriculum.

attend daily physical education classes, and

4. Establish an active School Health Council, with involve-

25% are overweight or at risk of becoming

ment from representatives of all components of the

overweight. Addressing these factors

Coordinated School Health Program.

through coordinated school health pro-

5. Implement quality wellness program for school staff

grams could improve health, spare lives,

and for students and their families.

and reduce the burden on our economy

6. Implement quality physical education programs.

and health care system as this generation

7. Increase opportunities for physical activity in addition

reaches adulthood.

to physical education and interscholastic sports

(e.g., recess, intramurals, clubs, fitness trails, and walking

Partners Help CDC Prevent

to school).

Chronic Disease

8. Implement quality school meals programs.

CDC is providing support to three state

9. Establish a healthy school nutrition environment

professional organizations as part of a new

(e.g., healthier food choices outside of school meals).

chronic disease prevention initiative: the

10. Establish tobacco-free schools.

Society of State Directors of Health,

Physical Education, and Recreation

(SSDHPER), the Association of State and

Territorial Chronic Disease Program

disease, cancer, and diabetes. CDC is also

Directors (ASTCDPD), and the Associa-

working with the American Heart Associa-

tion of State and Territorial Directors of

tion and the American Cancer Society to

Health Promotion and Public Health

build effective national approaches to

Education (ASTDHPPHE). CDC’s

reduce chronic disease health risk behav-

formalized collaboration with these

iors among young people. The new

organizations and others, including the

initiative is intended to help the nation’s

American Heart Association and the

schools implement effective tobacco-use

American Cancer Society, should help

prevention, physical activity, and nutrition

bolster resources and coordinate efforts at

programs that can prevent or reverse

the state and national levels to support

unhealthy patterns before they take hold in

school health programs. CDC recently

students’ lives. “By working together, we

hosted a meeting with representatives from

are able to reach a broad range of health

SSDHPER, ASTCDPD, and

professionals to improve chronic disease

ASTDHPPHE to develop plans to equip

prevention and health promotion and have

school health programs with strategies and

a greater impact on the health of our

tools to reduce the risk of cardiovascular

nation’s youth,” commented CDC health

Winter 2001

Special Focus:

School Health Programs

scientist Pete Hunt, MEd, MPH.

based guidelines for school health pro-

grams on how to promote physical activity

National Plan to Improve

and healthy eating and prevent tobacco

Adolescent and School Health

use. (See “Top 10 Physical Activity,

Nutrition, and Tobacco-Use Prevention

CDC employs four national strategies to

Priorities for Schools,” p. 3.) Two impor-

improve young people’s health:

tant tools were released in 2000 to help

• Monitor critical health events and

schools implement school health guide-

school policies and programs.

lines.

• Synthesize and apply research to

The first is the

School Health Index

improve school policies and programs.

RBSS data

(SHI) for Physical Activity and Healthy

• Enable constituents to help schools

Eating: A Self-Assessment and Planning

provide the

implement effective policies and

Guide

, which provides a checklist ques-

best, and in many

programs.

tionnaire to rate school polices and pro-

cases the only,

• Evaluate to improve policies and

grams against CDC standards. “The SHI

programs.

source of data on

will help schools identify the strengths and

youth behaviors.

weaknesses of their health promotion

Monitor critical health events and

policies and programs and develop an

school policies and programs

action plan for improving student health,”

Key to monitoring chronic disease risk

commented Dr. Wechsler. “It gives them

factors among young people is CDC’s

something concrete and specific they can

Youth Risk Behavior Sur veillance System

do to improve school programs and

(YRBSS; online at

www.cdc.gov/nccdphp

services.” The SHI is online at

/dash/yrbs/index.htm

). Since 1991 this

www.cdc.gov/nccdphp/dash/SHI

system has tracked tobacco use, physical

The second tool,

Fit, Healthy and Ready

activity, dietary intake, and weight control

to Learn

, was developed by the National

behaviors of high school students. “YRBSS

Association of State Boards of Education

data at the national, state, and city levels

with CDC support. This tool is a guide to

are used extensively and typically provide

school health policy development. It

the best, and in many cases the only,

focuses on policies related to physical

source of data on these behaviors,” ex-

activity, healthy eating, and tobacco-use

plained CDC health scientist Howell

prevention. Dr. Wechsler said, “This

Wechsler, EdD, MPH. In addition to

document translates the broad vision of

YRBSS, CDC conducts the School Health

the guidelines into concrete, specific policy

Policies and Programs Study (SHPPS).

language that proponents of school health

SHPPS, which was conducted in 1994 and

programs can bring to their school

2000, provides nationally representative

boards.” This tool is online at

data on various school policies and pro-

www.nasbe.org/healthyschools/

grams including physical education, food

fithealthy.mgi

services, and health education. Analyses of

Other resources include

SHPPS data, to be published in 2001, will

• CDC’s Healthy Youth Funding

assess all eight components of CDC’s

Database (HY-FUND), which gives

coordinated school health program model

users access to current information on

at the elementary, middle, and high school

federal funding, state revenue fund-

levels.

ing, and private sector funding. The

database offers examples of how states

Synthesize and apply research

use federal funds to support adoles-

to improve school policies

cent and school health programs. Visit

and programs

the site at

www.cdc.gov/nccdphp/

dash,

and

click the “Funding” button.

In the mid-1990s, CDC released science-

cdnr

Special Focus:

School Health Programs

• A database service developed by the

providing support one day to all 50 state

National School Boards Association

education agencies and health depart-

provides sample school district health

ments, along with education and health

policies on request. The database also

agencies in many of the nation’s large

provides advice on getting policies

cities,” said CDC health scientist Diane

adopted by local school boards. Visit

Allensworth, PhD.

www.nsba.org/schoolhealth/

Evaluate to improve policies

database.htm

for more information.

and programs

• CDC, as part of the Research to

Classroom program, has identified

CDC developed a process evaluation

and compiled in

Programs That Work

manual as an assessment tool for states

(PTW) a list of curricula with credible

with coordinated school health programs

evidence of effectiveness. Two to-

and provides support to these states for

bacco-use prevention programs have

evaluation. Also, economic evaluation

been identified in PTW:

Project

studies are being conducted to identify

Toward No Tobacco

and

Life Skills

cost-effective programs.

Training

Other strategies

Enable constituents to help schools

These four national strategies serve as

implement effective policies

concrete objectives in the fight against

and programs

chronic disease. In addition, state-, school-,

and district-level guidelines have been

CDC helps constituents establish policies

and programs to reduce chronic disease

outlined. CDC and its partners are em-

phasizing the need for local districts and

risk factors among youth by supporting

the development of coordinated school

states to implement effective strategies to

improve school health. For instance,

health programs in the education agencies

and health departments of 20 states. For

tobacco settlement money is being used in

Maine to fund a comprehensive cardiovas-

example, states are using CDC guidelines

to develop model health education cur-

cular health project. Specific outcomes will

include the assessment of health education

ricula or specific instructional objectives

that identify precisely what students

standards and monitoring of physical

fitness of all Maine students and the

should know and be able to do after

completing a health education course. To

placement of a health coordinator in 35

school districts. Until all school districts

improve school health, CDC recently

hosted two school-based tobacco preven-

take an aggressive and effective approach

to reduce chronic disease risk factors

tion workshops for 20 state teams, with

representatives from state education and

among young people, the number of

premature deaths due to cardiovascular

health agencies on each team. In addition,

other federal agencies and national organi-

disease, cancer, and diabetes will remain

high.

zations are key partners in the fight against

cardiovascular disease, cancer, and diabetes

To find out more about CDC’s coordi-

nated school health programs, visit

and their risk factors. “We expect to work

closely with all our partners and envision

www.cdc.gov/nccdphp/dash

Winter 2001

Special Focus:

School Health Programs

Coordinated School Health Programs

Make a Difference

very school day, 53 million young

has a place in achieving that goal,” said

people attend the nation’s 117,000

Eva Marx, a school health consultant.

schools. What we do to promote

“Establishing and maintaining coordi-

their health today will shape the future

nated school health programs and all their

health of the nation. In addition to read-

components in schools is our primary

ing, writing, and arithmetic, they need to

issue,” said William H. Datema, MS,

oordinated

know how to preserve and promote their

Executive Director, Society of State

school health

own health, as well as the health of the

Directors of Health, Physical Education,

not only improves

generation they will raise, by making

and Recreation.

children’s health,

healthy choices. School health advocates

The long-term issue in CSHPs is

it improves the

urge schools to focus on health in a

lifelong health. Research has shown that

coordinated way, not only keeping health

risk behaviors, often established during

learning capacity

and physical education (PE) in the daily

youth, account for most of the deaths from

of c hildren.

schedule, but including other components

chronic diseases: tobacco use, unhealthy

needed to make the school a healthy

diets, and inadequate physical activity.

environment supportive of healthy behav-

Obviously, equipping young people to

iors. These components involve the full

resist these behaviors can have a great

spectrum of the school community and

impact on reducing the toll of illness and

address food service, staff wellness, and

death in their future.

family and community support (see “A

Because of competing demands, educa-

Coordinated School Health Program: The

tors and administrators may not consider

CDC Eight Component Model of School

the need to make a school health program

Health Programs,” p. 7). The benefits of a

coherent and complete, but coordinated

coordinated school health program

programs offer many advantages. They

(CSHP) go well beyond improved physical

increase efficiency, reduce redundancy, and

conditioning and health, and they are

are more cost-effective. “Most schools have

immediate as well as long-term. “Coordi-

many health activities but not in a coordi-

nated school health not only improves

nated, targeted way,” said Ms. Marx. “It

children’s health, it improves the learning

can be quite haphazard.” CDC’s coordi-

capacity of children,” said Lloyd Kolbe,

nated school health program helps educa-

Director of CDC’s Division of Adolescent

tors focus attention and resources on

and School Health.

school health, gives them concrete objec-

An immediate issue is that children can’t

tives, and shows them how to harness

learn if they’re tired, hungry, on drugs, or

available resources. It supports schools that

worried about violence or domestic

want to improve their school health

problems. CSHPs merge such issues of

programs and empowers them by making

health and education. Schools with CSHPs

them part of a national network of other

report better attendance, less smoking,

states with similar programs.

lower rates of teen pregnancy, increased

The Need for Standards

participation in physical fitness activities,

and greater interest in healthier diets. “The

Accountability is a requisite of any sound

reason schools are educating children is so

educational system. At the core of account-

that they can become productive, respon-

ability are academic standards, which drive

sible members of society. Health certainly

curriculum development, instruction, and

O NTI NU ED

PA G E

cdnr

Special Focus:

School Health Programs

A Coordinated School Health Program: The CDC Eight-Component

Model of School Health Programs

he following are the eight

access or referral to primary health

to the health of students and creates

components of CDC’s model

care ser vices, foster appropriate use of

positive role modeling. Health

coordinated school health program:

primary health care services, prevent

promotion activities have improved

and control communicable disease and

productivity, decreased absenteeism,

Health Education:

A planned,

other health problems, provide

and reduced health insurance costs.

sequential, K–12 curriculum that

emergency care for illness or injur y,

addresses the physical, mental,

Counseling and Psychological

promote and provide optimal sanitary

emotional, and social dimensions

Services:

Services provided to

conditions for a safe school facility and

of health. The curriculum is

improve students’ mental, emo-

school environment, and provide

designed to motivate and assist

tional, and social health. These

educational and counseling opportuni-

students to maintain and improve

services include individual and

ties for promoting and maintaining

their health, prevent disease, and

group assessments, interventions,

individual, family, and community health.

reduce health-related risk behav-

and referrals. Organizational

Qualified professionals such as

iors. It encourages students to

assessment and consultation skills

physicians, nurses, dentists, health

develop and demonstrate increas-

of counselors and psychologists

educators, and other allied health

ingly sophisticated health-related

contribute not only to the health of

personnel provide these ser vices.

knowledge, attitudes, skills, and

students but also to the health of

practices. The comprehensive

Nutrition Services:

Access to a

the school environment. Profession-

curriculum includes a variety of

variety of nutritious and appealing

als such as certified school counse-

topics such as personal health,

meals that accommodate the health

lors, psychologists, and social

family health, community health,

and nutrition needs of all students.

workers provide these services.

consumer health, environmental

School nutrition programs reflect the

Healthy School Environment:

health, sexuality education, mental

Dietary Guidelines for Americans

The physical and aesthetic sur-

and emotional health, injury

(published by the U.S. Department of

roundings and the psychosocial

prevention and safety, nutrition,

Agriculture and the Department of

climate and culture of the school.

prevention and control of disease,

Health and Human Services; see

Factors that influence the physical

and substance use and abuse .

www.health.gov/

environment include the school

Qualified, trained teachers provide

dietaryguidelines/

) and other

building and the area surrounding it,

health education.

criteria to achieve nutrition integrity.

any biological or chemical agents

The school nutrition services offer

Physical Education:

A planned,

that are detrimental to health, and

students a learning laboratory for

sequential K–12 curriculum that

physical conditions such as tem-

classroom nutrition and health

provides cognitive content and

perature, noise, and lighting. The

education, and serve as a resource

learning experiences in a variety of

psychological environment includes

for linkages with nutrition-related

activity areas such as basic move-

the physical, emotional, and social

community services. Qualified child

ment skills; physical fitness; rhythms

conditions that affect the well-being

nutrition professionals provide these

and dance; games; team, dual, and

of students and staff.

services.

individual sports; tumbling and

Parent/Community Involve-

gymnastics; and aquatics. Quality

Health Promotion for Staff:

ment:

An integrated school,

physical education should promote,

Opportunities for school staff to

parent, and community approach for

through a variety of planned physical

improve their health status through

enhancing the health and well-being

activities, each student’s optimal

activities such as health assessments,

of students. School health advisory

physical, mental, emotional, and social

health education, and health-related

councils, coalitions, and broadly

development, and should promote

fitness activities. These opportunities

based constituencies for school

activities and sports that all students

encourage school staff to pursue a

health can build support for school

enjoy and can pursue throughout

healthy lifestyle that contributes to

health program efforts. Schools

their lives. Qualified, trained teachers

their improved health status, im-

actively solicit parent involvement

teach physical activity.

proved morale, and a greater per-

and engage community resources

sonal commitment to the school’s

Health Services:

Services pro-

and services to respond more

overall coordinated health program.

vided for students to appraise,

effectively to the health-related

This personal commitment often

protect, and promote health. These

needs of students.

transfers into greater commitment

services are designed to ensure

Winter 2001

Special Focus:

School Health Programs

training and technical assistance to pro-

Coordinated School Health Programs

Make a Difference

gram staff in each funded state and local

education agency to help improve policy

O NTINU E D

F R O M

PA G E

development and implementation, cur-

riculum design, and teacher training.

assessment by precisely and scientifically

Specific technical assistance in evaluation

defining what students should know and

assists program staff to continually im-

do in each subject area and at specified

prove health and physical education in

grade levels. Schools, districts, and state

their state.

education agencies are held accountable on

the extent to which students in their

Coordination Demands Good

f health and

respective jurisdictions achieve these

Communication

physical educa-

standards. Establishing standards and

What makes school health programs

assessments also helps to place health and

tion are in the

physical education as equal in importance

“coordinated” is strong collaboration

state standards,

between state agencies of education and

to other educational disciplines.

they’re much

Standards reflect the state’s educational

health. “Coordination at the local level is

more likely to be

really important, too, but without the state

priorities, and priorities drive resources.

taught in the

That’s why it was a victory when Kentucky

piece, it’s very hard to achieve,” said Jenny

schools.

Osorio, MPA, CDC. Funding and organi-

was recently able to establish a content

team that integrates practical living,

zation of states in CDC’s coordinated

school health program focuses on helping

vocational studies, and cardiovascular

health. Previously, content teams were

states to establish and run a statewide

program for coordinated school health.

limited to the core academic subjects of

mathematics, science, social studies, and

These programs address a range of health

issues. Currently many focus on reducing

language arts. States such as Kentucky,

Missouri, and Maine have also succeeded

chronic disease risk factors including

tobacco use, poor nutrition, and physical

in having health and physical education

accepted as core academic subjects that are

inactivity.

States in CDC’s coordinated school

assessed.

Without standards, overburdened

health program are encouraged to hire two

coordinators: one in the state department

schools with overloaded curricula some-

times try to find more room in the school

of education, one in the health depart-

ment. In many states the partnership

day by eliminating or reducing require-

ments for physical education and health.

between the agencies is regarded as a

unique strength. In New Mexico, for

In states like Wisconsin, however, which

established a requirement for health

instance, Kris Meurer, PhD, School Health

Director, State Department of Education,

education in the 1970s, the place of health

and PE in the curriculum has not been

shares a business card with Laurie Mueller,

her counterpart in the Department of

challenged. “If health and physical educa-

tion are in the state standards, they’re

Health. People can call either of them to

have their concerns addressed. “Our

much more likely to be taught in the

schools,” said Mr. Datema. Having state

criterion is that projects will go to the

agency that can most easily accomplish the

standards often enables the state depart-

ment of education to retain staff who help

task,” said Dr. Meurer.

It’s important to remember that educa-

local districts meet the requirements by

offering technical assistance and guidance

tion agencies aren’t health agencies, noted

Ms. Marx, who recalls once being advised

on program and staff development.

CDC’s adolescent and school health

to “talk and think like an educator.” The

field of education has its own language,

program plays a vital role by providing

cdnr

Special Focus:

School Health Programs

making it difficult for outsiders to com-

ized plan can be developed. In Kentucky,

municate with educators. “Health isn’t

for instance, a private nonprofit group

their priority, but they do realize that

called Kentucky Child 2000 collected data

health concerns can be a barrier to learn-

on 30 communities. The information will

ing,” said Ms. Marx.

allow the state to put resources where they

“It’s not necessarily hard for health

are most needed. Funding for the assess-

officials and educators to work together,”

ment was provided by a collaborative effort

said Mr. Datema. “The challenge is for

of four state agencies: the Department of

each group to understand the other’s

Education, the Cabinet for Health Ser-

priorities and to find mutual goals. One

vices, Cabinet for Families and Children,

way CDC has really had an impact is in

and the Department of Juvenile Justice.

helping states develop those relationships.”

The Kentucky Department of Education,

Another benefit of working with CDC

through a cardiovascular health grant

is the cadre of leaders it provides. More

funded by CDC, expanded the study to

experienced states provide models for

examine the extent to which the eight

others. “CDC’s role has been critical,” said

components of coordinated school health

Mr. Datema. “Its developmental model has

are implemented in these communities.

helped states work together.” Another role

CDC surveillance efforts also support

was in bringing nongovernmental organi-

states by gathering information on school

zations to the table. Said Janet Collins,

health policies and programs and youth

PhD, Deputy Director, NCCDPHP,

risk behaviors [see related articles, “Study

CDC, “CDC’s support and funding of

Will Strengthen School Health Policies

national education agencies helped them

and Programs” and “States Are Using

to support local schools in establishing

YRBSS Data to Improve the Health of

effective programs.”

Teenagers,” pp. 24 and 26]. CDC also

States in CDC’s CSHPs also have the

provides technical assistance to state and

opportunity to participate in training

local education agencies in evaluating their

programs with their counterparts in other

own programs, with tools such as the

states. Attendees not only learn how to

School Health Index. The Index is a self-

incorporate health messages into their

assessment and planning guide that

curriculum, they are able to return home

describes how to set up cross-functional

and educate others to do the same. In May

teams, and provides worksheets and

2000, teams from 15 states attended

checklists for evaluating how thoroughly

training in physical activity, nutrition, and

health concepts are being integrated into

tobacco programs. Each state had one

all areas of school life.

representative from education and one

Coordinated school health is “truly

from health. Presentations focused on

primary prevention,” said Ms. Osorio.

resources that could be used to promote

“We know that it is more difficult to

the need for CSHPs.

change unhealthy behaviors once they are

established. This is where we can really

A Customized Approach

make a difference. This is a good invest-

ment for our nation to make.”

Statewide planning means careful needs

and assets assessments, so that a custom-

Winter 2001

Special Focus:

School Health Programs

Secretaries Send Youth Physical Activity

Report to the White House

The Secretaries’ report—

Promoting

Better Health for Young People Through

Physical Activity and Sports

—was released

to the public at a White House ceremony

on November 29. The directive that the

Department of Health and Human

Services and the Department of Education

would work together in preparing this

report underscores the important role that

schools can play in reversing the obesity

epidemic and promoting the health of our

nation’s young people. The report focuses

strongly on ways to foster the renewal of

physical education in our schools and the

expansion of after-school programs that

offer physical activities and sports in

Former President

nhealthy habits, such as tobacco

addition to enhanced academics and

Clinton is surrounded

use, poor dietary patterns, and

cultural activities.

by America’s Olympic

physical inactivity, are fueling an

The report also highlights a critical need

athletes at a White

House ceremony at

obesity epidemic and an array of related

for environmental change. People feel they

which the former

health problems among the nation’s youth.

have few safe or efficient choices for

President announced

To help address these urgent problems,

getting around town other than by auto-

the release of the report

former President Clinton asked the

mobile. They have few destinations within

Promoting Better

Secretary of Health and Human Services

walking distance, limited access to recre-

Health for Young

and the Secretar y of Education to produce,

ational venues, and limited time for

People Through

within 90 days, a report on strategies to

recreational activities because of long

Physical Activity and

promote better health for our nation’s

commutes. Therefore, the report also

Sports.

youth through physical activity and fitness.

encourages the development of supportive

“By identifying effective new steps and

public policy and describes ways to pro-

strengthening public-private partnerships,

mote greater coordination of existing

we will advance our efforts to prepare the

public and private resources to shape

nation’s young people for lifelong physical

environments—for example, building

fitness,” Mr. Clinton said.

more walking and bicycle paths and

The request followed the January 2000

designing neighborhoods in a grid pattern

publication of

Healthy People 2010

, a

with connecting streets—that encourage

listing of the nation’s health objectives for

physical activity and sports.

the decade. Unlike previous sets of na-

In other words, “Make the healthy

tional health objectives,

Healthy People

choice the easiest choice,” said Susan B.

2010

included a set of leading health

Foerster, MPH, RD, Chief, Cancer

indicators—10 high-priority public health

Prevention and Nutrition Section, Califor-

areas for enhanced public attention. The

nia Department of Health Ser vices.

fact that the first leading health indicator is

Working together, the Secretaries, their

physical activity and the second is over-

staff members, and their partners in

weight and obesity speaks clearly to the

private and nongovernmental organiza-

national importance of these issues.

tions identified the following important

cdnr

Special Focus:

School Health Programs

factors for helping young people increase

10 Strategies for Promoting Lifelong

their levels of physical activity and fitness:

Physical Activity

•

Families

who model and support

participation in enjoyable physical

hese strategies emphasize the importance of collabora-

activity.

tion at all levels among families, schools, youth-serving

•

School programs—

including quality,

organizations, community planners, policymakers, and state-

daily physical education; health

level education and public health officials.

education; recess; and extracurricular

activities—that help students develop

1. Include education for parents and guardians as part of

the knowledge, attitudes, skills,

youth physical activity promotion initiatives.

behaviors, and confidence to adopt

2. Help all children, from prekindergarten through grade 12,

and maintain physically active

to receive quality, daily physical education. Help all

lifestyles, while providing opportuni-

schools to have certified physical education specialists;

ties for enjoyable physical activity.

appropriate class sizes; and the facilities, equipment, and

•

After-school care programs

that

supplies needed to deliver quality, daily physical educa-

provide regular opportunities for

tion.

active, physical play.

3. Publicize and disseminate tools to help schools improve

•

Youth sports and recreation pro-

their physical education and other physical activity

grams

that offer a range of develop-

programs.

mentally appropriate activities that are

4. Enable state education and health departments to work

accessible and attractive to all young

together to help schools implement quality, daily physical

people.

education and other physical activity programs that

•

A community structural environ-

• Have a full-time state coordinator for school physical

ment

that makes it easy and safe for

activity programs.

young people to walk, ride bicycles,

• Are part of a coordinated school health program.

and use close-to-home physical

• Have support from relevant governmental and non-

activity facilities.

governmental organizations.

•

Media campaigns

that help motivate

5. Enable more after-school care programs to provide

young people to be physically active.

regular opportunities for active, physical play.

6. Help provide access to community sports and recreation

“This report brings together for the first

programs for all young people.

time in one document a comprehensive

7. Enable youth sports and recreation programs to provide

agenda for action to promote physical

coaches and recreation program staff with the training

activity among young people,” said Lloyd

they need to offer developmentally appropriate, safe, and

Kolbe, PhD, Director of CDC’s Division

enjoyable physical activity experiences for young people.

of Adolescent and School Health. It

8. Enable communities to develop and promote the use of

presents 10 strategies (see “10 Strategies

safe, well-maintained, and close-to-home sidewalks,

for Promoting Lifelong Physical Activity”)

crosswalks, bicycle paths, trails, parks, recreation facilities,

and a process for facilitating their imple-

and community designs featuring mixed-use development

mentation that provide a framework for

and a connected grid of streets.

our children “to rediscover the joys of

9. Implement an ongoing media campaign to promote

physical activity and to incorporate

physical education as an important component of a

physical activity as a fundamental build-

quality education and long-term health.

ing-block of their present and future lives.”

10. Monitor youth physical activity, physical fitness, and

The major role that schools can play is

school and community physical activity programs in the

highlighted in strategies 2 through 4. The

nation and each state.

report recommends that schools

• Provide quality, daily physical educa-

tion.

Winter 2001

Special Focus:

School Health Programs

needed to enjoy a wide variety of

Percentage of High School Students Who Attended

physical activity experiences, includ-

Physical Education Classes Daily, 1991–1999

ing competitive and noncompetitive

activities.

• Keeping all students active for most of

the class period.

• Building students’ confidence in their

physical abilities.

• Influencing moral development by

providing students with opportunities

to assume leadership, cooperate with

others, and accept responsibility for

their own behavior.

• Having fun.

In recent years, federal agencies and

national organizations have developed a

large number of practical tools that can

help schools improve their physical educa-

tion and other physical activity programs.

However, according to the Secretaries’

report, many school administrators and

Source: CDC, National Youth Risk Behavior Survey.

educators do not have these materials, and

only modest efforts have been made to

• Schedule classroom health education

disseminate them. These tools are listed on

that complements and reinforces the

page 20 of the report, which recommends

importance of physical education.

an ongoing marketing initiative to system-

• Have daily recess periods for elemen-

atically distribute them to the nation’s

tary school students with time for

schools and school districts. The report

unstructured but supervised play.

also recommends the provision of staff

• Offer extracurricular physical activity

development to ensure effective use of the

programs—especially enjoyable and

tools.

inclusive intramural programs and

Another important recommendation in

physical activity clubs (dance, hiking,

the report is that state education and

yoga, for example)—that feature diverse

health departments work together under

choices for students, meet the needs and

the leadership of a full-time state coordina-

interests of all students, and emphasize

tor for school physical activity programs.

participation without pressure.

Full-time coordinators would play an

The report emphasizes

quality

physical

important role in implementing the

education classes for all students, from

essential staff development, resource

prekindergarten through grade 12,

ever y

dissemination, student assessment, moni-

school day

because physical education is at

toring, and evaluation recommendations

the core of a comprehensive approach to

made in the Secretaries’ report. Without

promoting physical activity through

such a coordinator, according to the

schools. According to the report, quality

report, a national initiative to promote

physical education is not a specific cur-

physical activity among young people will

ricula or program; it reflects, instead, an

inevitably fall through the cracks and fail

instructional philosophy that emphasizes

to get the statewide attention needed to

• Providing intensive instruction in the

make a difference.

motor and self-management skills

cdnr

Special Focus:

School Health Programs

Percentage of High School Students

For further reading...

Who Were at Risk of Becoming

Health, United States, 2000 (with Adolescent Health Chart Book

Were Overweight,

by Sex, 1999

†

by the National Center for Health Statistics, CDC. Online at

www.cdc.gov/nchs/products/pubs/pubd/hus/hus.htm

The Relation of Overweight to Cardiovascular Risk Factors

Among Children and Adolescents: the Bogalusa Heart Study,

by D.S. Freedman, W.H. Dietz, S.R. Srinivasan, and G.S.

Berenson, in

Pediatrics

, Vol. 103, pages 1175–1182 (1999).

Overweight and Obesity in the United States: Prevalence

and Trends, 1960–1994, by K.M. Flegal, M.D. Carroll, R.J.

Kuczmarski, and C.L. Johnson, in the

International Journal of

Obesity

, Vol. 22, No. 1, pages 39–47 (1998).

Current Estimates of the Economic Cost of Obesity in the

United States, by A.M. Wolf and G.A. Colditz, in

Obesity

Research

, Vol. 6, No. 2, pages 97–106 (1998).

Healthy People 2010: Understanding and Improving Health

, b y

*Students who were

percentile but <95

t h

the U.S. Department of Health and Human Services, Wash-

percentile for body mass index by age and sex.

Students who were

percentile for body mass

ington, D.C. (2000). Online at

www.health.gov/

†

index by age and sex.

healthypeople/document/tableofcontents.htm

Source: CDC, Youth Risk Behavior Survey, 1999.

Full implementation of all the recom-

tion and Physical Activity. “The vision

mended strategies will require the commit-

presented in this report,” he said, “can only

ment of resources, hard work, and creative

become a reality when the public and

thinking from many partners in federal,

private sectors come together at the na-

state, and local governments; nongovern-

tional, state, and local levels to coordinate

mental organizations; and the private

and reinforce their efforts.”

sector. The report further recommends

Copies of the report can be downloaded

that a broad, national coalition be devel-

from the CDC Web site at

www.cdc.gov/

oped to promote better health through

nccdphp/dash/presphysactrpt

or re-

physical activity and sports as an impor-

quested by mail from Healthy Youth, P.O.

tant first step in improving the health of

Box 8817, Silver Spring, MD 20907; by

our nation’s children and future adults.

telephone at 888/231-6405; or by E-mail

This emphasis on the importance of

at HealthyYouth@cdc.gov. For other

cooperation among a wide range of partners

related information, you may contact

was reinforced by William H. Dietz, MD,

Howell Wechsler by telephone at 770/488-

PhD, director of CDC’s Division of Nutri-

6197 or by E-mail at hwechsler@cdc.gov.

Winter 2001

Special Focus:

School Health Programs

Reaching and Protecting Young People

at Risk for HIV Infection

esearchers studying disease trends

Americans in the general U.S. population

note that some subpopulations of

(about 13%). Seven percent of HIV

young people in the United States

infections in people aged 13–24 years have

appear to be at greater risk for HIV

been reported among Hispanics and less

infection than are so-called “mainstream”

than 1% each among Asians/Pacific

adolescents. These youth in high-risk

Islanders and American Indians/Alaska

situations often have multiple risk factors,

Natives. In the general U.S. population,

and many are especially hard to reach with

Hispanics, Asians/Pacific Islanders, and

prevention messages and services. Young

American Indians/Alaska Natives represent

people in high-risk situations can be

13%, 4%, and 1%, respectively. Just over

extremely difficult to find. They may be

one-third (35%) of HIV infections in this

sex workers, migrants, or street kids—

age-group have been reported among

homeless or runaways—and many are gay,

whites, who represent nearly three-fourths

lesbian, bisexual, transgendered, or ques-

of the U.S. population.

tioning youth. They also are more likely

Even though the proportion of AIDS

than other adolescents to be pregnant,

cases attributed to heterosexual HIV

cause a pregnancy, or have HIV and other

transmission has increased over time, the

sexually transmitted diseases (STDs).

largest number of AIDS cases reported

Young people who live on the streets,

each year still occur among men who have

whether by choice or circumstances, often

sex with men. Young people who are

find themselves in situations that place

questioning or experimenting with their

them at great risk for acquiring HIV

sexual identity are at great risk for HIV

infection. These young people may trade

infection and are among the hardest to

sex for drugs or money to meet survival

reach with HIV prevention programs.

needs; others may share needles to inject

Young people in the juvenile justice

drugs. If they live in an area with high

system also are at high risk for HIV

HIV prevalence, they will be more likely to

infection, as well other STDs and hepati-

encounter an HIV-infected partner than

tis. Their risk appears to be greater for a

other young people.

number of reasons. Some of these young

Minority youth face similar risks because

people have used drugs; others have traded

the proportion of AIDS cases reported

sex for drugs or to meet basic survival

each year among people of color has

needs on the street. They often come from

grown. Today, in African American com-

inner-city areas where HIV prevalence is

munities across the United States, it is not

greater than in other communities, so their

uncommon for local officials to declare a

risk of encountering an infected sex or

state of emergency in response to the

needle-sharing partner is higher.

epidemic. Such actions are backed by

School health education to prevent

scientific findings, especially for young

the spread of HIV infections and AIDS.

people: Through December 1999, in the

CDC provides assistance to education

areas that now report cases of HIV infec-

departments in all 50 states, 19 major

tion among adolescents and adults, more

cities, and 7 U.S. territories to plan,

than half (56%) of cases in people aged

establish, and evaluate school health

13–24 years have occurred among African

programs to help prevent HIV/AIDS. The

Americans. This is a much greater propor-

agency also supports several projects that

tion than that represented by African

O NTINU E D

PA G E

cdnr

Special Focus:

School Health Programs

Avoiding HIV Infection: CDC’s 1999 HIV/AIDS Surveillance Report

Editor’s Note: The data in this

proportion of young women who

subpopulations have prompted

summary are from CDC’s

are infected with HIV—in 1999,

concerned officials to increase

HIV/AIDS Surveillance Report,

in areas with confidential HIV

their efforts to find ways to

1999, Volume 11, Number 2.

reporting systems, girls and

reach young people at highest

women accounted for almost half

risk, both in and outside of

hrough December 1999,

(49%) of all reported infections in

school.

more than 430,000 people

people between the ages of 13

in the United States had died

CDC works closely with many

and 24. Even more alarming, girls

with AIDS (acquired immune

other public and private part-

accounted for 64% of all new HIV

deficiency syndrome). Most of

ners at all levels to carry out,

infections reported among

these deaths (nearly 75%) were

evaluate, and further develop

adolescents (13–19 years) in

among persons under the age

and strengthen effective HIV

1999.

of 45, many of whom were

prevention efforts nationwide.

likely infected with human

CDC uses a comprehensive

CDC also provides financial and

immunodeficiency virus (HIV)

approach to preventing further

technical support for the follow-

in their teens and 20s. At least

spread of HIV and AIDS that

ing prevention activities:

half of all new HIV infections in

incorporates the following broad

• Disease surveillance.

this country are believed to

strategies:

• HIV antibody counseling,

occur among people under age

• Monitoring the epidemic to

testing, and referral services.

25.

target prevention and care

• Partner counseling and

With the advent of highly active

activities.

referral services.

antiretroviral therapy (HAART)

• Researching the effectiveness

• Street and community

for HIV-infected persons, the

of prevention methods and

outreach.

number of AIDS cases reported

translating findings for use in

• Risk-reduction counseling.

in the United States has de-

community settings.

• Prevention case manage-

clined. However, while young

• Funding local prevention

ment.

people aged 13–24 accounted

efforts for high-risk commu-

• Prevention and treatment of

for only 4% of all AIDS cases

nities.

other sexually transmitted

reported through the end of

• Fostering linkages with care

diseases that can increase

1999, they accounted for 17% of

and treatment programs.

risks for HIV transmission.

the reported HIV cases in areas

• Public information and

CDC is an active participant in

with confidential HIV infection

education.

helping young people avoid HIV

reporting (not all U.S. states

• School-based education on

infection. By providing funding

currently report cases of HIV

AIDS.

and technical support, the divi-

infection, including some states

• International research

sion assists national, state, and

with high rates of AIDS).

studies.

local education agencies and

• Technology transfer systems.

Scientists believe that cases of

other organizations that address

• Organizational capacity

new HIV infection diagnosed

adolescent health in identifying

building.

among 13–24-year-olds probably

and preventing HIV risk behav-

• Program-relevant epidemio-

are indicative of overall trends in

iors.

logic, sociobehavioral, and

HIV incidence (the number of

Collaborative efforts first

evaluation research.

new infections in a given time

concentrated on HIV prevention

period, usually a year) because

More data is available online at

education within the compre-

people in this age-range have

www.cdc.gov/hiv/dhap.htm.

hensive school health education

more recently initiated high-risk

program. Today, increasing

behaviors. A disturbing finding in

infection rates in many youth

this age-group is the growing

Winter 2001

Special Focus:

School Health Programs

important to try to understand the

Reaching and Protecting Young People

at Risk for HIV Infection

adolescent’s particular situation.” Dr.

Robin believes that providers of services

O NTINU E D

F R O M

PA G E

for young people in high-risk situations

train teams from these states, cities, and

need to know that it is important not to

territories to continuously improve HIV

make assumptions about behaviors. For

prevention programs. The major strategies

example, primary care providers may not

that education agencies employ include

realize that young women who self-identify

implementing HIV prevention policies,

as lesbian need information about birth

conducting staff development programs,

control; a recent study revealed that they

incorporating HIV prevention lessons and

were more likely than other young women

activities into the school’s formal and

to have had a pregnancy.

informal curriculum, and developing

Another obstacle to providing needed

targeted programs that address the needs

services is that many of these young people

of youth in high-risk situations. To assist

are difficult to find. “Where you find them

with the policy and resource development,

depends on the context,” said Dr. Robin.

as well as the training of professional staff,

For example, there was a high rate of

CDC funds approximately 40 national

homelessness in New York in the early

organizations representing professional

1990s, and many shelters viewed adoles-

staff in health, education, or youth-serving

cents as troublemakers and sent them to

organizations that promote HIV preven-

other locations. This often caused families

tion programming in school or commu-

to be divided by age groups. Some of these

nity sites. In addition, funding is provided

families never reunited, and many young

to eight national organizations that are

people ended up on the street.

helping postsecondary institutions set up a

Many community-based organizations

national system of integrated activities to

serve runaway and homeless youth. Most

prevent HIV/AIDS and other serious

of these groups have outreach programs to

health problems among students in our

help locate young people in need of

nation’s colleges and universities.

services. Some street youth go to public

What do we know about young

health clinics for medical care, but these

people in high-risk situations?

At a

clinics are unable to do enough, and many

November 1990 meeting, the CDC

young people receive no medical services at

Advisory Committee on the Prevention of

all. Alternative schools are another location

HIV Infection characterized young people

where young people at risk can be found—

in high-risk situations as feeling invulner-

some of these schools serve targeted youth

able, lacking adult supervision, having a

populations such as pregnant adolescents

history of abuse, feeling distrustful of

and teen mothers, young people from the

adults, and being disenfranchised from the

juvenile justice system, those who would

usual institutions that could offer them

not otherwise graduate, or gay or lesbian

help (schools, for instance). Attendees at

youth. Young people who are incarcerated

that meeting concluded that prevention

have recently become a focus of more

programs focusing on this group may not

intensive prevention efforts.

succeed unless attention is first given to

In many of the places where young

meeting their basic needs.

people in high-risk situations are found,

“You can never really generalize about

critically needed HIV prevention and

youth in high-risk situations,” said Leah

other social and health services may be

Robin, PhD, a CDC health scientist. “We

provided. Alternative schools serving

use labels like gay or lesbian or ‘young men

young women who are pregnant or have

who have sex with men’ because we are

small children, for example, can provide

interested in their risk behaviors, but it is

assistance with child care and nutrition.

cdnr

Special Focus:

School Health Programs

Other activities, called “resiliency-based”

years with a

Juvenile Justice Work Group

programs, do not focus specifically on risk

(JJWG) made up of representatives from

behaviors, but help young people develop

the CCCWG, the federal Office of Juve-

their strengths. These programs teach

nile Justice and Delinquency Prevention,

young people problem-solving skills and

several key juvenile justice organizations,

help them form attachments to caring

and grantees (ETR Associates and the

adults and their communities. Such

National Commission on Correctional

activities enhance the development of

Health Care) who are funded to provide

healthy relationships and promote self-

training in HIV prevention strategies to

efficacy and hopefulness for the future.

juvenile justice staff around the country.

“Most programs for nonmainstream

The JJWG has met several times since

kids have not been evaluated,” Dr. Robin

its inception and currently is working to

said, “so we don’t really know yet which

develop a series of workshops to be offered

are most likely to succeed.” For example, a

to state teams in 2002. The purpose of the

current study includes a component

upcoming training is to strengthen col-

designed to help students in alternative

laboration between public health and

schools learn to be useful by performing

juvenile justice organizations to prevent

community service, but it is unclear at this

and treat HIV, STDs, and hepatitis among

time how such programs will affect HIV

young people in the juvenile justice system

risk in this population. Dr. Robin also is

and to ensure continuity of prevention and

helping to evaluate an HIV prevention

care efforts in the communities to which

program, called

Power Moves

, for institu-

they return.

tional placements of all kinds. In this

“Historically, the public health system

study, researchers are working with 337

and the juvenile justice system have had

participants aged 12–19 years who were

competing priorities and different mis-

incarcerated at a juvenile justice facility in

sions,” said Jim Martindale, MSW, a CDC

Colorado. The HIV prevention lessons

health education specialist. “The top

used in this

Power Moves

program are

priority for a public health agency is

designed to stand alone because young

preventing health problems, but the top

people in the justice system tend to be

priority for any correctional facility is

moved around a lot between institutions,

security. We know that young people in

or be pulled out of classes due to changes

the juvenile justice system are at high risk

in facility schedules. Lessons learned from

in terms of health issues, and there are

such evaluation studies will be shared with

great unrealized opportunities to reach

CDC constituents who work with incar-

them through comprehensive and better

cerated young people.

coordinated public health practices in

In the juvenile justice system, according

these settings. When public health and

to Dr. Robin, “we usually try to intervene

juvenile justice are working well together,

with a narrowly defined group, and what

there is a respect for each other’s missions.”

we can do varies from state to state. For

Public health services that may be offered

these kids,” she said, “it may be our last

in correctional settings range from group

chance to intervene.”

education or individual counseling on

To help meet the health-related needs of

HIV/STD prevention, to clinical services

incarcerated young people, CDC’s

Cross-

such as STD screening or HIV testing and

Center Corrections Work Group

counseling, to ensuring continuity of care

(CCCWG) included a juvenile justice

in the community for those who are

portion in a series of 1-day in-service

released.

trainings sponsored by the CCCWG for

HIV prevention activities focusing on

CDC staff members last year. In addition,

the juvenile justice system are just one

CDC has been working over the last 2

example of the many programs that CDC

Winter 2001

Special Focus:

School Health Programs

coordinates to help slow the spread of HIV

Constituents funded to provide program-

and AIDS among young people.

ming to targeted populations are asked to

Programs for young people at greatest

work collaboratively. The expertise of these

risk for HIV infection

CDC assists a

funded constituents is then used to pro-

number of agencies that serve areas with

vide professional development opportuni-

high HIV prevalence in coordinating

ties for teams from funded state and local

activities to reach young people at high

education constituents and key commu-

risk, including minority youth, indigent

nity members who can assist them and

youth, or young people in difficult life

advocate for HIV prevention in the

situations—for example, runaways, men

respective target populations. Constituents

who have sex with men, recent immi-

and their community advocates work

grants, and those who are homeless,

together to develop action plans for the

incarcerated, pregnant, or in need of drug

targeted population. CDC project officers

or alcohol rehabilitation. The division also

provide technical assistance to help funded

supports many projects across the country

constituents implement the prevention

that are designed to assist professional

plans in their communities. This process is

educators, health professionals, parents,

repeated continuously as new information

and organizations that serve minority

about the most effective programs becomes

populations and young people who are not

available.

in school to establish effective programs to

For further information about CDC

prevent the spread of HIV infection and

programs to prevent HIV infection among

AIDS.

young people, visit the Web sites at

“CDC is systematically promoting

www.cdc.gov/nccdphp/dash

collaborative programming among agen-

www.cdc.gov/hiv/dhap.htm

cies in order to reach youth at high risk,”

CDC has released its new HIV preven-

said CDC health scientist Diane

tion and control plan,

HIV Strategic Plan

Allensworth, PhD. These programs, she

Through 2005

, which can be viewed online

said, follow a pattern established for all

www.cdc.gov/nchstp/od/news/

target groups. A work group conducts

prevention.pdf.

internal staff development activities.

Asthma: 10 Million School Days Lost

Each Year

Asthma, a chronic condition that is

added, is the impact of asthma on minor-

triggered by allergens or irritants in the

ity children. Death from asthma is 2 to 6

environment, is a major health problem of

times more likely among African Ameri-

increasing concern in the United States.

cans than in the general population.

Between 1980 and 1994, the prevalence of

CDC has launched a pilot effort involv-

asthma increased 75% overall and 74%

ing four local education agencies serving

among children 5 to 14 years of age.

large, urban school districts and capable of

“Today asthma affects 15 million people,

targeting racial or ethnic minority groups.

including nearly 5 million under the age of

An asthma wellness manual is in develop-

18, and it accounts for an estimated 10

ment and will become available in about

million lost school days annually,” said

16 months. In the interim, a helpful

CDC health scientist Mary Vernon-Smiley,

MD, MPH. Of special concern, she

O NTI NU E D

P AG E

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Special Focus:

School Health Programs

Michigan Gets Moving With Exemplary

Physical Education Curriculum

hen Michigan Governor John

EPEC has sound scientific grounding in

Engler took up the problem of

chronic disease prevention and uses state-

obesity in the state, he found

of-the-art educational theory. The result is

himself confronting a dilemma familiar to

an exciting curriculum for grades K–5 and

policymakers. Although school physical

6–8 that equips students to understand the

education (PE) programs were clearly part

importance of physical activity and to

of the solution, classes in PE and health

obtain the fitness, knowledge, motor skills,

were being squeezed out of the curriculum

and personal and social skills they need to

by competing demands. Furthermore, he

be active for life. “What EPEC gives

hesitated to mandate time for PE until an

children is the alphabet of movement on

effective program was available. He resolved

which they can build a lifetime of physical

the dilemma by founding the Michigan

activity,” said Glenna DeJong, PhD,

Governor’s Council on Physical Fitness,

Director of Educational Programs for the

Health and Sports and charging it to

Governor’s Council.

develop a curriculum that would help

EPEC breaks with traditional ap-

schools to equip children with the knowl-

proaches and teaches toward specific,

edge, skills, and motivation necessary to live

highly valued objectives in a systematic

a physically active lifestyle now and as

way to create lasting change. Instruction

adults. The result is the Exemplary Physical

based on clearly stated outcomes is at the

Education Curriculum (EPEC), a public

heart of the EPEC mission.

health initiative that addresses the crushing

“Programs that give students the knowl-

burden of chronic disease attributable to

edge, attitudes, motor skills, joy, and

physical inactivity. EPEC is being carried

confidence to participate in physical

out completely in the education arena.

activity may help young people establish

“Improved levels of physical activity

active lifestyles that continue throughout

represent a crucial step toward the preven-

their lives,” said Lloyd Kolbe, PhD,

tion and reduction of a number of chronic

director of CDC’s Division of Adolescent

diseases, such as obesity, diabetes, and

and School Health. EPEC lessons promote

cardiovascular disease. The Michigan

lifelong physical activity by providing

efforts are an important step in this

developmentally appropriate instruction

direction,” said William H. Dietz, MD,

that is perceived to be valuable in develop-

PhD, Director, Division of Nutrition and

ing students’ knowledge and mastery of

Physical Activity, NCCDPHP, CDC.

motor, behavioral, and fitness skills. Dr.

The Michigan Fitness Foundation

DeJong said the response from teachers has

provides funding and staff to carry out the

been “fantastic. In approximately 2 years,

initiatives of the Governor’s Council. The

we’ve reached 53% of our Michigan

Council and Foundation Boards comprise

market and trained more than 900 teach-

educators, physicians, policymakers,

ers.” EPEC materials have been praised for

business owners, and other professionals

their effectiveness, ease of use, and clear

from the field of health and sports. Collec-

learning objectives.

tively, they are working in an innovative

Other states that wish to provide quality

way to make systemic change, reverse the

physical education programs are looking to

trend toward sedentary living, and posi-

EPEC as a solution. Hawaii, Indiana,

tively affect many risk factors for serious

Ohio, and New York have all shown great

health problems.

Winter 2001

Special Focus:

School Health Programs

interest in adopting EPEC for their

EPEC students had better scores on a field

schools.

test of physical fitness and better self-

In 1997, 100 elementary school physical

reported personal/social behaviors than

education teachers taught and evaluated

non-EPEC students.

the EPEC K–2 lessons. More than 95% of

EPEC offers Michigan the potential to

the teachers found the EPEC lessons to be

improve the health of nearly 1.7 million

clearly written, easy to communicate and

school children each year. In addition to

implement, and developmentally appropri-

the curricula for grades K–5 and 6–8,

ate.

materials are being prepared for use in

Other study findings show that EPEC is

high schools. For more information on

effective. Two of nine factors investigated

EPEC, the Governor’s Council on Physical

contributed significantly to school differ-

Fitness, Health and Sports, or the Michi-

ences in student performance: whether the

gan Fitness Foundation, please call Glenna

teacher was certified with a major in

DeJong at 800/434-8642 or visit the Web

physical education and whether the

site at

www.michiganfitness.org

teacher used EPEC lessons. In addition,

Utah Takes a Unique Approach

to School Health

schools to participate in the Olympic spirit

by making their school and community a

healthier place.

Schools will be given a menu of criteria

to implement that will qualify them for

gold, silver, or bronze medal school

awards. CDC health indicators for envi-

ronmental and policy supports for schools

were the basis for the criteria (see “Gold

Medal School Project”p. 21). The state

health department worked with the state

Office of Education and others to decide

Utah students enjoy a

ith schools under tremendous

which criteria were the most important

Gold Medal break: a

pressure to increase standard-

and the most doable. “Using the criteria

walk outdoors.

ized test scores, motivating

gives schools credit for what they have

schools to adopt environmental and policy

already accomplished,” explained Joan

changes to improve health is a constant

Ware, MSPH, Director, Cardiovascular

challenge for public health professionals.

Health Program, Utah Department of

Utah’s Department of Health is meeting

Health.

this challenge by linking school health

“We’re very impressed with the program

with the biggest event to hit the state in

because it’s taking a creative, innovative

decades: the 2002 Winter Olympics. The

approach to letting schools know about

department is implementing the Gold

the most important policies and practices

Medal Schools Project to encourage

students and faculty in Utah elementary

O NTI NU E D

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cdnr

Special Focus:

School Health Programs

Gold Medal School

A Healthier You 2002 Moves Utahans

Project Guides

to Physical Activity

Policies to Promote

he Gold Medal School Project is part of a larger effort

Health

to inspire Utah to catch the Olympic spirit. A Healthier

You 2002™ provides information, opportunities for partici-

pation, and motivation to begin and maintain healthy habits

in schools, communities, and worksites. Physicians and

he Gold Medal School Project

health care providers were given prescription pads to

assists schools in creating an

encourage them to prescribe physical activity for their

environment that promotes healthy

patients. Thirty-seven communities have conducted a Gold

lifestyle choices for both students and

Medal Mile Event, 1-mile walks designed to encourage

teachers. Schools are given a menu of

Utahans to become more active. Participants who complete

criteria to implement that will qualify

the event receive the Gold Medal Olympic commemorative

them for gold, silver, or bronze medal

pin (valued at $20), which is available only to participants.

school awards.

“We wanted to let people know how healthy it would be to

Sample criteria for Gold Medal Schools:

walk a mile and that they could do it,” said Scott Williams,

• Establish a tobacco- and drug-free

MD, MPH, Deputy Director, Utah Department of Health.

policy, and ensure awareness of the

“We wanted them to see how short a mile really is.” The

policy among faculty and students.

project also involves the construction of permanent Gold

• Establish a policy that discourages

Medal Mile courses. CDC has provided funding for 20

withholding physical education or

courses; the state plans a total of 30. The courses must be

recess as a punishment.

accessible to the elderly and disabled.

• Establish a policy that requires

More than 50% of Utah’s population is overweight or

classroom instruction on nutrition,

obese. Despite having the lowest rate of cardiovascular

and ensure faculty awareness of this

disease and smoking in the nation, Utahans spend $342

policy.

million annually on hospital stays. A Healthier You 2002™

• Establish a policy that provides an

uses the Olympic legacy of athletic health and fitness to

adequate amount of time for students

improve and motivate Utahans to embrace a life of health

to eat school meals—at least 10

and wellness. The initiative promotes five sets of behaviors:

minutes for breakfast and 20 minutes

for lunch from the time students are

1. Physical Activity: 30 minutes of any type of physical

seated.

activity 3–5 days per week.

• Establish a faculty and staff wellness

2. Nutrition: Lower dietary fat and increase fruit and veg-

program, and ensure faculty awareness

etable consumption.

of this policy.

3. Healthy Behaviors: Quitting tobacco use and low-risk

• Establish a policy that elementary

alcohol use.

students will participate in at least 90

4. Safety: Regular seat belt and helmet use (for future

minutes of structured physical activity

implementation).

each week, and ensure student and

5. Prevention: Getting all recommended early detection

faculty awareness of the policy.

screening such as Papanicolau (Pap) tests, mammograms,

and blood pressure checks, as well as immunizations.

Winter 2001

Special Focus:

School Health Programs

Healthier Smiles: States Focus on Children’s

Oral Health

lthough

health programs (CSHPs) funded by CDC.

great

Activities for the initial planning year

strides

included assessing children’s oral health

have been made in

status in the respective states and forming

preventive oral

oral health coalitions with broad representa-

health since mid-

tion from the state education agency, health

century, many

department, school administration and

children continue

staff, child advocates, foundations, nongov-

to be at risk for

ernmental organizations, and other part-

dental decay, one

ners. In FY 1999, these three states as well

of the most common chronic infectious

as South Carolina were awarded 3-year

diseases. Nearly 80% of children have had

cooperative agreements to implement the

at least one cavity by the time they are 17

approaches selected. In FY 2000, another

years old. Poor and under-served children

state, Maine, received a 2-year cooperative

aged 2–9 years have twice as much

agreement under this initiative.

untreated dental decay as other children.

During the initial planning year, most of

Permanent first molars that erupt at about

these states conducted surveys of school

age 6 are most susceptible to decay.

administrators, school nurses, and health

Dental sealants, a plastic coating placed

educators to assess the level of school-based

into the pits and grooves of molar teeth,

oral health programs, determine how

are a cost-effective and proven prevention

schools identified and dealt with children

method, but only 23% of 8-year-olds—

who needed dental care, and examine

only 3% among poor 8-year-olds—have

current policies governing school-based oral

had their first molars sealed. Children of

health delivery systems. These surveys

some ethnic and racial groups, such as

revealed the need for enhanced oral health

Mexican Americans and African Ameri-

education and screening in schools. For

cans, may experience even greater dispari-

example, a survey of elementary school

ties in untreated tooth decay and sealant

nurses conducted in Ohio found that 10%

use, and often have less access to dental

of students had dental problems serious

care.

enough to affect a student’s attendance and

One strategy for reaching these and

ability to learn. In addition, only half of

other at-risk children is through school-

those students referred for care actually

based programs that support linkages

receive the needed dental treatment. In

with health care professionals and other

Rhode Island, only 18% of public schools

dental partners in the community. In FY

and 8% of private schools currently had

1998, CDC awarded cooperative agree-

oral health promotion programs. And in

ments to education agencies in three

South Carolina, 59% of the lead health

states—Ohio, Rhode Island, and Wiscon-

educators surveyed reported that not

sin—to develop models for school-based

enough emphasis was being placed on oral

programs to improve access to oral health

health topics in the school curriculum.

education, prevention, and treatment

After their initial planning year, the four

services for school-aged children. This

current grantee states are using various

effort builds on the coordinated school

approaches to improve the oral health of

cdnr

Special Focus:

School Health Programs

their school children. For example, the

oral health care services.

“Healthy Smiles for Wisconsin” program

The South Carolina Healthy Schools

for children is focusing on increasing

Oral Health Care Program has formed a

sealant use, oral health education, and

Children’s Oral Health Coalition, with

youth oral health surveillance. The kick-off

representation from school districts, school

for the program, held in the rotunda of the

nurses, state dental and dental hygiene

state capitol in Madison before an audi-

societies, the state’s dental school, success-

ence that included then-Wisconsin Gover-

ful oral health programs, and state agen-

nor Tommy G. Thompson (now Secretary

cies. During the program’s first year, the

of Health and Human Services), state

group identified a particular need in that

lawmakers, and legislative staff, was a

state for enhanced training on general oral

demonstration of dentists and dental

health education for school nurses. In

hygienists applying sealants to school

addition to supporting these training

children’s molars. As part of the Healthy

seminars, the project is developing and

Smiles program, five projects are directed

testing a classroom oral health curriculum

toward the urban poor in Milwaukee, and

for grades 3, 4, and 5.

others are being implemented widely in all

The newest grantee, Maine, is working

regions of the state. More information on

to strengthen linkages between the state

this program is available on the program’s

departments of education and health and

Web site,

www.healthysmilesforwi.org

to develop a multidisciplinary statewide

The Rhode Island initiative “Healthy

steering committee to address oral health

Schools! Healthy Kids!” is focusing on

issues, including increased coordination of

school- and community-based services,

school sealant programs.

family outreach and education, and oral

An evaluation tool for these projects is

health education and policies for schools.

currently being designed and will be

A unique result of this project, which

implemented during FY 2001.

currently is being implemented in poor

“The goal of these programs is to

urban neighborhoods in Providence,

develop comprehensive, integrated, and

involves changes in state policies that

sustainable approaches to address the oral

regulate how mandated oral health screen-

health needs of school-aged children in the

ings are performed. In one of the pro-

United States,” said William R. Maas,

gram’s pilot projects, children requiring

DDS, MPH, Director, Division of Oral

dental services are assigned a caseworker

Health, NCCDPHP, CDC. “These

who is responsible for linking the child

models will provide information about

and family with appropriate services (e.g.,

different school-based or school-linked

Medicaid or the Children’s Health Insur-

approaches and serve as guides for those

ance Program) and for finding the child a

states that are developing programs target-

“dental home.” The child, as well as family

ing oral health for vulnerable children.”

members, subsequently will be referred for

Asthma: 10 Million School Days Lost

Each Year

O NTINU E D

F R O M

PA G E

resource is the Environmental Protection

ment

(Publication EPA 402-K-00-003; to

Agency’s publication,

IAQ Tools for Schools:

view online or to order, go to

Managing Asthma in the School Environ-

www.epa.gov/iaq/schools/incentiv.html

Winter 2001

Special Focus:

School Health Programs

Study Will Strengthen School Health

Policies and Programs

n fall 2001, CDC will release data

for students? What policies are in

from the School Health Policies and

place to maintain students’ health

Programs Study (SHPPS), providing a

records? What types of health services

detailed look at school health activities at

are available to students at the school

he School

the state, district, school, and classroom

and through arrangements with

levels nationwide. The data were collected

providers in the community? How

Health Policies

in spring 2000 and will be used to improve

much time do school nurses and other

and Programs

school health policies and programs

health services personnel spend at the

Study (SHPPS) is

throughout the United States.

school?

the largest

“This is the largest assessment of school

•

Mental health and social services.

assessment of

health programs ever undertaken,” said

What types of mental health or social

school health

Laura Kann, PhD, Chief of the Surveil-

services are available to students at the

programs ever

lance and Evaluation Research Branch,

school and through arrangements

undertaken.

Division of Adolescent and School Health,

with providers in the community?

NCCDPHP. “SHPPS 2000 is a bigger and

What is the required ratio of students

better version of the survey we did in

to mental health or social services

1994. This time, we’re covering all eight

staff? What credentials and certifica-

components of school health programs at

tions are required of school guidance

the elementary, middle/junior high, and

counselors, school psychologists, and

senior high school levels. SHPPS 2000

school social workers?

data will be used to measure eight

Healthy

•

School policy and environment.

People 2010

objectives,” she noted. Follow-

What policies are in place regarding

ing are the eight components and examples

fighting, weapon possession, gang

of topics covered.

activities, harassment, and use of

•

Health education.

What are students

tobacco, alcohol, and other drugs?

being taught about health, and how

What policies are in place to promote

many hours of instruction are re-

school safety and prevent injuries?

quired? What materials and methods

•

Food service.

Are schools offering

do teachers use to teach health

breakfast and lunch to children? What

education? What kinds of health

variety of foods are offered? Do states

education goals and objectives are

and districts have any policies on junk

states and school districts setting for

food? Are school meals in compliance

schools?

with the U.S. Dietary Guidelines for

•

Physical education and activity.

Americans? Is staff development

What is being taught to students

provided to food service personnel?

during physical education? How many

•

Faculty and staff health promotion.

hours of instruction are required?

Are health or mental health services

What types of facilities are available for

provided to school faculty and staff?

physical education classes and for

Are employee assistance programs or

community use? What credentials and

wellness workshops offered? What

certifications are required of physical

about health screenings and physical

education teachers?

activity programs?

•

Health services.

What health screen-

•

Family and community involve-

ings and immunizations are required

ment.

How are students, parents,

cdnr

Special Focus:

School Health Programs

guardians, and community members

views with principals, health education

contributing to school health policies?

teachers, physical education teachers, food

Are faculty and staff collaborating

service directors, nurses, counselors, and

with community agencies on school

other personnel in a nationally representa-

health education, physical education,

tive sample of elementary, middle/junior

and nutrition projects? Are schools

high, and senior high schools. Students

promoting community awareness of

were not inter viewed. The next SHPPS

their health, physical education, food

probably will be conducted in 2006,

service, and mental health and social

according to Dr. Kann.

services programs?

For more information about SHPPS,

contact Nancy Brener, PhD; Surveillance

The SHPPS data were collected for

and Evaluation Research Branch, DASH,

CDC by Research Triangle Institute of

NCCDPHP, Mail Stop K–33; CDC; 4770

North Carolina. Surveys were mailed to all

Buford Hwy.; Atlanta, GA 30341-3717;

states and to a nationally representative

telephone 770/488-6184; E-mail

sample of school districts to find out about

nad1@cdc.gov. Information also is avail-

their school health policies for children in

able at

www.cdc.gov/nccdphp/dash/

kindergarten through 12th grade. Data

shpps

also were gathered during on-site inter-

Utah Takes a Unique Approach

to School Health

O NTINU E D

F R O M

PA G E

they can implement to promote physical

physical education. The goal is to get all

activity and good nutrition,” said Howell

500 Utah elementary schools, public and

Wechsler, EdD, MPH, a health scientist in

private, working toward some kind of

CDC’s Division of Adolescent and School

award.

Health.

The school administration will be

Having the three levels of excellence

charged with observing whether policies

allows schools to set their own goals for the

on nutrition, physical activity, and tobacco

project. The bronze level is the most basic;

are being followed. The program won’t go

at the gold and silver levels, additional

away after the Olympics, Ms. Ware

criteria must be met. Schools will receive

promised. Other plans for Utah’s school

an award of $500 for physical activity

children include soccer leagues that play

equipment if the criteria are achieved.

during school lunch, and structured

Mentoring packets will be provided to help

hopscotch and jump-rope activities.

schools find resources, and schools will be

For more information on the Gold

given access to college students majoring

Medal School Project, contact Karen

in physical education to help them figure

Coats, telephone 801/538-6227, E-mail

out how to meet the criteria related to

kcoats@doh.state.ut.us.

Winter 2001

Special Focus:

School Health Programs

How States Are Using YRBSS Data to

Improve the Health of Teenagers

decade ago,

Mr. Campana noted.

Another YRBSS success story involved

public

health and

tobacco use. “We looked at our YRBSS

data and saw that smoking rates had gone

education officials

had mostly

up steadily from 1991 through 1995. So

we established an early intervention

anecdotal evidence

of the health threats

program in 1996. We’ve since had a 20%

drop in substance abuse on campus, as

facing teenagers.

Today, the Youth

reported by the YRBSS, and a 20% drop

in suspensions for students using or posses-

Risk Behavior

Surveillance System

sing tobacco or marijuana or alcohol,” Mr.

Campana said.

(YRBSS) provides a

much clearer

Until San Diego began participating in

the YRBSS, “we had no sur veillance data

picture of teenagers’

health behaviors,

to see what the extent of high-risk behav-

ior was among adolescents,” he said.

both good and bad

(“YRBS Data for

“Now, the YRBSS data give us a much

more accurate account of where they’re at,

1990s,” p. 30).

“We’re 10 years into

and it gives us the opportunity to cross-

reference behaviors. For example, what

the YRBSS now,

and the real proof

other risk behaviors do binge drinkers

of its worth is in

have? We looked at the data and found

that binge drinkers were less likely than

how the data are being used,” said Laura

The Youth Risk

other students to use seat belts or con-

Kann, PhD, a CDC health survey research

Behavior Surveillance

doms. Suicide attempts were about the

System tracks health

specialist who oversees the YRBSS.

risk behaviors in

same, but in all other categories, binge

“In San Diego, we share the YRBSS data

children and

drinkers were more likely to exhibit high-

between health agencies, community

adolescents.

risk behaviors.”

agencies, and schools to help with program

development and planning; to show where

Focus on What’s Needed Most

our greatest needs are and justify requests

for grants; and to see where we are in

Montana has participated in the YRBSS

relation to other districts, states, and the

since 1991, and “our biggest hot issue

nation,” said Jack Campana, MEd, direc-

right now is tobacco,” noted Richard

tor of Health and Intervention Services for

Chiotti, Director, Coordinated School

the San Diego Unified School District.

Health Programs, Montana Office of

When San Diego’s YRBSS data revealed

Public Instruction. But funding for

that suicide attempts among adolescents

interventions should be driven by need

had increased dramatically, education and

and not hot issues, he said. “Say a school

public health officials used the data as

district has a rate of tobacco use that’s

evidence of the urgent need for interven-

below the national rate, but their violence

tions. “Because of the YRBSS data,

indicators far exceeded the national rate.

$2 million was provided for after-school

We can use the data to really focus on

programs to keep children active during

what’s needed most—in this example, that

some of the most critical hours when high-

would be violence prevention.”

risk behaviors are most likely to occur,”

cdnr

Special Focus:

School Health Programs

The YRBSS data also can be used to

health education programs, one size does

design a program to meet a need that is

not fit all,” said Laurie Bechhofer, MPH,

specific to a school, Mr. Chiotti said. “One

HIV/STD Prevention Consultant, Michi-

of our schools had a significant problem

gan Department of Education, Lansing,

with marijuana use, and school officials

Michigan. “The data showed that about

used YRBSS data to make their case when

half of students in regular high schools had

requesting support from the Safe and

ever had sex [in 1997], compared with

Drug-Free School’s Greatest Needs grant

about 90% of high school students in

funds, which we provide to schools. The

alternative education programs [in 1998].”

school then used the money to develop a

Recognizing the urgent need to help

campaign for marijuana use prevention

students in alternative schools, the state

and social norms marketing,” he said.

education and health departments held

Social marketing campaigns and the

several forums for educators and policy-

YRBSS go hand in hand, Mr. Chiotti

makers, “and we used the YRBSS data as a

added. The data from Youth Risk Behavior

springboard to get people thinking about

Surveys show teenagers “that not all of

what are the risks and needs of these

their peers are out there having sex,

students,” Ms. Bechhofer said. State

drinking, or using other drugs—not nearly

officials gave attendees a YRBSS chart

as much as kids or their parents think. The

showing that students in alternative high

norm is to not be involved in risk behav-

schools are far more likely than students in

iors, and once kids find this out, some of

regular high schools to drink and drive,

the pressure is removed for them to have

carry a weapon, fight, attempt suicide,

sex, smoke marijuana, drink, or practice

smoke, use illegal drugs, and have four or

these other behaviors,” he explained.

more sexual partners.

YRBSS data are also helping to dispel

When they saw how Michigan schools

myths about school violence. “You hear

compared with schools nationwide, some

about Columbine, and it’s very sad,” said

attendees were surprised. “Everyone likes

Mr. Chiotti, “but if you look at schools

to think their community looks different

nationwide, they’re very safe.” About 6

from the state and that their state looks

years ago, Montana changed the name of

different from the nation. The YRBSS data

its Drug-Free Schools Program to the Safe

showed us that we are not that different in

and Drug-Free Schools Program. “We

many of the categories of risk behaviors, and

wanted schools to look at fighting, both on

that was a surprise,” said Ms. Bechhofer.

and off school property, as an indicator for

Michigan officials are trying a new

violence, and to also look at conflict

approach this year to disperse state YRBSS

resolution and character development

findings to an even broader audience.

issues,” he explained. “Montana schools

They are hosting a series of monthly lunch

and other schools across the country are

meetings, each focusing on a particular

making a sincere and dedicated effort to

health threat facing adolescents and each

reduce violence in schools, and the YRBSS

geared to reach a different group of

is helping us do this.”

professionals. “For the lunch meeting

about nutrition in January 2001, we

One Size Does Not Fit All

invited people from the Dairy Council,

team nutritionists, food service staff,

In Michigan, the 1998 National Alterna-

representatives of voluntary agencies,

tive High School Youth Risk Behavior

health department people, epidemiologists,

Survey has provided strong evidence of the

and program people,” Ms. Bechhofer

need for health education programs

explained. Attendees reviewed YRBSS data

tailored to help students in the state’s

on nutrition issues and discussed what is

alternative schools. “The national data

being done to address the nutritional needs

were powerful in making the case that with

Winter 2001

Special Focus:

School Health Programs

the state to print and distribute thousands

Facts About the YRBSS

of copies of its YRBSS reports. The state

prints 5,000 copies of its YRBSS summary

• Has four components: state and large city school-based

report alone and also produces specialized

surveys of students in grades 9–12; national school-based

reports that present data separately for

surveys of students in grades 9–12; a national household

students in grades 7–8 and 9–12 and for

survey of young people 12–21 years old; and a national

subgroups, including American Indians

mail survey of college students in 2- and 4-year institu-

attending schools on the reservation, those

tions.

attending schools off the reservation,

• First conducted in 1990 and conducted every other year

students in alternative schools, and stu-

since 1991.

dents in special education programs.

• Monitors six categories of risk among adolescents: vio-

“We also have a Web site that allows you

lence and unintentional injury, tobacco use, alcohol and

to view state-level response percentages for

other drug use, sexual behaviors, dietary behaviors, and

every survey question ever asked during

physical activity.

the 1991, 1993, 1995, 1997, and 1999

• Is linked to 16 of the

Healthy People 2010

objectives and

Youth Risk Behavior Sur veys,” said Mr.

three of the 10 leading health indicators.

Chiotti. But the site includes much more

• Forty-one states, four territories, and 17 large cities

than just state-level percentages. “Visitors

participated in 1999. Thirty-seven sites had weighted data

can view several analyses of the data—for

• More than 12,000 students completed national YRBS

example, comparing responses from

questionnaires in 1999.

students who smoke vs. those who do not,

• Surveys in states and large cities are conducted by educa-

students from high-performing vs. low-

tion and health agencies, which are funded through coop-

performing schools, and students from

erative agreements with CDC.

high-economic well-being vs. low-eco-

• Participation is voluntary, and responses are anonymous.

nomic well-being areas,” he explained.

(Check out the Web site at

www.metnet.state.mt.us

. Select

Office of

of adolescents. Other topics to be covered

Public Instruction,

under

Services of OPI

during the lunch meeting series include

select

Health Enhancement,

and select

Youth

smoking, sexual activity, violence, safety,

Risk Behavior Survey.

)

alcohol use, drug use, depression and

In San Diego, YRBSS reports are

suicide, and physical activity.

prepared for elected officials, parents,

Montana’s YRBSS data also are widely

advisory groups, and health coalitions.

used outside the state’s Office of Public

Education staff make YRBSS presentations

Instruction. Reports summarizing the

to the media, school board, county health

statewide data are sent to a multitude of

advisory board, health agencies, advisory

recipients, such as schools, churches,

boards, and Healthy Start staff. “Also,

libraries, state and local health depart-

many of the six priority health behaviors

ments and their constituents, the depart-

are highlighted in our county health report

ment of transportation, department of

card for 2010. It’s our local version of

justice and their constituents, and Native

Healthy People 2010

, and in it we talk

American organizations, Mr. Chiotti

about our progress in meeting local goals,”

noted. Reports also are shared with the

explained Mr. Campana.

Healthy Mothers/Healthy Babies Program

The ways in which YRBSS data can be

and Blue Cross/Blue Shield of Montana,

used are limited only by the resources that

which are among nine partner agencies

states can invest. If Ms. Bechhofer had the

that support the Montana Youth Risk

time and money, her hope would be to

Behavior Survey. Funding from these

develop model lessons for students that

public and private partner agencies allows

would integrate survey techniques, tech-

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Special Focus:

School Health Programs

nology, math, civics, and health education,

To have weighted data, a state must have an

in effect making these subjects come alive

overall participation rate of at least 60%.

with actual challenges facing young

San Diego, Montana, and Michigan are

people. “Health education has always had

among the 22 participating areas that have

to compete with the core academic sub-

weighted data. Michigan has an 82%

jects, such as English, language arts, and

overall participation rate (calculated by

math,” she said. So why not use health

multiplying the percentage of participating

education—and the YRBSS—as a cross-

schools times the percentage of participat-

cutting theme to teach core subjects? In a

ing students). “We’ve had weighted data

civics lesson, for example, students could

since 1997, and it means the difference

use the YRBSS data to prepare a report

between having data that apply only to the

showing how certain social factors have

students who participated versus being

influenced adolescent health. Students

able to generalize your findings to the

could also prepare a school board presenta-

entire state,” explained Ms. Bechhofer.

tion aimed at influencing school health

“For us, the weighted YRBSS data have

policy and programs. To enhance math

been very powerful.”

skills, teachers could ask students to look

Another goal of Dr. Kann’s is to see

at YRBSS trends for Michigan and deter-

more collaboration between education and

mine which changes are statistically

health agencies. “The surveys are always

significant. They could also learn about

better when health and education work

weighting data. “If math used more real-

together to implement the survey and use

world examples that applied to the lives of

the data that come out of it. This is

young people, it would be interesting and

happening in a lot of places. For instance,

more relevant to them,” she predicted.

in some states—such as Alaska, Florida,

and Mississippi—the health department

The Power of Weighted Data

actually conducts the survey,” she said.

Dr. Kann has been involved in the

Dr. Kann is pleased with the innovative

YRBSS since it began. “In 1990, few states

ways in which states and cities are using

had good data to help develop programs

YRBSS data to promote the health of

for kids, and now many do, and that’s

adolescents, and her goal is to have all 50

great. Being able to base program and

states in the system, collecting high-quality

policy decisions on data is always better

data. “We’ve come a long way. The surveil-

than just guessing what kids need,” said

lance system has more participants today,

Dr. Kann. “We really hope that the YRBSS

and it is of a better quality than in years

has made a difference in the quality of

past. We started out with 23 states partici-

school health programs available to kids

pating in 1990. In 1999, 41 states partici-

today.”

pated, but only 22 of them had weighted

YRBS data can be viewed online at

data. We need to do better,” she affirmed.

www.cdc.gov/nccdphp/dash/yrbs/

Weighted data allow health and education

index.htm

officials to estimate rates for the entire state.

Winter 2001

Special Focus:

School Health Programs

YRBS Data for 1990s Show How Adolescents Are Faring

he national Youth Risk Behavior Survey (YRBS) is conducted every other year to assess the prevalence of

health risk behaviors among high school students. CDC combined survey responses into one data set to

examine trends in risk behaviors during the 1990s. Measures were taken to control for grade, sex, and

race/ethnicity. YRBS data are not included in the tables for risk behaviors that did not change significantly or

that had inconsistent patterns of change during the 9-year surveillance period.

Risk Behaviors That Improved

—National Youth Risk Behavior Surveys, 1991–1999

1991 1993 1995 1997 1999

Injury-related behaviors

Never or rarely wore a seat belt .............................................. 25.9 19.1 21.7 19.3 16.4

Never or rarely wore a bicycle helmet

96.2 92.8 92.8 88.4 85.3

2 . ... .... ... ... .... ... ... .... ... ... .... ... ... .... ... ... .... ... .

Rode with a drunk driver

39.9 35.3 38.8 36.6 33.1

3 ... ... ... .... ... ... .... ... ... .... ... ... .... ... ... .... ... ... .... ... ... .... ... ... .... ... ... .... .

Carried a gun

NA 7.9 7.6 5.9 4.9

4 .... ... ... .... ... ... .... ... ... .... ... ... .... ... ... .... ... ... .... ... ... .... ... ... .... ... ... .... ... ... .... ... ... .... ... ... .... ... .

Carried a weapon on school property

NA 11.8 9.8 8.5 6.9

4 . ... .... ... ... .... ... ... .... ... ... .... ... ... .... ... ... .... ... ... .

Involved in a physical fight

42.5 41.8 38.7 36.6 35.7

5 . ... .... ... ... .... ... ... .... ... ... .... ... ... .... ... ... .... ... ... .... ... ... .... ... ... .... .

Involved in a physical fight

on school property

NA 16.2 15.5 14.8 14.2

5 . ... ... .... ... ... .... ... ... .... ... ... .... ... ... .... ... ... .... ... ... .... ... ... .... ... ... .... ... ... .... ... ... .... ... .

Seriously considered suicide

29.0 24.1 24.1 20.5 19.3

6 .. .... ... ... .... ... ... .... ... ... .... ... ... .... ... ... .... ... ... .... ... ... .... ... ... .... .

Tobacco use

Current smokeless tobacco use

NA NA 11.4 9.3 7.8

4 .. .... ... ... .... ... ... .... ... ... .... ... ... .... ... ... .... ... ... .... ... ... .... ... ... .

Sexual behaviors

Ever had sexual intercourse .................................................... 54.1 53.0 53.1 48.4 49.9

Had four or more sexual partners ........................................... 18.7 18.7 17.8 16.0 16.2

Used a condom at last sexual intercourse

46.2 52.8 54.4 56.8 58.0

7 .. ... ... .... ... ... .... ... ... .... ... ... .... ... ... .... .

Had been taught about HIV/AIDS in school ........................ 83.3 86.1 86.3 91.5 90.6

Physical activity

Participated in strengthening exercises

47.8 51.9 50.3 51.4 53.6

8 . ... .... ... ... .... ... ... .... ... ... .... ... ... .... ... ... .... .

NA Data not collected.

Significant linear change; p < 0 .05

> 1 times during the 12 months preceding the survey.

Among students who rode bicycles during the 12 months preceding the survey.

During the 12 months preceding the survey.

> 1 times during the 30 days preceding the survey.

Among currently sexually active students.

On > 1 of the 30 days preceding the survey.

On > 3 of the 7 days preceding the survey.

Risk Behaviors That Worsened

—National Youth Risk Behavior Surveys, 1991–1999

1991 1993 1995 1997 1999

Tobacco use

Frequent cigarette use

12.7 13.8 16.1 16.7 16.8

2 .. ... .... ... ... .... ... ... .... ... ... .... ... ... .... ... ... .... ... ... .... ... ... .... ... ... .... ... ... .... ... .

Alcohol and other drug use

Episodic heavy drinking

31.3 30.0 32.6 33.4 31.5

3 ... ... ... .... ... ... .... ... ... .... ... ... .... ... ... .... ... ... .... ... ... .... ... ... .... ... ... .... ... .

Lifetime marijuana use ........................................................... 31.3 32.8 42.4 47.1 47.2

Current cocaine use

1.7 1.9 3.1 3.3 4.0

4 . .... ... ... .... ... ... .... ... ... .... ... ... .... ... ... .... ... ... .... ... ... .... ... ... .... ... ... .... ... ... .... ... ... ..

Lifetime illegal steroid use ........................................................ 2.7 2.2 3.7 3.1 3.7

Sexual behaviors

Used birth control pills at last sexual intercourse

20.8 18.4 17.4 16.6 16.2

5 . ... .... ... ... .... ... ... .... ... .

Physical activity

Attended physical education class daily .................................. 41.6 34.3 25.4 27.4 29.1

Significant linear change; p < 0.05.

> 1 times during the 30 days preceding the survey.

On > 20 of the 30 days preceding the survey.

Among currently sexually active students.

Drank > 5 drinks of alcohol on at least one occasion on > 1 of the 30 days preceding the survey.

cdnr

Special Focus:

School Health Programs

CDC Supports International School Health

Activities

FRESH focuses on four components that

n an increasingly global economy and

are used as a model, at the option of the

environment, the health of every

participating countries: health-related

citizen depends on the health of

school policies, a core framework for

neighbors in other countries. Around the

action, health and nutrition services, and

world, nations are becoming aware of the

provision of safe water and sanitation. It is

value of school health education and

hoped that this model will be effective in

school health programs in reaching not

both developed and developing nations.

only students, but teachers and families as

CDC also recently participated in the

well. CDC is often called upon for techni-

National Conference on Health-Promot-

cal advice, assistance, and support of such

ing Schools in Beijing, People’s Republic of

efforts.

China, where one important focus of

In the United States, CDC is the federal

school health programs has been elimina-

focal point for school health education,

tion of helminth (parasites such as hook-

providing guidance and support for school

worms and pinworms) infections, which

health education and health promotion

occur at a very high rate, especially in

activities to state and local education

China’s river regions.

agencies throughout the country. CDC

Among other countries that have asked

offers formal international support of

for or been offered technical assistance are

school health through a cooperative

the Russian Federation, South Africa,

agreement with the World Health Organi-

Australia, and Vietnam. CDC offers

zation (WHO), and informal support

technical assistance to Russia through the

through collaborative efforts with several

U.S.–Russia Joint Commission on Eco-

countries. For example, CDC participates

nomical and Technical Cooperation on

in WHO’s Mega Country Health Promo-

School Health, and has sent representatives

tion Network, which aims to enhance

to two forums focused on Russia’s move

health and health promotion strategies in

toward health-promoting schools and

countries with populations of 100 million

other school health initiatives. CDC is a

or more. The “Mega” countries are China,

member of the U.S.–South Africa Bina-

Bangladesh, India, Nigeria, Brazil, Mexico,

tional Commission on School Health.

Russia, Pakistan, Indonesia, and the

Because HIV infection rates in South

United States.” WHO characterizes a

Africa are among the highest in the world,

Health-Promoting School as a school that

the technical assistance provided to this

is “constantly strengthening its capacity as

country for its school health programs

a healthy setting for living, learning, and

focuses on HIV prevention in schools.

working.” Four United Nations agencies—

For more information on the Mega

WHO, UNICEF, UNESCO, and the

Country Health Promotion Network and

World Bank—are working together as part

the Global School Health Initiative, visit

of FRESH to help schools around the

the Web site of WHO’s Department of

world improve the health, and conse-

Health Promotion, Noncommunicable

quently the education, of young people.

Disease Prevention and Surveillance on the

Additional technical assistance is pro-

Internet at

www.who.int/hps

. More

vided through the FRESH (Focusing

information about CDC’s school health

Resources on Effective School Health)

programs may be found online at

program, “A FRESH Start to Improving

www.cdc.gov/nccdphp/dash

the Quality and Equity of Education.”

Winter 2001

Special Focus:

School Health Programs

Media Campaign Planned to Improve the

Health of America’s Children

sing new funding first provided by

market healthy behaviors to young people.

Congress for fiscal year 2001,

The campaign, titled by Congress the

CDC is mounting a campaign

National Campaign to Change Children’s

that employs the best principles of market-

Health Behavior, will involve young people

ing and communication strategies to

in all aspects of campaign planning and

influence America’s children to develop

implementation, and will enlist the

habits that foster good health over a

support and involvement of parents and

lifetime–including physical activity. Young

other role models. CDC will work with

people today are a multimedia generation

marketing and media experts to design and

with high rates of media consumption.

implement a successful media campaign.

These media sources, which include

For more information, call Faye Wong,

television, radio, music, print, and Internet

RD, MPH, Project Director, at 770/488-

use, offer a tremendous opportunity to

5131, or E-mail fwong@cdc.gov.

cdnotes

Conferences

Plan for Success: Strengthening the Public’s Health Through Health Promotion

National Conference on Health Education and Health Promotion

You are invited to join the Association of State and Territorial Directors of Health Promotion and Public

Health Education (ASTDHPPHE), the Centers for Disease Control and Prevention (CDC), and public health

professionals from across the nation for the 19

National Conference on Health Education and Health Promo-

tion. The conference will be held April 25–27, 2001, in Atlanta, Georgia, at the Crown Plaza Ravinia. Take

advantage of this opportunity to share successful health education and health promotion programs for a variety

of settings, levels, diverse populations, and public health issues. For more information or to register, contact

Rose Marie Matulionis, Executive Director, ATDHPPHE, at 202/312-6460 or fax 202/336-6012 or visit

www.astdhpphe.org/conf19/19confindex.htm

CDC’s Diabetes Translation Conference 2001

CDC’s Division of Diabetes Translation (DDT) will be hosting its annual conference April 30–May 3, 2001,

in Seattle, Washington. This year’s theme is Diabetes Across the Life Stages. The conference will bring together

a wide community of local, state, federal, territorial, and private-sector diabetes partners to explore science,

policy, and education as they relate to diabetes in every life stage. For more information, call toll-free

877/CDC-DIAB, E-mail diabetes@cdc.gov, or visit DDT’s Web site at

www.cdc.gov/diabete

CDC’s 2002 National Leadership Conference

CDC’s 2002 National Leadership Conference will convene February 8-13, 2002, at the Renaissance Hotel in

Washington, D.C. Each year this conference offers an outstanding opportunity for learning and networking

among dedicated professionals in the fields of HIV/AIDS prevention and school health, including those from

state and local education, health and social service agencies, national nongovernmental organizations, federal

cdnr

Special Focus:

School Health Programs

cdnotes

agencies, colleges and universities, and philanthropic organizations. Information about the 2001 Leadership

Conference and the program for the 2002 Leadership Conference will be posted in the coming months at

www.cdc.gov/nccdphp/dash

National Oral Health Care Conference

“Dental Public Health: Enhancing Health, Access, and Partnerships” will be the theme of the next National

Oral Health Conference to be held April 30–May 2, 2001, at the Marriott Hotel Downtown in Portland,

Oregon. The program will focus on Medicaid and access issues, national oral health initiatives, health promo-

tion and disease prevention, utilization cost-effectiveness and benefits of programs, education of health person-

nel, and innovative program evaluation. The meeting is sponsored by the Association of State and Territorial

Dental Directors, the American Association of Public Health Dentistry, CDC, the Health Care Financing

Administration, and the Health Resources and Services Administration. More information about the confer-

ence is available at the following Web sites:

www.astdd.org

www.aaphd.org

First National CDC Prevention Conference on Heart Disease and Stroke

CDC, the American Heart Association, and the National Heart, Lung, and Blood Institute are cosponsoring

the First National CDC Prevention Conference on Heart Disease and Stroke to be held August 22–24, 2001,

in Atlanta, Georgia, at the Westin Peachtree Plaza. The goal of the conference is to increase knowledge and

provide opportunities for information sharing, networking, and skill building for state health department staff

and cardiovascular health (CVH) partners to build and expand comprehensive CVH state programs. More

information about the conference is available at

www.cdc.gov/nccdphp/cvd

2001 Cancer Conference

CDC’s 2001 Cancer Conference will be held September 4–7, 2001, in Atlanta, Georgia, at the Marriott

Marquis Hotel. The theme is “Using Science to Build Comprehensive Cancer Programs: A 2001 Odyssey.”

The conference will explore evidence-based science and how it applies in a public health setting. Short courses

will be held September 4 as part of the preconference activities. Abstract submission deadline is March 19,

2001, and the registration deadline for the CyberExpo, exhibit booths, and tabletop exhibits is June 27, 2001.

To be added to the mailing list for the conference, write Laura Shelton at PSA, 2957 Clairmont Road, Suite

480, Atlanta, GA 30349, or call 404/633-6869, extension 214. For more information, E-mail Kathleen Carey,

Conference Co-Chair, at kcarey@cdc.gov or visit

www.cdc.gov/cancer/conference2001

National Conference on Chronic Disease Prevention and Control

The National Center for Chronic Disease Prevention and Health Promotion will host its 16

annual confer-

ence February 27–March 1, 2002, at the Sheraton Atlanta Hotel in Atlanta, Georgia. Participants will learn

about emerging chronic disease issues, data applications, and intervention research; network with health and

other professionals; develop new working relationships; and discover what others are doing in communications,

training, policy, and partnership. For more information, E-mail Dale Wilson at dnw3@cdc.gov or visit

www.cdc.gov/nccdphp/conference

Communications

Second Annual National Colorectal Cancer Awareness Month—March 2001

Colorectal cancer is the second leading cancer killer in the United States. The risk of developing this disease

increases with age; 93% of cases occur in people aged 50 years or older. However, most Americans in that age-

group are not screened for colorectal cancer. Therefore, the National Colorectal Cancer Awareness Month was

Winter 2001

Special Focus:

School Health Programs

cdnotes

established to increase awareness and encourage prevention and early detection through screening. March 2000

was the first National Colorectal Cancer Awareness Month, and 34 leading organizations, including CDC,

joined as collaborating partners. The Cancer Research Foundation of America (CRFA) spearheaded the drive to

have the month of March officially designated as National Colorectal Cancer Awareness Month. To learn more

about CRFA and future planning for National Colorectal Cancer Awareness Month 2001, call 1-877-35-

COLON or visit

www.preventcancer.org

Information Sources

National Oral Health Surveillance System Now Available

The National Oral Health Surveillance System (NOHSS) is a new policy resource available online. The

NOHSS Web site is designed to provide national and state information on oral health indicators including the

percentage of the adult population reporting a dental visit during the past year, the percentage of adults who

had their teeth cleaned during the past year, the percentage of senior population with complete tooth loss, and

the percentage of a state’s population on a community water system whose water is fluoridated. NOHSS also

includes selected information from the Synopses of State Oral Health Programs, which contains state-specific

information on demographics, as well as oral health infrastructure, administration, and program activities.

Additional oral health data will be added each year as they become available. For more information, visit

www.cdc.gov/nohss

Sample Medicaid Dental Purchasing Specifications

Sample Purchasing Specifications for Medicaid Pediatric Dental and Oral Health Services are now available.

These specifications describe comprehensive oral health care services for children and adolescents and are

especially useful for State Medicaid agencies, State Children’s Health Insurance Programs (SCHIPs), and

insurance providers that develop contracts for dental services for low-income children. To learn more about

these specifications, visit

www.gwu.edu/~chsrp/sps/dental

NCCDPHP News

Elizabeth Majestic Selected as NCCDPHP Associate Director

Elizabeth Majestic, MA, was named Associate Director for Planning, Evaluation, and Legislation, Office of the

Director, National Center for Chronic Disease Prevention and Health Promotion (NCCDPHP) and began her

new assignment on February 1. Since 1997, Dr. Majestic has served as Deputy Director, Office on Smoking

and Health (OSH), NCCDPHP, and, since September, Acting Director, OSH, while a search was under way

for the Director position. Before joining OSH, she served for 6 years as Chief, Special Populations Program,

Division of Adolescent and School Health, NCCDPHP.

Congressman Porter Recognized as “Champion of Prevention” at 15

National

Conference on Chronic Disease Prevention and Control

At the 15

National Conference on Chronic Disease Prevention and Control held November 29–December 1,

2000, in Washington, D.C., CDC Director Jeffrey P. Koplan, MD, MPH, presented CDC’s Champion of

Prevention Award to U.S. Congressman John E. Porter of Illinois in recognition of his work in promoting and

cdnr

Special Focus:

School Health Programs

cdnotes

protecting the health of all Americans, particularly the underserved. Dr. Koplan praised Congressman Porter as

a “true advocate of public health” and for being the first House Appropriation Subcommittee Chairman to visit

CDC. In addition to presiding over significant funding increases in CDC’s budget for improved facilities,

Congressman Porter supported public health programs for breast and cervical cancer, polio eradication, domes-

tic violence, oral health, immunizations, obesity and physical activity, school health programs, cardiovascular

diseases, and tobacco control. “It is because of efforts of leaders like Congressman Porter that scientists can

continue to open doors that will lead to longer, healthier, and more satisfying lives for people with chronic

disease,” said James S. Marks, MD, MPH, Director, National Center for Chronic Disease Prevention and

Health Promotion, CDC.

CDC Honors HIV/AIDS Education Leaders

CDC—in association with the U.S. Department of Education; the Society of State Directors of Health, Physi-

cal Education, and Recreation; and the Rollins School of Public Health of Emory University—presented the

following awards at the National Leadership Conference to Strengthen HIV/AIDS Education and Coordinated

School Health Programs, January 22–25, 2001, in Washington, D.C.:

Leadership Award (Coordinated School Health Programs):

Patricia Nichols, Department of Education, Michigan (retired)

Leadership Award (HIV):

Joyce Johnson, Department of Education, New Hampshire

Award of Excellence:

Brenda Z. Greene, National School Boards Association

Simon A. McNeely Award:

Marshall Kreuter, Division of Adult and Community Health, NCCDPHP, CDC

Director’s Special Award

Gordon Ambach, Council of Chief State School Officers

Director’s Special Award:

William Datema, Society of State Directors of Health, Physical Education, and Recreation

Diabetes Stamp

The United States Postal Service will issue a diabetes stamp March 16 in Boston at the Joslin Diabetes Center;

the stamp will go on sale nationwide the same day. The Boston event will feature celebrities and officials from

the postal service and their partners from the Centers for Disease Control and Prevention, the American

Diabetes Association, the Juvenile Diabetes Research Foundation International, and the National Institutes of

Health. The event will be an all-day symposium and workshop series with diabetes screening and informational

booths. The diabetes stamp encourages everyone to “Know More About Diabetes” and will help promote

awareness about the need for early detection and for continued research and education to help find a cure for

this devastating disease. Designed by James Steinberg, the stamp includes two elements associated with diabetes

testing and research—a microscope and a test tube containing blood. To see an image of the stamp, visit the

CDC Diabetes Public Health Resource Web page at

www.cdc.gov/diabetes

or call toll-free 1-877-CDC-

DIAB.

Chronic Disease Notes & Reports

is pub-

lished by the National Center for Chronic

Disease Prevention and Health Promotion,

Centers for Disease Control and Preven-

tion, Atlanta, Georgia. The contents are in

the public domain.

Director, Centers for Disease Control

and Prevention

Jeffrey P. Koplan, MD, MPH

Director, National Center for Chronic

Disease Prevention and Health Promotion

James S. Marks, MD, MPH

Managing Editor Guest Editor

Teresa Ramsey Jane Zanca

Staff Writers

Linda Elsner Teresa Ramsey

Valerie Johnson Diana Toomer

Suzanne Johnson-DeLeon

Guest Writer Layout & Design

Linda Orgain Herman Surles

Copy Editor

Suzanne Johnson-DeLeon

Address correspondence to Managing Editor,

Chronic Disease Notes & Reports

, Centers for Disease

Control and Prevention, Mail Stop K–11, 4770

Buford Highway, NE, Atlanta, GA 30341-3717;

770/488-5050, fax 770/488-5095

E-mail: ccdinfo@cdc.gov

NCCDPHP Internet Web site:

http://www.cdc.gov/nccdphp

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