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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
I
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
C
,
3
O NTI NU E D
PA G E
 
2
Fall 2000
Special Focus:
Cancer
Commentary
Commentary
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
I
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
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Special Focus:
School Health Programs
Promoting Healthy Behaviors
Top 10 Physical Activity, Nutrition,
Among Youth
and Tobacco-Use Prevention Priorities
C
1
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
 
4
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
Y
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
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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
.
 
6
Winter 2001
Special Focus:
School Health Programs
Coordinated School Health Programs
Make a Difference
E
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
C
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
C
,
8
O NTI NU ED
PA G E
 
cdnr
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Special Focus:
School Health Programs
A Coordinated School Health Program: The CDC Eight-Component
Model of School Health Programs
T
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
 
8
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
C
6
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
I
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
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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-

10
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
U
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
11
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
T
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.
 
12
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
13
Special Focus:
School Health Programs
Percentage of High School Students
For further reading...
Who Were at Risk of Becoming
or
*
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
=
85
percentile but <95
t h
t h
the U.S. Department of Health and Human Services, Wash-
percentile for body mass index by age and sex.
Students who were
=
95
percentile for body mass
ington, D.C. (2000). Online at
www.health.gov/
†
th
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.
 
14
Winter 2001
Special Focus:
School Health Programs
Reaching and Protecting Young People
at Risk for HIV Infection
R
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
C
,
16
O NTINU E D
PA G E
 
cdnr
15
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.
T
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
 
16
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.
C
14
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
17
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
 
18
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
or
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
at
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
C
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cdnr
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Special Focus:
School Health Programs
Michigan Gets Moving With Exemplary
Physical Education Curriculum
W
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.

20
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
W
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
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cdnr
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Special Focus:
School Health Programs
Gold Medal School
A Healthier You 2002 Moves Utahans
Project Guides
to Physical Activity
Policies to Promote
T
he Gold Medal School Project is part of a larger effort
Health
to inspire Utah to catch the Olympic spirit.  A Healthier
T
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.

22
Winter 2001
Special Focus:
School Health Programs
Healthier Smiles: States Focus on Children’s
Oral Health
A
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
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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
C
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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
).
 
24
Winter 2001
Special Focus:
School Health Programs
Study Will Strengthen School Health
Policies and Programs
I
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
T
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
25
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
C
19
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.

26
Winter 2001
Special Focus:
School Health Programs
How States Are Using YRBSS Data to
Improve the Health of Teenagers
A
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
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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
 
28
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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29
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.
 
30
Winter 2001
Special Focus:
School Health Programs
YRBS Data for 1990s Show How Adolescents Are Faring
T
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
1
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.
1
5
Among students who rode bicycles during the 12 months preceding the survey.
During the 12 months preceding the survey.
2
6
> 1 times during the 30 days preceding the survey.
Among currently sexually active students.
3
7
On > 1 of the 30 days preceding the survey.
On > 3 of the 7 days preceding the survey.
4
8
Risk Behaviors That Worsened
—National Youth Risk Behavior Surveys, 1991–1999
1
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.
1
4
On > 20 of the 30 days preceding the survey.
Among currently sexually active students.
2
5
Drank > 5 drinks of alcohol on at least one occasion on > 1 of the 30 days preceding the survey.
3
 
cdnr
31
Special Focus:
School Health Programs
CDC Supports International School Health
Activities
I
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.”
 
32
Winter 2001
Special Focus:
School Health Programs
Media Campaign Planned to Improve the
Health of America’s Children
U
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.
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Conferences
Plan for Success: Strengthening the Public’s Health Through Health Promotion
19
National Conference on Health Education and Health Promotion
th
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-
th
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
s.
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
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Special Focus:
School Health Programs
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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
or
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
.
16
National Conference on Chronic Disease Prevention and Control
th
The National Center for Chronic Disease Prevention and Health Promotion will host its 16
annual confer-
th
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
 
34
Winter 2001
Special Focus:
School Health Programs
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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
th
Conference on Chronic Disease Prevention and Control
At the 15
National Conference on Chronic Disease Prevention and Control held November 29–December 1,
th
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
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Special Focus:
School Health Programs
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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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