Opinions of U.S. Adults About School Health Programs 81% of parents of children in K-12 want their kids to receive daily physical education1 74% of parents of adolescents said schools should spend more time or the same amount of time teaching health education as they do teaching other subjects2 1. Survey by Opinion Research Corp. based on interviews with a nationally representative sample of 1,017 adults, February 2000 (margin of error = +6%) 2. Gallup Organization for the American Cancer Society, national telephone survey of 1,003 parents of adolescents enrolled in U.S. public schools, 1993

Overview A Missing Link in School Reform A Coordinated Approach to School Health The Need for Coordinated School Health in Tennessee The Future of Our Nation

Coordinated School Health: The Components Health Education Physical Education Family and Community Involvement Health Services Health Promotion for Staff Nutrition Services Healthy and Safe School Environment Counseling, Psychological, and Social Services

Coordinated School Health: The Process School health coordinators and councils/teams, with the active support of school administrators, provide leadership to enable school districts and schools to: foster collaboration across CSH components and between the school and the community integrate health-related goals and objectives into school improvement plans 4

Coordinated School Health: The Process Priorities determined through a systematic assessment and planning process that Is evidence-based and data- driven Includes extensive input from the school community use assessment to develop, implement, and monitor plans for improvement

A Coordinated Approach Addresses Many Critical Health Issues Affecting Students, Including: Asthma and other chronic health conditions Mental health Immunizations Infectious diseases Oral health Emergency preparedness Physical activity, nutrition, and obesity Tobacco use Sexual health, including pregnancy, HIV, and other STD Safety and violence Alcohol and other drug use

Benefits of Coordinated School Health Increased effectiveness of each component Synergy from collective effort Greater focus on the Whole Child Reduced duplication and fragmentation Links with community resources Greater likelihood of sustainability

Overview A Missing Link in School Reform A Coordinated Approach to School Health The Need for Coordinated School Health in Tennessee The Future of Our Nation

Tennessee Youth Risk Behavior Survey, 2009 Number of students in a high school class of 30 who: Attempted suicide1 (7%) Used marijuana2 (20%) Smoked cigarettes2 (21%) Had been in a physical fight1 (32%) Had at least one drink of alcohol2 (34%) Had ever had sexual intercourse (53%) Did not get enough physical activity3 (76%) Did not eat enough fruits and vegetables3 (82%) 2 6 6 10 10 16 23 25 1 - During the past 12 months; 2 – During the past 30 days; 3 – During the past week Source: Youth Risk Behavior Survey

Birth Rates Among Girls 15–19, 2009 Lowest: 16 TN: 51 Highest: 64 Birth rate/1,000 girls 15–19 US rate: 39 Europe: 4 (lowest)–24 (highest) Source: National Vital Statistics System, National Center for Health Statistics, CDC

Teen Pregnancy Rates in U.S. and 5 European Nations, 1970 and 2006 39% 80% 68% 82% 81% 80%

% of Secondary Schools That… School Health Profiles 2010 Results: Median Among 47 States vs. Tennessee % of Secondary Schools That… Median, 47 States Tennessee Had a school health council, committee, or team 58% 75% Used the CDC School Health Index to assess health policies, activities, and programs 34% 72% Did not sell junk food or sugar sweetened beverages 38% 61% CDC, School Health Profiles

% of Secondary Schools That… School Health Profiles 2010 Results: Median Among 47 States vs. Tennessee % of Secondary Schools That… Median, 47 States Tennessee Required students to take >2 health education courses 52% 31% Taught all 14 essential nutrition education topics 66% 62% Prohibited all tobacco use at all times in all locations 57% 45% CDC, School Health Profiles

Overview A Missing Link in School Reform A Coordinated Approach to School Health The Need for Coordinated School Health in Tennessee The Future of Our Nation

A Survey of >400 Employers # 1 factor that will have the largest impact on the workplace over the next five years: #1 emerging content area in terms of its importance for future graduates entering the U.S. workforce in the next five years: Rising Health Care Costs Making Appropriate Choices Concerning Health and Wellness (76% of employer respondents rated it as “most critical”)

Estimated Financial Costs of Our Failure to Sufficiently Address Youth Health Problems Among 15-24 year olds in 2000: Total lifetime costs of injuries: $79.8 billion1 Costs of new cases of STDs: $6.5 billion2 Average annual costs associated with a child born to a teen mother in 2004: $9.1 billion3 Total costs for treating asthma in 2006: $8 billion4 1 - Finkelstein EA et al. The Incidence and Economic Burden of Injuries in the United States. 2006 2 - Chesson HW et al. Perspectives on Sexual and Reproductive Health 2004; 36(1):11-19 3 - The National Campaign to Prevent Teen Pregnancy. By the Numbers: The Public Costs of Teen Childbearing 4 - AHRQ. Statistical Brief # 242. April 2009

Economic Costs Associated with Obesity are High Direct health care costs of obesity and overweight: 1998: $74 billion 2008: $147 billion ½ of costs publicly financed by Medicare or Medicaid Obesity accounts for 9.1% of annual medical spending Note that the $147 Billion for 2008 is estimated based on 2006 data. Obesity is defined as BMI > 30 Finkelstein EA, et al. Annual medical spending attributable to obesity: payer and service-specific estimates. Health Affairs. 2009;28(4)

Weight Issues Plague the Military The Department of Defense estimates as many as 1/3 of military-age youth are ineligible for service because of their weight.2 In 2007, approximately 15,000 military recruits failed the entrance physical exam because of weight/body fat limits; this was the most common reason for medical disqualification among applicants for active duty enlisted service.3-4 Note: AMSARA is the Accession Medical Standards Analysis & Research Activity Annual Report: Attrition & Morbidity Data for FY 2008 Accessions 1. Mission Readiness press release , Feb 9, 2010 2.Hsu et al. J Adolesc Health. 2007 3. AMSARA Annual Report 2008. 4. Reading, Willing , and Unable to Serve, 2010.

Obesity: A National Security Threat “Obesity rates threaten the overall health of America and the future strength of our military. We must act, as we did after World War II, to ensure that our children can one day defend our country, if need be.” -Retired U.S. Army Gens. John M. Shalikashvili and Hugh Shelton Source: The Washington Post, April 30, 2010

Obesity: A National Security Threat “We urge Congress to: Get the junk food and high-calorie beverages out of our schools. Upgrade the quality of meals served in schools. Develop research-based strategies, implemented through our schools, to help parents and children adopt healthy habits.” -Retired U.S. Army Gens. John M. Shalikashvili and Hugh Shelton Source: The Washington Post, April 30, 2010

Howell Wechsler, EdD, MPH Promoting Health and Academic Achievement Through Coordinated School Health Howell Wechsler, EdD, MPH Director, Division of Adolescent and School Health Tennessee School Boards Association Annual Convention Nashville, TN, November 14, 2011 National Center for Chronic Disease Prevention and Health Promotion Division of Adolescent and School Health