Results from the School Health Policies and Practices Study 2016

Results from the School Health

Policies and Practices Study

2016

U.S. Department of Health and Human Services

Centers for Disease Control and Prevention

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Results from the School Health

Policies and Practices Study

2016

U.S. Department of Health and Human Services

Centers for Disease Control and Prevention

PAGE INTENTIONALLY LEFT BLANK

Contents

Background and Introduction...................................................................................................................................................................................................................................................................................................................................1

Health Education ............................................................................................................................................................................................................................................................................................................................................................................... 1

Physical Education and Physical Activity .............................................................................................................................................................................................................................................................................................. 2

Nutrition Environment and Services ............................................................................................................................................................................................................................................................................................................. 2

Health Services and Counseling, Psychological, and Social Services

(includes Employee Wellness) ................................................................................................................................................................................................................................................................................................................................... 3

Healthy and Safe School Environment (includes Social and Emotional Climate) ........................................................................................................................................................ 3

Physical Environment ............................................................................................................................................................................................................................................................................................................................................................... 4

Overview of Report ....................................................................................................................................................................................................................................................................................................................................................................... 4

Methods ..............................................................................................................................................................................................................................................................................................................................................................................................................................................................................5

Questionnaire Development ........................................................................................................................................................................................................................................................................................................................................ 5

Table 1. Contents of modularized questionnaires—SHPPS 2016 ......................................................................................................................................................................................................................... 6

Sampling .......................................................................................................................................................................................................................................................................................................................................................................................................... 6

Sampling frame ................................................................................................................................................................................................................................................................................................................................................................................... 6

Sample selection ............................................................................................................................................................................................................................................................................................................................................................................... 6

Response rates ...................................................................................................................................................................................................................................................................................................................................................................................... 7

Table 2. Summary of response rates—SHPPS 2016 ................................................................................................................................................................................................................................................................ 7

Recruitment and Data Collection ........................................................................................................................................................................................................................................................................................................................ 7

Data Cleaning, Weighting, and Analysis ................................................................................................................................................................................................................................................................................................ 8

Cleaning ............................................................................................................................................................................................................................................................................................................................................................................................................ 8

Weighting....................................................................................................................................................................................................................................................................................................................................................................................................... 8

Analysis............................................................................................................................................................................................................................................................................................................................................................................................................... 9

Limitations and Future Plans ..................................................................................................................................................................................................................................................................................................................................... 9

Results ...................................................................................................................................................................................................................................................................................................................................................................................................................................................................................10

Table 1.1. Percentage of districts that had adopted specific policies related to health education standards—SHPPS 2016 .......................................10

Table 1.2. Percentage of districts with specific health education policies and practices, by school level—SHPPS 2016 .................................................10

Table 1.3. Percentage of districts with other specific health education policies and practices—SHPPS 2016 ................................................................................ 10

Table 1.4. Percentage of districts that follow specific standards for health education, by school level—SHPPS 2016 ....................................................... 11

Table 1.5. Percentage of districts that had adopted a policy stating that schools will teach specific health topics, by

school level—SHPPS 2016 ........................................................................................................................................................................................................................................................................................................................................ 11

Table 1.6. Percentage of districts that provided specific resources for health education,

by school level—SHPPS 2016 .............................................. 12

Table 1.7. Percentage of districts that had adopted specific staffing policies for newly hired staff who teach health

education, by school level

—SHPPS 2016 ..........................................................................................................................................................................................................................................................................................12

Table 1.8. Percentage of districts with policies requiring schools to meet the health education needs of students

with disabilities by using specific strategies—SHPPS 2016 ...................................................................................................................................................................................................................................... 12

Table 1.9. Percentage of districts that had adopted a policy requiring those who teach health education to

receive professional development on specific health topics, and the percentage of districts that provided funding

for professional development or offered professional development on these topics to those who teach health

education

Table 1.10. Percentage of districts that provided funding for professional development or offered professional

development on specific instructional strategy topics to those who teach health education

—SHPPS 2016 ..................................................................................... 14

Table 1.11. Percentage of districts in which health education staff worked on health education activities with other

district-level and local agency or organization staff

Table 2.1. Percentage of districts that had adopted specific policies related to physical education standards—

SHPPS 2016 .....................................................................................................................................................................................................................................................................................................................................................................................16

Table 2.2. Percentage of districts that follow specific standards for physical education, by school level—SHPPS 2016 .................................................16

Table 2.3. Percentage of districts that had adopted specific policies related to physical education requirements and

exemptions from these requirements, by school level—SHPPS 2016 ......................................................................................................................................................................................................... 17

Table 2.4. Percentage of districts with specific physical education policies and practices, by school level—SHPPS 2016 ............................................18

Table 2.5. Percentage of districts that provided specific resources for physical education,

by school level—SHPPS 2016 .........................................18

Table 2.6. Percentage of districts with specific requirements and recommendations related to assessments, by

Table 2.7. Percentage of districts that had adopted specific staffing policies for newly hired staff who teach physical

education, by school level—SHPPS 2016 ............................................................................................................................................................................................................................................................................................19

Table 2.8. Percentage of districts with policies requiring schools to meet the physical education needs of students

Table 2.9. Percentage of districts with requirements and recommendations related to recess—SHPPS 2016 .............................................................................. 20

Table 2.10. Percentage of districts with requirements and recommendations related to physical activity, by school

level—SHPPS 2016 ............................................................................................................................................................................................................................................................................................................................................................ 20

Table 2.11. Percentage of districts with other physical education and physical activity policies and practices—

Table 2.12. Percentage of districts that provided funding for professional development or offered professional

development on specific topics to those who teach physical education

—SHPPS 2016 ................................................................................................................................................... 22

Table 2.13. Percentage of districts in which physical education staff worked on physical education activities with

other district-level and local agency or organization staff

Table 2.14. Percentage of districts with specific policies and practices related to interscholastic sports—SHPPS 2016 .................................................24

Table 2.15. Percentage of districts with specific policies and practices related to concussions during interscholastic

sports—SHPPS 2016 .........................................................................................................................................................................................................................................................................................................................................................24

Table 3.1. Percentage of districts with specific school nutrition services policies and practices—SHPPS 2016 ........................................................................... 25

Table 3.2. Percentage of districts with food procurement contracts that address specific issues—SHPPS 2016 ....................................................................... 26

Table 3.3. Percentage of districts

that almost always or always used healthy food preparation practices

—SHPPS 2016 ........................................ 26

Table 3.4. Percentage of districts in which nutrition services staff worked on school nutrition services activities with

other district-level and local agency or organization staff

Table 3.5. Percentage of districts that used specific practices

to promote school nutrition services—SHPPS 2016 ............................................................ 28

Table 3.6. Percentage of districts with other practices related to school nutrition services—SHPPS 2016 ....................................................................................... 29

Table 3.7. Percentage of districts with practices related to local wellness policies—SHPPS 2016 .................................................................................................................. 30

Table 3.8. Percentage of districts with specific staffing policies for nutrition services staff—SHPPS 2016 ......................................................................................31

Table 3.9. Percentage of districts that provided funding for professional development or offered professional

development on specific topics to nutrition services staff—SHPPS 2016..............................................................................................................................................................................................32

Table 3.10. Percentage of districts that require or recommend that schools implement specific nutrition practices—SHPPS 2016 ...............33

Table 3.11. Percentage of district food service directors

with specific qualifications—SHPPS 2016 ......................................................................................................... 34

Table 3.12. Percentage of districts with specific policies and practices related to beverages available outside the

school meal program—SHPPS 2016 ...........................................................................................................................................................................................................................................................................................................35

Table 3.13. Percentage of districts that require or recommend that schools prohibit specific practices related to

foods and beverages available outside of the school meal program—SHPPS 2016.................................................................................................................................................................35

iii

Health Services and Counseling, Psychological, and Social Services ............................................................................................................................................................................................ 36

Table 4.1. Percentage of districts with specific policies and practices related to health services and counseling,

psychological, and social services—SHPPS 2016 ..................................................................................................................................................................................................................................................................... 36

Table 4.2. Percentage of districts that had adopted a policy stating that schools will obtain and keep certain

information in any type of student record—SHPPS 2016 .............................................................................................................................................................................................................................................37

Table 4.3. Percentage of districts with specific policies and practices related to immunizations—SHPPS 2016.........................................................................37

Table 4.4. Percentage of districts that had adopted a policy stating specific immunization requirements for school

entry—SHPPS 2016 .......................................................................................................................................................................................................................................................................................................................................................... 38

Table 4.5. Percentage of districts with specific practices related to tuberculosis (TB) screening and testing—SHPPS 2016 .................................... 39

Table 4.6. Percentage of districts that had adopted policies related to student medications—SHPPS 2016 ................................................................................... 39

Table 4.7. Percentage of districts in which health services staff worked on school health services activities with

other district-level and local agency or organization staff

Table 4.8. Percentage of districts in which counseling, psychological, or social services staff worked on school

counseling, psychological, or social services activities with other district-level and local agency or organization staff

—SHPPS 2016 .... 40

Table 4.9. Percentage of districts that reviewed, measured, or evaluated aspects of school health services and school

counseling, psychological, or social services

Table 4.10. Percentage of districts that had adopted policies related to student health screening—SHPPS 2016 ...................................................................41

Table 4.11. Percentage of districts that had adopted a policy that schools will provide specific health and prevention

services to students—SHPPS 2016 ...............................................................................................................................................................................................................................................................................................................42

Table 4.12. Percentage of districts with specific policies related to condom availability, by school level

—SHPPS 2016 .............................................. 43

Table 4.13. Percentage of districts that had adopted a policy that schools will provide referrals for specific services

or conditions to students—SHPPS 2016 ..............................................................................................................................................................................................................................................................................................44

Table 4.14. Percentage of districts that had adopted a policy specifying education and certification requirements for

health services and counseling, psychological, or social services staff—SHPPS 2016 ........................................................................................................................................................ 45

Table 4.15. Percentage of districts with specific staffing policies and practices for health services and counseling,

psychological, or social services staff—SHPPS 2016 .......................................................................................................................................................................................................................................................... 46

Table 4.16. Percentage of districts that provided funding for professional development or offered professional

development

to school health services staff or counseling, psychological, or social services staff on specific services

or topics—SHPPS 2016 .................................................................................................................................................................................................................................................................................................................................................47

Table 4.17. Percentage of districts that provided funding for training or offered training to any teachers,

administrators, and school staff other than school nurses and counseling, psychological, and social services staff on

specific topics

—SHPP S 2016 ............................................................................................................................................................................................................................................................................................................................. 49

Table 4.18. Mean number of school-based health centers per district that offer specific types of services to students

in the district—SHPPS 2016 ................................................................................................................................................................................................................................................................................................................................. 49

Table 4.19. Percentage of districts that had arrangements with specific organizations or healthcare professionals to

provide health services or counseling, psychological, or social services to students in the district—SHPPS 2016 ..................................................................... 49

Table 4.20. Percentage of districts that had arrangements with organizations or healthcare professionals to provide

specific health services, prevention services, and counseling, psychological, or social services to students in the district—SHPPS 2016 50

Table 4.21. Percentage of districts with specific employee wellness policies and practices—SHPPS 2016 ........................................................................................51

Table 4.22. Percentage of districts that provided funding for or offered specific screenings or services for employees

—SHPPS 2016 ...51

Table 4.23. Percentage of district health services coordinators

with an undergraduate major or minor or graduate

degree in specific areas—SHPPS 2016 ....................................................................................................................................................................................................................................................................................................52

Healthy and Safe School Environment

(includes Social and Emotional Climate) ............................................................................................................................................................................................................................................................................................53

Table 5.1. Percentage of districts with specific policies related to keeping the school environment safe and secure,

by school level—SHPPS 2016 ...............................................................................................................................................................................................................................................................................................................................53

Table 5.2. Percentage of districts with specific practices related to school start times, by school level

—SHPPS 2016 .................................................. 54

Table 5.3. Percentage of districts in which students must live a standard distance from their school to be eligible for

riding a school bus, by school level

Table 5.4. Percentage of districts that support or promote transportation-related practices—SHPPS 2016 .................................................................................. 54

Table 5.5. Percentage of districts with specific policies and practices related to bullying and harassment—SHPPS 2016 ...........................................55

Table 5.6. Percentage of districts with specific policies and practices related to gang activity, drug testing, and

suicide prevention—SHPPS 2016 ...................................................................................................................................................................................................................................................................................................................55

Table 5.7. Percentage of districts with specific tobacco-use prevention policies—SHPPS 2016 ........................................................................................................................ 56

Table 5.8. Percentage of districts with specific injury prevention and safety policies and the percentage of districts

that have ever been sued because of an injury—SHPPS 2016............................................................................................................................................................................................................................... 57

Table 5.9. Percentage of districts with specific playground safety policies and practices

—SHPPS 2016 ............................................................................................ 58

Table 5.10. Percentage of districts that require or recommend that schools implement specific sun safety practices—SHPPS 2016 .......... 58

Table 5.11. Percentage of districts with specific policies and practices related to crisis preparedness, response, and

recovery—SHPPS 2016..................................................................................................................................................................................................................................................................................................................................................59

Table 5.12. Percentage of districts with crisis preparedness, response, and recovery plans that include specific

elements—SHPPS 2016 ...............................................................................................................................................................................................................................................................................................................................................59

Table 5.13. Percentage of districts that require schools to include specific topics in their crisis preparedness,

response, and recovery plans—SHPPS 2016 .................................................................................................................................................................................................................................................................................. 60

Table 5.14. Percentage of districts that worked with specific groups to develop their crisis preparedness, response,

and recovery plans

Table 5.15. Percentage of districts with specific policies related to community service and service learning—SHPPS 2016 ....................................61

Table 5.16. Percentage of districts that provided funding for professional development or offered professional

development for school faculty and staff on how to implement school-wide policies and programs related to specific

topics

Table 5.17. Percentage of districts with specific practices related to school health coordination—SHPPS 2016 ....................................................................... 62

Table 5.18. Percentage of districts that had one or more district-level school health councils, committees, or teams that

addressed specic school health program components and health topics and engaged in specic activities

—SHPPS 2016 .......................................................................................... 62

Table 5.19. Percentage of districts that had one or more school health councils that included representatives from

specific school groups and local agencies or organizations

Table 6.1. Percentage of districts with specific policies and practices related to the physical school environment—

Table 6.2. Percentage of districts with specific policies and practices related to indoor and outdoor air quality and

drinking water quality—SHPPS 2016 ...................................................................................................................................................................................................................................................................................................... 64

Table 6.3. Percentage of districts with specific pest management policies and practices—SHPPS 2016 ............................................................................................. 65

Table 6.4. Percentage of districts that provided funding for training or offered training to custodial or maintenance

staff on specific topics

Table 6.5. Percentage of districts that have adopted specific green building policies—SHPPS 2016 ........................................................................................................ 66

Table 6.6. Percentage of districts that found specific factors influential in deciding to build a new school facility

rather than renovate an existing facility

—SHPPS 2016............................................................................................................................................................................................................................................... 66

Table 6.7. Percentage of districts that found specific factors influential in deciding where to build a new school

facility

Table 6.8. Percentage of districts that required formal consultation or input from groups on new school construction—SHPPS 2016 ....67

Table 6.9. Percentage of districts with specific policies and practices related to joint use agreements

—SHPPS 2016 ................................................... 68

Trends Over Time ............................................................................................................................................................................................................................................................................................................................................................................................................... 69

Table 7.1. Significant trends over time

in the percentage of districts with specific health education policies and

practices, SHPPS 2000, 2006, 2012, and 2016 ............................................................................................................................................................................................................................................................................... 69

Table 7.2. Significant trends over time

in the percentage of districts with specific physical education and physical

activity policies and practices, SHPPS 2000, 2006, 2012, and 2016 .................................................................................................................................................................................................................70

Table 7.3. Significant trends over time

in the percentage of districts with specific nutrition environment and

services policies and practices, SHPPS 2000, 2006, 2012, and 2016 ............................................................................................................................................................................................................... 72

Table 7.4. Significant trends over time

in the percentage of districts with specific health services and counseling,

psychological, and social services policies and practices, SHPPS 2000, 2006, 2012, and 2016 ..................................................................................................................................74

Table 7.5. Significant trends over time

in the percentage of districts with specific school environment policies and

Table 7.6. Significant trends over time

in the percentage of districts with specific physical school environment

policies and practices, SHPPS 2000, 2006, 2012, and 2016 ......................................................................................................................................................................................................................................... 79

Healthy People 2020 Objectives ....................................................................................................................................................................................................................................................................................................................... 79

Table 8.1. National health objectives from Healthy People 2020 measured by SHPPS ...................................................................................................................................................... 79

Discussion ............................................................................................................................................................................................................................................................................................................................................................................................................................................................80

Health Services and Counseling, Psychological, and Social Services (includes Employee Wellness) .................................................................................. 83

Conclusion .........................................................................................................................................................................................................................................................................................................................................................................................................................................................87

References .......................................................................................................................................................................................................................................................................................................................................................................................................................................................... 88

Appendix 1: National Reviewers ..............................................................................................................................................................................................................................................................................................................91

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Background and Introduction

Students in the United States engage in behaviors that

place them at risk for the leading causes of morbidity and

mortality among youth and adults (1). ese behaviors

oen are established during childhood and adolescence

and extend into adulthood; therefore, it is important to

prevent such behaviors at an early age. Because schools have

direct contact with more than 95 percent of our nation’s

young people aged 5-17 years, they play a critical role

in promoting the health and safety of young people and

helping them establish lifelong healthy behavior patterns.

In 2014, the Association for Supervision and Curriculum

Development (ASCD) and the Centers for Disease Control

and Prevention (CDC) released the Whole School, Whole

Community, Whole Child (WSCC) model (2). is model

“incorporates the components of a coordinated school

health program around the tenets of a whole child approach

to education and provides a framework to address the

symbiotic relationship between learning and health” (2,

p. 6). e WSCC model contains 10 components: health

education; physical education and physical activity;

nutrition environment and services; health services;

counseling, psychological and social services; social

and emotional climate; physical environment; employee

wellness; family engagement; and community involvement.

To monitor progress in each of these areas, it is critical to

measure periodically the extent to which schools and school

districts nationwide have policies and practices in place that

address these components. In addition, data are needed to

monitor national health objectives that pertain to schools

and school districts, as well as to assist with program

planning, help drive policy improvement, and track changes

over time in these policies and practices. In response to

these needs, CDC developed the School Health Policies

and Practices Study (SHPPS). SHPPS is a national survey

periodically conducted to assess school health policies and

practices at multiple levels for each of the components of the

WSCC model. SHPPS was conducted at the state, district,

school, and classroom levels in 1994, 2000, and 2006. In

2012, SHPPS was conducted only at the state and district

levels, and in 2014, it was conducted only at the school and

classroom levels. SHPPS 2016 was conducted at the district

level only; this report therefore provides district-level data

on each of the components described below. Note that some

components have been combined to reect the organization

of the study questionnaires (see Methods section).

Health Education

Health education is a fundamental part of an overall

school health program and one of 10 components in the

WSCC model (2) described above. e importance of

health education is recognized by Healthy People 2020

which has established four relevant objectives (3):

EMC-4. Increase the proportion of

elementary, middle, and senior high schools

that require school health education.

ECBP-2. Increase the proportion of elementary,

middle, and senior high schools that provide

comprehensive school health education to prevent

health problems in the following areas: unintentional

injury; violence; suicide; tobacco use and addiction;

alcohol or other drug use; unintended pregnancy,

HIV/AIDS, and STD infection; unhealthy dietary

patterns; and inadequate physical activity.

ECBP-3. Increase the proportion of elementary, middle,

and senior high schools that have health education

goals or objectives which address the knowledge and

skills articulated in the National Health Education

Standards (high school, middle, and elementary).

ECBP-4. Increase the proportion of elementary,

middle, and senior high schools that provide school

health education to promote personal health and

wellness in the following areas: hand washing or hand

hygiene; oral health; growth and development; sun

safety and skin cancer prevention; benets of rest and

sleep; ways to prevent vision and hearing loss; and

the importance of health screenings and checkups.

Health instruction in schools is shaped, in large part, by

the health education curriculum. Research has identied

the following characteristics of eective health education

curricula (4-17): focuses on clear health goals and related

behavioral outcomes; is research-based and theory-

driven; addresses individual values, attitudes, and beliefs;

addresses individual and group norms that support health-

enhancing behaviors; focuses on reinforcing protective

factors and increasing perceptions of personal risk and

harmfulness of engaging in specic unhealthy practices

and behaviors; addresses social pressures and inuences;

builds personal competence, social competence, and self-

ecacy by addressing skills; provided functional health

knowledge that is basic, accurate, and directly contributes

to health-promoting decisions and behaviors; uses strategies

designed to personalize information and engage students;

provides age-appropriate and developmentally appropriate

information, learning strategies, teaching methods, and

materials; incorporates learning strategies, teaching

methods, and materials that are culturally inclusive;

provides adequate time for instruction and learning;

provides opportunities to reinforce skills and positive

health behaviors; provides opportunities to make positive

connections with inuential others; and includes teacher

information and plans for professional development and

training that enhance eectiveness of instruction and

student learning. CDC has developed the Health Education

Curriculum Analysis Tool (HECAT) to help schools identify

curricula that feature these characteristics of eective

health education curricula (18). In addition, the Registries

of Programs Eective in Reducing Youth Risk Behavior

(http://www.cdc.gov/healthyyouth/adolescenthealth/

registries.htm) identify specic interventions and curricula

determined to be worthy of recommendation on the basis of

expert opinion or a review of design and research evidence.

e National Health Education Standards (NHES) (19)

have been developed to further shape health instruction

in schools. e NHES help establish, promote, and

support health-enhancing behaviors for students in

grades preK-12 and provide a framework for designing or

selecting curricula, allocating instructional resources, and

assessing student achievement. e NHES outline specic

expectations for what students should know and be able

to do by grades 2, 5, 8, and 12 to promote personal, family,

and community health. e NHES also have become an

accepted reference on health education and provide a

framework for adoption of standards by most states.

Physical Education and Physical Activity

Physical education and physical activity in schools

can positively impact students’ health and academic

achievement outcomes (e.g., grades, classroom behavior,

and cognitive performance) (20-23). Districts can

provide support to schools to help students attain the

nationally recommended 60 minutes of daily physical

activity. rough the WSCC model, districts and

schools can develop policies and practices that promote

a Comprehensive School Physical Activity Program

(CSPAP) (24). e goal of a CSPAP is to increase physical

activity opportunities before, during, and aer school

and increase students’ overall physical activity and health

(24). A CSPAP includes strong coordination across ve

components: physical education, physical activity during

school, physical activity before and aer school, sta

involvement, and family and community engagement.

Physical education serves as the foundation of a CSPAP

and is a K-12 academic subject that provides standards-

based curricula and instruction that is part of a well-

rounded education (25). Districts can support the four

essential components that provide the structure for

physical education. ese include: policy and environment

(e.g., daily minutes of physical education, not allowing

exemptions, waivers, and substitutions); curriculum

(e.g., written physical education curriculum for grades

K–12 that is sequential and comprehensive); student

assessment (e.g., evidence-based practices that measure

student achievement in all areas of instruction, including

physical tness); and appropriate instruction (e.g.,

instructional practices and inclusion of all students) (26).

In addition, districts can help schools provide other

opportunities for students to apply what they have

learned in physical education, which can help increase

their physical activity during the school day (22-24).

One opportunity is through recess, which is a regularly

scheduled period within the school day for physical activity

and play that is monitored by trained sta and volunteers

(27). Another way to increase physical activity during the

school day is by encouraging the use of physical activity,

such as stretching, jumping, and dancing in the classroom

(22, 24). Physical activity before and aer school also

provides opportunities for all students to be physically

active. Activities might include programs promoting

or supporting walking or biking to and from school,

physical activity clubs, intramural programs (i.e., sports

organized by the school or community in which any child

can participate), interscholastic sports (i.e., competitive

sports between schools), and physical activity in before-

school and aer-school extended day programs (22, 24).

Nutrition Environment and Services

A school’s nutrition environment and services include

the foods and beverages that are available to students

throughout the school day, and the information and

messages about food, beverages, and nutrition that students

encounter on school grounds (28). A school’s nutrition

environment and services can aect students’ dietary

choices and understanding about good nutrition. A healthy

school nutrition environment makes it easier for students

to make healthy choices by giving them access to nutritious

and appealing foods and beverages, providing consistent

and accurate messages about good nutrition, and oering

ways for students to learn about and practice healthy eating.

School meal programs, including the National School

Lunch Program (NSLP) and the School Breakfast Program

(SBP), provide students with balanced meals that meet

federal nutrition standards including a variety of fruits,

vegetables, and whole grains; limits on saturated fat and

sodium; and minimum and maximum calorie levels (29).

All students can participate in school meal programs, and

some students are eligible to receive free or reduced-price

meals (25). Students may also have access to competitive

foods, which are foods and beverages that are sold outside

of the school meal programs, through fundraisers,

school stores, vending machines, snack bars, and a la

carte items. Competitive foods must meet federal Smart

Snacks in School nutrition standards (30). In addition to

competitive foods and beverages that are sold during the

school day, some schools may also oer students foods and

beverages during classroom parties, school celebrations,

and rewards for good behavior or academic performance.

Although these foods and beverages that are oered are

not required to meet Smart Snacks in School standards, all

school districts that participate in a school meal program

(e.g., NSLP) are required to establish nutrition standards

for these items in their local school wellness policy. e

district’s local school wellness policy must also include goals

for nutrition education and promotion, nutrition guidelines

for all foods sold on each school campus during the school

day, goals for physical activity, goals for other opportunities

to promote student wellness, and nutrition standards for

food and beverage marketing that allow marketing and

advertising of only those foods and beverages that meet

the Smart Snacks in School nutrition standards (31).

Health Services and Counseling,

Psychological, and Social Services

(includes Employee Wellness)

School health services and counseling, psychological, and

social services support student health, broadly dened to

include physical, mental, behavioral, and social-emotional

health. By providing prevention and intervention services,

schools can support students’ educational success. Health

services range from rst aid and emergency care to the

management of chronic conditions, such as asthma

or diabetes, and also include wellness promotion. At

school, health services are provided most frequently by

registered school nurses. e importance of their role

is apparent in multiple policy and position statements

from the National Association of School Nurses (32)

and the American Academy of Pediatrics (33). Further,

school health services are “designed to ensure access and/

or referrals to the medical home or private healthcare

provider” (34, p. 733). Indeed, schools can play a valuable

role in providing access to health care available in the

community for students who might otherwise have

diculty obtaining access to such services (35).

Counseling, psychological, and social services include

screenings, evaluations, and assessments; individual or

group counseling and consultation as appropriate; and

referrals to school and community support services

when needed. In the school setting, professionals such

as school counselors, school psychologists, and school

social workers typically provide these services. School

mental health services may be oered according to one

of three models: 1) school-supported with a separate

mental health unit in the school, 2) formal community

connections and linkages through contracts with

mental health professionals, and 3) comprehensive and

integrated health and mental health services through

school-based health centers and programs that address

prevention, screening, referral, and direct care (36).

Students’ health and academic success also can be

supported by fostering school employees’ physical and

mental health through employee wellness programs. ese

programs are designed to address multiple risk factors (e.g.,

lack of physical activity, tobacco use) and health conditions

(e.g., diabetes, depression) to meet the health and safety

needs of those working in schools. When school employees

are healthy, they are more productive, less likely to be

absent, and can serve as positive role models for students.

Employee wellness programs “can improve a district’s

bottom line by decreasing employee health insurance

premiums, reducing employee turnover, and cutting

costs of substitutes” (34). Ideally, such programs include

a coordinated set of programs, policies, benets, and

environmental supports. e Directors of Health Promotion

and Education developed School Employee Wellness: A

Guide for Protecting the Assets of Our Nation’s Schools to

help school district sta establish, implement, and sustain

eective school employee wellness programs (37).

Healthy and Safe School Environment

(includes Social and Emotional Climate)

School districts promote a healthy and safe school

environment through a variety of policies and practices

that cover a wide range of issues, including transportation,

unintentional injury and violence prevention, sun

safety, tobacco use prevention, and crisis preparedness.

A healthy and safe school environment also addresses

the social and emotional climate, or “psychosocial

aspects of students’ educational experience that

inuence their social and emotional development” (34).

A positive social and emotional climate encourages

students to engage in school activities, fosters positive

relationships in school and in the community, and

promotes more eective teaching and learning (34).

Healthy and safe school environment policies and practices

can be supported with professional development for

sta and with a school health council, committee, or

team. “Professional development is a systematic process

that strengthens how professionals obtain and retain

knowledge, skills, and attitudes” (38). When well executed,

professional development enables school sta to transfer

knowledge and skills to students or other sta (38).

us, eective professional development that addresses

the health and safety needs of students is an important

aspect of a healthy and safe school environment. Such

professional development can be enhanced by the work

of a school health council, a diverse group of school

sta and community members whose role is to make

health policy, program, and practice recommendations

to schools or school districts that promote the health of

students and sta (65). ese councils take advantage of

a variety of community resources and are an important

aspect of creating healthy and safe schools (65).

Physical Environment

As dened in the WSCC model, the physical school

environment component includes not only the school

building and its contents, but also the land on which

it is built and the area surrounding it. is component

encompasses a wide range of issues such as ventilation,

moisture, temperature, noise, lighting, trac, pollution,

and chemical and biological agents in the air, water, and

soil (34, 39, 40). ese issues inuence the health and safety

of students, sta, and visitors (39, 40), and as summarized

by Michael et al., a growing body of literature supports the

importance of addressing the physical school environment

because of its inuence on academic achievement (21).

Providing a healthy physical school environment can be

dicult for many schools because of limited resources to

address the unique and diverse challenges of maintaining

healthy school buildings and grounds. For example, the

range of activities that schools support include food

preparation, physical activity and athletics, laboratory

sciences, and traditional educational activities, to name

a few. Each of these activities has its own environmental

health and safety-related concerns such as indoor air

quality, pest management, and chemical safety and

management. And while some school districts are facing

reductions in student enrollment, in others, regional

residential growth has led to overcrowding with associated

health and school performance issues (41). Districts

with aging schools and overcrowding need to make

decisions about renovations or capital investments in

new schools. High property costs or lack of property

options can lead to imperfect school location decisions.

ese school siting decisions aect trac and trac-

related air pollution, busing, walkability, community

use of school facilities or school use of community

facilities, and sometimes exposure to poor soil or air

quality (42). Trained custodial and maintenance sta

and informed school personnel are important allies in

promoting a healthy and safe school environment.

Overview of Report

is report provides results from the SHPPS conducted in

2016. Following a detailed Methods section, 2016 results

are presented in a series of 90 tables organized around the

components of the WSCC model described above. Tables

1.1 through 6.9 provide the percentage of districts with

certain policies and practices in place. Results are shown

separately by school level (elementary school, middle

school, and high school) if the questions were asked

separately by school level. For each variable, the prevalence

estimate is shown along with a 95% condence interval.

Tables 7.1 through 7.6 then provide the results of trend

analyses examining changes over time in selected school

health policies and practices (see the Methods section for

the criteria used to determine which variables are reported).

Table 8.1 provides results for the 7 Healthy People 2020

objectives and sub-objectives monitored by SHPPS

2016 (3). Following the Results section is a Discussion

section that highlights the key ndings of the report.

Methods

e School Health Policies and Practices Study (SHPPS)

2016 was conducted by CDC through a contract with

ICF Macro, Inc., an ICF Company. e study, formerly

known as the School Health Policies and Programs Study,

was previously conducted in 1994, 2000, 2006, 2012, and

2014. SHPPS 2016 examined seven components of school

health among a nationally representative sample of public

school districts. ese components correspond to those

in the Whole School, Whole Community, Whole Child

(WSCC) model (2): health education; physical education

and physical activity; nutrition environment and services;

health services; counseling, psychological, and social

services; healthy and safe school environment (including

social and emotional climate); and physical school

environment. SHPPS 2016 also included a limited number

of questions on employee wellness, family engagement,

and community involvement, which were integrated into

the questionnaires assessing the other components.

Questionnaire Development

While previous cycles of SHPPS used seven questionnaires

at the district level, SHPPS 2016 used only ve: Health

Education, Physical Education and Physical Activity,

Nutrition Services, Health Services, and Healthy and Safe

School Environment. Content from the two previously

elded questionnaires, Mental Health and Social Services

(now called Counseling, Psychological, and Social Services

in line with the WSCC model) and Faculty and Sta Health

Promotion (now called Employee Wellness in line with the

WSCC model) was incorporated into the Health Services

and Healthy and Safe School Environment questionnaires.

e questionnaire development process for SHPPS 2016

began in March 2015. First, CDC convened a series

of meetings with subject matter experts to complete a

question-by-question review of the 2012 versions of the

questionnaires. Questions were agged for deletion or

revision if the 2012 data revealed very high prevalence

or a large number of missing responses. Subject

matter experts also proposed deletion or revision of

questions that were outdated or no longer of interest

and proposed new questions to address data needs.

Next, all new questions and those that been revised

substantially were subjected to cognitive testing. is testing

was conducted by three trained interviewers who asked

respondents to answer each question and then asked follow-

up questions to ascertain the respondents’ understanding

of the question and response options. Interviews were

conducted via telephone, but to simulate the Web-based

administration used in SHPPS 2016, respondents viewed

a PowerPoint presentation in which each slide contained

a single question and its associated response options

and “help” statements. Testing was conducted in eight

districts selected to vary in geographic location, size, and

urbanicity, but not included in the SHPPS 2016 sample.

Between six and eight interviews were conducted for

each questionnaire, resulting in a total of 42 interviews.

While the cognitive interviews were being conducted,

CDC distributed the dra questionnaires to reviewers

representing federal agencies, national nongovernmental

organizations, foundations, universities, and businesses

nationwide. Appendix 1 contains the list of reviewers who

provided comments. Based on the comments received

from the reviewers and the results of the cognitive testing,

CDC revised the dra questionnaires and produced a nal

version. ese questionnaires were then programmed

into a Web-based survey system. Print versions of all

questionnaires are available at www.cdc.gov/shpps.

ree of the nal questionnaires were divided into modules:

Health Education, Physical Education and Physical Activity,

and Healthy and Safe School Environment. Modularization

served two purposes. First, to reduce burden and improve

reporting accuracy, related items were grouped together

so that a single respondent could complete each module.

Second, modularization allowed dierent respondents

to complete one or more sections of each questionnaire

based on their area of expertise. Table 1 shows the

modules comprising each modularized questionnaire.

Table 1. Contents of modularized questionnaires — SHPPS 2016

Questionnaire Module contents

Health

Education

Module 1 — Standar ds

Module 2 — Elementary School Instruction

Module 3 — Middle School Instruction

Module 4 — High School Instruction

Module 5 — Students with Disabilities, Stang and Professional Development, Collaboration and Promotion, and Evaluation

Module 6 — Health Education Coordinator

Healthy and Safe

School Environment

Module 1 — General School Environment (Elementary Schools, Middle Schools, High Schools), Transportation, Joint Use Agreements, Violence

Prevention, Tobacco Use Prevention, Student Drug Testing, Injury Prevention and Safety

Module 2 — Physical School Environment

Module 3 — Crisis Preparedness, Response, and Recovery

Module 4 — Community Service and Service Learning, Foods and Beverages Available Outside of the School Meal Programs, Professional

Development, Employee Wellness, and School Health Coordination

Physical Education

and Physical Activity

Module 1 — Standar ds

Module 2 — Elementary School Instruction

Module 3 — Middle School Instruction

Module 4 — High School Instruction

Module 5 — Students with Disabilities, Physical Activity, Use of Protective Gear, Use of Physical Activity for Discipline, Stang and Professional

Development, Collaboration and Promotion, Evaluation, and Interscholastic Sports

Module 6 — Physical Education Coordinator

Sampling

SHPPS 2016 used a stratied random sample of

public school districts in the United States to obtain

nationally representative data. Unlike district samples

drawn for previous cycles of SHPPS, the district

sample did not need to provide a platform for a

linked school sample, allowing for a simpler and more

ecient sampling design than in previous cycles.

Sampling frame

e sampling frame was based on the October 2015

version of the Market Data Retrieval (MDR) database

(43). e frame included 13,320 districts, including

12,628 regular districts, 504 districts that were sub-units

of supervisory unions, 49 “main” districts (see description

below), and 139 career/technical education districts.

Districts were not included in the frame if they were

supervisory unions, sub-districts, or special education

districts. Supervisory unions were “parent” districts that

contained sub-units, so they were excluded to ensure that

each unit was included only once in the frame. “Main”

districts were typically large districts broken down by

school level or region into sub-districts; only the main

districts were included in the frame to avoid duplication.

Sample selection

Stratication of the frame of school districts was based

on locale codes developed by the National Center for

Education Statistics (NCES) that were included in the

MDR database. ese NCES locales created 12 strata that

classied districts based on urban status: city (divided

into large, midsize, and small), suburb (divided into large,

midsize, and small), town (divided into fringe, distant,

and remote), and rural (divided into fringe, distant, and

remote). e sample was allocated proportionally across the

12 strata, creating a nearly self-weighting sample of districts.

Initially, 972 districts were sampled. is sample included

with certainty 17 districts funded for school-based HIV/

STD prevention by the Division of Adolescent and School

Health (DASH) at CDC at the time of the study, so that

future analyses could examine how these districts might

dier from those without this funding. e initial sample

was validated to ensure that the sampled districts met

eligibility criteria. Districts were considered ineligible if

they served fewer than 30 students across all schools in the

district, if they served only a special population of students,

if they only contained schools that served students for whom

primary education services were provided within schools

in other districts (such as vocational schools), or if they

only functioned for administrative purposes and did not

contain schools. Of the 972 sampled districts, 14 were found

to be ineligible during sample validation and were replaced

by similar districts in the same stratum. An additional

15 districts were deemed ineligible for participation

during recruitment. ese districts were not subsequently

replaced, resulting in a total of 957 districts in the sample.

Response rates

Response rates were calculated by questionnaire

and module and are shown in Table 2. A total of 740

districts (77.3%) completed at least one module or

one questionnaire. Not every district was eligible to

complete every module. For example, if a district did

not contain elementary schools, that district was not

eligible to complete any elementary school modules.

Table 2. Summary of response rates — SHPPS 2016

Questionnaire/Module

# of eligible

districts

# of ineligible

districts

# of participating

districts

Participation

rate (%)

Health Education (overall)

957 0 619 64.7*

Standards, Professional Development, Collaboration,

and Evaluation

957 0 561 58.6

Elementary School Instruction

942 15 527 55.9

Middle School Instruction

930 27 515 55.4

High School Instruction

863 94 472 54.7

Health Education Coordinator

957 0 535 55.9

Health Services

957 0 613 64.1

Healthy and Safe School Environment (overall)

957 0 613 64.1*

General School Environment

957 0 544 56.8

Physical School Environment

957 0 517 54.0

Crisis Preparedness

957 0 572 59.8

Nutrition Services

957 0 599 62.6

Physical Education and Physical Activity (overall)

957 0 589 61.6*

Standards, Professional Development, Collaboration,

and Interscholastic Sports

957 0 541 56.5

Elementary School Instruction

942 15 506 53.7

Middle School Instruction

929 28 495 53.3

High School Instruction

862 95 444 51.5

Physical Education Coordinator

957 0 515 53.8

*Percentage of districts that completed at least 1 module in that questionnaire.

Recruitment and Data Collection

Recruitment began in June of 2015 with the solicitation of

state support for the study. Contacts in each state were sent

an information packet about SHPPS. ese contacts, who

worked in state education agencies and state departments

of health, were asked to facilitate a letter of support for the

study from the head of their agency. Aer a state sent a

letter of support from one or both state agencies or made

it clear that no letter of support would be forthcoming, a

study invitation packet was mailed to the superintendent

of each selected district in that state. e invitation packets

and follow-up telephone calls sought each district’s

agreement to participate in the study. Participating districts

then identied questionnaires and modules not applicable

to the district and the most knowledgeable respondent for

each questionnaire and module. ese respondents were

district sta such as superintendents, health and physical

education coordinators, and school food authority directors.

Aer district contacts agreed that their district would

participate in the study and identied respondents

for each questionnaire and module, respondents were

contacted directly by both e-mail and overnight mail.

ese e-mails and letters contained information about

the study and provided respondents with instructions for

accessing the secure data collection Web site, including

a unique access code. When respondents logged into

the Web site using their access code, they were asked to

conrm their district’s name and were then presented with

an on-screen consent statement. Aer acknowledging

consent, each respondent was presented with a home

page that displayed their assigned questionnaire(s) and

module(s). Respondents assigned to complete multiple

questionnaires or modules could complete them in any

order. If respondents did not complete a questionnaire or

module during a log-in session, their responses were saved

and they could return to their stopping point the next

time they logged in. Within each questionnaire or module,

respondents could leave a question blank and still advance

to the next question. Upon completing a questionnaire or

module, respondents could review their responses, edit

any previous responses, and ll in any missing responses

before submitting the questionnaire or module.

Data collection began in October 2015 and concluded in

August 2016. Respondents who had not submitted all of

their questionnaires or modules received a reminder e-mail

every 15 business days. In March 2016, data collection

transitioned to a mixed mode of administration to increase

response rates. Individuals who had been identied as

respondents by their districts but had not yet submitted

Web-based questionnaires received two rounds of mailings

that oered them the option of completing paper-and-

pencil versions of the questionnaires and returning them

in pre-paid envelopes. In addition, districts that had not

yet indicated a decision to participate received two rounds

of paper-and-pencil questionnaires via mail that could

be distributed to respondents in those districts. ese

mailings also included instructions for accessing the Web-

based questionnaires if respondents preferred to submit

their responses that way. In May 2016, a third round of

correspondence in the form of a postcard was sent to

respondents who had not yet submitted questionnaires.

is postcard included a brief message encouraging

respondents to go to the Web site to complete their assigned

questionnaires. Recruiters followed up with district contacts

and respondents by telephone aer each mailing to answer

any questions and elicit a commitment to participate.

At the end of the data collection period (August 2016),

94.2% of the completed questionnaires or modules

were submitted via the Web-based system, and 5.8%

were submitted as paper questionnaires that were

subsequently entered into the Web-based system

by project sta. In 97.8% of districts, at least one

questionnaire or module was submitted via the Web-

based system and in 23.6%, at least one questionnaire

or module was submitted on paper via mail.

Incentives were oered at both the district level and at

the individual respondent level. District contacts were

oered incentives beginning in March 2016 in the form

of an Amazon gi code. To receive this incentive, the

district contact had to commit to district participation

and complete and return a form identifying respondents

for each questionnaire and module. Incentives also

were introduced at the individual level in March 2016.

Previously identied respondents who had not submitted

questionnaires and newly identied respondents who

had not submitted questionnaires within six weeks of

being invited to participate were oered an Amazon

gi code for each completed questionnaire.

Data Cleaning, Weighting, and Analysis

Cleaning

e Web-based data collection system contained built-in

checks to limit invalid and out-of-range responses. For

example, if a question was supposed to be skipped by a

respondent based on the answer to a previous question, that

question was never displayed, so the respondent did not have

an opportunity to enter an invalid response. Aer verifying

that all programming logic was implemented correctly,

data were edited for logically inconsistent responses.

Weighting

SHPPS 2016 included a stratied random sample of

school districts, plus 17 DASH-funded districts selected

with certainty. Each of the DASH-funded districts had

a sampling weight of 1.0. For the remaining districts,

the base weight, or sampling weight, was computed as

the inverse of the selection probability within each of

the 12 strata dened by NCES locales. Base weights

were then adjusted for non-response using a simple

ratio adjustment, computed as the ratio of weighted

totals within weight adjustment classes. e ratio used

was the total of the base weights computed over all the

sampled districts to the same total computed over all

the participating districts. e weight adjustment classes

were dened by census region, NCES locale, and poverty

level. ese variables were found to be the best predictors

of response propensities in non-response analysis.

Because response rates were calculated for each

questionnaire, the weight for nonresponse was

calculated separately by questionnaire, resulting in

a set of questionnaire-specic weights to be used

for questionnaire-specic analyses. In addition, an

overall weight was computed for use in analyses that

merged data from two or more questionnaires. For

this weight, the nonresponse adjustment was made

based on an aggregated overall response indicator, in

which a district was considered as responding if at

least one module or questionnaire was completed.

As a nal step, the district weights were post-stratied to

control totals. Post-stratum cells were dened by census

region and NCES locale, for which population totals

are available from the MDR database. e adjustment

made the nal adjusted weights sum to the total number

of districts in the post-stratum cell. Note that although

each component was post-stratied independently,

they shared a common set of control totals.

Analysis

Statistical analyses were conducted on weighted data using

SAS and SUDAAN soware to account for the sampling

design. Prevalence estimates and 95% condence intervals

were computed for all variables. Unless otherwise indicated,

the denominator for all analyses included all districts

rather than a subset of districts. When analyzing changes

between SHPPS 2000 and later cycles, many variables from

SHPPS 2000 were recalculated so that the denominators

used for all years of data were dened identically. As a

result of this recalculation, percentages previously reported

for SHPPS 2000 might dier from those provided in the

trends over time section of this report. Only estimates

that use the same denominator should be compared.

Secular trend analyses were performed using regression

analysis to determine whether changes over time were

statistically signicant for variables that had at least two

years of data. Time was treated as a continuous variable;

orthogonal coecients reected a linear time component

and spacing between the study years. Trend analyses took

into account all available years of data for each variable.

Several criteria were used to determine which changes

over time to present in this report. To account for

multiple comparisons, changes were reported only if the

p-value from the regression analysis was less than .01,

and either the dierence between the two endpoints was

greater than 10 percentage points, or the 2016 estimate

increased by at least a factor of two or decreased by

at least half as compared to the baseline estimate.

Limitations and Future Plans

As in previous cycles, SHPPS 2016 is limited in its

ability to provide data on the quality of the policies and

practices measured. Respondents were asked only to

report whether certain policies existed. It is possible

that a policy could exist but not reect best practices

in its content or implementation. In addition, as with

any study that relies on self-report, it is possible that

the data reect some amount of overreporting or

underreporting, as well as lack of knowledge on the part

of the respondents. For example, a content analysis of

written policies might have resulted in dierent ndings

because self-report relies on both the knowledge of the

respondents and their interpretation of existing policies.

Unlike previous cycles, SHPPS 2016 collected data

at only the district level. As a result, the types of

analyses that can be performed are limited, although

the district-level data does contain state identiers

that allow the data to be linked to extant state-level

data, such as state policy databases. No immediate

plans exist for conducting future cycles of SHPPS.

Results

Health Education

Table 1.1. Percentage of districts that had adopted specic policies related to health education standards — SHPPS 2016

Policy Districts (%)

Schools will follow any national, state, or district health education standards

81.7 (77.9 – 85.0)

Schools will follow standards based on the National Health Education Standards

63.0 (58.6 – 67.3)

Schools will follow standards based on the National Sexuality Education Standards

41.3 (36.8 – 45.9)

Table 1.2. Percentage of districts with specic health education policies and practices, by school level — SHPPS 2016

Districts (%)

Policy or practice

Elementary

school

Middle

school

High

school

Requires schools to assess student achievement of health education

standards used by district

38.5 (33.6 – 43.7) 4 4.6 (39.7 – 49.6) 54.6 (49.5 – 59.7)

Requires schools to notify parents or guardians before students receive

instruction on pregnancy prevention, HIV prevention, other STD prevention,

or human sexuality

79.4 (74.1 – 83.9) 75.2 (70.4 – 79.4) 6 6.3 (61.2 – 71.2)

Requires schools to require parental permission before children receive

instruction on pregnancy prevention, HIV prevention, other STD prevention,

or human sexuality

66.4 (60.2 – 72.1) 61.7 (56.5 – 66.6) 53.1 (47.8 – 58.4)

Requires schools to allow parents or guardians to exclude their children

from receiving instruction on pregnancy prevention, HIV prevention, other

STD prevention, or human sexuality

83.0 (77.9 – 87. 2) 80.4 (75.9 – 84.2) 74.7 (69.7 – 79.0)

Ever used a curriculum analysis tool (e.g., the Health Education Curriculum

Analysis Tool [HECAT]) to assess one or more health education curricula

11.3 (8.8 – 14.5) 15.3 (12.2 – 18.9) 17.7 (14.3 – 21.7)

Has speciﬁed time requirements for health education

32.0 (27.8 – 36.5) 52.3 (47.6 – 56.9) 72.3 (67.7 – 76.4)

Among the 81.1%, 87.7%, and 93.4% of districts that follow standards for elementary, middle, and high school health education, respectively.

Among the 57.9%, 82.5%, and 87.3% of districts requiring elementary, middle, and high schools, respectively, to teach about at least one of those topics.

Table 1.3. Percentage of districts with other specic health education policies and practices — SHPPS 2016

Policy or practice Districts (%)

Requires each school to have someone to oversee or coordinate health education at the school

42.2 (37.8 – 46.6)

Requires those who teach health education to earn continuing education credits on health education topics or

instructional strategies

39.6 (35.4 – 44.1)

Offered any health education to families of all students

40.6 (36.2 – 45.1)

Provided district or school personnel (e.g., classroom teachers, administrators, or school board members)

with information on school health education

69.0 (6 4.8 – 73.0)

Sought positive media attention for school health education

34.4 (30.3 – 38. 8)

Reviewed or updated health education policies

58.6 (54.0 – 63.0)

Reviewed or updated health education curricula

62.8 (58.4 – 67.1)

Evaluated any health education professional development or in – service programs

42.1 (37.6 – 46.7)

Has someone in district who oversees or coordinates health education

69.0 (6 4.6 – 73.0)

During the 12 months before the study.

During the 2 years before the study.

Table 1.4. Percentage of districts that follow specic standards for health education, by school level — SHPPS 2016

Districts (%)

Standard

Elementary

school

Middle

school

High

school

Follows health education standards

81.1 (77.2 – 84.5) 87.7 (84.3 – 90.5) 93.5 (90.6 – 95.5)

Follows standards that specifically address:

Accessing valid information, products, and services to enhance

health

65.0 (60.5 – 69.3) 8 0.4 (76.3 – 83.9) 87.9 (84.5 – 90.7)

Advocating for personal, family, and community health

70.7 (66.3 – 74.7) 78.9 (74.7 – 82.5) 88.3 (84.9 – 91.0)

Analyzing the inﬂuence of family, peers, culture, media, technology,

and other factors on health behaviors

70.9 (66.6 – 74.9) 84.5 (80.8 – 87.6) 9 0.7 (87.5 – 93.1)

Comprehending concepts related to health promotion and disease

prevention to enhance health

77.3 (73.2 – 80.9) 8 6.0 (82.4 – 89.0) 92.2 (89.1 – 94.4)

Practicing health-enhancing behaviors to avoid or reduce health risks

77.1 (73.0 – 80.8) 85.0 (81.4 – 88.1) 92.2 (89.2 – 94.4)

Using decision-making skills to enhance health

77.1 (73.0 – 80.7) 86.5 (82.9 – 89.4) 92.6 (89.7 – 94.8)

Using goal-setting skills to enhance health

69.2 (64.8 – 73.3) 80.1 (76.1 – 83.7) 88.7 (85.2 – 91.4)

Using interpersonal communication skills to enhance health and

avoid or reduce health risks

71.8 (67.5 – 75.8) 8 4.3 (80.5 – 87.5) 90.2 (86.9 – 92.7)

Table 1.5. Percentage of districts that had adopted a policy stating that schools will teach specic health topics, by

school level — SHPPS 2016

Districts (%)

Health topic

Elementary

school

Middle

school

High

school

Alcohol or other drug use prevention

63.9 (59.4 – 6 8. 3) 79.7 (75.7 – 83.1) 8 6.0 (82.3 – 89.0)

Asthma

40.1 (35.6 – 4 4.8) 47.4 (42.7 – 52.1) 53.2 (48.3 – 58.0)

Chronic disease prevention (e.g., diabetes or obesity prevention)

48.4 (43.7 – 53.1) 65.8 (61.2 – 70.1) 76.5 (72.2 – 8 0.4)

Emotional and mental health

56.9 (52.2 – 61.5) 74.2 (70.0 – 78.0) 82.2 (78.3 – 85.6)

Food allergies

44.8 (40.2 – 49.4) 50.2 (45.5 – 54.8) 59.0 (5 4.1 – 63.7)

Foodborne illness prevention

34.6 (30.3 – 39.1) 47.9 (43.2 – 52.6) 59.6 (54.7 – 64.3)

Human immunodeﬁciency virus (HIV) prevention

29.0 (24.9 – 33.4) 70.6 (66.1 – 74.7) 82.4 (78.3 – 85.9)

Human sexuality

51.9 (47. 2 – 56.6) 75.4 (71.2 – 79.1) 79.6 (75.4 – 83.2)

Infectious disease prevention (e.g., ﬂu prevention)

55.1 (50.4 – 59.7) 63.4 (58.8 – 67.7) 71.6 (67.0 – 75.8)

Injury prevention and safety

66.9 (62.3 – 71.1) 71.3 (6 6.8 – 75.4) 77.1 (72.7 – 80.9)

Nutrition and dietary behavior

70.6 (66.2 – 74.7) 76.9 (72.8 – 80.6) 8 4.6 (80.7 – 87. 8)

Oral health

57.7 (53.0 – 62.2) 54 .9 (50. 3 – 59.6 ) 56.1 (51.2 – 60.9)

Other sexually transmitted disease (STD) prevention

22.9 (19.1 – 27.1) 69.0 (6 4.6 – 73.1) 81.6 (77.6 – 85.1)

Physical activity and ﬁtness

60.7 (56.1 – 65.1) 71.4 (67.0 – 75.4) 79.6 (75.5 – 83.2)

Pregnancy prevention

18.9 (15.6 – 22.8) 59.7 (55.0 – 64.3) 76.3 (71.8 – 8 0.2)

Suicide prevention

36.0 (31.6 – 40.6) 65.4 (60.8 – 69.7) 78.6 (74.4 – 82.3)

Tobacco use prevention

65.9 (61.4 – 70.2) 80.0 (76.1 – 83.4) 85.6 (81.9 – 8 8.7)

Violence prevention (e.g., bullying or ﬁghting prevention)

86.3 (82.7 – 89.2) 85.0 (81.4 – 88.0) 87.3 (83.7 – 90.1)

Table 1.6. Percentage of districts that provided specic resources for health education,

by school level — SHPPS 2016

Districts (%)

Resource

Elementary

school

Middle

school

High

school

Goals, objectives, and expected outcomes for health education

50.9 (46.3 – 55.5) 56.8 (52.1 – 61.3) 6 4.9 (60.2 – 69.4)

A chart describing the annual scope and sequence of instruction for health

education

33.5 (29.2 – 38.0) 39.5 (35.1 – 44.2) 47.1 (42.3 – 52.0)

A list of one or more recommended health education curricula

44.1 (39.6 – 48.8) 50.7 (46.1 – 55.4) 56.6 (51.7 – 61.3)

Lesson plans or learning activities for health education

50.5 (45.9 – 55.1) 57.6 (52.9 – 62.2) 62.1 (57.3 – 6 6.7)

Plans for how to assess student performance in health education

36.9 (32.4 – 41.5) 48 .8 (44.2 – 53.4) 53.7 (48.8 – 58.6)

During the 2 years before the study.

Table 1.7. Percentage of districts that had adopted specic stang policies for newly hired sta who teach health

education, by school level

— SHPPS 2016

Districts (%)

Policy

Middle

school

High

school

Will have undergraduate or graduate training in health education

58.7 (54.0 – 63.3) 6 8.6 (63.8 – 73.1)

Will be certiﬁed, licensed, or endorsed by the state to teach health education

67.8 (63.2 – 72.1) 78.4 (74.0 – 82.2)

Will be Certiﬁed Health Education Specialists (CHES)

16.9 (13.6 – 20.7) 19.3 (15.7 – 23.5)

Questions not asked for elementary school level.

Table 1.8. Percentage of districts with policies requiring schools to meet the health education needs of students with

disabilities by using specic strategies — SHPPS 2016

Strategy Districts (%)

Assigning a teacher or aide to assist students

90.3 (87.1 – 92.8)

Assigning note takers or readers for class work

80.1 (76.1 – 83.5)

Coordinating assignments with a special education teacher

90.6 (87.5 – 93.0)

Increasing skill modeling, practice, or repetition

90.8 (87.7 – 93.2)

Providing preferential seating

92.6 (89.7 – 94.8)

Simplifying instructional content or varying the amount or difﬁculty of material taught

91.9 (88.9 – 94.1)

Using modiﬁed assessments

94.3 (91.5 – 96.2)

Using modiﬁed instructional strategies

94.7 (92.1 – 96.5)

Table 1.9. Percentage of districts that had adopted a policy requiring those who teach health education to

receive professional development on specic health topics, and the percentage of districts that provided funding

for professional development or oered professional development on these topics to those who teach health

education

— SHPPS 2016

Districts (%)

Health topic

Required

professional

development

Provided funding for

professional development or

offered professional development

Alcohol or other drug use prevention

40.1 (35.8 – 4 4.6) 59.8 (55.3 – 64.1)

Asthma

32. 5 (28.4 – 36.8) 44.7 (40.2 – 49.2)

Chronic disease prevention (e.g., diabetes or obesity prevention)

32.4 (28.3 – 36.7) 47.2 (42.7 – 51.8)

Emotional and mental health

41.2 (36.9 – 45.8) 6 3.6 (59.2 – 67.8)

Food allergies

34.0 (29.9 – 38.4) 4 6.5 (42.1 – 51.0)

Foodborne illness prevention

27.9 (24.0 – 32.0) 38.1 (33.8 – 42.6)

Human immunodeﬁciency virus (HIV) prevention

38.8 (34.5 – 43.3) 49.0 (4 4.5 – 53.5)

Human sexuality

37.1 (32.8 – 41.6) 50.4 (45.9 – 54.9)

Infectious disease prevention (e.g., ﬂu prevention)

36.9 (32.7 – 41.3) 47.7 (43.3 – 52.3)

Injury prevention and safety

44.0 (39.6 – 48.5) 61.0 (56.5 – 65.3)

Nutrition and dietary behavior

38.1 (33.8 – 42.6) 56.0 (51.5 – 60.5)

Oral health

27.2 (23.3 – 31.4) 37.3 (33.1 – 41.8)

Other sexually transmitted disease (STD) prevention

37.2 (32.9 – 41.7) 4 8.9 (4 4.4 – 53.4)

Physical activity and ﬁtness

37.8 (33.5 – 42.3) 6 0.1 (55.6 – 64.5)

Pregnancy prevention

32.6 (28.5 – 37.0) 44.5 (40.0 – 49.0)

Suicide prevention

47.9 (43.4 – 52.4) 6 8.8 (64.5 – 72.8)

Tobacco use prevention

39.2 (34.9 – 43.7) 55.1 (50.6 – 59.5)

Violence prevention (e.g., bullying or ﬁghting prevention)

54.6 (50.1 – 59.0) 78.4 (74.5 – 81.9)

During the 2 years before the study.

Table 1.10. Percentage of districts that provided funding for professional development or oered professional

development on specic instructional strategy topics to those who teach health education

— SHPPS 2016

Instructional strategy topic Districts (%)

Aligning health education standards to curriculum, instruction, or student assessment

69.6 (65.3 – 73.5)

Assessing or evaluating students in health education

61.2 (56.8 – 65.5)

Creating safe and supportive learning environments for all students, including students of different sexual orientations or

gender identities

60.8 (56.3 – 65.2)

How to involve students’ families in health education

41.5 (37.2 – 4 6.0)

How to involve the community in students’ health education

41.0 (36.6 – 45.5)

Teaching online or distance education courses

27.6 (23.6 – 31.9)

Teaching skills for behavior change

62.2 (57.7 – 66.5)

Teaching students of various cultural backgrounds

62.0 (57.5 – 6 6.2)

Teaching students with limited English proﬁciency

61.9 (57.6 – 66.1)

Teaching students with long-term physical, medical, or cognitive disabilities

65.8 (61.4 – 70.0)

Using classroom management techniques (e.g., social skills training, environmental modiﬁcation, conﬂict resolution and

mediation, or behavior management)

76.3 (72.3 – 80.0)

Using data to plan or evaluate health education policies or practices

47.5 (43.0 – 52.1)

Using interactive teaching methods (e.g., role plays or cooperative group activities)

70.4 (6 6.1 – 74.3)

Using peer educators

47.8 (43.3 – 52.3)

Using technology (e.g., computers, the Internet, or social media) to enhance instruction or improve student learning

82.5 (79.0 – 85.6)

Using the Health Education Curriculum Analysis Tool (HECAT) to help assess health education curricula

15.1 (12.1 – 18.6)

During the 2 years before the study.

Table 1.11. Percentage of districts in which health education sta worked on health education activities with other

district-level and local agency or organization sta

— SHPPS 2016

Staff Districts (%)

District staff

Counseling, psychological, or social services

58.5 (54.1 – 62.9)

General curriculum coordinators or supervisors

66.8 (62.4 – 70.8)

Health services

58.0 (53.5 – 62.3)

Media or technology

53.7 (49.1 – 58.2)

Nutrition or food service

53. 2 (48.7 – 57.7)

Physical education

64.0 (59.6 – 68.3)

Local agency or organization staff

A community-based organization that provides sexual and reproductive health services

32. 2 (28.1 – 36.6)

A health organization (e.g., the American Heart Association or the American Cancer Society)

59.8 (55.3 – 64.2)

A local business

37.5 (33.2 – 41.9)

A local college or university

41.4 (37.0 – 45.9)

A local dental or oral health association

44.3 (39.9 – 48.9)

A local health department

52.3 (47.7 – 56.8)

A local hospital

40.9 (36.6 – 45.4)

A local juvenile justice department

38.9 (34.6 – 43.4)

A local law enforcement agency

57.1 (52.6 – 61.5)

A local mental health or social services agency

57.3 (52.8 – 61.7)

A local service club (e.g., Rotary Club)

31.0 (27.0 – 35.4)

A local youth organization (e.g., the Boys and Girls Clubs)

27.7 (23.8 – 32.0)

A state afﬁliate of the American Association for Health Physical Education, Recreation, and Dance (AAHPERD)/

SHAPE America

29.3 (25.3 – 33.5)

Local ﬁre or emergency medical services

53.0 (48.5 – 57. 5)

The state health department

37.1 (32.8 – 41.6)

During the 12 months before the study.

Physical Education and Physical Activity

Table 2.1. Percentage of districts that had adopted specic policies related to physical education standards —

SHPPS 2016

Policy Districts (%)

Schools will follow any national, state, or district physical education standards

85.6 (82.1 – 88.5)

Schools will follow standards based on the National Standards and Grade Level Outcomes for K-12 Physical Education

from SHAPE America

6 0.0 (55 .4 – 6 4 .4)

Schools will assess student achievement of the physical education standards used by the district

58 .9 (54 .4 – 6 3.3)

Table 2.2. Percentage of districts that follow specic standards for physical education, by school level — SHPPS 2016

Districts (%)

Standard

Elementary

school

Middle

school

High

school

Follows physical education standards

93.9 (91.2 – 95.9) 95.6 (93.4 – 97.1) 94.3 (91.7 – 96.1)

Follows standards that specifically address:

Competency in a variety of motor skills and movement patterns

93.4 (90.6 – 95.4) 93.7 (91.1 – 95.6) 90.4 (87.2 – 92.9)

Knowledge and skills needed to achieve and maintain a health-

enhancing level of physical activity and ﬁtness

93.3 (90.5 – 95.4) 94.6 (92.2 – 96.3) 93.2 (90.5 – 95. 2)

Knowledge of concepts, principles, strategies, and tactics related to

movement and performance

93.1 (90.2 – 95.1) 94.3 (91.5 – 96.1) 92.1 (89.2 – 94.3)

Recognition of the value of physical activity for health, enjoyment,

challenge, self-expression, and/or social interaction

93.1 (90.2 – 95.2) 93.3 (90.4 – 95.4) 93.5 (90.7 – 95.5)

Responsible personal and social behavior that respects self

and others

92.6 (89.6 – 94.8) 94.1 (91.3 – 96.0) 91. 2 (88.0 – 93.6)

Table 2.3. Percentage of districts that had adopted specic policies related to physical education requirements and

exemptions from these requirements, by school level — SHPPS 2016

Districts (%)

Policy

Elementary

school

Middle

school

High

school

Schools will teach physical education

92.6 (89.8 – 94.7) 89.7 (86.5 – 92.2) 92.9 (90.0 – 95.0)

The use of waivers, exemptions, or substitutions for physical education

requirements

for students is prohibited

13.6 (10.3 – 17.8) 13.3 (10.0 – 17. 5) 18.0 (13.9 – 2 2.9)

Reasons that students may be excused from physical education

requirements

through waivers, exemptions, or substitutions are described

14.2 (10.9 – 18.3) 22.0 (17.6 – 27.1) 33.5 (28.2 – 39.3)

Students may be excused from physical education requirements

1,2

for:

Achievement of positive, passing, or high physical ﬁtness

assessment scores

2.6 (1.3 – 4.9) 2.2 (1.1 – 4.4) 3.3 (1.9 – 6.0)

Cognitive disability

6.9 (4.7 – 10. 2) 9.9 (7.1 – 13.6) 14.1 (10.6 – 18. 5)

Enrollment in other courses (e.g., math or science)

NA 1.8 (0.8 – 4.2) 4.3 (2.7 – 6.9)

Long-term physical or medical disability or chronic health condition

13.1 (9.9 – 17.1) 17.6 (13.7 – 22.4) 2 5. 8 (2 1.0 – 31.3)

Participation in community service activities

0.7 (0.1 – 2.9) 0.7 (0.2 – 2.1) 1.0 (0.4 – 2.6)

Participation in community sports activities

0.7 (0.1 – 2.9) 2.0 (0.9 – 4.4) 2.3 (1.2 – 4.6)

Participation in school activities other than sports (e.g., band or

chorus)

3.0 (1.7 – 5.3) 5.7 (3.6 – 8.9) 17.7 (13.7 – 22.4)

Participation in school sports

NA 3.8 (2.2 – 6.5) 16.1 (12.4 – 20.7)

Participation in vocational training

NA 1.0 (0.4 – 2.8) 2.6 (1.4 – 4.6)

Religious reasons

4.4 (2.7 – 6.9) 7.3 (4.8 – 10.8) 8.3 (5.7 – 12.0)

Students may be excused from one or more physical education class

periods for additional instructional time, remedial work, or test preparation

for other subjects

14.3 (11.3 – 18.0) 19.2 (15.6 – 23.5) 11.3 (8.6 – 14.7)

For one grading period or longer.

Among the 92.6%, 89.6%, and 92.9% of districts requiring elementary, middle, and high schools, respectively, to teach physical education.

Not asked about elementary schools.

Table 2.4. Percentage of districts with specic physical education policies and practices, by school level — SHPPS 2016

Districts (%)

Policy or practice

Elementary

school

Middle

school

High

school

Has speciﬁed time requirements for physical education

73.5 (69.1 – 7 7.5) 70.5 (65.9 – 74.7) 76.4 (72.0 – 80.4)

Speciﬁes a maximum student-to-teacher ratio for physical education

25.9 (22.0 – 30.2) 25.0 (21.1 – 29.3) 30.5 (26. 2 – 35.2)

Requires that schools use one particular curriculum for physical education

20.9 (17.4 – 24.8) 19. 3 ( 15.9 – 2 3 .3) 20.7 (17.1 – 24.9)

Recommends that schools use one particular curriculum for physical

education

25.1 (21.3 – 29.3) 26.8 (22.8 – 31.1) 27.7 (23.4 – 32.3)

Physical education curriculum required or recommended by district developed by:

College or university

5.3 (2.8 – 9.9) 5. 2 (2.8 – 9.6) 3.3 (1.5 – 7.2)

Commercial company

19.1 (13.9 – 25.5) 9.1 (5.8 – 14.1) 9.1 (5.5 – 14.5)

National or state-level health organization (e.g., the American Heart

Association or the American Cancer Society)

17.6 (12.9 – 23.4) 15. 7 (11. 3 – 21. 5 ) 14 .0 (9. 9 – 19.6 )

Other state agency

2.6 (1.0 – 6.6) 3.2 (1.6 – 6.7) 0.4 (0.1 – 2.9)

School district

62.6 (55.7 – 69.1) 66.3 (59.6 – 72.4) 72.4 (65.6 – 78.3)

State education agency

51.3 (4 4.4 – 58. 2) 53.9 (47.0 – 6 0.7) 59. 2 (52.1 – 6 6.0)

Other

12.8 (8.8 – 18.2) 12.1 (8.2 – 17.5) 10.5 (6.8 – 16.0)

Ever used a curriculum analysis tool (e.g., the Physical Education Curriculum

Analysis Tool [PECAT]) to assess one or more physical education curricula

12.5 (9.7 – 15.9) 14.5 (11.5 – 18.2) 11.8 (9.0 – 15.3)

Requires schools to participate in the Presidential Youth Fitness Program

(PYFP)

11.9 (9.2 – 15.3) 14.6 (11.6 – 18.3) 9.6 (7.1 – 12.9)

Recommends that schools participate in the Presidential Youth Fitness

Program (PYFP)

34.4 (30.1 – 38.9) 33.2 (28.9 – 37.7) 28.7 (24.4 – 33.4)

Among the 45.9%, 46.1%, and 48.4% of districts that required or recommended that elementary, middle, and high schools use one particular curriculum for

physical education, respectively.

Table 2.5. Percentage of districts that provided specic resources for physical education,

by school level — SHPPS 2016

Districts (%)

Resource

Elementary

school

Middle

school

High

school

Goals, objectives, and expected outcomes for physical education

66.2 (61.8 – 70.4) 67.1 (62.6 – 71.4) 67.5 (62.8 – 72.0)

A chart describing the annual scope and sequence of instruction for physical

education

46.1 (41.6 – 50.7) 43.1 (38.6 – 47.8) 49.0 (44.1 – 53.9)

A list of one or more recommended physical education curricula

43.9 (39.3 – 48.5) 4 6 . 5 (41. 8 – 51. 2) 51.2 (46.2 – 56.2)

Lesson plans or learning activities for physical education

55.3 (5 0.6 – 59.9) 5 4.1 (49.4 – 58.8) 56.5 (51.5 – 61.3)

Plans for how to assess student performance in physical education

60.5 (55.9 – 65.0) 58.1 (53.3 – 62.7) 58 .7 (53.7 – 63. 5)

Resources for ﬁtness assessment in schools

68.4 (63.9 – 72.6) 69.9 (65.4 – 74.1) 69.4 (64.6 – 73.8)

Physical activity monitoring devices (e.g., pedometers or heart rate

monitors) for physical education

41.4 (36.9 – 46.0) 42.3 (37.7 – 47.0) 4 8.4 (43.6 – 53.3)

During the 2 years before the study.

Table 2.6. Percentage of districts with specic requirements and recommendations related to assessments, by school

level — SHPPS 2016

Districts (%)

Requirement or recommendation

Elementary

school

Middle

school

High

school

Requires schools to give written assessments of students’ knowledge

related to physical education

13.0 (10.1 – 16.5) 17.8 (14.5 – 21.7) 21.8 (18.0 – 26.2)

Recommends that schools give written assessments of students’ knowledge

related to physical education

27.7 (23.8 – 32.0) 38.2 (33.7 – 42.9) 39.5 (34.7 – 44.4)

Requires schools to give skill performance assessments of students’

knowledge related to physical education

24.6 (20.7 – 29.0) 18.7 (15.3 – 22.6) 25.3 (21.2 – 29.9)

Recommends that schools give skill performance assessments of students’

knowledge related to physical education

39.5 (35.1 – 44.1) 45.7 (41.0 – 50.5) 41.9 (37.1 – 4 6.9)

Requires schools to assess students’ physical activity levels (e.g., through

the use of physical activity logs or pedometers)

7.1 (5.0 – 9.9) 7.5 (5.4 – 10.4) 10.7 (8.0 – 14.3)

Recommends that schools assess students’ physical activity levels (e.g.,

through the use of physical activity logs or pedometers)

33.2 (28.9 – 37.7) 39.6 (35.1 – 44.4) 41.6 (36.8 – 46.6)

Requires schools to assess students’ ﬁtness levels

30.6 (26.5 – 35.0) 32.0 (27.8 – 36.5) 30.0 (25.7 – 34.6)

Recommends that schools assess students’ ﬁtness levels

40.0 (35.5 – 4 4.6) 39.6 (35.1 – 44.3) 38.1 (33.4 – 43.0)

Requires schools to use Fitnessgram

27.3 (23.3 – 31.7) 26.9 (22.9 – 31.3) 21.9 (18.1 – 26.2)

Recommends that schools use Fitnessgram

26.1 (22.3 – 30.3) 27.9 (23.9 – 32. 3) 2 5.5 (21.4 – 30.0)

Requires schools to use the Physical Fitness Test from the President’s

Challenge

11.3 (8.7 – 14.6) 10.7 (8.1 – 14.1) 8.6 (6.2 – 11.9)

Recommends that schools use the Physical Fitness Test from the

President’s Challenge

25.9 (22.1 – 30. 2) 26.4 (22.5 – 30.7) 2 5.0 (20.9 – 29.5)

Requires schools to use any other ﬁtness assessment

9.2 (6.7 – 12.4) 5.7 (3.9 – 8.2) 8.1 (5.8 – 11.3)

Recommends that schools use any other ﬁtness assessment

15.3 (12.3 – 18.8) 20.2 (16.7 – 24.3) 21.9 (18.1 – 26.3)

Requires schools to submit students’ ﬁtness assessment results to the state

or district

44.9 (39.5 – 50.5) 4 0.4 (35.0 – 46.0) 42.4 (36.5 – 48.5)

Requires schools to share the results of students’ ﬁtness assessments with

students’ parents or guardians

20.4 (16.2 – 25.5) 14.6 (11.0 – 19.1) 14.7 (10.8 – 19.8)

Recommends that schools share the results of students’ ﬁtness

assessments with students’ parents or guardians

40.2 (35.0 – 45.7) 44.8 (39.3 – 50.5) 4 4.9 (38.9 – 51.1)

Table 2.7. Percentage of districts that had adopted specic stang policies for newly hired sta who teach physical

education, by school level — SHPPS 2016

Districts (%)

Policy

Elementary

school

Middle

school

High

school

Will have undergraduate or graduate training in physical education or a

related ﬁeld

70.6 (66.1 – 74.7) 74.2 (69.8 – 78.2) 81.2 (77.1 – 8 4.7)

Will be certiﬁed, licensed, or endorsed by the state to teach physical

education

78.2 (74.0 – 81.9) 8 6.0 (82.3 – 89.0) 89.6 (86.2 – 92.3)

Table 2.8. Percentage of districts with policies requiring schools to meet the physical education needs of students with

disabilities by using specic strategies — SHPPS 2016

Strategy Districts (%)

Including accommodations in physical education in 504 plans or Individualized Education Programs (IEPs)

97.6 (95.6 – 98.7)

Mainstreaming into regular physical education as appropriate

97.2 (95.2 – 98.4)

Providing adapted physical education as appropriate

91.0 (88.0 – 93.3)

Using modiﬁed assessments

94.2 (91.7 – 9 6.0)

Using modiﬁed equipment or facilities in regular physical education

89.4 (86.4 – 91.8)

Using modiﬁed instructional strategies

95.5 (93.2 – 97.0)

Using teaching assistants in regular physical education

78.6 (74.6 – 82.1)

Table 2.9. Percentage of districts with requirements and recommendations related to recess — SHPPS 2016

Requirement or recommendation Districts (%)

Requires that elementary schools provide students with regularly scheduled recess

64.8 (60.3 – 69.0)

Recommends that elementary schools provide students with regularly scheduled recess

31.3 (27.3 – 35.7)

Required or recommended number of minutes per day of recess for elementary school students:

Less than 10 minutes

0.6 (0.2 – 1.8)

10 to 19 minutes

18.7 (15.3 – 22.6)

20 to 29 minutes

35.1 (30. 8 – 39.6)

30 or more minutes

30.2 (26.0 – 34.6)

No speciﬁed time requirements or recommendations

15.5 (12.3 – 19.4)

Requires that elementary schools provide recess before students eat lunch

7.8 (5.5 – 10.8)

Recommends that elementary schools provide recess before students eat lunch

22.6 (19.0 – 26.6)

Among the 96.1% of districts that required or recommended that elementary schools provide regularly scheduled recess.

Table 2.10. Percentage of districts with requirements and recommendations related to physical activity, by school

level — SHPPS 2016

Districts (%)

Requirement or recommendation

Elementary

school

Middle

school

High

school

Requires that schools provide regular classroom physical activity breaks

during the school day

10.7 (8.2 – 13.8) 7.5 (5.3 – 10.4) 2.2 (1.1 – 4.3)

Recommends that schools provide regular classroom physical activity

breaks

during the school day

49.6 (45.0 – 54.2) 38.7 (34.4 – 43.3) 27.6 (23.6 – 32.0)

Requires that schools provide opportunities for physical activity before the

school day

2.6 (1.5 – 4.5) 1.2 (0.5 – 2.7) 0.8 (0.3 – 2.1)

Recommends that schools provide opportunities for physical activity before

the school day

28.6 (24.6 – 32.9) 25.2 (21.4 – 29.4) 24.0 (20.1 – 28.3)

Requires that schools provide opportunities for physical activity after the

school day

2.1 (1.1 – 3.9) 4.7 (3.0 – 7. 3) 6.8 (4.7 – 9. 8)

Recommends that schools provide opportunities for physical activity after

the school day

38.2 (33.9 – 42.7) 50.9 (4 6.3 – 55.5) 47.7 (42.9 – 52.5)

For elementary schools, this is dened as “outside of physical education class and recess.” For middle schools and high schools, this is dened as “outside of

physical education class.”

Table 2.11. Percentage of districts with other physical education and physical activity policies and practices —

SHPPS 2016

Policy or practice Districts (%)

Requires students to wear appropriate protective gear:

During physical education

38.9 (34.6 – 43.4)

When engaged in physical activity clubs or intramural sports

51.6 (47.0 – 56.1)

When engaged in interscholastic sports

83.7 (80.0 – 86.8)

Prohibits or actively discourages elementary schools from excluding students from all or part of recess as punishment for

inappropriate behavior or failure to complete class work

52.1 (47.4 – 56.7)

Prohibits or actively discourages schools from using physical activity to punish students for inappropriate behavior in

physical education

62.3 (57.8 – 6 6.6)

Prohibits or actively discourages schools from using physical activity to punish students for poor performance or

inappropriate behavior in interscholastic sports

57.7 (53.1 – 62.1)

Prohibits or actively discourages schools from excluding students from all or part of physical education class to punish

students for inappropriate behavior or failure to complete class work in another class

68.1 (63.6 – 72.2)

Prohibits or actively discourages schools from excluding students from all or part of physical education class to punish

students for inappropriate behavior in physical education class

57.6 (53.0 – 62.1)

Requires each school to have someone to oversee or coordinate physical education at the school

46.9 (42.4 – 51.4)

Requires each school to have someone to oversee or coordinate a Comprehensive Physical Activity Program (CSPAP) at

the school

15.4 (12.4 – 18.9)

Requires each school to have a written plan for a Comprehensive School Physical Activity Program (CSPAP)

12.5 (9.9 – 15.7)

Requires those who teach physical education to earn continuing education credits on physical education topics or

instructional strategies

45.5 (41.0 – 50.1)

Provided district or school personnel (e.g., classroom teachers, administrators, or school board members) with

information on school physical education

68.4 (64.0 – 72.4)

Provided district or school personnel (e.g., classroom teachers, administrators, or school board members) with

information on school physical activity

65.8 (61.3 – 70.0)

Sought positive media attention for school physical education

45.5 (41.1 – 50.0)

Sought positive media attention for school physical activity

49.3 (4 4.8 – 53.8)

Provided awards or recognition for outstanding implementation of school physical activity programs (e.g., physical

activity clubs or intramural sports programs)

40.3 (35.9 – 44.8)

Reviewed or updated physical education policies²

56.3 (51.7 – 6 0.8)

Reviewed or updated physical education curricula

65.2 (60.8 – 69.4)

Evaluated any physical education professional development or in-service programs

44.0 (39.6 – 48.5)

Requires schools to report:

Number of minutes of physical education required in each grade

59.0 (54 .4 – 6 3.5)

Number of minutes of elementary school recess

50.3 (45.6 – 55.0)

Number of minutes of classroom physical activity breaks

14.5 (11.6 – 18.1)

Has someone in the district who oversees or coordinates physical education

66.6 (62.2 – 70.7)

During the 12 months before the survey.

During the 2 years before the survey.

Table 2.12. Percentage of districts that provided funding for professional development or oered professional

development on specic topics to those who teach physical education

— SHPPS 2016

Topic Districts (%)

Administering or using ﬁtness assessments

67.6 (63.1 – 71.7)

Aligning physical education standards to curriculum, instruction, or student assessment

74.3 (70.0 – 78.1)

Assessing or evaluating student performance in physical education

69.4 (65.0 – 73.5)

Assessing student weight status using body mass index (BMI), skinfolds, or bioelectric impedance

43. 2 (38.8 – 47.8)

Chronic health conditions (e.g., asthma or diabetes), including recognizing and responding to severe symptoms or

reducing triggers

56.8 (52. 2 – 61.3)

Developing and using student portfolios for physical education

34.9 (30.7 – 39.4)

Developing, implementing, and evaluating a Comprehensive School Physical Activity Program (CSPAP)

22.7 (19.1 – 26 .7)

Encouraging family involvement in physical activity

49.8 (45.3 – 54.4)

Establishing walking or biking to school programs

30.2 (26.2 – 34.5)

Helping classroom teachers integrate physical activity into their classrooms

43.6 (39.1 – 48.2)

Helping students develop individualized physical activity plans

49.1 (44.6 – 53.7)

How to prevent, recognize, and respond to concussions among students

81.5 (77.6 – 8 4.8)

Implementing the Presidential Youth Fitness Program (PYFP)

39.6 (35.3 – 4 4.2)

Injury prevention and ﬁrst aid

78.6 (74.5 – 82.1)

Methods for developing, implementing, and evaluating physical activity clubs or intramural sports programs

32.4 (28.3 – 36.8)

Methods to increase the amount of time students are engaged in moderate-to-vigorous physical activity during physical

education class

62.4 (57.8 – 6 6.7)

Methods to promote gender equity in physical education and sports

51.2 (46.7 – 55.8)

Providing Physical Activity Leader (PAL) training through Let’s Move! Active Schools

22.1 (18.6 – 26.1)

Teaching individual or paired activities or sports

60.4 (55.8 – 64.8)

Teaching methods to promote inclusion and active participation of overweight and obese children during

physical education

46.5 (42.0 – 51.1)

Teaching movement skills and concepts

64.1 (59.6 – 68.5)

Teaching online or distance education courses

20.3 (16.8 – 24.2)

Teaching physical education to students with long-term physical, medical, or cognitive disabilities

59.9 (55. 3 – 6 4.4)

Teaching team or group activities or sports

66.3 (61.7 – 70.5)

Using data to plan or evaluate physical education policies or practices

52.2 (47.6 – 56.8)

Using physical activity monitoring devices (e.g., pedometers or heart rate monitors) for physical education

57.5 (53.0 – 62.0)

Using technology (e.g., computers, the Internet, or social media) to enhance instruction or improve student learning

78.5 (74.5 – 82.0)

Using the Physical Education Curriculum Analysis Tool (PECAT) to help assess physical education curricula

15.0 (12.0 – 18.5)

During the 2 years before the survey.

Table 2.13. Percentage of districts in which physical education sta worked on physical education activities with other

district-level and local agency or organization sta

— SHPPS 2016

Staff Districts (%)

District staff

Counseling, psychological, or social services

39.3 (3 4.9 – 43.9)

General curriculum coordinators or supervisors

56.5 (51.9 – 61.0)

Health education

52.2 (47.7 – 56.7)

Health services

42.1 (37.7 – 46.7)

Media or technology

43.6 (39.1 – 48.1)

Nutrition or food service

41.3 (36.8 – 45.9)

Local agency or organization staff

A health organization (e.g., the American Heart Association or the American Cancer Society)

59.0 (54 .5 – 63.4)

A local business

29.8 (25.8 – 34.2)

A local college or university

31.1 (27.1 – 35.4)

A local department of transportation or public works

9.3 (7.0 – 12.3)

A local health department

39.0 (34.7 – 43.6)

A local health or ﬁtness club

27.1 (23.2 – 31.3)

A local hospital

27.1 (23.2 – 31.4)

A local law enforcement agency

31.8 (27.7 – 36.2)

A local mental health or social services agency

33.2 (29.0 – 37.7)

A local parks or recreation department

39.6 (35.3 – 4 4.2)

A local professional sports team

10.3 (7.9 – 13.3)

A local service club (e.g., Rotary Club)

22.1 (18.5 – 26.2)

A local youth organization (e.g., the Boys and Girls Clubs)

28.4 (24.4 – 32.7)

A state afﬁliate of the American Association for Health Physical Education, Recreation, and Dance (AAHPERD)/

SHAPE America

31.8 (27.7 – 36.1)

The state health department

27.0 (23.1 – 31.2)

During the 12 months before the study.

Table 2.14. Percentage of districts with specic policies and practices related to interscholastic sports — SHPPS 2016

Policy or practice Districts (%)

Requires head coaches of interscholastic sports to

Be certiﬁed in cardiopulmonary resuscitation (CPR)

76.0 (71.9 – 79.7)

Be certiﬁed in ﬁrst aid

72.5 (68.3 – 76.4)

Be employed by the school or school district

43.7 (39.2 – 48.3)

Complete a coaches

training course

73.8 (69.6 – 77.6)

Complete a sports safety course

76.0 (71.7 – 79.7)

Have a teaching certiﬁcate

29.4 (25.5 – 33.7)

Have previous coaching experience in any sport

25.0 (21.2 – 29.2)

Have previous coaching experience in the sport(s) they will be coaching

27.0 (23.1 – 31.3)

Have training on how to prevent, recognize, and respond to concussions among students

90.3 (87.1 – 92.8)

Requires assistant coaches or volunteer athletic aides to complete a coaches

training course

60.9 (56.4 – 65.3)

Provided any funding for professional development or offered professional development to coaches of interscholastic

sports

65.6 (61.1 – 69.8)

During the 2 years before the study.

Table 2.15. Percentage of districts with specic policies and practices related to concussions during interscholastic

sports — SHPPS 2016

Policy or practice Districts (%)

Provided educational materials to student athletes or their parents on preventing, recognizing, and responding to

concussions

87.4 (84.0 – 90.2)

Provided educational sessions to student athletes or their parents on preventing, recognizing, and responding to

concussions

71.3 (67.0 – 75.3)

Provides student athletes returning to class after a suspected concussion with necessary academic accommodations

(i.e., a return-to-learn protocol)

78.8 (74.8 – 82.3)

Requires clearance by a healthcare provider before allowing student athletes to further participate in practice or

competition after a suspected concussion

91.4 (88.4 – 93.7)

Requires schools to conduct neurocognitive testing of student athletes before participation in interscholastic sports

41.4 (37.0 – 4 6.0)

Requires student athletes suspected of having a concussion to be removed immediately from practice or competition

90.9 (87.8 – 93. 2)

Requires student athletes who required medical clearance by a healthcare provider after a suspected concussion to

successfully return to the classroom before returning to athletic participation

67.8 (63.3 – 71.9)

During the 12 months before the study.

Nutrition Environment and Services

Table 3.1. Percentage of districts with specic school nutrition services policies and practices — SHPPS 2016

Policy or practice Districts (%)

Participates in the:

National School Lunch Program (NSLP)

98.0 (96.3 – 99.0)

National School Lunch Program After-School Snack Program

32.9 (29.0 – 37.0)

School Breakfast Program (SBP)

91.1 (88.3 – 93.3)

After-School Supper Program

9.0 (6.9 – 11.7)

Sponsored the USDA Summer Food Service Program in any schools

34.5 (30.7 – 38.6)

Nutrition services program operated by:

School district

77.1 (73.3 – 80.5)

Food service management company

19.9 (16.7 – 23.5)

Other

3.0 (1.8 – 4.9)

Nutrition services program has primary responsibility for deciding which foods to order for schools

94.1 (91.7 – 95.8)

Nutrition services program has primary responsibility for cooking foods for schools (e.g., in a central kitchen)

81.6 (78.0 – 84.7)

Requires all schools to offer breakfast to students

82.9 (79.3 – 85.9)

Requires some categories of schools

to offer breakfast to students

5.9 (4.2 – 8.4)

Requires schools to encourage breakfast consumption by serving breakfast to students:

On the school bus

1.5 (0.7 – 3.1)

In the classroom

27.1 (23.4 – 31.1)

As grab-and-go meals

41.5 (37.2 – 45.8)

After ﬁrst period or during a morning break

20.8 (17.5 – 24.6)

Requires schools to offer lunch to students

96.3 (94.4 – 97.7)

Requires a minimum amount of time students will be given to eat breakfast once they receive their meal

19.4 (16.2 – 23.0)

Recommends a minimum amount of time students will be given to eat breakfast once they receive their meal

32.7 (28.7 – 36.9)

Minimum required or recommended amount of time students given to eat breakfast once they receive their meal

is:

Less than 5 minutes

0 (. – .)

5 to 9 minutes

11.7 (8. 2 – 16.5)

10 to 14 minutes

37.5 (32.0 – 43.4)

15 to 19 minutes

25.8 (20.9 – 31.4)

20 or more minutes

25.0 (20.3 – 30.4)

Requires a minimum amount of time students will be given to eat lunch once they receive their meal

35.5 (31.4 – 39.7)

Recommends a minimum amount of time students will be given to eat lunch once they receive their meal

40.2 (36.0 – 44.6)

Minimum required or recommended amount of time students given to eat lunch once they receive their meal

is:

Less than 10 minutes

0.4 (0.1 – 1.5)

10 to 19 minutes

33.9 (29.3 – 38.8)

20 to 29 minutes

53. 8 (48.8 – 58.8)

30 or more minutes

11.9 (9.1 – 15.4)

Has a district-level plan for feeding students who rely on the school meal programs in the event of an unplanned school

dismissal or school closure

33.8 (29.7 – 38.2)

Purchases foods from local or regional growers or producers

68.7 (6 4.7 – 72.3)

Has someone in the district who oversees or coordinates nutrition services (e.g., a district food service director or school

food authority director)

93.6 (91.2 – 95.3)

During the summer of 2015.

Such as those with a certain percentage of students eligible for free or reduced-price meals.

Among districts with a required or recommended minimum time.

Table 3.2. Percentage of districts with food procurement contracts that address specic issues — SHPPS 2016

Issue Districts (%)

Cooking methods for precooked items (e.g., baked instead of deep fried)

89.3 (86.3 – 91.7)

Food safety

97.0 (95.1 – 98.1)

Hazard Analysis and Critical Control Points (HACCP)

95.1 (93.0 – 96.6)

Limiting artiﬁcial colors, sweeteners, and preservatives

76.8 (72.8 – 80.4)

Nutritional standards for a la carte foods

85.4 (82.1 – 88.3)

Preference for locally or regionally grown foods

59.8 (55.4 – 6 4.0)

Use of low-sodium canned products

92.3 (89.4 – 9 4.5)

Use of whole grain-rich foods

97.7 (95.6 – 98.8)

Table 3.3. Percentage of districts

that almost always or always used healthy food preparation practices

— SHPPS 2016

Practice Districts (%)

Substitution techniques

Used canned fruit packed in light syrup or juice instead of canned fruit packed in heavy syrup

93.9 (91.4 – 95.7)

Used cooked dried beans, canned beans, soy products, or other meat extenders instead of meat

5.6 (3.8 – 8.3)

Used fresh or frozen fruit instead of canned

37.5 (33.0 – 42. 2)

Used fresh or frozen vegetables instead of canned

55.6 (50.9 – 60.1)

Used ground turkey or lean ground beef instead of regular ground beef

57.9 (53. 2 – 62.5 )

Used low-fat or nonfat yogurt, mayonnaise, or sour cream instead of regular mayonnaise, sour cream, or creamy

salad dressings

70.3 (65.9 – 74.3)

Used low-sodium canned vegetables instead of regular canned vegetables

75.8 (71.6 – 79.6)

Used non-stick spray or pan liners instead of grease or oil

91.5 (88.6 – 93.8)

Used olive or canola oil instead of shortening, butter, or margarine

49.0 (44.3 – 53.8)

Used other seasonings instead of salt

67.9 (63.3 – 72.1)

Used part-skim or low-fat cheese instead of regular cheese

81.5 (77.6 – 8 4.9)

Used skim, low-fat, soy, or nonfat dry milk instead of whole milk

89.0 (85.7 – 91.6)

Used whole grain-rich foods instead of non-whole grain-rich foods

94.0 (91.5 – 95.8)

Reduction techniques

Reduced the amount of salt called for in recipes or used low-sodium recipes

76.4 (72.1 – 80.1)

Reduced the amount of saturated fats and oils called for in recipes

64.8 (60.1 – 69.2)

Reduced the amount of sugar called for in recipes or used low-sugar recipes

55.2 (5 0.5 – 59.9)

Meat/poultry preparation techniques

Drained fat from browned meat

70.7 (66.1 – 74.8)

Removed skin from poultry or used skinless poultry

46.8 (42.1 – 51.6)

Roasted meat or poultry on a rack so fat would drain

44.3 (39.7 – 49.1)

Roasted, baked, or broiled meat rather than fried it

66.0 (61.4 – 70.3)

Skimmed fat off warm broth, soup, stew, or gravy

73.1 (68.6 – 77. 2)

Spooned solid fat from chilled meat or poultry broth

76.2 (71.8 – 80.1)

Trimmed fat from meat or used lean meat

58 .5 (5 3.8 – 63.1)

Vegetable preparation techniques

Boiled, mashed, or baked potatoes rather than fried or deep fried them

86.8 (83.1 – 89.8)

Prepared vegetables without using butter, margarine, or a cheese or creamy sauce

74.3 (70.0 – 78.1)

Rinsed canned vegetables and/or beans

56.5 (51.7 – 61.2)

Steamed or baked other vegetables

86.2 (82.6 – 89.2)

Among the 81.6% of districts that have primary responsibility for cooking foods for schools in the district.

During the 30 days before the study.

An additional 31.0% of districts used only precooked meat/poultry.

Table 3.4. Percentage of districts in which nutrition services sta worked on school nutrition services activities with other

district-level and local agency or organization sta

— SHPPS 2016

Staff Districts (%)

District staff

Counseling, psychological, or social services

29.0 (25.1 – 33.1)

Health education

47.6 (43.3 – 52.0)

Health services

55.8 (51.4 – 60.0)

Physical education

38.4 (34.2 – 42.7)

Local agency or organization staff

A county cooperative extension ofﬁce

27.2 (23.5 – 31.2)

A food commodity organization (e.g., the Dairy Council or produce growers association)

44.3 (40.0 – 48.6)

A food policy council

21.4 (18.1 – 25.3)

A health organization (e.g., the American Heart Association or the American Cancer Society)

16.9 (14.0 – 20.3)

A local anti-hunger organization (e.g., a food bank)

34.6 (30.7 – 38.8)

A local business

29.1 (25.2 – 33.3)

A local college or university

19.3 (16.1 – 2 2.9)

A local health department

56.4 (52.1 – 60.5)

A local hospital

9.0 (6.8 – 11.9)

A local mental health or social services agency

9.7 (7.3 – 12.7)

A local or state chapter of the School Nutrition Association

53.0 (48.7 – 57.2)

A local service club (e.g., Rotary Club)

11.6 (9.1 – 14.8)

A local youth organization (e.g., the Boys and Girls Clubs)

13.3 (10.6 – 16.6)

A non-governmental organization promoting farm to school activities

24.1 (20.5 – 28.0)

A Supplemental Nutrition Assistance Program-Education (SNAP-Ed) implementing agency

21.6 (18.2 – 25.4)

The state agriculture department

33.4 (2 9.4 – 37.6 )

The state health department

35.4 (31.4 – 39.7)

During the 12 months before the study.

Table 3.5. Percentage of districts that used specic practices

to promote school nutrition services — SHPPS 2016

Practice Districts (%)

Made menus available to students

98.6 (97.2 – 99.3)

Made information available to students on the nutrition and caloric content of foods available to them

74.0 (70.2 – 77.4)

Made menus available to families of all students

98.8 (97.5 – 99.5)

Made information available to families of all students on the nutrition and caloric content of foods available to students

63.1 (59.0 – 67.1)

Made information about school nutrition services available at community events

47.6 (43.4 – 51.9)

Led an activity about healthy eating for students

49.0 (44.8 – 53.3)

Recommended that schools:

Make healthful foods more visible

92.6 (90.2 – 94.4)

Improve the presentation of healthful foods in the cafeteria

89.4 (86.6 – 91.7)

Improve the lunchroom atmosphere

83.2 (79.7 – 86.2)

Offer grab-and-go meals

64.7 (6 0.7 – 68. 5)

Involve students in menu development and promotion

55.9 (51.7 – 60.1)

Involve students in taste tests of new menu items

67.5 (63.5 – 71. 2)

Provided ideas to schools:

On how to involve school nutrition services staff in classrooms

35.9 (31.8 – 40.2)

On how to use the cafeteria as a place where students might learn about food safety, food preparation, or other

nutrition-related topics

41.4 (37.1 – 45.8)

For nutrition-related special events

38.8 (34.8 – 43.1)

During the 12 months before the study.

Table 3.6. Percentage of districts with other practices related to school nutrition services — SHPPS 2016

Practice Districts (%)

Uses direct certiﬁcation to determine students’ eligibility for free school meals

96.7 (94.8 – 97.9)

Uses the community eligibility provision to offer free school meals to all students

30.8 (27.0 – 34.8)

Used Hazard Analysis and Critical Control Points (HACCP)-based recipes:

Never

2.9 (1.7 – 4. 8)

Rarely

2.0 (1.1 – 3.7)

Sometimes

13.0 (10.3 – 16.3)

Almost always or always

82.1 (78. 5 – 85.2)

Participates in any farm to school activities

37.9 (33.9 – 42.1)

Provided assistance

to schools for providing meals for students:

With food allergies, sensitivities, or intolerances

89.3 (86.4 – 91.6)

With chronic health conditions that require dietary modiﬁcation (e.g., diabetes)

79.4 (75.9 – 82.6)

Who are vegetarians

62.3 (58.2 – 66.1)

Measured or monitored:

The number of students participating in the nutrition services program

96.6 (94.7 – 97. 8)

The nutritional quality of school meals

95.0 (93.0 – 9 6.5)

The nutritional quality of meals and snacks served in after-school or extended day programs

46. 2 (42.0 – 50.4)

The amount of plate waste

65.6 (61.4 – 69.6)

Food safety procedures

96.2 (94.3 – 97.5)

Evaluated any professional development or in-service programs for nutrition services staff

69.6 (65.5 – 73.5)

Limits the sale of foods and beverages that do not meet Smart Snacks standards during the school day for fundraising purposes by:

Following state policy that does not allow the sale of such foods and beverages

40.0 (35.6 – 44.5)

Following limits set by the state on the number of days schools can sell such foods and beverages

52.5 (48.0 – 57.0)

Setting more restrictive limits than the state on the number of days schools can sell such foods and beverages

7.5 (5.5 – 10.3)

Prohibits or actively discourages schools from using food or food coupons as a reward for good behavior or good

academic performance

50.3 (45.8 – 54.8)

Prohibits or actively discourages schools from withholding food or restricting the types of foods available as a form of

punishment for students’ behavior

70.0 (65.7 – 73.9)

During the 30 days before the survey.

During the 12 months before the survey.

During the 2 years before the survey.

Table 3.7. Percentage of districts with practices related to local wellness policies — SHPPS 2016

Practice Districts (%)

Policy made available to the public by:

Posting on the district or school web sites

87.0 (83.9 – 89.5)

Sending home with students

27.0 (23.1 – 31.2)

Mailing to families

13.9 (11.0 – 17.5)

Emailing to families

11.4 (8.7 – 15.0)

Posting in schools

49.3 (4 4.8 – 53.9)

Publishing in the local newspaper or other media outlets

13.1 (10.2 – 16.6)

Sharing through social media

19.9 (16.5 – 23.7)

Sharing during meetings where parents are in attendance

49.5 (45.0 – 54.0)

Publishing in the district newsletter or in school publications

37.8 (33.4 – 42.3)

Including in the student handbook

50.1 (45.6 – 54.7)

Individual identiﬁed as responsible for ensuring compliance with policy:

No single individual is identiﬁed

31.3 (27.3 – 35.6)

Superintendent

27.4 (23.6 – 31.6)

Assistant superintendent

3.3 (2.1 – 5.3)

District food service director (school food authority director)

15.6 (12.6 – 19.2)

Other district-level staff member

7.6 (5.6 – 10.3)

A school administrator

11.3 (8.8 – 14.5)

A school-level faculty or staff member

3.4 (2.2 – 5.2)

Policy last reviewed:

Never

2.1 (1.1 – 4.0)

During the 12 months before the survey

64.3 (60.0 – 68.4)

Between 1 and 3 years before the survey

25.7 (22.1 – 29.6)

More than 3 years before the survey

7.9 (5.8 – 10.6)

Policy last updated:

Never

2.5 (1.4 – 4.4)

During the 12 months before the survey

53.6 (49.1 – 58.0)

Between 1 and 3 years before the survey

30.6 (26.7 – 34.8)

More than 3 years before the survey

13.3 (10.6 – 16.6)

Groups involved during last review or update of policy:

Students

35.1 (30.9 – 39. 6)

Students’ parents or guardians

52.9 (48.4 – 57.4)

Representatives of the school food authority

73.7 (69.6 – 77.4)

School board members

51.0 (46.6 – 55.5)

School administrators

86.9 (83.5 – 89.6)

Community members

43.4 (39.0 – 47.9)

Physical education teachers

58.8 (54.3 – 63. 2)

Other classroom teachers

38.4 (34.1 – 42.9)

Other school health professionals, such as health educators, school nurses, or school counselors

65.8 (61.4 – 70.0)

continued

Practice Districts (%)

Tools and resources used during last review or update of policy:

WellSAT or WellSAT 2.0

8.6 (6.3 – 11.8)

Action for Healthy Kids Wellness Policy Tool

32.0 (27.6 – 36.8)

Any other standardized tool

25.4 (21.4 – 29.9)

CDC’s School Health Guidelines to Promote Healthy Eating and Physical Activity

32.6 (28.2 – 37.4)

State’s model wellness policy

83.6 (79.8 – 86.8)

Another organization’s model wellness policy (e.g., Alliance for a Healthier Generation)

34.5 (30. 2 – 39.2)

Another district’s wellness policy

42.4 (37.8 – 47.2)

Made results of last evaluation or assessment of implementation of wellness policy available to the public

65.9 (61.0 – 70.4)

Among the 99.0% of districts that have either reviewed or updated their policy.

Among the 83.5% of districts that have evaluated or assessed the implementation of their policy.

Table 3.8. Percentage of districts with specic stang policies for nutrition services sta — SHPPS 2016

Policy Districts (%)

Requires a newly hired district food service director to have as minimum education level:

High school diploma or GED

33.1 (29. 2 – 37.3)

Associate’s degree in nutrition or a related ﬁeld

13.8 (11.1 – 17. 2)

Undergraduate degree in nutrition or a related ﬁeld

20.8 (17.5 – 24.6)

Graduate degree in nutrition or a related ﬁeld

8.5 (6.3 – 11.5)

No speciﬁc education requirements

23.7 (20.1 – 27.8)

Requires a newly hired district food service director to have:

A Registered Dietitian (RD) or Registered Dietitian Nutritionist (RDN) credential from the Commission on Dietetic

Registration

6.0 (4.2 – 8.5)

A School Nutrition Specialist credential from the School Nutrition Association

9.8 (7.3 – 13.0)

A School Nutrition Association certiﬁcation

21.4 (17.9 – 25.3)

Successfully completed a school nutrition services training program provided or sponsored by the state

50.5 (46.0 – 54.9)

ServSafe or other food safety certiﬁcation

76.2 (72.3 – 79.8)

Requires a newly hired district food service director to be certiﬁed, licensed, or endorsed by the state

23.4 (19.7 – 27.5)

Requires the district food service director is required to earn continuing education credits on nutrition topics

49.1 (44.7 – 53.5)

Requires each school to have someone to oversee or coordinate nutrition services at the school (e.g., a school food

service manager)

6 4.4 (59.9 – 6 8. 6)

Requires newly hired district school food service managers to have as minimum education level:

High school diploma or GED

59.6 (55.1 – 64.0)

Associate’s degree in nutrition or a related ﬁeld

8.2 (6.1 – 11.1)

Undergraduate degree in nutrition or a related ﬁeld

4.3 (2.9 – 6.4)

Graduate degree in nutrition or a related ﬁeld

2.2 (1.1 – 4.4)

No speciﬁc education requirements

25.6 (21.8 – 29.8)

Requires newly hired school food service managers to have:

A Registered Dietitian (RD) or Registered Dietitian Nutritionist (RDN) credential from the Commission on Dietetic

Registration

1.7 (0.9 – 3.4)

A School Nutrition Specialist credential from the School Nutrition Association

4.9 (3.3 – 7.2)

A School Nutrition Association certiﬁcation

15.8 (12.7 – 19.5)

Successfully completed a school nutrition services training program provided or sponsored by the state

47.1 (42.6 – 51.6)

ServSafe or other food safety certiﬁcation

77.1 (73.2 – 80.6)

Requires newly hired school food service managers to be certiﬁed, licensed, or endorsed by the state

18.6 (15.3 – 22.3)

Requires school food service managers to earn continuing education credits on nutrition topics

50.5 (46.1 – 54.9)

Table 3.9. Percentage of districts that provided funding for professional development or oered professional

development on specic topics to nutrition services sta — SHPPS 2016

Topic Districts (%)

Access to free drinking water

72.3 (68.2 – 76.0)

Competitive food policies that meet or exceed Smart Snacks in School standards

78.8 (75.0 – 82.2)

Culinary skills

50.6 (46.3 – 55.0)

Cultural diversity in meal planning

40.5 (36.2 – 4 4.9)

Customer service

71.3 (67.3 – 75.0)

Decreasing marketing of less nutritious foods

55.6 (51.3 – 59.9)

Facility design and layout, including equipment selection

38.0 (33.8 – 42.4)

Financial management

59.3 (5 4.8 – 63. 6)

Food preparation methods for students with food allergies, sensitivities, or intolerances

78.1 (74.2 – 81.5)

Food safety

91.8 (89.1 – 93.9)

Healthy food preparation methods

80.9 (77.1 – 8 4.1)

Implementing local wellness policies at the school level

68.1 (63.9 – 72.1)

Implementing the updated USDA requirements for school meals

92.2 (89.6 – 94.3)

Increasing the percentage of students participating in school meals

72.2 (6 8.1 – 75.9)

Involving students in menu development and promotion

53.1 (48.7 – 57.4)

Making school meals more appealing

84.0 (80.4 – 87.0)

Menu planning for healthful meals

82.4 (78.8 – 85.4)

Nutrition services for students with special dietary needs other than food allergies

77.3 (73.5 – 80.8)

Nutrition standards for foods and beverages served in after-school or extended day programs

51.1 (46.7 – 55.5)

Personal safety for nutrition services staff

83.5 (80.0 – 86.5)

Personnel management

60.0 (55.6 – 6 4.2)

Procedures for handling severe food allergy reactions

76.1 (72.1 – 79.6)

Procedures for responding to food recalls

69.5 (65.3 – 73.4)

Program regulations and procedures

85.2 (81.9 – 8 8.0)

Promoting vegetables and salads

86.5 (83.2 – 8 9.1)

Selecting and ordering food

74.7 (70.7 – 78.3)

Sourcing foods locally or regionally

51.5 (47.1 – 55.8)

Strategies to improve the lunchroom atmosphere

73.1 (69.0 – 76.8)

Strategies to improve the presentation of healthful foods in the cafeteria

78.3 (74.5 – 81.7)

Using Hazard Analysis and Critical Control Points (HACCP)

82.6 (79.1 – 85.7)

Using produce from school gardens

19.5 (16.3 – 23.2)

Using the cafeteria for nutrition education

51.1 (46.6 – 55.5)

Table 3.10. Percentage of districts that require or recommend that schools implement specic nutrition

practices — SHPPS 2016

Districts (%)

Practice Require Recommend

Offer students whole grain-rich foods each day for breakfast

78.9 (75.1 – 82.3) 10.0 (7.7 – 12.9)

Offer a choice between the following items each day for lunch:

2 or more different entrees or main courses

33.7 (29.7 – 37.8) 32.4 (28.5 – 36.6)

2 or more different non-fried vegetables

37.8 (33.7 – 42.0) 36.9 (32.9 – 41.2)

2 or more different fruits

39.9 (35.7 – 44.2) 39.4 (35.2 – 43.7)

Offer a vegetarian entrée or main course each day for lunch

11.0 (8.4 – 14.1) 25.5 (21.9 – 29.5)

Offer students whole grain-rich foods each day for lunch

79.9 (76.2 – 83.1) 14.0 (11.3 – 17. 2)

Offer self-serve salad bars

15.5 (12.7 – 18.9) 28.9 (25.0 – 33.0)

Prohibit offering foods and beverages that do not meet Smart Snacks standards:

At classroom parties

31.9 (27.9 – 36.1) 39.2 (35.0 – 43.6)

In after-school or extended day programs

31.1 (27.2 – 35.4) 23.3 (19.8 – 27.2)

At staff meetings

3.1 (1.9 – 5.1) 23.1 (19.6 – 26.9)

At meetings attended by students’ family members

5.8 (4.0 – 8.4) 25.7 (22.0 – 29.8)

In school stores, canteens, or snack bars not during the school day

29.2 (25.4 – 33.4) 19.7 (16.4 – 23.5)

In vending machines not during the school day

47.9 (43.6 – 52.3) 17.1 (14.1 – 20.5)

At concession stands not during the school day

8.3 (6.0 – 11.2) 26.1 (22.4 – 30.2)

Restrict the availability of deep-fried foods

58 .9 (54 .5 – 63. 2) 17.9 (14.9 – 21.4)

Prohibit offering brand-name fast foods as part of school meals or as a la carte items

35.3 (31.1 – 39.6) 12.0 (9.4 – 15.2)

Prohibit sales of beverages containing caffeine (e.g., coffee, tea, or energy drinks)

37.8 (33.7 – 42.2) 18.4 (15.3 – 22.1)

Make fruits or vegetables available to students whenever other food is offered or sold1

16.3 (13.2 – 20.0) 29.4 (25.5 – 33.6)

Make whole grain-rich foods available to students whenever other food is offered or sold1

19.7 (16.4 – 23.5) 29.6 (25.7 – 33.9)

Make healthful beverages (e.g., plain water or nonfat milk) available to students whenever other

beverages are offered or sold

23.3 (19.8 – 27. 2) 34.1 (30.1 – 38.4)

Intentionally price healthful foods (e.g., fruits, vegetables, and whole grains) at a lower cost than

other foods

8.5 (6.3 – 11.4) 22.6 (19.1 – 26.4)

Intentionally price healthful beverages (e.g., nonfat milk) at a lower cost than other beverages

(e.g., sugar-sweetened beverages)

7.9 (5.9 – 10. 5) 10.1 (7.8 – 13.0)

Have written plans for:

Implementation of a risk-based approach to food safety (e.g., a HACCP- based program)

83.0 (79.5 – 85.9) 8.0 (6.0 – 10.6)

Feeding students with food allergies, sensitivities, or intolerances

65.9 (61.6 – 69.9) 2 2 . 5 ( 19.0 – 2 6. 3)

Feeding students who rely on the school meal programs in the event of an unplanned

school dismissal or closure

25.5 (21.7 – 29.6) 22.5 (19.0 – 26.4)

For example, at classroom parties or in school stores.

An additional 54.2% of districts do not sell sugar-sweetened beverages.

Table 3.11. Percentage of district food service directors

with specic qualications — SHPPS 2016

Qualiﬁcation Districts (%)

Works for:

School district

86.6 (82.8 – 89.7)

Food service management company

13.7 (10.6 – 17.6)

Other

1.1 (0.4 – 2.6)

Has degree

in:

Business

20.9 (17.0 – 25.4)

Culinary arts

8.5 (6.2 – 11.7)

Family and consumer sciences

3.7 (2.3 – 5.9)

Food service management

17.9 (14.3 – 22.1)

Foods and nutrition

27.2 (23.0 – 31.8)

Nutrition education

12.2 (9.3 – 15.8)

Public/school administration

7.0 (4.9 – 10.1)

None of these

43.4 (38.7 – 48.3)

Holds the following credentials:

Licensed Nutritionist or Dietitian

6.6 (4.6 – 9.4)

Registered Dietitian (RD) or Registered Dietitian Nutritionist (RDN) credential from the Commission on Dietetic

Registration

8.7 (6.4 – 11.9)

A School Nutrition Association certiﬁcation

31.8 (27.3 – 36.6)

A School Nutrition Specialist credential from the School Nutrition Association

11.0 (8.2 – 14.7)

State food service certiﬁcate

19.1 (15.4 – 23.5)

ServSafe or other food safety certiﬁcation

78.9 (74.7 – 82.6)

Health department certiﬁcation

15.2 (11.8 – 19.2)

Certiﬁed dietary manager

4.6 (2.9 – 7.2)

Dietetic Technician, Registered (DTR)

1.2 (0.6 – 2.8)

Other

9.6 (6.9 – 13.1)

None of the above

9.4 (7.0 – 12.5)

Among the 76.8% of districts that had a food service director who served as the respondent to the nutrition services questionnaire.

Associate’s degree, undergraduate major or minor, or graduate degree.

Table 3.12. Percentage of districts with specic policies and practices related to beverages available outside the school

meal program — SHPPS 2016

Policy or practice Districts (%)

Adopted a policy that allows students to have a drinking water bottle with them during the school day

51.8 (47.3 – 56.4)

Requires schools to provide free drinking water to students in:

The cafeteria during breakfast

60.6 (56.1 – 64.9)

The cafeteria during lunch

64.2 (59.8 – 68.4)

The gymnasium or other indoor physical activity facilities

63.2 (58.7 – 67.4)

Outdoor physical activity facilities and sports ﬁelds

55.5 (51.0 – 59.9)

Hallways throughout the school

65.9 (61.5 – 70.1)

Allows schools to sell soft drinks

to students after the ofﬁcial school day in any venue

60.9 (56.5 – 65.2)

District receives a speciﬁed percentage of soft drink sales receipts

38.1 (33.9 – 42.6)

District receives incentives from soft drink sales (e.g., cash awards or donations of equipment, supplies, or other

donations) once receipts total a speciﬁed amount

9.1 (6.9 – 12.0)

District prohibited from selling soft drinks produced by more than one company

18.4 (15.1 – 22.1)

Such as sports drinks, soda pop, or fruit drinks that are not 100% juice.

Table 3.13. Percentage of districts that require or recommend that schools prohibit specic practices related to foods and

beverages available outside of the school meal program — SHPPS 2016

Districts (%)

Prohibited practice Require Recommend

Student access to vending machines during the school day:

Elementary schools

38.4 (34.1 – 42.9) 2.1 (1.2 – 3.8)

Middle schools

43.6 (39.1 – 48.2) 8.5 (6.3 – 11.5)

High schools

44. 2 (39.5 – 49.0) 14.4 (11.4 – 18.1)

Marketing of fast food restaurants and foods and beverages that do not meet Smart Snack standards

in the following places:

In school buildings

51.4 (4 6.8 – 55.9) 17.4 (14.2 – 21.1)

On school grounds, on the outside of the school building, on playing ﬁelds, or other areas

of the campus

39.9 (35.6 – 44.5) 23.2 (19.5 – 27.2)

On school buses or other vehicles used to transport students

41.6 (37.2 – 46.2) 19.0 (15.7 – 22.9)

In school publications (e.g., newsletters, newspapers, web sites, or other school

publications)

33.0 (28.8 – 37. 3) 20.9 (17.3 – 24.9)

In curricula or other educational materials (including assignment books, school supplies,

book covers, and electronic media)

30.0 (26.0 – 34.3) 2 3.3 (19.6 – 27.4)

Through the distribution of products to students (e.g., t-shirts or hats)

25.5 (21.8 – 29.6) 19.1 (15.7 – 23.0)

Sale of foods and beverages that do not meet Smart Snack standards as part of fundraising for

school organizations

33.2 (29.0 – 37.6) 27.5 (23.6 – 31.7)

Fundraiser nights at fast food restaurants where a portion of the sales made during a particular

night beneﬁt the school

5.9 (4.1 – 8.5) 16.9 (13.9 – 20. 5)

An additional 53.9% of districts have no elementary schools with vending machines.

An additional 31.8% of districts have no middle schools with vending machines.

An additional 11.4% of districts have no high schools with vending machines.

Such as soft drinks or candy.

Health Services and Counseling, Psychological, and Social Services

Table 4.1. Percentage of districts with specic policies and practices related to health services and counseling,

psychological, and social services — SHPPS 2016

Policy or practice Districts (%)

Has someone in the district who oversees or coordinates health services

79.3 (75.4 – 82.7)

Has someone in the district who oversees or coordinates counseling, psychological, or social services

79.5 (75.5 – 82.9)

Has arrangements to provide health services or counseling, psychological, or social services to students in the district at

other sites not on school property

48.4 (4 4.0 – 52.9)

Requires students entering kindergarten or ﬁrst grade to have:

A hearing screening

79.5 (75.7 – 82.8)

A vision screening

82.7 (79.1 – 85.9)

An oral health examination

41.4 (37. 2 – 45.7)

A physical examination

59.1 (5 4.9 – 63. 2)

A developmental examination assessing readiness to learn

68.6 (64.3 – 72.6)

Allows standing orders for administration of:

Quick-relief inhalers

60.6 (56.4 – 64.6)

Epinephrine auto-injectors (e.g., Epi-Pen)

82.7 (79.3 – 85.7)

Insulin

50.0 (45.8 – 54.2)

Receives Medicaid reimbursement for eligible health services

provided to:

Students with Individualized Education Programs or 504 plans

67.8 (63.4 – 71.8)

Other eligible students

33.6 (29.5 – 38.0)

Requires schools to submit student injury report data to the school district or local health department

70.6 (66.7 – 74.3)

Requires schools to complete a report when a student experiences a serious illness at school

71.3 (67.2 – 75.0)

Requires schools to submit information on student weight status to the state, school district, or local health department

27.6 (24.1 – 31.5)

Has real-time access to student attendance or absenteeism information for all schools in the district

75.1 (71. 2 – 78.7)

Requires schools to submit information to the school district or local health department on the reasons for student

absences

53.0 (48.7 – 57.3)

Recommends that schools in the district use a speciﬁed electronic system for reporting student attendance or

absenteeism information

91.6 (88.8 – 93.8)

Requires schools in the district to close or dismiss all students when the percentage of absent students or staff reaches a

speciﬁed level

33.7 (29.6 – 38.0)

Requires supplies for applying standard or universal precautions to be available:

In all classrooms

59.7 (55. 3 – 6 3.8)

In the gymnasium, on playgrounds, or on playing ﬁelds

63.4 (59.1 – 67. 5)

In the cafeteria

66.7 (62.5 – 70.6)

On school buses or in other vehicles used to transport students

68.4 (64.2 – 72.4)

Requires student assistance programs to be offered to all students

58.7 (54.3 – 63.0)

Requires schools to create and maintain student support teams

69.4 (65.1 – 73.4)

Requires the following staff to participate in the development of Individualized Education Programs when indicated:

School nurses

71.5 (67.4 – 75.3)

School counseling, psychological, or social services staff

86.6 (83.4 – 89.3)

Requires the following staff to participate in the development of 504 plans when indicated:

School nurses

76.5 (72.6 – 79.9)

School counseling, psychological, or social services staff

87.0 (83.6 – 89.7)

Requires school counseling, psychological, or social services staff to participate in the development of Individualized

Health Plans when indicated

69.3 (65.0 – 73.3)

Requires health services staff to follow Do Not Resuscitate orders

23.1 (19.5 – 27. 2)

Table 4.2. Percentage of districts that had adopted a policy stating that schools will obtain and keep certain information

in any type of student record — SHPPS 2016

Type of information Districts (%)

A physical health history

84.5 (81.1 – 87.3)

An authorization for emergency treatment

85.6 (82.4 – 88.4)

An emotional or mental health history

45.7 (41.5 – 50.0)

Asthma action plans

86.9 (83.7 – 89.6)

Dietary needs or restrictions

86.4 (83.3 – 89.1)

Emergency contact information

95.6 (93.4 – 97.0)

Insurance coverage information

49.6 (45.4 – 53.8)

Medication needs

94.0 (91.8 – 95.7)

Other screening records (e.g., vision or hearing)

93.0 (90.5 – 94.8)

Physical activity restrictions

83.6 (80.1 – 86. 5)

Reasons for absences

86.1 (82.8 – 88.8)

Severe food or other allergies

93.7 (91. 2 – 95.5)

Tuberculosis screening results

38.4 (34.4 – 42.6)

Weight status (e.g., body mass index)

38.7 (34.7 – 42.8)

Table 4.3. Percentage of districts with specic policies and practices related to immunizations — SHPPS 2016

Policy or practice Districts (%)

Requires students to receive an inﬂuenza vaccine annually

4.0 (2.6 – 6.0)

Allows students to be exempted from required immunizations for:

Medical reasons

97.0 (95.1 – 98.2)

Religious reasons

90.8 (87. 8 – 93.1)

Personal beliefs

49.2 (45.0 – 53.4)

Exclusion policies for students entering kindergarten or ﬁrst grade

Students who have not received the required immunizations are immediately excluded from attending classes

26.6 (23.1 – 30.6)

Students who have not received the required immunizations are allowed to attend classes for a speciﬁed number

of days and then excluded

60.7 (56.5 – 64.8)

Does not have a policy that excludes students from attending classes if they have not received the

required immunizations

12.7 (10.1 – 15.8)

Exclusion policies for students entering middle school

Students who have not received the required immunizations are immediately excluded from attending classes

27.6 (23.9 – 31.6)

Students who have not received the required immunizations are allowed to attend classes for a speciﬁed number

of days and then excluded

58.8 (54.6 – 63.0)

Does not have a policy that excludes students from attending classes if they have not received the

required immunizations

13.6 (11.0 – 16.7)

Exclusion policies for students entering high school

Students who have not received the required immunizations are immediately excluded from attending classes

24.6 (20.9 – 28.7)

Students who have not received the required immunizations are allowed to attend classes for a speciﬁed number

of days and then excluded

57.7 (53.2 – 62.1)

Does not have a policy that excludes students from attending classes if they have not received the

required immunizations

17.7 (14.5 – 21.3)

Table 4.4. Percentage of districts that had adopted a policy stating specic immunization requirements for school

entry — SHPPS 2016

Policy Districts (%)

Requirements for kindergarten or ﬁrst grade entry

A hepatitis A vaccine series

37.0 (33.0 – 41.1)

A hepatitis B vaccine series

89.0 (86.1 – 91.3)

A pertussis vaccine series

93.6 (91.2 – 95.3)

A polio vaccine series

95.6 (93.7 – 97.0)

A second chicken pox or varicella vaccine

84.5 (81.1 – 87.4)

A second measles vaccine

94.4 (92.2 – 96.1)

A tetanus vaccine series

93.6 (91.2 – 95.4)

Requirements for middle school entry

A hepatitis A vaccine series

27.4 (23.8 – 31.3)

A hepatitis B vaccine series

84.0 (80.6 – 86.9)

A human papillomavirus (HPV) vaccine series

7.4 (5.4 – 10.0)

A meningococcal conjugate vaccine

47.2 (42.9 – 51.5)

A second chicken pox or varicella vaccine

75.3 (71.3 – 78.9)

A second measles vaccine

87.0 (83.8 – 89.6)

A tetanus-diphtheria-pertussis (Tdap) vaccine series

89.5 (86.5 – 91.9)

Requirements for high school entry

A hepatitis A vaccine series

23.1 (19.6 – 27.0)

A hepatitis B vaccine series

83.9 (8 0.5 – 86 .9)

A human papillomavirus (HPV) vaccine series

6.6 (4.7 – 9.3)

A meningococcal conjugate vaccine

44.9 (4 0.4 – 49.4)

A second chicken pox or varicella vaccine

68.2 (63. 8 – 72.3)

A second measles vaccine

84.9 (81.5 – 87.8)

A tetanus-diphtheria-pertussis (Tdap) vaccine series

85.0 (81.5 – 87.9)

Table 4.5. Percentage of districts with specic practices related to tuberculosis (TB) screening and testing — SHPPS 2016

Practice Districts (%)

Screens

students for TB prior to entry into kindergarten or ﬁrst grade

15.0 (12.2 – 18.4)

TB testing

prior to entry into kindergarten or ﬁrst grade:

Required based on the result of TB screening

11.8 (9.3 – 14.9)

Required for all students

5.8 (4.0 – 8. 2)

Not required for any students

82.4 (78.8 – 85.5)

Periodic TB testing after school entry

Required for all students

1.9 (1. 0 – 3. 6)

Required for students previously identiﬁed through screening

3.6 (2.3 – 5.4)

Not required for any students

94.5 (92.3 – 96.1)

Methods accepted as evidence that a student does not have TB:

PPD skin test done by Mantoux method

71.8 (61.7 – 80.0)

A negative skin test not otherwise speciﬁed

39.3 (30.0 – 49.5)

A negative chest x-ray

55.5 (45.6 – 65. 0)

A negative blood test

41.9 (32.5 – 52.0)

Letter from a physician stating that the student is free of TB

59. 7 ( 49. 6 – 6 9.1)

Dened as the identication of individuals meeting certain risk criteria. Students meeting these criteria would then be referred for TB testing or required to provide

evidence of medical clearance.

Dened as a clinical test for TB.

Among the 18.8% of districts that require any TB testing.

Table 4.6. Percentage of districts that had adopted policies related to student medications — SHPPS 2016

Policy Districts (%)

Some students may carry and self-administer:

A prescription quick-relief inhaler

91.2 (88.6 – 93.3)

An epinephrine auto-injector (e.g., Epi-Pen)

82.7 (79.3 – 85.6)

Insulin or other injected medications

69.2 (65.1 – 72.9)

Any other prescribed medications

23.2 (19.8 – 27.1)

Any over-the-counter medications

22.6 (19.2 – 26.5)

Who may administer:

Prescription medications to a student at school

95.7 (93.6 – 97.1)

Over-the-counter medications to a student at school

94.8 (92.6 – 96.4)

When someone who is not a licensed healthcare professional administers prescription medications to students, they must be:

Licensed or certiﬁed to administer medications

30.2 (26.4 – 34.3)

Trained to administer medications

83.4 (80.0 – 86.3)

When someone who is not a licensed healthcare professional administers over-the-counter medications to students, they must be:

Licensed or certiﬁed to administer medications

26.7 (2 3.1 – 30.7 )

Trained to administer medications

77.6 (73.8 – 80.9)

Schools will have written instructions from the physician or prescriber before school nurses, teachers, or any other school staff may administer:

Prescription medications to a student

92.8 (90.2 – 94.7)

Over-the-counter medications to a student

59.0 (54 .8 – 63. 2)

Schools will have a written request from the parent or guardian before school nurses, teachers, or any other school staff may administer:

Prescription medications to a student

92.7 (90.0 – 94.7)

Over-the-counter medications to a student

91.4 (88.5 – 93.6)

Schools will have written information on possible side effects before school nurses, teachers, or any other school staff may administer:

Prescription medications to a student

44.0 (39.7 – 48.4)

Over-the-counter medications to a student

32.3 (28.3 – 36.6)

Table 4.7. Percentage of districts in which health services sta worked on school health services activities with other

district-level and local agency or organization sta

— SHPPS 2016

Staff Districts (%)

District staff

Counseling, psychological, or social services

82.6 (78.9 – 85.8)

Health education

74.0 (69.8 – 77.9)

Nutrition or food service

77.7 (73.7 – 81.3)

Physical education

72.3 (68.0 – 76.2)

School-based health center

34.4 (30.0 – 39.1)

Local agency or organization staff

A community healthcare provider

62.9 (5 8.7 – 66 .9)

A community-based organization that provides sexual and reproductive health services

34.2 (30.2 – 38.5)

A health organization (e.g., the American Heart Association or the American Cancer Society)

60.9 (56.6 – 65.1)

A local business

39.0 (34.8 – 43.4)

A local child welfare agency

57.9 (53. 6 – 62 .1)

A local college or university

38.1 (34.0 – 42.3)

A local health department

78.7 (74.8 – 82.1)

A local hospital

49.4 (45.2 – 53.7)

A local juvenile justice department

38.2 (34.0 – 42.6)

A local mental health or social services agency

64.3 (60.0 – 68.4)

A local service club (e.g., Rotary Club)

50.9 (46.5 – 55. 2)

The state health department

56.2 (51.9 – 6 0.5)

During the 12 months before the study.

Table 4.8. Percentage of districts in which counseling, psychological, or social services sta worked on school counseling,

psychological, or social services activities with other district-level and local agency or organization sta

— SHPPS 2016

Staff Districts (%)

District staff

Health education

65.7 (61.0 – 70.2)

Health services

81.1 (77.2 – 84.4)

Nutrition or food service

51.5 (4 6.7 – 56.4)

Physical education

57.6 (52.7 – 62.3)

School-based health center

32. 8 (28.4 – 37.5)

Local agency or organization staff

A dropout prevention organization (e.g., Communities in Schools)

32. 2 (28.1 – 36.6)

A health organization (e.g., the American Heart Association or the American Cancer Society)

33.5 (29.2 – 38.0)

A local business

37.1 (32.7 – 41.7)

A local child welfare agency

69.7 (65.4 – 73.7)

A local college or university

42.5 (38.1 – 47.1)

A local health department

50.7 (4 6.0 – 55.3)

A local hospital

46.3 (41.8 – 50.8)

A local juvenile justice department

58.3 (53.7 – 62.7)

A local law enforcement agency

68.8 (64.4 – 72. 8)

A local mental health or social services agency

75.6 (71.5 – 79.2)

A local service club (e.g., Rotary Club)

39.6 (35.3 – 4 4.2)

The state health department

34.2 (29.9 – 38.7)

During the 12 months before the study.

Table 4.9. Percentage of districts that reviewed, measured, or evaluated aspects of school health services and school

counseling, psychological, or social services

— SHPPS 2016

Aspects reviewed, measured, or evaluated Districts (%)

Reviewed or updated:

District’s health services policies

80.0 (76.3 – 83.3)

District’s counseling, psychological, or social services policies

65.0 (60.3 – 69.4)

Measured or monitored:

Student use of school health services in the district

61.8 (57.5 – 65.9)

Student use of school counseling, psychological, or social services in the district

59.6 (54.8 – 64. 2)

Student or family satisfaction with school health services in the district

20.8 (17.4 – 24.5)

Student or family satisfaction with school counseling, psychological, or social services in the district

34.4 (30.0 – 39.2)

Evaluated any professional development or in-service programs for:

Health services staff

47.9 (43.6 – 52.2)

Counseling, psychological, or social services staff

51.8 (47.0 – 56.7)

During the 2 years before the study.

Table 4.10. Percentage of districts that had adopted policies related to student health screening — SHPPS 2016

— Districts (%)

Type of

screening

Policy that schools

will screen

students

Policy that parents

or guardians will

be notiﬁed

Policy that

teacher will be

notiﬁed

Policy that schools

must provide

referrals

Hearing problems

87.5 (84.4 – 90.1) 97.4 (95.7 – 98.5) 74.4 (70.2 – 78.2) 64.1 (59.7 – 68.4)

Mental health problems

12.3 (9.6 – 15.6) 96.5 (89.9 – 98.9) 84.3 (72.7 – 91.5) 78.3 (65.5 – 87.3)

Oral health problems

26.0 (22.5 – 30.0) 95.8 (90.3 – 98.2) 60.9 (52.5 – 68.7) 76.2 (68.5 – 82.6)

Vision problems

88.0 (84.9 – 90.5) 97.5 (95.8 – 98.5) 75.1 (70.9 – 78.8) 6 4.1 (59.7 – 68.3)

Weight status using BMI

30.1 (26.4 – 34.0) 60.0 (52.3 – 67.1) NA 28.0 (21.8 – 35.2)

NA = Question not asked.

If screening indicates a potential problem, among districts requiring schools to screen students for that problem.

Table 4.11. Percentage of districts that had adopted a policy that schools will provide specic health and prevention

services to students — SHPPS 2016

Service Districts (%)

Health service

Administration of medications

94.5 (92.0 – 96.3)

Administration of sports physicals

37.0 (33.0 – 41.2)

Administration of topical ﬂuorides (e.g., mouthrinses, varnish, or supplements)

12.2 (9.8 – 15.1)

Alcohol or other drug use treatment

19.0 (15.8 – 22.7)

Application of dental sealants

7.7 (5.8 – 10.2)

Assistance with accessing beneﬁts for students with disabilities

53.4 (49.0 – 57.8)

Assistance with enrolling in Medicaid or SCHIP

33.1 (29.0 – 37.4)

Assistance with enrolling in WIC or SNAP or accessing food stamps or food banks

28.5 (24.7 – 32.7)

Assistance with securing temporary or permanent housing

26.8 (23.0 – 30.9)

Cardiopulmonary resuscitation (CPR)

86.3 (83.0 – 89.0)

Case management for students with chronic health conditions (e.g., asthma or diabetes)

65.7 (61.4 – 69.7)

Case management for students with disabilities

76.5 (72.5 – 80.0)

Counseling after a natural disaster or other emergency or crisis situation

64.8 (60.4 – 6 8.9)

Counseling for emotional or behavioral disorders (e.g., anxiety, depression, or ADHD)

60.3 (55.8 – 64.6)

Crisis intervention for personal problems

69.6 (65.4 – 73.6)

First aid

90.8 (88.0 – 93.0)

HIV testing

0.3 (0.1 – 1.2)

Human papillomavirus (HPV) vaccine

2.3 (1.3 – 4.0)

Identiﬁcation of eating disorders

20.8 (17.4 – 24.6)

Identiﬁcation of emotional or behavioral disorders (e.g., anxiety, depression, or ADHD)

56.0 (51.5 – 60.3)

Identiﬁcation of oral health problems

27.7 (24.0 – 31.6)

Identiﬁcation of physical, sexual, or emotional abuse

68.0 (63.7 – 72.0)

Identiﬁcation of students with family problems (e.g., parental divorce, substance abuse, or violence)

52.7 (48.3 – 57. 2)

Identiﬁcation or school-based management of acute illnesses

68.4 (64.2 – 72.2)

Identiﬁcation or school-based management of chronic health conditions (e.g., asthma or diabetes)

76.2 (72.4 – 79.7)

Immunizations other than human papillomavirus (HPV) and seasonal inﬂuenza

6.5 (4.7 – 8.9)

Instruction on self-management of chronic health conditions (e.g., asthma or diabetes)

66.5 (62.3 – 70.5)

Job readiness skills programs

51.1 (46.5 – 55.7)

Pregnancy testing

1.1 (0.6 – 2.3)

Provision of condom-compatible lubricant

1.0 (0.4 – 2.5)

Provision of contraceptives other than condoms

1.1 (0.5 – 2.4)

Seasonal inﬂuenza vaccine

8.3 (6.3 – 10.9)

STD testing

0.5 (0.2 – 1.4)

STD treatment

0.6 (0.3 – 1.6)

Stress management

34.8 (30.7 – 39.1)

Tobacco use cessation

18.8 (15.7 – 22.4)

Tracking of students with chronic health conditions (e.g., asthma or diabetes)

69.4 (65.2 – 73.3)

Weight management

9.2 (7.0 – 12.0)

continued

Service Districts (%)

Prevention service

Alcohol or other drug use prevention

57.8 (53.2 – 62.2)

HIV prevention

31.7 (27.6 – 36.0)

Injury prevention and safety counseling

52.7 (48.1 – 57.2)

Nutrition and dietary behavior counseling

24.8 (21.2 – 28.9)

Physical activity and ﬁtness counseling

30.5 (26.5 – 34.7)

Pregnancy prevention

31.2 (27.2 – 35.5)

STD prevention

32. 2 (28.1 – 36.5)

Suicide prevention

56.1 (51.5 – 60.5)

Tobacco use prevention

52.7 (48.1 – 57.2)

Violence prevention (e.g., bullying, ﬁghting, or dating violence prevention)

77.4 (73.4 – 80.9)

Not asked among districts containing only elementary schools.

Provided in one-on-one or small group sessions, not as part of classroom instruction.

Table 4.12. Percentage of districts with specic policies related to condom availability, by school level

— SHPPS 2016

Districts (%)

Policy

Middle

school

High

school

Required to make condoms available to students

0.2 (0.0 – 0. 8) 1.0 (0.4 – 2.4)

Neither required nor prohibited from making condoms available to students

49.3 (4 4.7 – 53.9) 49.0 (4 4.2 – 53.7)

Prohibited from making condoms available to students

50.6 (46.0 – 55.2) 50.1 (45.3 – 54.9)

Not asked among districts containing only elementary schools.

Table 4.13. Percentage of districts that had adopted a policy that schools will provide referrals for specic services or

conditions to students — SHPPS 2016

Service or condition Districts (%)

Acute illnesses

47.5 (43.3 – 51.9)

Administration of topical ﬂuorides (e.g., mouthrinses, varnish, or supplements)

13.5 (10.9 – 16.7)

After-school programs for students (e.g., supervised recreation)

40.2 (35.9 – 44.7)

Alcohol or other drug use treatment

44.7 (40.3 – 49.1)

Application of dental sealants

12.7 (10.2 – 15.8)

Assistance with accessing beneﬁts for students with disabilities

52.0 (47.5 – 56. 5)

Assistance with enrolling in Medicaid or SCHIP

35.5 (31.3 – 40.0)

Assistance with enrolling in WIC or SNAP or accessing food stamps or food banks

32. 5 (28.5 – 36.8)

Assistance with securing temporary or permanent housing

32. 8 (28.8 – 37.2)

Child care for teen parents

17.6 (14.4 – 21.4)

Chronic health conditions (e.g., asthma or diabetes)

50.6 (46.3 – 54.9)

Condom-compatible lubricant

7. 2 (5.2 – 9.9)

Condoms

9.1 (6.8 – 12.1)

Contraceptives other than condoms

10.2 (7.8 – 13.3)

Counseling after a natural disaster or other emergency or crisis situation

57.0 (52.5 – 61.3)

Crisis intervention for personal problems

57.7 (53.2 – 62.0)

Eating disorders

30.7 (26.8 – 34.9)

Emotional or behavioral disorders (e.g., anxiety, depression, or ADHD)

57.3 (52.7 – 61.7)

HIV testing

14.8 (11.9 – 18.3)

HIV treatment

13.1 (10.4 – 16.5)

Human papillomavirus (HPV) vaccine

12.2 (9.7 – 15.3)

Immunizations other than human papillomavirus (HPV) and seasonal inﬂuenza

38.4 (34.3 – 42.6)

Job readiness skills programs

42.3 (37.8 – 46.9)

nPEP (non-occupational post-exposure prophylaxis for HIV)

9.0 (6.7 – 11.9)

Oral healthcare

36.5 (32.5 – 40.8)

Physical, sexual, or emotional abuse

58 .9 (54 .4 – 6 3.3)

Pregnancy testing

19.1 (15.7 – 22.9)

Prenatal care

21.5 (18.1 – 25.4)

Seasonal inﬂuenza vaccine

18.9 (15.8 – 22.4)

Services for students with family problems (e.g., parental divorce, substance abuse, or violence)

52.2 (47.6 – 56.6)

Sports physicals

55.8 (51.4 – 60.1)

STD testing

15.8 (12. 8 – 19.4)

STD treatment

14.8 (11.8 – 18.3)

Stress management

36.7 (32.5 – 41.1)

Tobacco use cessation

23.1 (19.6 – 27.0)

Weight management

16.8 (13.8 – 20.4)

Not asked among districts containing only elementary schools.

Table 4.14. Percentage of districts that had adopted a policy specifying education and certication requirements for

health services and counseling, psychological, or social services sta — SHPPS 2016

Policy Districts (%)

Health services staff

Requires a newly hired school nurse to have as minimum education level:

Undergraduate/baccalaureate degree in nursing (e.g., BSN)

26.0 (22.4 – 30.0)

Graduate degree in nursing

3.6 (2.3 – 5.7)

Associate’s degree in nursing

23.6 (20.2 – 27.5)

Other

26.0 (22.4 – 30.1)

No speciﬁc education requirements

20.7 (17.3 – 24.4)

Requires a newly hired school nurse to have:

A Licensed Practical Nurse’s (LPN) license

27.0 (23.0 – 31.3)

A Registered Nurse’s (RN) license

79.0 (75.3 – 82. 2)

A national school nurse certiﬁcation from the National Board for Certiﬁcation of School Nurses

7.3 (5.2 – 10.0)

A state school nurse certiﬁcation

39.1 (34.9 – 43.5)

Counseling, psychological, and social services staff

Requires a newly hired school counselor to have as minimum education level:

Undergraduate degree in counseling

26.5 (22.4 – 31.0)

Master’s degree in counseling

53.7 (48.8 – 58.6)

Other degree

5.7 (3.7 – 8.7)

No speciﬁc education requirements

14.1 (11.1 – 17.8)

Requires a newly hired school psychologist to have as minimum education level:

Undergraduate degree in psychology

12.9 (9.8 – 16.7)

Master’s degree in psychology

50.0 (44.9 – 55.1)

Doctoral degree in psychology

4.2 (2.6 – 6.7)

Other degree

10.7 (8.0 – 14.3)

No speciﬁc education requirements

22.2 (18.4 – 26.6)

Requires a newly hired school social worker to have as minimum education level:

Undergraduate degree in social work

24.3 (20.1 – 29.1)

Master’s degree in social work

36.9 (32.0 – 42.1)

Other degree

11.3 (8.2 – 15.3)

No speciﬁc education requirements

27.5 (23.2 – 32.3)

Requires the following newly hired staff to be licensed, certiﬁed, or credentialed by a state agency or board:

School counselor

77.6 (73.1 – 81.4)

School psychologist

73.7 (69.1 – 77.8)

School social worker

59.2 (54.1 – 6 4.1)

Requires school counseling, psychological, or social services staff to earn continuing education credits on counseling,

psychological, or social services topics

6 4 . 6 ( 59. 5 – 6 9. 3)

Table 4.15. Percentage of districts with specic stang policies and practices for health services and counseling,

psychological, or social services sta — SHPPS 2016

Policy or practice Districts (%)

Health services staff

Requires each school to have someone to oversee or coordinate health services at the school

57.5 (53.1 – 61.9)

Speciﬁes a maximum student-to-school nurse ratio

10.9 (8.6 – 13.7)

Requires each school to have a full-time school nurse

33.7 (29.8 – 37.8)

Requires each school to have a speciﬁed ratio of school nurses to students

8.2 (6.2 – 10.7)

Requires each school to have at least a part-time school nurse

18.1 (15.0 – 21.7)

Employs or contracts with physician or nurse practitioner who can be contacted to consult as needed during the school day

37.9 (33.9 – 42.1)

Requires school health aides to work under the supervision of a Registered Nurse (RN) at all times

65.5 (59.3 – 71.2)

School nurses employed by:

School district

79.7 (76.0 – 83.0)

Schools

21.0 (17.7 – 24.7)

Local health departments

7.6 (5.6 – 10.3)

Some other organization or agency

13.1 (10.2 – 16.6)

Counseling, psychological, and social services staff

Requires schools at each level to have a speciﬁed ratio of counselors to students:

Elementary schools

16.2 (13.0 – 19.9)

Middle schools

16.8 (13.6 – 20.7)

High schools

19.8 (16.1 – 24.1)

Requires each school to have someone to oversee or coordinate counseling, psychological, or social services at the school

56.3 (51.6 – 60.9)

School counseling, psychological, and social services staff employed by:

School district

89.4 (86.3 – 91.8)

Schools

25.3 (21.6 – 29.4)

Local mental health and social services agencies

19.9 (16.5 – 23.8)

Some other organization or agency

20.9 (17.4 – 24.8)

Among the 48.3% of districts that employ school health aides.

Table 4.16. Percentage of districts that provided funding for professional development or oered professional

development

to school health services sta or counseling, psychological, or social services sta on specic services

topics — SHPPS 2016

Service or topic Districts (%)

Health service or counseling, psychological, or social service topic

Accessing beneﬁts for students with disabilities

42.2 (37.7 – 46.8)

Accurately measuring student height and weight

30.9 (27.0 – 35.0)

Administration of medications

62.9 (58.6 – 67.0)

After-school programs for students (e.g., supervised recreation)

38.7 (34.4 – 43.3)

Alcohol or other drug use treatment

39.0 (34.8 – 43.4)

Calculating student weight status using body mass index (BMI)

28.4 (24.6 – 32.4)

Case management for students with chronic health conditions (e.g., asthma or diabetes)

57.3 (52.9 – 61.6)

Case management for students with disabilities

59.3 (5 4.9 – 63.6)

Child care options for teen parents

14.8 (11.7 – 18.5)

Counseling after a natural disaster or other emergency or crisis situation

49.6 (45.2 – 54.1)

Counseling for emotional or behavioral disorders (e.g., anxiety, depression, or ADHD)

63.2 (58.7 – 67.4)

CPR or use of AED equipment

88.2 (85.1 – 90.7)

Crisis intervention for personal problems

56.5 (52.0 – 60.9)

Dental sealants

11.4 (8.9 – 14.6)

Emergency preparedness

74.8 (70.7 – 78.5)

Enrolling in Medicaid or SCHIP

26.1 (22.2 – 30.4)

Enrolling in WIC or SNAP or accessing food stamps or food banks

20.3 (16.8 – 24.3)

Federal laws that protect the privacy of student health information (e.g., HIPAA or FERPA)

68.1 (63.8 – 72.1)

First aid

78.1 (74.2 – 81.5)

HIV testing

11.2 (8.6 – 14.4)

HIV treatment

10.4 (7.9 – 13.6)

How to identify a teen-friendly health service provider

17.7 (14.5 – 21.5)

Human papillomavirus (HPV) vaccine

11.0 (8.6 – 14.0)

Identiﬁcation of emotional or behavioral disorders (e.g., anxiety, depression, or ADHD)

64.2 (59.8 – 68.4)

Identiﬁcation of students with family problems (e.g., parental divorce, substance abuse, or violence)

51.8 (47. 2 – 56.3)

Identiﬁcation or school-based management of acute illnesses

53.1 (48.7 – 57.4)

Identiﬁcation or school-based management of chronic health conditions (e.g., asthma or diabetes)

64.1 (59.8 – 68.1)

Immunizations other than seasonal inﬂuenza and human papillomavirus (HPV)

33.0 (29.0 – 37. 2)

Infectious disease outbreak detection and response

50.7 (4 6.3 – 55.1)

Infectious disease prevention (e.g., hand hygiene or food safety)

58.6 (54.1 – 62.9)

Job readiness skills programs

38.8 (34.4 – 43.4)

Meeting the unique health-related needs of lesbian, gay, bisexual, or transgender students

34.6 (30.4 – 39.0)

nPEP (non-occupational post-exposure prophylaxis for HIV)

8.5 (6.3 – 11.4)

Oral health services

25.2 (21.6 – 29.2)

Pregnancy testing

11.8 (9.2 – 15.1)

Prenatal care

11.6 (9.0 – 14.9)

PrEP (pre-exposure prophylaxis for HIV)

8.3 (6.1 – 11.2)

Provision of condom-compatible lubricant

6.5 (4.6 – 9.1)

Provision of condoms

7.6 (5.5 – 10.3)

Provision of contraceptives other than condoms

7.0 (5.0 – 9.6)

continued

Service or topic Districts (%)

Seasonal inﬂuenza vaccine

32.9 (29.0 – 37.2)

Securing temporary or permanent housing

20.6 (17.1 – 24.6)

Services for eating disorders

30.2 (26.2 – 34.5)

Services for physical, sexual, or emotional abuse

56.4 (51.8 – 60.9)

Sports physicals

26.9 (2 3.3 – 30.9)

STD testing

12.8 (10.1 – 16.1)

STD treatment

14.0 (11.2 – 17. 5)

Stress management

42.0 (37.6 – 46.5)

Teaching self-management of chronic health conditions (e.g., asthma or diabetes)

55.2 (5 0.9 – 59.5 )

Tobacco use cessation

26.9 (23.2 – 31.0)

Topical ﬂuorides (e.g., mouthrinses, varnish, or supplements)

14.9 (12.1 – 18.2)

Tracking students with chronic health conditions (e.g., asthma or diabetes)

55.0 (50.7 – 59.4)

Weight management

18.8 (15.6 – 22.5)

Prevention services topic

Alcohol or other drug use prevention

53.4 (4 8.9 – 58.0)

HIV prevention

27.9 (24.0 – 32.1)

Injury prevention and safety counseling

50.7 (4 6.2 – 55.3)

Nutrition and dietary behavior counseling

31.3 (27.3 – 35.6)

Physical activity and ﬁtness counseling

38.4 (34.1 – 42.9)

Pregnancy prevention

26.7 (22.9 – 30.9)

STD prevention

27.7 (23.8 – 31.8)

Suicide prevention

67.9 (63.6 – 72.0)

Tobacco use prevention

41.2 (36.8 – 45.8)

Violence prevention (e.g., bullying, ﬁghting, or dating violence prevention)

75.5 (71.5 – 79. 2)

Counseling, psychological, or social services topic

Case management for students with emotional or behavioral problems

60.2 (55.4 – 64.7)

Comprehensive assessment or intake evaluation

39.1 (34.5 – 43.9)

Family counseling

33.5 (29.2 – 38.0)

Group counseling

38.9 (34.3 – 43.6)

Individual counseling

52.6 (47. 8 – 57.3)

Peer counseling or mediation

41.4 (36.7 – 46.2)

Self-help or support groups

37.1 (32.6 – 41.9)

Student assistance programs

47.4 (42.7 – 52.1)

Student support teams

47.2 (42.5 – 52.0)

During the 2 years before the study.

Includes professional development about the service or referral for the service.

Table 4.17. Percentage of districts that provided funding for training or oered training to any teachers, administrators,

and school sta other than school nurses and counseling, psychological, and social services sta on specic

topics

— SHPPS 2016

Topic Districts (%)

CPR or use of AED equipment

90.7 (87.6 – 93.1)

HIV infection

37.1 (32.9 – 41.4)

Severe food or other allergies

74.8 (70.8 – 78.4)

Chronic health conditions (e.g., asthma or diabetes), including chronic disease management, recognizing and responding

to severe symptoms, or reducing triggers

74.8 (70.8 – 78.5)

Infectious disease prevention (e.g., hand hygiene or food safety)

72.8 (68.6 – 76.6)

Making appropriate referrals for health services providers

41.6 (37.1 – 4 6.2)

Recognizing signs and symptoms of:

Physical, sexual, or emotional abuse

70.7 (66.3 – 74.8)

Substance abuse

58.3 (53.6 – 62.8)

Depression and suicidal behavior

69.5 (65.0 – 73.6)

Bullying victimization

83.5 (79.8 – 8 6.6)

Dating violence

44.0 (39.4 – 48.7)

Making appropriate referrals to a school counselor, psychologist, or social worker

69.9 (65.5 – 74.0)

Managing students with emotional or behavioral problems

74.0 (69.7 – 77.8)

During the 2 years before the study.

Not asked among districts containing only elementary schools.

Table 4.18. Mean number of school-based health centers per district that oer specic types of services to students in the

district — SHPPS 2016

Type of service Districts (%)

Primary care

0.5 (0.3 – 0.6)

Counseling, psychological, or social services

0.6 (0.4 – 0.7)

Oral health services

0.3 (0. 2 – 0.4)

Table 4.19. Percentage of districts that had arrangements with specic organizations or healthcare professionals to

provide health services or counseling, psychological, or social services to students in the district — SHPPS 2016

Organization or healthcare professional Districts (%)

A community health clinic or health center

20.3 (17.0 – 24.0)

A dental or dental hygiene school

6.1 (4.3 – 8.4)

A local health department

31.7 (27.7 – 35.9)

A local hospital

17. 3 (14.2 – 20.8)

A local mental health or social services agency

35.9 (31.9 – 40.2)

A managed care organization

2.5 (1.5 – 4.2)

A private counselor

8.6 (6.4 – 11.4)

A private dentist

6.7 (4.8 – 9.1)

A private nurse practitioner

3.4 (2.2 – 5.3)

A private physician

15.0 (12.2 – 18.4)

A private psychiatrist

4.8 (3.3 – 7.0)

A private psychologist

6.7 (4.9 – 9. 2)

A private social worker

5.2 (3.5 – 7.6)

A school-linked health center

10.2 (7.9 – 13.0)

A university, medical school, or nursing school

11.7 (9.2 – 14.7)

Table 4.20. Percentage of districts that had arrangements with organizations or healthcare professionals to provide

specic health services, prevention services, and counseling, psychological, or social services to students in the

district — SHPPS 2016

Service Districts (%)

Health service

Administration of sports physicals

24.8 (21.3 – 28.7)

Administration of topical ﬂuorides (e.g., mouthrinses, varnish, or supplements)

19.4 (16.2 – 23.0)

After-school programs for students (e.g., supervised recreation)

26.4 (22.7 – 30.5)

Alcohol or other drug use treatment

14.7 (11.8 – 18.1)

Application of dental sealants

19.2 (16.0 – 22.8)

Assistance with accessing beneﬁts for students with disabilities

24.0 (20.4 – 28.1)

Assistance with enrolling in Medicaid or SCHIP

17.7 (14.6 – 21.4)

Assistance with enrolling in WIC or SNAP, or accessing food stamps or food banks

16.7 (13.6 – 20.3)

Assistance with securing temporary or permanent housing

17.4 (14.2 – 21.1)

Case management for students with chronic health conditions (e.g., asthma or diabetes)

15.7 (12.8 – 19.2)

Case management for students with disabilities

20.0 (16.7 – 23.8)

Child care for teen parents

8.0 (5.9 – 10.8)

Counseling after a natural disaster or other emergency or crisis situation

26.6 (22.9 – 30.7)

Counseling for emotional or behavioral disorders (e.g., anxiety, depression, or ADHD)

27.4 (23.6 – 31.5)

Crisis intervention for personal problems

28.1 (24.2 – 32.3)

HIV testing

8.1 (5.9 – 10.9)

HIV treatment

7.3 (5.2 – 10.0)

Human papillomavirus (HPV) vaccine

8.8 (6.7 – 11.5)

Identiﬁcation of emotional or behavioral disorders (e.g., anxiety, depression, or ADHD)

25.6 (21.9 – 29.7)

Identiﬁcation or school-based management of acute illnesses

13.4 (10.8 – 16.5)

Identiﬁcation or school-based management of chronic health conditions (e.g., asthma or diabetes)

14.0 (11.3 – 17.2)

Immunizations other than seasonal inﬂuenza and human papillomavirus (HPV)

15.8 (12.9 – 19.2)

Job readiness skills programs

23.9 (2 0.3 – 27.9)

Lab tests other than for HIV, other STDs, or pregnancy

7.9 (5.8 – 10.6)

nPEP (non-occupational post-exposure prophylaxis for HIV)

5.8 (4.1 – 8.3)

Oral healthcare

23.6 (20.2 – 27.5)

Pregnancy testing

10.5 (8.1 – 13.6)

Prenatal care

8.4 (6.3 – 11.2)

Prescriptions for medications

8.6 (6.4 – 11.3)

Primary care

10.0 (7.7 – 12.9)

Provision of condom-compatible lubricant

4.6 (3.1 – 6. 8)

Provision of condoms

6.2 (4.4 – 8.7)

Provision of contraceptives other than condoms

5.5 (3.8 – 7.9)

Seasonal inﬂuenza vaccine

25.6 (22.0 – 29.5)

Services for eating disorders

9.2 (6.9 – 12.1)

Services for physical, sexual, or emotional abuse

22.9 (19.4 – 26.8)

Services for students with family problems (e.g., parental divorce, substance abuse, or violence)

23.0 (19.4 – 27.0)

STD testing

9.2 (6.9 – 12.2)

STD treatment

8.8 (6.6 – 11.8)

Stress management

18.7 (15.4 – 22.4)

continued

Service Districts (%)

Tobacco use cessation

10.8 (8.4 – 13.8)

Weight management

6.6 (4.7 – 9.1)

Prevention service

Alcohol or other drug use prevention

20.4 (17.0 – 24.3)

HIV prevention

12.5 (9.8 – 15.9)

Injury prevention and safety counseling

15.5 (12.5 – 19.1)

Nutrition and dietary behavior counseling

10.0 (7.6 – 13.0)

Physical activity and ﬁtness counseling

10.2 (7.8 – 13.2)

Pregnancy prevention

12.1 (9.5 – 15.4)

STD prevention

13.1 (10.3 – 16.5)

Suicide prevention

19.9 (16.6 – 23.7)

Tobacco use prevention

17. 3 (14.2 – 20.9)

Violence prevention (e.g., bullying, ﬁghting, or dating violence prevention)

20.9 (17.5 – 24.8)

Counseling, psychological, or social service

Case management for students with emotional or behavioral problems

29.3 (25.4 – 33.5)

Comprehensive assessment or intake evaluation

25.4 (21.7 – 29.5)

Family counseling

21.2 (17.8 – 25.1)

Group counseling

20.8 (17.4 – 24.7)

Individual counseling

31.1 (27.1 – 35.3)

Peer counseling or mediation

16.6 (13.5 – 20.3)

Self-help or support groups

18.4 (15.2 – 22.2)

Table 4.21. Percentage of districts with specic employee wellness policies and practices — SHPPS 2016

Policy or practice Districts (%)

Requires schools to have an employee wellness program

54.0 (49.5 – 58.5)

Has someone in the district who oversees or coordinates employee wellness programs throughout the district

59.9 (55.4 – 6 4.1)

Requires each school to have someone to oversee or coordinate employee wellness programs

30.6 (26.6 – 35.0)

Provided funding for an Employee Assistance Program (EAP) or offered an Employee Assistance Program for employees

43.3 (39.0 – 47.7)

Provided funding for health risk appraisals or offered health risk appraisals for employees

40.7 (36.3 – 45.2)

Employees receive subsidies or discounts for off-site health promotion activities

34.5 (30.4 – 38.9)

Provided funding for incentives for employee participation or goal achievement in employee wellness programs

1,2

27.8 (23.9 – 32.0)

During the 12 months before the study.

An additional 26.4% of districts do not have employee wellness programs.

Table 4.22. Percentage of districts that provided funding for or oered specic screenings or services for

employees

— SHPPS 2016

Screening or service Districts (%)

Blood pressure screening

41.4 (37.1 – 45.7)

Body mass index (BMI) screening

24.8 (21.2 – 28.8)

Diabetes screening

22.0 (18.6 – 25.9)

Immunizations (e.g., inﬂuenza vaccines)

60.8 (56.4 – 6 4.9)

Physical ﬁtness assessment

14.7 (11.7 – 18.2)

Serum cholesterol screening

25.6 (22.0 – 29.7)

During the 12 months before the survey, regardless of what is covered through employees’ health insurance.

Table 4.23. Percentage of district health services coordinators

with an undergraduate major or minor or graduate degree

in specic areas — SHPPS 2016

Area Districts (%)

Biology

1.8 (0.9 – 3.8)

Counseling

3.0 (1.5 – 5.9)

Education

23.4 (18.9 – 28.7)

Healthcare administration or business

5.0 (3.0 – 8. 2)

Nursing

80.3 (75.4 – 84.5)

Other science

4.4 (2.5 – 7.4)

Psychology

6.8 (4.3 – 10.4)

Public health

7.1 (4.6 – 10.8)

Social work

1.8 (0.7 – 4.3)

None of these

3.5 (2.0 – 6.1)

Among the 59.6% of districts that had a health services coordinator who served as the respondent to the health services questionnaire.

Healthy and Safe School Environment

(includes Social and Emotional Climate)

Table 5.1. Percentage of districts with specic policies related to keeping the school environment safe and secure, by

school level — SHPPS 2016

Districts (%)

Policy

Elementary

school

Middle

school

High

school

Requires schools to maintain closed campuses

83.0 (79.4 – 86.1) 82.6 (78.8 – 85.7) 62.9 (58.2 – 67.4)

Requires schools to assign staff or adult volunteers to monitor:

School halls during classes

40.3 (36.0 – 44.8) 43.8 (39.3 – 48.4) 49.3 (4 4.6 – 54.1)

School halls between classes

69.0 (6 4.6 – 73.1) 76.2 (72.0 – 80.0) 77.5 (73.1 – 81.4)

Restrooms

49.6 (45.1 – 54.2) 43.4 (3 8.9 – 47.9) 42.8 (38.2 – 47.6)

School grounds

76.1 (71.9 – 79.8) 73.7 (69.5 – 77.6) 72.0 (67.5 – 76.1)

Cafeterias

86.0 (82.4 – 89.0) 87.7 (84.2 – 90.5) 85.5 (81.5 – 88.7)

Requires schools to routinely conduct locker searches

NA 51.3 (4 6.7 – 55.8) 64.2 (59.4 – 68.7)

Requires students to wear school uniforms

5.6 (4.0 – 7.8) 5.6 (4.0 – 7.8) 5.2 (3.5 – 7.7)

Requires schools to enforce student dress code

77. 2 (73.0 – 80.8) 8 6.5 (82.9 – 89.4) 89.4 (85.9 – 92.1)

Requires the following groups to wear identiﬁcation badges:

Students

1.5 (0.8 – 2.9) 4.7 (3.2 – 7.0) 8.7 (6.3 – 11.9)

Faculty and staff

60.0 (55.8 – 6 4.1) 6 0.1 (55.8 – 6 4.2) 6 0.5 (56.1 – 64.7)

Visitors

86.9 (83.7 – 89.6) 86.0 (82.5 – 88.9) 86.9 (83.3 – 89.8)

Requires schools to use:

Security or surveillance cameras, either inside or outside the building

75.9 (71.7 – 79.6) 83.0 (79.2 – 86. 2) 85.5 (81.8 – 88.5)

Metal detectors

3.5 (2.3 – 5.4) 4.7 (3.2 – 6.7) 6.4 (4.5 – 9.1)

Communication devices for security purposes (e.g., cell phones,

2-way radios, walkie-talkies, or intercoms)

82.2 (78.5 – 85.4) 82.5 (78.7 – 85.7) 82.4 (78.4 – 85.8)

Requires schools to keep all entrances locked during the school day

76.0 (71.7 – 79.8) 75.7 (71.4 – 79.5) 71.6 (67.2 – 75.7)

Requires students to refrain from using personal communication devices

(e.g., cell phones) during the school day

78.9 (74.8 – 82.4) 74.6 (70.5 – 78.4) 58.8 (54.0 – 63.4)

Requires schools to use police, school resource ofﬁcers, or security guards

during the regular school day

35.4 (31.3 – 39.7) 42.7 (38.5 – 47.1) 54.1 (49.7 – 58. 5)

Students are not allowed to leave school during the school day, including during lunchtime.

Question not asked regarding elementary schools.

Among districts that do not require school uniforms.

Can include adhesive stickers with hand-written names.

Does not include the use of smart phones, tablets, or computers for educational purposes.

Table 5.2. Percentage of districts with specic practices related to school start times, by school level

— SHPPS 2016

Districts (%)

Practice Middle school High school

School start times are set by the district, not by individual schools

90.2 (87.2 – 92.5) 8 8.2 (84.7 – 90.9)

School start times are set by individual schools, but the district requires schools start no earlier

than a speciﬁc time

3.8 (2.5 – 5.9) 4.4 (2.8 – 6.7)

School start times are set by individual schools, but the district recommends schools start no

earlier than a speciﬁc time

1.6 (0.8 – 3.1) 2.2 (1.1 – 4.1)

School start times are set by individual schools and the district does not require or recommend an

earliest start time

4.4 (2.9 – 6.7) 5.3 (3.5 – 8.0)

Earliest start time set, required, or recommended by district is 8:30am or later

9.4 (6.8 – 12.9) 7.7 (5.3 – 11.1)

Questions not asked about elementary school start times.

Among the 95.6% and 94.7% of districts that set, require, or recommend an earliest start time for middle schools and high schools, respectively.

Table 5.3. Percentage of districts in which students must live a standard distance from their school to be eligible for

riding a school bus, by school level

— SHPPS 2016

Districts (%)

Distance

Elementary

school

Middle

school

High

school

More than ½ mile

8.7 (6.4 – 11.6) 7.5 (5.4 – 10.3) 9.4 (6.9 – 12.7)

More than ¾ mile

3.3 (2.0 – 5.5) 3.5 (2.1 – 5.9) 2.4 (1.3 – 4.5)

More than 1 mile

23.0 (19.3 – 27.2) 22.0 (18.4 – 26.2) 21.4 (17.6 – 25.7)

More than 1½ miles

9.4 (7.0 – 12.5) 10.6 (8.0 – 13.8) 9.0 (6.5 – 12.2)

More than 2 miles

16.3 (13.2 – 20.0) 18. 2 (14.9 – 22.1) 18.9 (15. 2 – 23.1)

No minimum distance

39.3 (35.0 – 43.7) 38.2 (34.0 – 42.6) 39.0 (34.5 – 43.7)

Does not include students with special needs or those eligible for hazard busing.

Table 5.4. Percentage of districts that support or promote transportation-related practices — SHPPS 2016

Practice Districts (%)

Walking or biking to and from school

32.9 (28.8 – 37.3)

The use of public transportation for its students to travel to and from school

13.4 (10.5 – 16.9)

The use of public transportation for its faculty and staff to travel to and from school

4.1 (2.6 – 6.4)

An additional 67.4% of districts had no public transportation available.

Table 5.5. Percentage of districts with specic policies and practices related to bullying and harassment — SHPPS 2016

Policy or practice Districts (%)

Prohibits bullying:

On school property

99.7 (98.7 – 9 9.9)

At any locations on the way to and from school (e.g., school bus stops)

97.0 (95.2 – 98.2)

At off-campus, school-sponsored events

95.7 (93.4 – 97.1)

Has a policy prohibiting bullying that lists (or enumerates) groups with speciﬁc traits or characteristics

71.9 (67.7 – 75.7)

Has the following student traits listed or enumerated in the district’s bullying policy:

Age

53.7 (49. 2 – 58.1)

Disability

70.5 (66.2 – 74.4)

Gender identity or expression

58 .9 (54 .5 – 63. 2)

Race or ethnicity

71.1 (66.9 – 74.9)

Religion

70.1 (65.8 – 74.0)

Sex

69.5 (65.2 – 73.5)

Sexual orientation

63. 5 (59.1 – 67.7)

Socio-economic status

56.0 (51.5 – 60.4)

Other traits or characteristics

33.6 (29.5 – 38.0)

Prohibits electronic aggression or cyber-bullying that interferes with the educational environment, even if it does not

occur on school property or at school-sponsored events

93.2 (90.6 – 95.1)

Prohibits sexual harassment:

On school property

99.4 (97.8 – 99.8)

At any locations on the way to and from school (e.g., school bus stops)

95.0 (92.6 – 96.6)

At off-campus, school-sponsored events

96.1 (93.9 – 97.5)

Among districts with a policy that prohibits bullying.

Table 5.6. Percentage of districts with specic policies and practices related to gang activity, drug testing, and suicide

prevention — SHPPS 2016

Policy or practice Districts (%)

Prohibits gang activity (e.g., recruiting or wearing gang colors, symbols, or other gang attire)

75.9 (71.9 – 79.5)

Has adopted a student drug-testing policy

37.5 (33.3 – 42.0)

Requires schools to have a plan for the actions to be taken when a student

at risk for suicide is identiﬁed

79.5 (75.6 – 82.9)

Requires the student’s family to be informed

96.7 (94.2 – 98.1)

Requires that the student be referred to a mental health provider

83.5 (79.4 – 86.9)

Requires a visit with a mental health provider to be documented before the student returns to school

59.9 (5 4.9 – 6 4.8)

Among districts that require schools to have a plan for the actions to be taken when a student at risk for suicide is identied.

Table 5.7. Percentage of districts with specic tobacco-use prevention policies — SHPPS 2016

Policy Districts (%)

For students

Prohibits cigarette smoking

99. 2 (97.9 – 99.7)

In school buildings

99. 2 (97.9 – 99.7)

Outside on school grounds, including parking lots and playing ﬁelds

99. 2 (97.9 – 99.7)

On school buses or other vehicles used to transport students

98.3 (96.6 – 99.2)

At off-campus, school-sponsored events

95.9 (93.8 – 97.4)

Prohibits smokeless tobacco use

97.4 (95.7 – 98.5)

In school buildings

96.9 (95.0 – 98.1)

Outside on school grounds, including parking lots and playing ﬁelds

96.9 (95.0 – 98.1)

On school buses or other vehicles used to transport students

96.1 (94.0 – 97.5)

At off-campus, school-sponsored events

94.3 (91.9 – 96.0)

Prohibits cigar or pipe smoking

95.1 (92.8 – 96.7)

Prohibits the use of electronic vapor products (e.g., e-cigarettes, e-cigars, e-pipes, vape pipes, vaping pens, e-hookahs,

and hookah pens)

81.8 (78.1 – 85.1)

For faculty and staff during any school-related activity

Prohibits cigarette smoking

95.9 (93.5 – 97.4)

In school buildings

95.9 (93.5 – 97.4)

Outside on school grounds, including parking lots and playing ﬁelds

95.0 (92.6 – 96.7)

On school buses or other vehicles used to transport students

95.7 (93.3 – 97.3)

At off-campus, school-sponsored events

91.9 (89.0 – 94.1)

Prohibits smokeless tobacco use

92.9 (90.1 – 95.0)

In school buildings

93.0 (90.2 – 95.0)

Outside on school grounds, including parking lots and playing ﬁelds

92.3 (89.4 – 9 4.4)

On school buses or other vehicles used to transport students

93.0 (90.2 – 95.0)

At off-campus, school-sponsored events

90.3 (87.2 – 92.8)

Prohibits cigar or pipe smoking

92.9 (90.1 – 94.9)

Prohibits the use of electronic vapor products (e.g., e-cigarettes, e-cigars, e-pipes, vape pipes, vaping pens, e-hookahs,

and hookah pens)

77.3 (73.3 – 80.9)

For school visitors

Prohibits cigarette smoking

96.6 (94.5 – 97.9)

In school buildings

96.5 (94.4 – 97. 8)

Outside on school grounds, including parking lots and playing ﬁelds

93.0 (90.4 – 95.0)

On school buses or other vehicles used to transport students

95.8 (93.6 – 97.3)

At off-campus, school-sponsored events

82.2 (78.5 – 85.5)

Prohibits smokeless tobacco use

90.8 (87. 8 – 93.1)

In school buildings

90.0 (86.9 – 92.5)

Outside on school grounds, including parking lots and playing ﬁelds

87.3 (84.0 – 90.0)

On school buses or other vehicles used to transport students

90.0 (86.9 – 92.5)

At off-campus, school-sponsored events

79.1 (75.2 – 82.6)

Prohibits cigar or pipe smoking

93.1 (90.5 – 95.1)

Prohibits the use of electronic vapor products (e.g., e-cigarettes, e-cigars, e-pipes, vape pipes, vaping pens, e-hookahs,

and hookah pens)

75.7 (71.6 – 79.4)

continued

Policy Districts (%)

Marketing

Prohibits marketing of tobacco or other products containing nicotine

In school buildings

93.3 (90.8 – 95. 2)

Outside on school grounds, including parking lots and playing ﬁelds

92.8 (90.1 – 9 4.7)

On school buses or other vehicles used to transport students

92.0 (89.2 – 94.1)

In school publications

90.5 (87.4 – 92.8)

Through sponsorship of school events

89.9 (86.8 – 92.3)

Prohibits students from wearing tobacco brand-name apparel or carrying merchandise with tobacco company names,

logos, or cartoon characters on it

82.9 (79.2 – 86.0)

Table 5.8. Percentage of districts with specic injury prevention and safety policies and the percentage of districts that

have ever been sued because of an injury — SHPPS 2016

Policy Districts (%)

Requires inspection or maintenance of:

Automated external deﬁbrillators (AEDs)

86.1 (82.4 – 89.0)

Fire extinguishers

94.8 (92.3 – 96.5)

Indoor athletic facilities and equipment (e.g., playing surfaces, benches, tumbling mats, and weight lifting

equipment)

76.2 (72.2 – 79.8)

Lighting inside school buildings

79.3 (75.5 – 82.7)

Lighting outside school buildings

78.6 (74.8 – 82.0)

Other school areas (e.g., halls, stairs, and regular classrooms)

79.5 (75.8 – 82.8)

Outdoor athletic facilities and equipment (e.g., playing ﬁelds and bleachers)

78.6 (74.8 – 82.0)

Playground facilities and equipment (e.g., playing surfaces, benches, monkey bars, and swings)

77.3 (73.3 – 80.8)

Smoke alarms

91.0 (88.1 – 93.3)

Special classroom areas (e.g., chemistry labs, workshops, and art rooms)

79.0 (75.1 – 82.4)

Sprinkler systems

83.8 (80.3 – 86.7)

Requires students to wear appropriate protective gear when engaged in:

Classes such as wood shop or metal shop

73.5 (69.3 – 77.4)

Lab activities for photography, chemistry, biology, or other science classes

84.9 (81.2 – 87.9)

Requires students to use hearing protection devices during classes or activities where they are exposed to potentially

unsafe noise levels

61.3 (56.7 – 65.7)

Ever been sued because of an injury that occurred on school property or at an off-campus, school-sponsored event

26.5 (22.6 – 30.7)

Question asked only among districts containing elementary schools.

An additional 22.7% of districts did not have these types of classes.

An additional 8.7% of districts did not have these types of activities.

Table 5.9. Percentage of districts with specic playground safety policies and practices

— SHPPS 2016

Policy or practice Districts (%)

Has adopted a policy addressing:

A discipline procedure for students who are not following the rules

86.2 (82.7 – 89.0)

A procedure for what to do in case of an injury

90.1 (87.0 – 92.5)

Criteria for selecting playground monitors

38.5 (34.1 – 43.0)

Criteria for the selection, placement, and installation of playground surfacing materials

61.6 (57.1 – 66.0)

Criteria for the selection, placement, and installation of playground equipment

61.5 (57.0 – 65.9)

Duties of playground monitors

65.3 (60.9 – 69.6)

Ratio of playground monitors to students

40.9 (36.5 – 45.5)

The identiﬁcation of an individual responsible for enforcing the policy

62.9 (58.3 – 67.2)

The posting of rules for the safe use of speciﬁc types of equipment (e.g., swings, slides, or climbing structures)

44.5 (40.0 – 49.1)

Training for playground monitors

44. 2 (39.7 – 48.9)

Provided training for playground monitors

41.9 (37.4 – 46.6)

Question asked only among districts containing elementary schools.

During the 2 years before the study.

Table 5.10. Percentage of districts that require or recommend that schools implement specic sun safety

practices — SHPPS 2016

Districts (%)

Practice Require Recommend

Allow students to apply sunscreen while at school

2.6 (1.5 – 4.6) 4 6.9 (42.4 – 51.4)

Encourage students to apply sunscreen while at school

1.5 (0.7 – 2.9) 4 4.3 (39.8 – 4 8.9)

Encourage students to wear hats or visors when in the sun during the school day

0.5 (0.1 – 1.8) 38.5 (34.1 – 43.0)

Encourage students to wear protective clothing (e.g., long sleeve shirts or long pants) when in the sun

during the school day

1.3 (0.5 – 3.0) 39.3 (34.9 – 43.8)

Encourage students to wear sunglasses when in the sun during the school day

0.5 (0.1 – 1.8) 24.1 (20.4 – 28.2)

Schedule outdoor activities to avoid times when the sun is at peak intensity during the school day

3.9 (2.5 – 6.2) 33.2 (29.0 – 37.6)

Table 5.11. Percentage of districts with specic policies and practices related to crisis preparedness, response, and

recover y — SHPPS 2016

Policy or practice Districts (%)

Ever used any materials from the U.S. Department of Education to develop policies or plans related to crisis

preparedness, response, and recovery

71.8 (67.8 – 75.5)

Has a comprehensive district-level plan to address crisis preparedness, response, and recovery in the event of a natural

disaster or other emergency or crisis situation

94.6 (92.3 – 9 6.2)

Requires schools to have a comprehensive plan to address crisis preparedness, response, and recovery in the event of a

natural disaster or other emergency or crisis situation

86.4 (83. 2 – 89.0)

Provided funding for training or offered training on the crisis preparedness, response, and recovery plan

1,2

to:

School faculty and staff

89.6 (86.4 – 92.0)

Students

59.5 (55.0 – 63.7 )

Students’ families

17.4 (14.2 – 21.0)

Offered education on crisis preparedness, response, and recovery to students’ families

21.6 (18.1 – 25.5)

Evaluated or assessed district’s crisis preparedness, response, and recovery plan

1,3

85.4 (81.9 – 88. 2)

Is a member of a local emergency planning committee or emergency management team

54.5 (50.1 – 58.7)

Has schools designated to serve as staging areas or community shelters during local emergencies

77.4 (73.6 – 80.8)

Conducted any district-level crisis response or emergency drills other than ﬁre drills

83.4 (80.0 – 86.4)

Requires all schools to have a National Oceanic and Atmospheric Administration (NOAA) weather radio

38.0 (33.9 – 42.3)

Among the 95.9% of districts with either a district-level plan or a requirement for schools to have a plan.

During the 2 years before the study.

During the 12 months before the study.

Dened as a group of local agencies that coordinates crisis preparedness, response, and recovery eorts in a community.

Table 5.12. Percentage of districts with crisis preparedness, response, and recovery plans that include specic

elements — SHPPS 2016

Topic Districts (%)

Establishment of an incident command system

88.5 (85.5 – 91.0)

Evacuation protocols for crises involving more than one school

85.4 (82.1 – 88.1)

Mechanisms for communicating with parents or guardians of students

93.6 (91.1 – 95.4)

Mechanisms for communicating with school personnel

94.0 (91.6 – 95.7)

Mechanisms for evaluating outside offers of assistance during or after a crisis

57.6 (53.2 – 61.8)

Plans for serving as a community shelter or coordinating center during a community-wide crisis

76.9 (73.1 – 80.3)

Plans for supplying food, water, and medical supplies to schools in extended shelter-in-place

62.9 (5 8.7 – 66 .9)

Plans for training school staff (e.g., in triage or ﬁrst aid skills)

70.4 (6 6.3 – 74.2)

Plans to resume normal activities after buildings or facilities have been damaged

65.7 (61.5 – 69.6)

Procedures for ensuring the continuity of education (e.g., online classes or prepackaged assignments) during unplanned

school closure

43.0 (38.8 – 47.4)

Procedures for implementing unplanned school dismissal or school closure

88.7 (85.5 – 91.2)

Procedures for responding to media inquiries

92.0 (89.4 – 94.0)

Procedures for responding to pandemic inﬂuenza (ﬂu) or other infectious disease outbreaks

73.6 (69.7 – 77.2)

Protocols for communicating with building-level managers during a crisis

92.6 (90.1 – 94.6)

Provision of mental health services for students, faculty, and staff after a crisis has occurred

84.5 (81.2 – 87.3)

Requirements to conduct district-level crisis-response drills

86.3 (83.0 – 89.0)

Requirements to periodically review and revise emergency response plans

90.9 (88.1 – 93.0)

Table 5.13. Percentage of districts that require schools to include specic topics in their crisis preparedness, response, and

recover y plans — SHPPS 2016

Topic Districts (%)

Establishment of an incident command system

79.5 (75.9 – 82.7)

Evacuation plans

85.1 (81.9 – 87.8)

Family reuniﬁcation procedures

74.4 (70.5 – 77.9)

Mechanisms for communicating the plan to students’ families

78.7 (75.0 – 81.9)

Mechanisms for communicating with parents or guardians of students

83.3 (80.0 – 86.2)

Mechanisms for communicating with school personnel

83.7 (80.4 – 8 6.6)

Plans to resume normal activities after buildings or facilities have been damaged

63.0 (58.8 – 67.0)

Plans to seek immediate shelter and remain in that area during a chemical, biological, or radiological emergency rather

than evacuating, or shelter-in-place plans

77.9 (74.2 – 81.2)

Procedures for ensuring the continuity of education (e.g., online classes or prepackaged assignments) during unplanned

school closure

43.8 (39.5 – 4 8.2)

Procedures for implementing unplanned school dismissal or school closure

80.8 (77. 2 – 84.0)

Procedures for responding to media inquiries

81.2 (77.7 – 8 4.3)

Procedures for responding to pandemic inﬂuenza (ﬂu) or other infectious disease outbreaks

65.3 (61.2 – 69.3)

Procedures to control the exterior of the building and school grounds

77. 8 (74.1 – 81.1)

Procedures to stop people from leaving or entering school buildings (i.e., lock down plans)

83.8 (80.5 – 86.7)

Provision of mental health services for students, faculty, and staff after a crisis has occurred

77.6 ( 73.9 – 80.9)

Provisions for students and staff with special needs

79.9 (76.2 – 83.0)

Requirements to conduct regular emergency drills, other than ﬁre drills

84.0 (80.6 – 86.8)

Requirements to periodically review and revise emergency response plans

82.4 (79.0 – 85.3)

Table 5.14. Percentage of districts that worked with specic groups to develop their crisis preparedness, response, and

recovery plans

— SHPPS 2016

Group Districts (%)

A local ﬁre department

93.0 (90.5 – 94.9)

A local health department

54.4 (50.0 – 58. 8)

A local homeland security ofﬁce or emergency management agency

49.5 (45.1 – 53.9)

A local hospital

35.5 (31.4 – 39.8)

A local law enforcement agency

97.8 (96.1 – 98.8)

A local mental health or social services agency

43.6 (39.2 – 4 8.0)

Local emergency medical services

81.9 (78.2 – 85.1)

Other community members

71.3 (67.2 – 75.1)

Staff from individual schools within your district

97.8 (96.1 – 98.8)

Students

42.6 (38.3 – 47.1)

Students’ families

33.9 (29.7 – 38.3)

The local public transportation department

16.7 (13.6 – 20.3)

Among the 95.9% districts with either a district-level plan or a requirement for schools to have a plan.

An additional 22.4% of districts did not have a local homeland security oce or emergency management agency.

An additional 62.2% of districts did not have a local public transportation department.

Table 5.15. Percentage of districts with specic policies related to community service and service learning — SHPPS 2016

Policy Districts (%)

Requires students at any school level to participate in community service

30.4 (26.4 – 34.8)

Requires that schools provide service-learning opportunities to students

10.3 (8.0 – 13.3)

Recommends that schools provide service-learning opportunities to students

54.4 (49.9 – 58.9)

Requires schools at the following levels to participate in programs in which family or community members serve as role models to students or

mentor students:

Elementary schools

15.9 (12.8 – 19.6)

Middle schools

14.4 (11.4 – 18.1)

High schools

17.4 (14.0 – 21.5)

Table 5.16. Percentage of districts that provided funding for professional development or oered professional

development for school faculty and sta on how to implement school-wide policies and programs related to specic

topics

— SHPPS 2016

Topic Districts (%)

Alcohol use prevention

58 .9 (54 .3 – 63.3)

Classroom management

87.6 (84.2 – 90.3)

Community involvement

63.2 (58.6 – 67.5)

Crisis preparedness, response, and recovery

88.8 (85.7 – 91.4)

Dating violence prevention

57.9 (53.4 – 62. 3)

Drinking water quality

19.2 (15.8 – 2 3.1)

Electronic aggression or cyber-bullying prevention

87.3 (84.0 – 90.1)

Employee wellness

73.8 (69.6 – 77.6)

Family engagement

62.8 (58.4 – 67.1)

Green cleaning products and practices

43.1 (38.7 – 47.7)

Illegal drug use prevention

63. 8 (59.3 – 68 .1)

Indoor air quality

27.4 (23.5 – 31.6)

Injury prevention and safety

75.1 (71.0 – 78.7)

Integrated pest management

43.9 (39.4 – 4 8.5)

Mercury exposure prevention

23.0 (19.3 – 27.1)

Other bullying prevention

94.4 (91.8 – 96.2)

Other violence prevention

74.6 (70.5 – 78.3)

Radon testing and mitigation

22.7 (19.0 – 26.8)

Sexual harassment prevention

83.5 (79.8 – 8 6.6)

Sun safety

19.7 (16.2 – 23.7)

Tobacco use prevention

56.7 (52.2 – 61.2)

During the 2 years before the study.

Table 5.17. Percentage of districts with specic practices related to school health coordination — SHPPS 2016

Practice Districts (%)

Has a district-level school health council, committee, or team

61.0 (56.6 – 65.2)

Number of times group met

0 times

1.6 (0.7 – 3.9)

1 or 2 times

39.1 (33. 5 – 45.1)

3 or 4 times

37.6 (32.0 – 43.5)

5 or 6 times

9.5 (6.6 – 13.6)

More than 6 times

12.2 (8.7 – 16.7)

Provided any funding or offered to help schools establish a school health council, committee, or team

1,3

30.7 (26.6 – 35.2)

Ever used a self-assessment tool to assess the district’s health and safety policies and activities

43. 2 (38.7 – 47.9)

Requires that schools use a self-assessment tool (e.g., the School Health Index)

6.1 (4.3 – 8. 8)

Recommends that schools use a self-assessment tool (e.g., the School Health Index)

25.7 (21.8 – 30.1)

Has a district-level school improvement plan that includes health and safety objectives

59.4 (5 4. 8 – 6 3.8)

Requires schools to include health and safety objectives in their written School Improvement Plan

44.5 (39.9 – 49.2)

Has someone in the district who oversees or coordinates the district’s health and safety policies and activities (e.g., a

district health coordinator)

57.8 (53.2 – 62.2)

Dened as a group that oers guidance on the development of policies or coordinates activities that are health-related.

During the 12 months before the study, among districts with a school health council, committee, or team.

During the 2 years before the study.

An additional 13.1% of districts do not have a district-level School Improvement Plan.

In an additional 15.8% of districts, schools do not have a written School Improvement Plan.

Table 5.18. Percentage of districts that had one or more district-level school health councils, committees, or teams that

addressed specic school health program components and health topics and engaged in specic activities

— SHPPS 2016

Component, topic, or activity Districts (%)

School health program component

Community involvement in school health programs

59.0 (53.1 – 6 4.8)

Counseling, psychological, and social services

71.3 (65.8 – 76.3)

Employee wellness

76 .8 ( 71. 6 – 8 1. 2)

Family engagement in school health programs

56.5 (50.5 – 62.3)

Health education

85.4 (80.9 – 88.9)

Health services

77.6 (72.4 – 82.0)

Nutrition environment and services

92.4 (88.8 – 94.9)

Physical education and physical activity

9 0.9 (86 .9 – 93. 8)

Physical school environment

72.4 (66.9 – 77.2)

Social and emotional school climate

73.3 (68.0 – 78.1)

Topic

Alcohol or other drug use prevention

69.6 (64.0 – 74.8)

Crisis preparedness, response, and recovery

79.1 (74.0 – 83.3)

Human immunodeﬁciency virus (HIV) prevention

49.2 (43.2 – 55.1)

Injury prevention and safety

71.6 (6 6.0 – 76.5)

Local wellness policies

83.9 (79.1 – 87.8)

Management of chronic health conditions (e.g., asthma or diabetes)

58.5 (52.5 – 6 4.2)

Management of food allergies

70.1 (64.5 – 75.2)

Management of foodborne illnesses

52.4 (46.4 – 58.3)

Management of infectious diseases (e.g., inﬂuenza [ﬂu])

64.3 (58.4 – 69.7)

continued

Component, topic, or activity Districts (%)

Other sexually transmitted disease (STD) prevention

51.6 (45.7 – 57.5)

Pregnancy prevention

46. 2 (40.3 – 52.2)

Tobacco use prevention

70.6 (65.0 – 75.6)

Violence prevention (e.g., bullying, ﬁghting, or dating violence prevention)

70.2 (64.6 – 75.3)

Activities

Communicate the importance of health and safety policies and activities to the school board, district

administrators, school administrators, or community members

85.5 (81.1 – 89.1)

Identify student health needs based on a review of relevant data

67.2 (61.4 – 72.4)

Recommend new or revised health and safety policies and activities to district administrators or the school board

88.5 (84.3 – 91.6)

Review health-related curricula or instructional materials

71.1 (65.5 – 76.2)

Seek funding or leverage resources to support health and safety priorities for students and staff

67.2 (61.5 – 72.5)

Among the 61.0% of districts with a district-level school health council, committee, or team.

Table 5.19. Percentage of districts that had one or more school health councils that included representatives from

specic school groups and local agencies or organizations

— SHPPS 2016

Group Districts (%)

School group

District administrators

95.6 (92.8 – 97.4)

Health education teachers

80.7 (75.5 – 85.1)

Health services staff (e.g., school nurses)

90.1 (86.1 – 93.0)

Library or media center staff

32.9 (27.4 – 38. 8)

Maintenance staff

46.5 (40.7 – 52.4)

Mental health and social services staff

70.1 (64.7 – 75.0)

Nutrition or food service staff

87.2 (82.6 – 90.7)

Physical education teachers

88.0 (83.4 – 91.5)

School-level administrators

93.2 (89.6 – 95.6)

Students

56.0 (50.1 – 61.8)

Students’ parents or families

74.0 (68.6 – 78.8)

Technology staff

39.7 (3 4.0 – 45.6)

Transportation staff

35.6 (30.2 – 41.5)

Agency or organization

Businesses

33.0 (27.6 – 38.9)

Community members

78.4 (73.3 – 82.8)

Faith-based organizations

24 .7 (19. 8 – 3 0. 3)

Health department

40.9 (35. 2 – 46.9)

Health organizations (e.g., the local Red Cross chapter)

20.4 (15.9 – 25.8)

Healthcare providers (e.g., pediatricians or dentists)

36.5 (30.9 – 42.4)

Hospitals

32.3 (26.9 – 38.1)

Mental health or social services agencies

44.7 (38.9 – 50.6)

Other local government agencies

33.7 (28.2 – 39.7)

Public safety agencies (e.g., police, ﬁre, or emergency services)

55.7 (49.8 – 61.4)

School board members

48. 2 (42.4 – 54.2)

Service clubs (e.g., the Rotary Club)

25.2 (20.1 – 30.9)

Youth organizations (e.g., the Boys and Girls Clubs)

16.5 (12.5 – 21.5)

Among the 61.0% of districts with a school health council, committee, or team.

Physical Environment

Table 6.1. Percentage of districts with specic policies and practices related to the physical school environment —

SHPPS 2016

Policy or practice Districts (%)

Has at least one school with a main instructional building that was constructed before 1980

92.1 (89.3 – 94.1)

Requires schools constructed before 1980 to inspect for lead in cracked or peeling paint

1,2

37.2 (32.6 – 42.0)

Requires schools constructed before 1980 to inspect for PCBs in caulking around windows and doors

24.1 (20.2 – 28.5)

Requires schools constructed before 1980 to inspect for PCBs in ﬂuorescent light ballasts

21.4 (17.7 – 25.6)

Requires schools to purchase mercury-free products for use in and around school buildings

52.4 (47.7 – 57.0)

Requires district approval before products are used by teachers, administrative or custodial staff, or contractors at a school:

Cleaning and maintenance products (e.g., disinfectants, air fresheners, polishes, or waxes)

68.4 (64.0 – 72.4)

Pesticides

79.2 (75.3 – 82.6)

Chemicals or other potentially hazardous materials used in science labs, vocational education, art, or other

classes

77. 2 (73.1 – 80.8)

Requires Phase I environmental site assessments prior to constructing a new school facility

30.4 (26.3 – 34.9)

Requires a newly hired person who oversees custodial, maintenance, and environmental issues to have any formal

training in issues related to the physical environment of buildings and health hazards likely to be encountered in schools

57.6 (53.0 – 62.1)

Among districts that have at least one school with a main instructional building that was constructed before 1980.

In an additional 36.6% of districts, lead paint in schools was previously identied and remediated.

In an additional 32.0% of districts, PCBs in caulking in schools were previously identied and remediated.

In an additional 45.8% of districts, PCBs in uorescent light ballasts in schools were previously identied and remediated.

Table 6.2. Percentage of districts with specic policies and practices related to indoor and outdoor air quality and

drinking water quality — SHPPS 2016

Policy or practice Districts (%)

Indoor and outdoor air quality

Has an indoor air quality management program

48.9 (44.3 – 53.5)

Has an indoor air quality management program based on the Environmental Protection Agency’s Indoor Air Quality Tools

for Schools

39.3 (34.9 – 4 4.0)

Requires schools to conduct periodic inspections:

For appropriate cleaning of the school facility

83.0 (79.3 – 86.2)

For condensation in and around the school facilities

58.4 (53.7 – 62.8)

For mold

69.1 (64.7 – 73.2)

Of the building foundation, walls, and roof for cracks, leaks, or past water damage

71.3 (66.9 – 75.3)

Of the heating, ventilation, and air conditioning (HVAC) system

77.0 (73.0 – 80.6)

Of the plumbing system

65.3 (60.8 – 69.5)

Has a policy regarding how schools should address mold problems

54.6 (50.0 – 59.2)

Requires schools to respond to moisture-related issues within 48 hours or less

54.1 (49.4 – 58.7)

Requires schools to test for radon

33.2 (28.9 – 37.7)

Implemented an engine idling reduction program for:

School buses

49.2 (4 4.7 – 53.8)

Commercial vehicles (e.g., delivery trucks)

25.2 (21.5 – 29.4)

Personal vehicles (e.g., cars)

16.5 (13.4 – 20.2)

Provided bus drivers with training related to the engine idling reduction program

82.4 (76.6 – 87.0)

Requires purchase of low-emitting products

for use and around the school and school grounds

33.9 (29.6 – 38.4)

continued

Policy or practice Districts (%)

Drinking water quality

Requires schools to conduct periodic inspections that test drinking water outlets for lead

50.0 (45.4 – 54.7)

Requires schools to test drinking water at least once per year for:

Bacteria

30.1 (25.5 – 35.1)

Coliforms

29.6 (25.1 – 34.6)

Other contaminants

31.4 (26.7 – 36.4)

Requires schools to ﬂush drinking water outlets after periods of non-use (e.g., after weekends or school vacations)

18.3 (15.0 – 22.2)

During the 2 years before the study, among districts that have implemented such a program.

Dened as products designed to give o little to no chemical fumes or vapors.

Among the 83.0% of districts that have schools served by community water systems for which water testing is voluntary.

Table 6.3. Percentage of districts with specic pest management policies and practices — SHPPS 2016

Policy or practice Districts (%)

Uses integrated pest management

87.4 (83.9 – 90.2)

Requires schools to conduct a campus-wide inspection for pests at least monthly

54.5 (49.9 – 59.0)

Requires schools to notify staff, students, and families prior to each application of pesticides

43. 2 (38.7 – 47.8)

Requires schools to:

Allow eating only in designated areas to control pests

52.9 (48.3 – 57. 5)

Keep vegetation, shrubs, and wood mulch at least 1 foot away from buildings to control pests

54.5 (49.9 – 59.1)

Mark indoor and outdoor areas that have been treated with pesticides

55.4 (50.8 – 60.0)

Remove infested or diseased plants

77.0 (72.8 – 80.6)

Repair cracks in pavement and sidewalks

69.1 (64.6 – 73.2)

Seal openings in walls, ﬂoors, doors, and windows with caulk or weather stripping

80.3 (76.4 – 83.7)

Store food in plastic, glass, or metal containers with tight lids so that it is inaccessible to pests

78.3 (74.2 – 81.9)

Store food waste in plastic, glass, or metal containers with tight lids so that it is inaccessible to pests

72.3 (68.0 – 76.2)

Use spot treatments and baiting rather than widespread applications of pesticides

80.4 (76.5 – 83.8)

Dened as an approach to pest control that seeks to address safety concerns when using pesticides and to use methods that focus on eliminating pest access to

food, water, and shelter in and around the school.

Table 6.4. Percentage of districts that provided funding for training or oered training to custodial or maintenance sta

on specic topics

— SHPPS 2016

Topic Districts (%)

Disposal of hazardous materials

80.1 (76.2 – 83.6)

Green cleaning products and practices

61.9 (57.4 – 66.3)

How to address mold problems

59.1 (5 4. 5 – 6 3.5)

How to reduce the use of hazardous materials

63.3 (58.7 – 67.6)

Indoor air quality

52.1 (47.5 – 56.7)

Integrated pest management

63.2 (58.7 – 67. 5)

Labeling of hazardous materials

80.6 (76.7 – 84.0)

Mercury spill cleanup

27.3 (23.2 – 31.8)

School drinking water quality

36.7 (32.3 – 41.3)

Storage of hazardous materials

82.2 (78.4 – 85.5)

Use of hazardous materials

78.3 (74.3 – 81.8)

During the 2 years before the study.

Table 6.5. Percentage of districts that have adopted specic green building policies — SHPPS 2016

Policy Districts (%)

Includes green design when building new school buildings or renovating existing buildings

28.0 (24.0 – 32.4)

Requires the use of a third party green building certiﬁcation, labeling, or rating system

54.0 (44.9 – 62.8)

Addresses the following practices for new school campuses or renovations:

Conservation of water (e.g., using rainwater or plumbing ﬁxtures that conserve water)

37.2 (32.8 – 41.9)

Creating a system for managing arrivals and departures of pedestrians and bicycles

35.6 (31.2 – 40.2)

Implementation of recycling programs

61. 5 (56 .9 – 6 5.9)

Orienting buildings to optimize energy conservation, use of daylight, and noise reduction

31.7 (27.5 – 36.1)

Preservation of green space or protection of the existing landscape

32. 5 (28.3 – 37.1)

Use of alternative transportation including public transportation, walking, or biking

19.1 (15.7 – 23.1)

Use of building materials (e.g., ﬂoor and wall coverings, paints, sealants, caulk, adhesives, or furniture) that are

low- or no-volatile organic compound (VOC) emitting materials

45.6 (41.0 – 50.2)

Use of energy efﬁcient lighting and electrical systems

65.4 (6 0.9 – 69.7)

Use of landscaping that includes only native planting materials

25.8 (21.9 – 30.2)

Use of natural light for visual comfort or energy conservation

40.3 (35.8 – 4 4.9)

Use of procedures or systems to protect indoor air quality

54.3 (49.7 – 58.9)

Use of radon resistant new construction practices

34.0 (29.7 – 38.7)

Use of renewable energy (e.g., solar or wind power)

22.4 (18.7 – 26.6)

Among districts with a green building design policy.

Table 6.6. Percentage of districts that found specic factors inuential in deciding to build a new school facility rather

than renovate an existing facility

— SHPPS 2016

— Districts (%)

Factor

Not a

factor

Somewhat

inﬂuential

Very

inﬂuential

Cost of repairing existing facility

31. 8 ( 2 3. 5 – 41. 3) 15.6 (9.9 – 23.7) 52.6 (43.0 – 62.0)

Desire to accommodate community use of the school facility or campus

(e.g., an auditorium, classrooms, or athletic ﬁelds)

28.5 (20.7 – 37.9) 2 9. 8 (2 1. 8 – 3 9. 3) 41.7 (32.5 – 51.5)

Desire to have a more energy-efﬁcient facility

22.9 (15.9 – 32.0) 27.8 (20.0 – 37.1) 49.3 (39.8 – 58.9)

Ease of obtaining approvals to construct a new school rather than renovate

an existing school

39.7 (30.7 – 49.4) 33.0 (24.7 – 42.5) 27.4 (19.3 – 37.2)

Ease of obtaining funding to construct a new school rather than renovate an

existing school

37.5 (28.6 – 47.3) 30.3 (22.3 – 39.7) 32.2 (23.7 – 42.1)

Need to accommodate population growth

20.1 (13.6 – 28.7) 26.5 (18.9 – 35.9) 53.4 (43.8 – 62.8)

Need to support current or future educational programs

6.6 (3.6 – 12.1) 28 .6 (20.8 – 38.0) 6 4.7 (55.3 – 73.1)

School consolidation policy

57.7 (4 8.0 – 66.9) 25.0 (17.3 – 34.6) 17.4 (11.4 – 25.6)

Among the 23.4% of districts that had initiated the construction of a school facility on a new school site during the 5 years before the study.

Table 6.7. Percentage of districts that found specic factors inuential in deciding where to build a new school

facility

— SHPPS 2016

Districts (%)

Factor

Not a

factor

Somewhat

inﬂuential

Very

inﬂuential

Ability for students to walk or bike to school

54.8 (45.1 – 6 4.1) 31.3 (23.1 – 4 0.8) 14.0 (8.4 – 22. 2)

Availability or design of existing roads and infrastructure

35.1 (26.4 – 4 4.9) 45.3 ( 35.9 – 55.0) 19.6 (13.1 – 28.4)

Compatibility with local community growth plan related to future residential

development

40.8 (31.8 – 50.4) 31.2 (23.0 – 40.7) 28.1 (20.2 – 37.6)

Demographic characteristics (e.g., race, ethnicity, and poverty status) of

students who would attend that school

71.6 (61.8 – 79.6) 14.3 (8.8 – 22.4) 14.1 (8.2 – 23.2)

Desire to accommodate community use of the school facility or campus

(e.g., an auditorium, classrooms, or athletic ﬁelds)

36.9 (28.2 – 46.6) 27.1 (19.3 – 36.5) 36.1 (27.3 – 45.9)

Environmental concerns related to on-site contamination or potential nearby

sources of pollution

66.7 (56.8 – 75.4) 14.0 (8.3 – 22.6) 19. 3 (12 . 7 – 2 8 . 3)

Land prices

51. 5 (41. 9 – 6 0 .9) 23.8 (16.8 – 32.7) 24.7 (17.2 – 34.1)

Local government ofﬁcials’ input

47.9 (38.5 – 57.4) 31.3 (23.2 – 4 0.7) 20.8 (13.8 – 30.2)

Need for athletic facilities

47.4 (38.0 – 57.0) 32.3 (24.2 – 41.7) 20.3 (13.5 – 29.3)

Need for parking

44.1 (34.8 – 53.8) 39.8 (30.9 – 49.5) 16.1 (10.2 – 24.6)

Potential clean-up costs of contaminated sites

75.8 (66.4 – 83.3) 9.3 (4.9 – 16.7) 14.9 (9.1 – 23.5)

Site already owned

36.7 (28.0 – 46.3) 13.3 (7.8 – 21.7) 50.1 (4 0.6 – 59.6)

Site donated

84.0 (75.4 – 90.0) 8.7 (4.5 – 16.2) 7.3 (3.6 – 14.1)

Among the 23.4% of districts that had initiated the construction of a school facility on a new school site during the 5 years before the study.

Table 6.8. Percentage of districts that required formal consultation or input from groups on new school

construction — SHPPS 2016

— Districts (%)

Group

Whether to

construct a new

school

Where to

construct a new

school

Environmental

review of

candidate sites

Local government land use or community planning ofﬁcials

47.1 (42.4 – 51.9) 45.4 (40.8 – 50.1) 40.1 (35.5 – 4 4.8)

Local government transportation ofﬁcials

30.6 (26.3 – 35.2) 28.8 (24.6 – 33.4) 22.9 (19.0 – 27.2)

Local health department or environmental health ofﬁcials

42.7 (38.1 – 47.3) 37.8 (33.4 – 42.5) 36.8 (32.3 – 41.5)

State government ofﬁcials

49.7 (45.1 – 54.4) 41.9 (37. 3 – 46.6) 4 0.3 (35.8 – 45.1)

The public

67.5 (63.0 – 71.7) 55.8 (51.1 – 60.4) 38.2 (33.6 – 42.9)

Table 6.9. Percentage of districts with specic policies and practices related to joint use agreements

— SHPPS 2016

Policy or practice Districts (%)

Has a formal written joint use agreement

59.4 (55.0 – 63. 6)

Has a formal written joint use agreement that allows:

Community members or groups to use school facilities

54.6 (50.1 – 58.9)

Students to use community facilities (e.g., a park or recreation center)

29.3 (25.5 – 33.5)

Has a formal written joint use agreement that applies to community member or community group use of school facilities for:

Adult education programs

28.6 (24.7 – 32.9)

Before- or after-school programs for school-aged children

38.4 (34.1 – 42.8)

Education-based programs hosted by universities, colleges, or technical schools

32. 5 (28.5 – 36.9)

Emergency response (e.g., emergency food or shelter)

42.9 (38.5 – 47.4)

Healthcare services

13.6 (10.7 – 17.0)

Indoor recreation, sports, or physical activity

47.5 (43.1 – 52.0)

Library services

12.6 (10.0 – 15.9)

Meeting or ofﬁce space for local government use

19.6 (16.2 – 23.4)

Meeting space for civic or community groups (e.g., the Lions Club, League of Women Voters, historical society, or

music or theater group)

34.4 (30.3 – 38. 8)

Mental health or social services

16.9 (13.8 – 20.6)

Outdoor recreation, sports, or physical activity

4 4.2 (39.8 – 4 8.6)

Performances, such as dance, theater, or music

36.0 (31.8 – 40.4)

Preschool or infant child care programs

25.5 (21.8 – 29.6)

Has a written formal joint use agreement with:

A civic or community group (e.g., the Lions Club, League of Women Voters, historical society, or music or

theater group)

24.5 (20.8 – 28.6)

A faith-based organization

14.5 (11.6 – 18.1)

A health club

5.2 (3.6 – 7.5)

A healthcare facility, practice, or group

8.7 (6.5 – 11.6)

A library system

9.2 (6.9 – 12.1)

A local government department, ofﬁce, or program

29.0 (25.1 – 33.3)

A mental health or social services facility, practice, or group

16.8 (13.7 – 20.4)

A sports program or league not operated by local government

32. 2 (28.1 – 36.6)

A university, college, or technical school

21.5 (18.0 – 25.4)

A youth group or organization (e.g., the Boys or Girls Clubs, the Boy Scouts or Girl Scouts, or 4H Clubs)

34.7 (30.5 – 39.0)

Any other public or private entity

6.4 (4.5 – 9.0)

Allow community members or groups to use the following types of school facilities without a formal joint use agreement:

Indoor facilities only

2.7 (1.6 – 4.5)

Outdoor facilities only

14.6 (11.6 – 18.2)

Both indoor and outdoor facilities

40.8 (36.6 – 45.2)

No facilities allowed to be used without a formal joint agreement

41.9 (37.6 – 46.3)

Dened as a formal written agreement between the school district and another public or private entity to jointly use or share either school facilities or community

facilities to share costs and responsibilities.

Trends Over Time

Health Education

Table 7.1. Signicant trends over time

in the percentage of districts with specic health education policies and

practices, SHPPS 2000, 2006, 2012, and 2016

Policy or practice 2000 2006 2012 2016 Trend

Requires schools to follow any national, state, or district health education

standards

68.8 79.3 82.4 81.7 Increased

Requires elementary schools to teach the following health topics:

Alcohol or other drug use prevention

81.3 79.0 78.4 63.9 Decreased

HIV prevention

58.6 48.6 40.1 29.0 Decreased

Infectious disease prevention

NA NA 70.5 55.1 Decreased

STD prevention

39.4 32.8 29.1 22.9 Decreased

Tobacco use prevention

79.9 81.1 79.7 65.9 Decreased

Violence prevention

73.4 83.6 85.8 86.3 Increased

Requires middle schools to teach the following health topics:

HIV prevention

81.9 79.0 75.7 70.6 Decreased

Suicide prevention

53.8 62.3 65.1 65.4 Increased

Violence prevention

71.6 83.8 86.3 85.0 Increased

Has speciﬁed time requirements for middle school health education

NA 66.9 58.7 52.3 Decreased

Requires high schools to teach violence prevention

74.5 85.0 88.3 87.3 Increased

Provided funding for professional development or offered professional development to those who teach health education on the

following health topics:

Emotional and mental health

44.0 58.6 59.8 63.6 Increased

Infectious disease prevention

NA NA 59.1 47.7 Decreased

Injury prevention and safety

40.0 66.2 63.6 61.0 Increased

Nutrition and dietary behavior

43.3 65.3 62.9 56.0 Increased

Physical activity and ﬁtness

43.3 75.3 74.6 60.1 Increased

Suicide prevention

41.5 56.1 62.6 68.8 Increased

Violence prevention

62.1 77.6 82.7 78.4 Increased

Provided funding for professional development or offered professional development to those who teach health education on the following

instructional strategy topics:

Assessing or evaluating students in health education

NA 49.9 49.8 61.2 Increased

Teaching students of various cultural backgrounds

37.9 46.1 52.6 62.0 Increased

Teaching students with limited English proﬁciency

27.7 44.8 51.0 61.9 Increased

Teaching students with long-term physical, medical, or cognitive

disabilities

47.0 58.5 60.0 65.8 Increased

Using interactive teaching methods (e.g., role plays or cooperative

group activities)

55.2 66.1 60.0 70.4 Increased

Health education staff worked on health education activities with:

A local business

24.2 26.8 35.4 37.4 Increased

District-level counseling, psychological, or social services staff

36.8 38.9 43.0 58.5 Increased

Provided district or school personnel (e.g., classroom teachers, administrators,

or school board members) with information on school health education

NA 79.2 66.5 69.0 Decreased

NA = Data not available.

Signicant linear trends based on regression analyses with all years of available data. Trends are presented if p < .01 and the dierence between the two

endpoints (2000 and 2016, 2006 and 2016, or 2012 and 2016) was greater than 10 percentage points or showed an increase of at least a factor of 2 or a decrease

of at least half.

During the 2 years before the study.

During the 12 months before the study.

Physical Education and Physical Activity

Table 7.2. Signicant trends over time

in the percentage of districts with specic physical education and physical activity

policies and practices, SHPPS 2000, 2006, 2012, and 2016

Policy or practice 2000 2006 2012 2016 Trend

Requires elementary schools to teach physical education

82.6 93.3 93.6 92.6 Increased

Requires or recommends elementary schools use one particular curriculum

developed by a commercial company

NA 4.8 11.6 19.1 Increased

Requires or recommends that schools at each level use Fitnessgram:

Elementary schools

12.8 21.5 36.5 53.4 Increased

Middle schools

9.5 24.1 40.2 54.8 Increased

High schools

8.3 21.2 40.3 47.3 Increased

Requires or recommends that schools at each level use any other ﬁtness assessment:

Elementary schools

NA NA 8.7 24.4 Increased

Middle schools

NA NA 9.4 26.0 Increased

High schools

NA NA 12.4 30.0 Increased

Requires schools to meet the physical education needs of students with disabilities by using the following strategies:

Mainstreaming into regular physical education as appropriate

82.3 98.5 97.8 97.2 Increased

Providing adapted physical education as appropriate

74.6 92.7 92.8 91.0 Increased

Using modiﬁed equipment or facilities in regular physical education

65.0 93.2 91.5 89.4 Increased

Using teaching assistants in regular physical education

57.2 86.5 79.2 78.6 Increased

Requires students to wear appropriate protective gear:

When engaged in interscholastic sports

73.4 84.2 83.7 83.7 Increased

When engaged in physical activity clubs or intramural sports

40.8 44.8 57.9 51.6 Increased

Provided funding for professional development or offered professional development to those who teach physical education

on the following topics:

Administering or using ﬁtness assessments

49.8 62.5 71.1 67.6 Increased

Assessing or evaluating student performance in physical education

48.0 62.2 66.3 69.4 Increased

Developing, implementing, and evaluating a Comprehensive School

Physical Activity Program (CSPAP)

NA NA 42.2 22.7 Decreased

Encouraging family involvement in physical activity

28.0 51.0 53.9 49.8 Increased

Helping students develop individualized physical activity plans

35.1 47.2 52.9 49.1 Increased

Injury prevention and ﬁrst aid

62.6 72.0 81.0 78.6 Increased

Methods to promote gender equity in physical education and sports

35.4 48.9 46.1 51.2 Increased

Teaching individual or paired activities or sports

46.4 59.7 60.1 60.4 Increased

Teaching movement skills and concepts

51.6 62.8 61.9 64.1 Increased

Teaching physical education to students with long-term physical,

medical, or cognitive disabilities

45.5 55.9 54.7 59.9 Increased

Teaching team or group activities or sports

54.9 68.9 66.0 66.3 Increased

Physical education staff worked on school physical education activities with district-level:

Counseling, psychological, or social services staff

12.5 27.1 30.9 39.3 Increased

Health education staff

41.1 54.8 56.3 52.2 Increased

Health services staff

29.9 48.1 44.8 42.1 Increased

Nutrition or food service staff

12.1 46.0 41.5 41.3 Increased

continued

Policy or practice 2000 2006 2012 2016 Trend

Physical education staff worked on school physical education activities with:

A health organization (e.g., the American Heart Association or the

American Cancer Society)

46.4 59.2 62.4 59.0 Increased

A local business

15.9 21.5 30.0 29.8 Increased

A local health department

24.1 34.3 48.3 39.0 Increased

A local mental health or social services agency

14.1 22.5 33.2 33.2 Increased

A local parks or recreation department

26.2 31.2 35.4 39.6 Increased

A local youth organization (e.g., the Boys and Girls Clubs)

15.3 24.4 25.2 28.3 Increased

Requires schools to report number of minutes of classroom

physical activity breaks

NA NA 30.1 14.5 Decreased

Requires head coaches of interscholastic sports to:

Be certiﬁed in cardiopulmonary resuscitation (CPR)

NA 57.7 68.6 76.0 Increased

Be certiﬁed in ﬁrst aid

NA 61.3 68.0 72.5 Increased

Be employed by the school or school district

NA 56.8 50.2 43.7 Decreased

Complete a coaches’ training course

48.5 61.5 70.5 73.8 Increased

Complete a sports safety course

NA NA 65.2 76.0 Increased

Have a teaching certiﬁcate

47.1 46.0 35.0 29.4 Decreased

Have training on how to prevent, recognize, and respond to

concussions among students

NA NA 77.0 90.3 Increased

Provided educational materials to student athletes or their parents on

preventing, recognizing, and responding to concussions

NA NA 73.4 87.4 Increased

Provided educational sessions to student athletes or their parents on

preventing, recognizing, and responding to concussions

NA NA 58.7 71.3 Increased

NA = Data not available.

Signicant linear trends based on regression analyses with all years of available data. Trends are presented if p < .01 and the dierence between the two endpoints

(2000 and 2016, 2006 and 2016, or 2012 and 2016) was greater than 10 percentage points or showed an increase of at least a factor of 2 or a decrease of at least

half.

Other than Fitnessgram and the Physical Fitness Test from the President’s Challenge. 3 During the 2 years before the study.

During the 12 months before the study.

Nutrition Environment and Services

Table 7.3. Signicant trends over time

in the percentage of districts with specic nutrition environment and services

policies and practices, SHPPS 2000, 2006, 2012, and 2016

Policy or practice 2000 2006 2012 2016 Trend

Has food procurement contracts that address:

Cooking methods for precooked items

(e.g., baked instead of deep fried)

NA 77.7 84.0 89.3 Increased

Food safety

NA 83.5 93.6 97.0 Increased

Hazard Analysis and Critical Control Points (HACCP)

NA 74.1 92.1 95.1 Increased

Nutritional standards for a la carte foods

NA 55.1 73.5 85.4 Increased

Almost always or always used healthy food preparation practices:

2,3

Boiled, mashed, or baked potatoes rather than fried or deep fried them

NA 74.1 78.7 86.8 Increased

Drained fat from browned meat

93.7 91.4 79.0 70.7 Decreased

Prepared vegetables without using butter, margarine, or a cheese or

creamy sauce

59.1 48.4 63.5 74.3 Increased

Reduced the amount of salt called for in recipes or used

low-sodium recipes

32.6 28.3 46.1 76.4 Increased

Reduced the amount of sugar called for in recipes or

used low-sugar recipes

12.7 17.5 30.3 55.2 Increased

Roasted meat or poultry on a rack so fat would drain

33.2 34.4 41.7 44.3 Increased

Roasted, baked, or broiled meat rather than fried it

NA 86.7 76.2 66.0 Decreased

Skimmed fat off warm broth, soup, stew, or gravy

60.2 64.9 70.8 73.1 Increased

Steamed or baked other vegetables

59.5 77.7 83.7 86.2 Increased

Used ground turkey or lean ground beef instead of regular ground beef

35.1 40.5 44.1 57.9 Increased

Used low-fat or nonfat yogurt, mayonnaise, or sour cream instead of

regular mayonnaise, sour cream, or creamy salad dressings

26.8 39.8 53.1 70.3 Increased

Used low-sodium canned vegetables instead of

regular canned vegetables

7.4 14.3 34.4 75.8 Increased

Used other seasonings instead salt

33.0 32.5 46.9 67.8 Increased

Used part-skim or low-fat cheese instead of regular cheese

34.1 50.3 69.4 81.5 Increased

Used skim, low-fat, soy, or nonfat dry milk instead of whole milk

67.4 77.9 90.7 89.0 Increased

Nutrition services staff worked on school nutrition services activities with district-level:

Counseling, psychological, or social services staff

8.8 23.3 22.1 29.0 Increased

Health education staff

26.0 59.9 51.1 47.6 Increased

Health services staff

23.9 55.1 51.4 55.8 Increased

Physical education staff

13.9 44.3 39.9 38.4 Increased

Nutrition services staff worked on school nutrition services activities with:

A local anti-hunger organization (e.g., a food bank)

NA NA 24.1 34.6 Increased

A local business

8.8 19.9 20.9 29.1 Increased

A local college or university

8.7 11.8 17.9 19.2 Increased

A local health department

37.6 45.2 52.0 56.3 Increased

Made information available to students on the nutrition and caloric content of

foods available to them

46.0 49.4 68.2 74.0 Increased

Provided assistance to schools for providing meals for students who are

vegetarians

NA NA 45.4 62.3 Increased

Made results of last evaluation or assessment of implementation of wellness

policy available to the public

NA NA 53.0 65.9 Increased

Newly hired district food service director required to have ServSafe or other

food safety certiﬁcation

NA 54.0 70.1 76.2 Increased

continued

Policy or practice 2000 2006 2012 2016 Trend

Newly hired food service manager required to:

Have a high school diploma or GED

95.3 74.1 58.4 59.6 Decreased

Have an undergraduate degree

0.7 1.5 4.2 4.3 Increased

Have ServSafe or other food safety certiﬁcation

NA 53.9 70.5 77.1 Increased

Be certiﬁed, licensed, or endorsed by the state

33.8 16.0 15.8 18.6 Decreased

Provided funding for professional development or offered professional

development to nutrition services staff on nutrition services for students with

special dietary needs other than food allergies

NA NA 62.7 77.3 Increased

Requires schools to restrict the availability of deep-fried foods

NA 42.1 48.0 58.9 Increased

Requires schools to have a written plan for implementation of a risk-based

approach to food safety (e.g., a HACCP-based program)

NA 58.2 78.3 83.0 Increased

District receives a speciﬁed percentage of soft drink sales receipts

NA 64.4 41.6 38.1 Decreased

District receives incentives from soft drink sales (e.g., cash awards or

donations of equipment, supplies, or other donations) once receipts total a

speciﬁed amount

NA 32.5 13.9 9.1 Decreased

District prohibited from selling soft drinks produced by more than one

company

NA 43.0 24.7 18.4 Decreased

NA = Data not available.

Signicant linear trends based on regression analyses with all years of available data. Trends are presented if p < .01 and the dierence between the two endpoints

(2000 and 2016, 2006 and 2016, or 2012 and 2016) was greater than 10 percentage points or showed an increase of at least a factor of 2 or a decrease of at least

half.

During the 30 days before the study.

Among the districts that have primary responsibility for cooking foods for schools in the district.

During the 12 months before the study.

Among the districts that have evaluated or assessed the implementation of their policy.

During the 2 years before the study.

Health Services and Counseling, Psychological, and Social Services

Table 7.4. Signicant trends over time

in the percentage of districts with specic health services and counseling,

psychological, and social services policies and practices, SHPPS 2000, 2006, 2012, and 2016

Policy or practice 2000 2006 2012 2016 Trend

Requires schools to obtain and keep the following information in any type of student record:

Dietary needs/restrictions

69.9 84.2 88.5 86.4 Increased

TB screening results

48.9 47.7 40.4 38.4 Decreased

Weight status (e.g., body mass index)

NA NA 51.5 38.7 Decreased

Requires the following vaccines:

A meningococcal conjugate vaccine for middle school entry

NA NA 33.2 47.2 Increased

A meningococcal conjugate vaccine for high school entry

NA NA 27.2 44.8 Increased

A second measles vaccine for high school entry

66.8 73.2 84.5 84.9 Increased

Has adopted a policy that some students may carry and self-administer:

An epinephrine auto-injector (e.g., EpiPen)

46.6 55.2 75.6 82.6 Increased

Insulin or other injected medications

58.8 45.1 60.9 69.2 Increased

Any other prescribed medications

36.8 15.6 22.8 23.2 Decreased

Any over-the-counter medications

35.1 15.9 21.3 22.6 Decreased

Health services staff worked on school health services activities with:

Counseling, psychological, or social services staff

56.6 58.7 60.9 82.6 Increased

Nutrition or food service staff

49.5 71.3 69.3 77.7 Increased

Physical education staff

59.9 63.8 63.1 72.3 Increased

Requires schools to submit injury report data to the school district or local

health department

53.2 69.1 67.8 70.6 Increased

Requires schools to complete a report when a student experiences a serious

illness at school

48.6 63.1 60.0 71.3 Increased

Requires supplies for applying standard or universal precautions to be

available in the gymnasium, on playgrounds, or on playing ﬁelds

73.5 68.6 64.6 63.4 Decreased

Requires teachers to be notiﬁed when screening indicates hearing problems

85.5 79.7 77.4 74.4 Decreased

Requires schools to provide referrals to community healthcare providers when

screening indicates oral health problems

NA NA 62.9 76.2 Increased

Requires schools to provide the following health services:

Alcohol or other drug use treatment

46.2 33.6 30.4 19.0 Decreased

Assistance with enrolling in Medicaid or SCHIP

44.4 38.9 34.9 33.0 Decreased

Identiﬁcation or school-based management of acute illnesses

50.0 68.8 70.9 68.4 Increased

Identiﬁcation or school-based management of chronic health

conditions (e.g., asthma or diabetes)

46.5 76.0 80.5 76.2 Increased

Instruction on self-management of chronic health conditions

NA 44.7 48.6 66.5 Increased

Tobacco use cessation

42.1 36.9 26.9 18.8 Decreased

Requires schools to provide the following prevention services:

HIV prevention

47.4 46.6 39.5 31.7 Decreased

STD prevention

45.0 44.9 36.7 32.2 Decreased

Violence prevention

59.2 70.0 77.9 77.4 Increased

continued

Policy or practice 2000 2006 2012 2016 Trend

Requires health services staff to follow Do Not Resuscitate orders

9.2 23.8 17.7 23.1 Increased

Requires a newly hired school nurse to have a Registered Nurse’s license

95.6 75.1 86.1 79.0 Decreased

School nurses employed by school district

93.7 81.3 83.3 79.7 Decreased

Has arrangements with a university, medical school, or nursing school to

provide services to students in the district

NA NA 4.7 11.7 Increased

Has arrangements with other sites not on school property to provide:

Administration of topical ﬂuorides (e.g., mouthrinses, varnish, or

supplements)

NA NA 9.1 19.4 Increased

Alcohol or other drug use treatment

42.9 43.0 35.1 14.7 Decreased

Application of dental sealants

NA 6.9 9.1 19.2 Increased

Assistance with accessing beneﬁts for students with disabilities

NA NA 40.7 24.0 Decreased

Assistance with enrolling in Medicaid or SCHIP

30.8 32.3 29.1 17.7 Decreased

Assistance with enrolling in WIC or SNAP or accessing food stamps or

food banks

28.9 32.2 28.4 16.7 Decreased

Case management for students with emotional or behavioral problems

NA 46.9 48.1 29.3 Decreased

Comprehensive assessment or intake evaluation

40.4 40.6 42.4 25.4 Decreased

Counseling for emotional or behavioral disorders (e.g., anxiety,

depression, or ADHD)

NA 47.4 44.1 27.4 Decreased

Crisis intervention for personal problems

49.1 51.2 42.0 28.1 Decreased

Family counseling

41.7 39.2 39.4 21.2 Decreased

Group counseling

37.3 35.7 34.7 20.8 Decreased

Identiﬁcation of emotional or behavioral disorders (e.g., anxiety,

depression, or ADHD)

NA 48.0 41.8 25.6 Decreased

Individual counseling

49.0 47.4 48.8 31.1 Decreased

Job readiness skills programs

36.9 37.7 38.3 23.9 Decreased

Seasonal inﬂuenza vaccine

NA NA 12.5 25.6 Increased

Self-help or support groups

32.1 30.0 28.0 18.4 Decreased

Suicide prevention

NA NA 9.6 19.9 Increased

Tobacco use cessation

29.0 33.8 26.1 10.8 Decreased

Counseling, psychological, or social services staff worked on counseling, psychological, or social services activities with district-level:

Health education staff

45.3 59.9 57.3 65.7 Increased

Health services staff

50.7 58.8 62.6 81.1 Increased

Nutrition services staff

11.2 39.3 37.6 51.5 Increased

Physical education staff

32.4 41.7 46.8 57.6 Increased

Requires schools to create and maintain student support teams

NA NA 80.1 69.4 Decreased

Requires school counseling, psychological, or social services staff to

participate in the development of Individualized Health Plans when indicated

38.5 58.6 57.2 69.3 Increased

Requires a newly hired school counselor to have as minimum education level:

Undergraduate degree in counseling

NA NA 15.2 26.5 Increased

Master's degree in counseling

NA NA 70.7 53.7 Decreased

Requires a newly hired school psychologist to have an undergraduate degree

in psychology

NA NA 4.6 12.8 Increased

Requires school counseling, psychological, or social services staff to earn

continuing education credits on counseling, psychological, or social services

topics

NA NA 51.4 64.6 Increased

continued

Policy or practice 2000 2006 2012 2016 Trend

Requires schools at each level to have a speciﬁed ratio of counselors to students:

Elementary schools

NA NA 26.4 16.2 Decreased

Middle schools

NA NA 28.1 16.8 Decreased

High schools

NA NA 32.0 19.8 Decreased

Provided funding for professional development or offered professional development to counseling, psychological, or social services staff on the

following topics:

Peer counseling or mediation

56.6 56.1 45.2 41.4 Decreased

Student support teams

NA NA 60.7 47.2 Decreased

Has someone in the district who oversees or coordinates counseling,

psychological, or social services

62.6 71.9 63.1 79.5 Increased

Employee wellness

Requires each school to have someone to oversee or coordinate employee

wellness programs

NA 18.0 15.7 30.6 Increased

Provided funding for health risk appraisals or offered health risk appraisals for

employees

NA 12.3 25.9 40.6 Increased

NA = Data not available.

Signicant linear trends based on regression analyses with all years of available data. Trends are presented if p < .01 and the dierence between the two

endpoints (2000 and 2016, 2006 and 2016, or 2012 and 2016) was greater than 10 percentage points or a factor of 2.

During the 2 years before the study.

During the 12 months before the study.

Healthy and Safe School Environment

(includes Social and Emotional Climate)

Table 7.5. Signicant trends over time

in the percentage of districts with specic school environment policies and

practices, SHPPS 2000, 2006, 2012, and 2016

Policy or practice 2000 2006 2012 2016 Trend

Safety and security measures

Requires schools at each level to assign staff or adult volunteers to monitor school halls during classes

Elementary schools

NA 51.7 43.4 40.3 Decreased

Middle schools

NA 55.9 47.1 43.8 Decreased

Requires schools at each level to assign staff or adult volunteers to monitor school restrooms

Middle schools

57.5 54.1 47.6 43.4 Decreased

High schools

59.3 52.7 47.5 42.8 Decreased

Requires faculty and staff at each level to wear identiﬁcation badges

Elementary schools

NA 33.0 49.9 60.0 Increased

Middle schools

NA 33.9 51.4 60.1 Increased

High schools

NA 34.8 52.2 60.5 Increased

Requires visitors at each level to wear identiﬁcation badges

Elementary schools

NA 66.7 83.6 86.9 Increased

Middle schools

NA 71.3 82.4 86.0 Increased

High schools

NA 68.3 80.4 86.9 Increased

Requires high school students to wear identiﬁcation badges

3.5 5.2 9.9 8.7 Increased

Requires schools at each level to use security or surveillance cameras

Elementary schools

11.0 29.1 59.0 75.9 Increased

Middle schools

16.4 37.2 68.6 82.9 Increased

High schools

19.2 46.4 74.9 85.4 Increased

Requires students at each level to refrain from using personal communication devices (e.g., cell phones) during the school day

Middle schools

NA NA 88.4 74.6 Decreased

High schools

NA NA 82.4 58.8 Decreased

Requires high school students to wear school uniforms

1.3 1.9 5.1 5.2 Increased

Requires high schools to enforce student dress code

77.5 90.4 83.5 89.4 Increased

Supports or promotes walking or biking to and from school

NA 17.5 30.2 32.9 Increased

Violence prevention

Prohibits gang activity (e.g., recruiting or wearing gang colors, symbols, or

other gang attire)

62.5 78.5 73.0 75.9 Increased

Prohibits electronic aggression or cyber-bullying that interferes with the

educational environment

NA NA 82.0 93.2 Increased

Tobacco use prevention

Prohibits students from wearing tobacco brand-name apparel or carrying

merchandise with tobacco company names, logos, or cartoon characters on it

70.5 80.5 82.3 82.9 Increased

Prohibits faculty and staff from

Cigarette smoking outside on school grounds, including parking lots

and playing ﬁelds

78.3 86.8 92.4 95.0 Increased

Cigarette smoking at off-campus, school-sponsored events

75.7 82.2 89.0 91.9 Increased

Smokeless tobacco use outside on school grounds

74.2 80.5 87.1 92.3 Increased

Smokeless tobacco use at off-campus school-sponsored events

72.6 78.3 84.6 90.3 Increased

Prohibits school visitors from

Cigarette smoking outside on school grounds, including parking lots

and playing ﬁelds

72.1 76.8 91.1 93.0 Increased

continued

Policy or practice 2000 2006 2012 2016 Trend

Cigarette smoking at off-campus, school-sponsored events

61.8 70.2 81.1 82.2 Increased

Smokeless tobacco use

79.4 82.6 90.3 90.8 Increased

Smokeless tobacco use in school buildings

78.7 81.7 89.5 90.0 Increased

Smokeless tobacco use outside on school grounds, including parking

lots and playing ﬁelds

64.8 71.8 85.0 87.3 Increased

Smokeless tobacco use on school buses or other vehicles used to

transport students

77.6 80.8 89.0 90.0 Increased

Smokeless tobacco use at off-campus, school-sponsored events

58.3 64.8 76.7 79.1 Increased

Has adopted a student drug-testing policy

NA 25.5 29.6 37.5 Increased

Injury prevention and safety

Requires inspection or maintenance of smoke alarms

72.2 89.8 91.6 91.0 Increased

Requires students to wear appropriate protective gear when engaged in

classes such as wood shop or metal shop

86.6 83.1 72.4 73.5 Decreased

Requires students to use hearing protection devices during classes or

activities where they are exposed to potentially unsafe noise levels

NA NA 47.5 61.3 Increased

Crisis prevention, response, and recovery

Ever used any materials from the U.S. Department of Education to develop

policies or plans related to crisis preparedness, response, and recovery

NA 85.9 73.8 71.8 Decreased

Worked with a local mental health or social services agency to develop their

crisis preparedness, response, and recovery plan

NA 57.5 46.1 43.6 Decreased

Evaluated or assessed district’s crisis preparedness, response, and recovery plan

6,7

NA 74.6 74.2 85.3 Increased

School health coordination

Provided funding for professional development or offered professional development for school faculty and staff on how to implement school-

wide policies and programs related to:

Alcohol use prevention

NA 73.3 62.8 58.9 Decreased

Illegal drug use prevention

NA 76.7 64.9 63.8 Decreased

Tobacco use prevention

NA 70.0 58.8 56.7 Decreased

Had one or more district-level councils, committees, or teams that addressed

Alcohol or other drug use prevention

NA 86.1 84.6 69.6 Decreased

HIV prevention

NA 66.1 64.2 49.2 Decreased

Management of foodborne illnesses

NA NA 64.6 52.4 Decreased

Management of infectious diseases (e.g., inﬂuenza)

NA NA 78.1 64.3 Decreased

Tobacco use prevention

NA 84.2 82.5 70.6 Decreased

Had one or more school health councils that included representatives from

School maintenance staff

NA NA 59.4 46.5 Decreased

School mental health or social services staff

NA 57.4 66.4 70.1 Increased

School transportation staff

NA NA 48.3 35.6 Decreased

Students

NA 74.4 64.3 56.0 Decreased

Provided any funding or offered to help schools establish a school health

council, committee, or team

42.9 50.5 39.4 30.7 Decreased

NA = Data not available.

Signicant linear trends based on regression analyses with all years of available data. Trends are presented if p < .01 and the dierence between the two

endpoints (2000 and 2016, 2006 and 2016, or 2012 and 2016) was greater than 10 percentage points or a factor of 2.

Inside or outside school building.

Does not include the use of smart phones, tablets, or computers for educational purposes.

Among districts that do not require school uniforms.

Even if it does not occur on school property or at school-sponsored events.

Among the 95.9% districts with either a district-level plan or a requirement for schools to have a plan.

During the 12 months before the study.

Among the districts with a district-level school health council, committee, or team.

During the 2 years before the study.

Physical Environment

Table 7.6. Signicant trends over time

in the percentage of districts with specic physical school environment policies

and practices, SHPPS 2000, 2006, 2012, and 2016

Policy or practice 2000 2006 2012 2016 Trend

Has an indoor air quality management program

NA 35.4 47.7 48.9 Increased

Provided funding for training or offered training to custodial or maintenance

staff on how to reduce the use of hazardous materials

NA NA 74.8 63.3 Decreased

Includes green design when building new school buildings or renovating

existing buildings

NA 13.4 30.0 28.0 Increased

Provided funding for professional development or offered professional

development for school faculty and staff on how to implement school-wide

policies and programs related to integrated pest management

NA 27.4 41.4 43.9 Increased

NA = Data not available.

Signicant linear trends based on regression analyses with all years of available data. Trends are presented if p < .01 and the dierence between the two

endpoints (2000 and 2016, 2006 and 2016, or 2012 and 2016) was greater than 10 percentage points or a factor of 2.

During the 2 years before the study.

Healthy People 2020 Objectives

Table 8.1. National health objectives from Healthy People 2020 measured by SHPPS

Healthy People 2020 Objective

2020

Target (%)

Baseline

data (%)

Data from

SHPPS

2016 (%)

NWS-2.2: Increase the proportion of school districts that require schools to

make fruits or vegetables available whenever other food is offered or sold

18.6 6.6

16.3

PA-6.2: Increase the proportion of school districts that require regularly

scheduled elementary school recess

62.8 57.1

64.8

PA-7: Increase the proportion of school districts that require or recommend

elementary school recess for an appropriate period of time

67.7 61.5

64.5

PREP-5: Increase the percentage of school districts that require schools to include speciﬁc topics in their crisis preparedness, response, and

recovery plans

PREP-5.1: Increase the percentage of school districts that required

schools to include family reuniﬁcation plans

74.6 67.8

74.4

PREP-5.2: Increase the percentage of school districts that required

schools to include procedures for responding to pandemic ﬂu or

other infectious disease outbreaks

75.9 69.0

65.3

PREP-5.3: Increase the percentage of school districts that required

schools to include speciﬁc provisions for students and staff with

special needs

87.9 79.9

79.9

PREP-5-4: Increase the percentage of school districts that required

schools to include speciﬁc provisions for mental health services for

students, faculty, and staff after a crisis has occurred

76.2 69.3

77.6

2006 data.

2012 data.

Discussion

e SHPPS 2016 results presented in this report provide

detailed information about school health policies and

practices in districts nationwide. Below, results from several

of the WSCC model’s components are highlighted, noting

areas of strength as well as those in need of improvement.

Health Education

Nationwide, 81.7% of districts required schools to follow

any national, state, or district health education standards

which is a signicant increase from the 68.8% of districts

that had this policy in 2000. However, less than two thirds

specically required schools to follow standards based

on the National Health Education Standards and less

than half specically required schools to follow standards

based on the National Sexuality Education Standards.

Among districts that follow any standards for health

education, 38.5% require elementary schools, 44.6%

require middle schools, and 54.6% require high schools

to assess student achievement of the health education

standards used by the district. Districts can help improve

the quality of health education by providing additional

support to schools for following well established standards

such as the National Health Education Standards (19)

and the National Sexuality Education Standards.

Requiring schools to teach specic health topics is an

appropriate role for districts and one that can demonstrate

commitment to a comprehensive, developmentally

appropriate curriculum. Unfortunately, districts are most

likely to have adopted a policy stating that high schools

rather than elementary schools or middle schools will

teach specic health topics. Elementary schools and middle

schools were required by more than 80% of districts

to teach about just one (violence prevention) and two

(tobacco use prevention and violence prevention), topics,

respectively. However, high schools were required by more

than 80% of districts to teach about seven topics (alcohol

or other drug use prevention, emotional and mental

health, HIV prevention, nutrition and dietary behavior,

other sexually transmitted disease prevention, tobacco

use prevention, and violence prevention). Interestingly,

violence prevention was the only specic health topic that

more than 80% of districts in 2016 required schools at the

elementary, middle, and high school levels to teach and the

only topic for which an increase was observed since 2000

at all three levels in the percentage of districts that required

schools to teach it. e percentage of districts requiring

suicide prevention to be taught by middle schools is the

only other specic health topic for which an increase was

observed since 2000. In contrast, declines since 2000 were

observed in the percentage of districts requiring elementary

schools to teach alcohol or drug use prevention, HIV

prevention, infectious disease prevention, STD prevention,

and tobacco use prevention and middle schools to teach

HIV prevention. Reversing these trends is critical to ensure

that elementary schools and middle schools are teaching

topics closely linked to priority public health issues.

Among districts requiring that pregnancy prevention, HIV

prevention, other STD prevention, or human sexuality

be taught, more than three fourths required elementary

and middle schools and two thirds required high schools

to notify parents or guardians before students receive

instruction and more than half required schools at all three

levels to require parental permission before instruction.

ree fourths or more of districts required schools at all

three levels to allow parents or guardians to exclude their

children from receiving instruction on these topics.

Stang in support of health education could be improved

at both the district and school levels. About two-thirds

(69.0%) of districts have someone who oversees or

coordinates health education and less than half (42.2%) of

districts require each school to have someone to oversee

or coordinate health education at the school. Only 4 of 10

districts require those who teach health education to earn

continuing education credits on health education topics

or instructional strategies. At the middle school level,

newly hired sta who teach health education must have

undergraduate or graduate training in health education in

58.7% of districts; must be certied, licensed, or endorsed

by the state to teach health education in 67.8% of districts;

and must be Certied Health Education Specialists

(CHES) in 16.9% of districts. Expectations for newly

hired sta are not much better at the high school level.

Newly hired sta who teach health education must have

undergraduate or graduate training in health education

in 68.6% of districts; must be certied, licensed, or

endorsed by the state to teach health education in 78.4%

of districts; and must be CHES in 19.3% of districts.

Professional development for those who teach health

education can improve the eectiveness of health education.

While 54.6% of districts required those who teach health

education to receive professional development on violence

prevention, less than half of districts had adopted a policy

requiring those who teach health education to receive

professional development on 17 other specic health topics.

However, even though few districts required professional

development on specic health topics, more than half

provided funding for or oered professional development

during the two years before the study on alcohol or other

drug use prevention, emotional and mental health, human

sexuality, injury prevention and safety, nutrition and dietary

behavior, physical activity and tness, suicide prevention,

tobacco use prevention, and violence prevention. Since

2000, the percentage of districts that provided funding

for professional development or oered professional

development to those who teach health education on the

following topics increased: emotional and mental health,

injury prevention and safety, nutrition and dietary behavior,

physical activity and tness, suicide prevention, and

violence prevention. Additional district requirements for

those who teach health education to receive professional

development on specic health topics are needed.

Besides professional development on specic health

topics, it is also important for those who teach health

education to receive professional development on specic

instructional strategies. Districts can make sure that this

kind of professional development is made available. More

than 60% of districts provided funding for or oered

professional development during the two years before

the study to those who teach health education on the

following specic instructional strategy topics: aligning

health education standards to curriculum, instruction, or

student assessment; assessing or evaluating students in

health education; creating safe and supportive learning

environments for all students; teaching skills for behavior

change; teaching students of various cultural backgrounds;

teaching students with limited English prociency; teaching

students with long-term physical medical, or cognitive

disabilities; using classroom management techniques;

using interactive teaching methods; and using technology

to enhance instruction or improve student learning. Since

2000, the percentage of districts that provided funding

for professional development or oered professional

development to those who teach health education on

the following instructional strategy topics increased:

assessing or evaluating students in health education;

teaching students of various cultural backgrounds; teaching

students with limited English prociency; teaching

students with long-term physical, medical, or cognitive

disabilities; and using interactive teaching methods.

Physical Education and Physical Activity

In the recent 2016 National Physical Activity Report Card,

the U.S. received the grade of D-, which indicates that

most U.S. children and adolescents are not getting the

nationally recommended 60 minutes of physical activity

daily (44). Districts can provide leadership to help schools

enhance policies and practices for physical education and

physical activity through a CSPAP that will assist students

in attaining the national recommendation and improving

their health and education outcomes (24). SHPPS 2016

found that only 15% of districts require each school to

have someone to oversee or coordinate a CSPAP at the

school and even fewer districts (13%) require each school

to have a written plan for a CSPAP. One possible way to

increase these practices in schools is to incorporate them

into a district policy such as the local wellness policy.

Physical education is the cornerstone for CSPAP and can

be adequately addressed by four essential components of

physical education: policy and environment; curriculum;

student assessment; and appropriate instruction

(26). SHPPS 2016 revealed that there is policy and

environmental support for physical education at the

district level. For all school levels, more than 89% of

districts require schools to teach physical education, and

this requirement increased signicantly for elementary

schools since 2000. In addition, for all school levels,

the majority of districts follow national standards for

physical education; have time requirements for physical

education; and have stang policies that require sta

who teach physical education to be certied, licensed,

or endorsed by the state to teach physical education.

However, for all school levels, less than 20% of districts

prohibit the use of waivers, exemptions, or substitutions

for physical education requirements for students. It is

essential that physical education be taught to students

so they may gain the knowledge, skills, and condence

to be physically active for a lifetime. Allowing waivers,

exemptions, and substitutions reduces the opportunity

for all students to experience physical education.

Districts provide leadership and direction for physical

education curriculum, and having a comprehensive

written curriculum provides the framework for what

and how physical education should be taught to ensure

equitable education for all students. SHPPS 2016 found

districts could be doing more to support improvements in

physical education curriculum. For example, for all school

levels, less than 15% of districts ever used a curriculum

analysis tool to assess one or more physical education

curricula. In addition, for all school levels, less than 50%

of districts provide a chart describing the annual scope

and sequence of instruction for physical education.

Trend analyses showed a signicant increase since 2000 in

the percentage of districts that require or recommend that

schools at each level use Fitnessgram,® a tness assessment.

While this is a positive nding, physical education teachers

can collect information other than tness assessment

results to measure student learning and improvement.

SHPPS 2016 found that for all school levels only about

60% of districts provide plans for how to assess student

performance in physical education. is nding indicates

a need for improvement in the area of student assessment.

Suggestions and additional resources for how to assess

students in physical education are explained in SHAPE

America’s Essential Components of Physical Education (26).

An important aspect of appropriate instruction is

ensuring the inclusion of all students and making

the necessary adaptations for students with special

needs or disabilities. SHPPS 2016 revealed that the

percentage of districts that require schools to meet the

physical education needs of students with disabilities

by mainstreaming into regular physical education as

appropriate, providing adapted physical education as

appropriate, using modied equipment or facilities in

regular physical education, and using teaching assistants

in regular education increased signicantly since 2000.

SHPPS also found that only 46% of districts require those

who teach physical education to earn continuing education

credits on physical education topics and instructional

strategies. However, the percentage of districts that

provided funding for professional development or oered

professional development to those who teach physical

education on several topics (e.g., teaching movement

skills and concepts, assessing or evaluating student

performance in physical education, and teaching team

or group activities or sports) increased signicantly

since 2000. Providing physical education teachers with

professional development is necessary for improving

physical education instruction and programs.

In addition to physical education, other opportunities

exist for students to engage in physical activity that

allow them to apply the knowledge and skills they learn

from physical education. SHPPS 2016 found that 65%

of districts require that elementary schools provide

students with regularly scheduled recess. SHPPS 2016

also found that the percentage of districts requiring

schools to provide regular classroom physical activity

breaks during the school day varied by school level—

only 11% of elementary schools, 8% of middle schools,

and 2% of high schools. Very few districts require that

schools provide before and aer school physical activity.

However, more districts recommend these type of

activities, especially opportunities aer the school day.

SHPPS 2016 results show that districts can be playing

a larger role in helping schools provide physical

activity opportunities before, during, and aer school.

e CDC and some national organizations have

developed key resources to assist districts in supporting

schools to develop, implement, and evaluate a CSPAP.

In addition, many resources are available to help

implement the individual components of CSPAP.

is information can be found in CDC’s National

Framework for School Physical Education and Physical

Activity at www.cdc.gov/healthyschools/PEandPA.

Concussions among student athletes are a potential

negative outcome of physical activity, so it is important

to prevent, recognize, and respond to them. While

increases have occurred since 2012 in the percentage

of districts that require head coaches of interscholastic

sports to have training on concussions, as well as in the

percentage of districts that provide educational materials

and sessions to student athletes or their parents, room

for improvement still exists. To help guide districts and

schools in these eorts, CDC has developed Heads Up

(www.cdc.gov/headsup/index.html), a series of resources

for recognizing, responding to, and minimizing the

risk of concussion or other serious brain injury.

Nutrition Environment and Services

Many school districts are using a variety of policies and

practices to improve the school nutrition environment.

Almost all districts participate in the NSLP and SBP,

which provide students with access to balanced meals

during the school day. However, only one third of districts

participate in the Aer-School Snack Program, and fewer

than 10% of districts participate in the Aer-School

Supper Program. Additionally, only one third of districts

sponsor the United States Department of Agriculture

(USDA) Summer Food Service Program in any schools

within the district. Participation in these programs can

help combat food insecurity by ensuring that students

have access to nutritious snacks and meals outside of

the typical school day and during summer break.

It is recommended that students receive at least 10 minutes

to eat breakfast and at least 20 minutes to eat lunch once

they receive their meal (25) and research indicates that

students consume more of their meal and have better intake

of key nutrients when they have more than 20 minutes to

eat their lunch (45-47). Among the districts that require

or recommend that a minimum amount of time be given

to students for meals, most require or recommend that

students receive at least 10 minutes to consume breakfast,

while only 65% of districts require or recommend that

students receive at least 20 minutes to consume lunch.

Among the 80% of school districts that have the primary

responsibility for preparing foods for schools, there has

been a signicant increase since 2000 in the percentage

that are using a range of healthy food preparation

techniques including reducing the amount of salt called

for in recipes or using low-sodium recipes, reducing

the amount of sugar called for in recipes or using low-

sugar recipes, using low-sodium canned vegetables

instead of regular canned vegetables, using other

seasonings instead salt, and using part-skim or low-fat

cheese instead of regular cheese. As districts continue to

implement federal requirements for school meals, food

preparation strategies to reduce the sodium and saturated

fat content of meals will continue to be important.

SHPPS 2016 results demonstrate signicant improvements

in competitive food policies and practices. Between 2006

and 2016, there has been a signicant decrease in the

percentage of districts that receive a specied percentage of

so drink sales as well as incentives from so drink sales

(e.g., cash awards or donations of equipment) once receipts

total a specied amount. Additionally, the percentage of

districts prohibited from selling so drinks produced by

more than one company (e.g., exclusive contracts) has

decreased signicantly. e target for the Healthy People

2020 objective NWS-2.2 (increase the proportion of school

districts that require schools to make fruits or vegetables

available whenever other food is oered or sold) (3) is

18.6% and SHPPS 2016 found that 16.3% of districts

require schools to make fruits and vegetables available

whenever other food is oered or sold, up from 6.6% in

2006. While these trends are encouraging, it is important

for districts to continue to ensure that competitive foods

meet or exceed Smart Snacks in School nutrition standards.

SHPPS 2016 revealed that fewer than half of districts

prohibit schools from marketing fast food restaurants and

unhealthy foods and beverages on school grounds, on

school buses or other vehicles used to transport students,

in school publications, in curricula or other educational

materials, and through distribution of products to students.

Additionally, only 33.2% of districts prohibit schools from

selling foods and beverages that do not meet Smart Snacks

in School nutrition standards for fundraisers, and fewer

than 6% prohibit fundraiser nights at fast food restaurants.

Marketing unhealthy foods and beverages in schools sends

inconsistent messages to students about good nutrition

and healthy eating. School districts are now required to

address food marketing in the local school wellness policy

by establishing nutrition standards that allow marketing

and advertising of only those foods and beverages that

meet the Smart Snacks in School nutrition standards (31).

Providing students with access to clean, free drinking water

during the school day can help improve students’ overall

water consumption and maintain adequate hydration

(48) which aects their cognitive function (49-52). While

more than half of districts have a policy that allows

students to have a drinking water bottle with them during

the school day, more than one third of districts do not

require schools to provide drinking water to students in

the cafeteria during breakfast, and in the cafeteria during

lunch, which is required by USDA under the Healthy,

Hunger-Free Kids Act of 2010 (30). Additionally, more

than one-third of districts do not require schools to

provide free drinking water to students in other locations

including the gymnasium and hallways throughout the

school. School districts can help support water access

and encourage water consumption by ensuring that

schools regularly clean and maintain water fountains; by

periodically testing water and sharing results with students,

parents, and school sta; by helping schools implement

water promotion campaigns; and by including language

about water access in a local school wellness policy.

Results from SHPPS 2016 provide insight about

districts’ implementation of local school wellness policy

requirements. Engaging stakeholders and communicating

broadly about the wellness policy is important so that

students, parents, school and district sta, as well as

community members are aware of the policy and the

role they play in helping to implement the policy. While

more than 60% of districts engaged representatives of

the school food authority and school administrators in

the process of reviewing and revising the local wellness

policy (LWP), students, community members, or other

classroom teachers were involved in this process in fewer

than half of districts. Nearly one third of districts have not

identied anyone as responsible for ensuring compliance

with the LWP, which is required by the 2017-18 school

year (31). Almost all districts posted the LWP on the

district website, but fewer than half of districts used other

strategies to communicate about the LWP including

posting it in schools, sharing it during meetings where

parents are in attendance, and sharing it through social

media. Finally, most districts have evaluated or assessed

the implementation of their LWP, but only two thirds of

those have made the results of that evaluation or assessment

available to the public. While there has been some progress

in wellness policy strength and comprehensiveness (i.e.,

addressing required components) since the wellness policy

mandate rst went into eect during the 2006-2007 school

year, wellness policies remain weak overall (53). Districts

can continue to strengthen wellness policy language,

and focus on ensuring that wellness policy requirements

are implemented at schools within the district.

Health Services and Counseling,

Psychological, and Social Services (includes

Employee Wellness)

Despite recent a policy statement from the American

Academy of Pediatrics recommending a full-time nurse in

every school (33), SHPPS 2016 revealed that only about

one third of districts nationwide require each school

to have a full-time school nurse. Further, few districts

oer health services or counseling, psychological, or

social services through school-based health centers,

and less than half have arrangements to provide these

services to students in the district at other sites not on

school property. Indeed, trend analyses showed that the

percentage of districts with arrangements to provide several

specic services at other sites not on school property has

decreased signicantly since 2000. Taken together, these

district policies and practices create a missed opportunity

to help students obtain access to health services.

SHPPS 2016 also found that the percentage of districts

requiring schools to oer specic services varied widely

by type of service. For example, while more than 90% of

districts had adopted a policy that schools will provide

basic services such as administration of medications and

rst aid, fewer than 2% had policies requiring schools to

provide sexual health services such as testing for HIV,

STDs, and pregnancy. More districts, however, require

schools to provide referrals for these types of services,

although such policies are far from prevalent. Room for

improvement clearly exists in the support school districts

oer to help students obtain sexual health services.

In contrast, the majority of districts require schools to

provide services to students with chronic health conditions,

such as case management for students with chronic

health conditions and tracking of students with chronic

health conditions. In addition, the percentage of districts

requiring schools to provide identication or school-based

management of chronic health conditions and instruction

on self-management of chronic health conditions has

increased signicantly since 2000 and 2006, respectively.

Strategies to further support districts’ eorts in meeting

the needs of students with chronic health conditions can be

found in a series of briefs recently released by CDC (54-56).

Specic to counseling, psychological, and social

services, SHPPS 2016 found signicant improvements

since 2000 in collaboration among district-level sta

working on activities in this area. Further, since 2000, the

percentage of districts that had someone to oversee and

coordinate counseling, psychological, or social services

in the district also increased. ese improvements in

infrastructure can help better meet the counseling,

psychological, and social services needs of students.

Regarding employee wellness, SHPPS 2016 revealed

a signicant increase since 2006 in the percentage of

districts that require each school to have someone to

oversee or coordinate employee wellness programs,

as well as in the percentage that provided funding for

health risk appraisals or oered health risk appraisals for

employees. Despite these positive changes, however, the

prevalence of this requirement and this practice remain

low, which indicates areas for further improvement in

supporting wellness programs for school employees.

Healthy and Safe School Environment

(includes Social and Emotional Climate)

Districts use a variety of policies and practices to ensure

students and sta are safe from unintentional injuries.

SHPPS 2016 found that most districts have policies

related to the inspection and maintenance of school safety

systems or supplies (e.g., re extinguishers, smoke alarms,

sprinkler systems), the school building (e.g., lighting,

classrooms, halls), and physical activity facilities and

equipment. Since 2012, the percentage of districts that

required students to use hearing protection devices during

classes or activities where they are exposed to potentially

unsafe noise levels increased signicantly to 61.3%.

e Surgeon General’s Call to Action to Prevent Skin

Cancer (57) promotes policies that encourage sun

safety in schools, because not only do such policies

oer protection to students during the school day,

but they also can support broader community eorts

to reduce skin cancer risk. However, fewer than half

of districts recommended and almost no districts

required a variety of policies and practices related to

sun safety such as allowing or encouraging students

to apply sunscreen while at school and encouraging

students to wear hats or visors, protective clothing, or

sunglasses when in the sun during the school day.

Other district policies and practices address school

violence and security. Policies requiring faculty and sta

and visitors to wear identication badges at all school

levels (elementary, middle, and high school) increased

signicantly since 2006, and policies requiring high

school students to wear identication badges increased

signicantly since 2000. Likewise, policies requiring schools

at all three levels to use security or surveillance cameras

increased signicantly since 2006. District policies requiring

high school students to wear school uniforms, requiring

high schools to enforce student dress codes, and requiring

schools at all levels to prohibit gang activity (e.g., recruiting

or wearing gang colors, symbols, or other gang attire)

all signicantly increased since 2000. However, policies

requiring elementary and middle schools to assign sta or

adult volunteers to monitor school halls during classes and

requiring middle and high schools to assign sta or adult

volunteers to monitor school restrooms have decreased

signicantly since 2006. Policies requiring students in

middle and high schools to refrain from using personal

communication devices (e.g., cell phones) during the school

day decreased signicantly since 2012. Except in relatively

rare instances, schools remain safe places for students

and sta. e Task Force on Community Preventive

Services concluded that universal school-based violence

prevention programs—that is, programs administered

to all students in classrooms and not to only those

students who have already exhibited violent or aggressive

behavior or have risk factors for these behaviors—can

be eective in addressing school violence (58).

Nearly every district prohibits bullying and sexual

harassment on school property, at any location on

the way to and from school (e.g., school bus stops),

and at o-campus, school-sponsored events; 71.9% of

districts have a policy prohibiting bullying that lists (or

enumerates) groups with specic traits or characteristics.

e percentage of districts that prohibited electronic

aggression or cyber-bullying that interferes with the

educational environment (even if it does not occur on

school property or at school-sponsored events) increased

signicantly since 2012 such that nearly all districts

(93.2%) had such a policy. is increase follows increased

attention throughout the 2000s and into the 2010s to

bullying in general, but especially to electronic aggression

as schools began to struggle to balance o-campus

cyber-bullying behavior and school discipline (59, 60).

Another way to keep schools safe is to have a crisis

preparedness, response, and recovery plan. ese

plans help schools respond quickly and eciently

in a crisis (61, 62). Nearly all districts (94.6%) had

a comprehensive district-level plan to address crisis

preparedness, response, and recovery in the event of a

natural disaster or other emergency or crisis situation,

and since 2006, there has been a signicant increase in

the percentage of districts that evaluated or assessed

the district’s crisis preparedness, response, and recovery

plan during the 12 months before the study.

e percentage of districts that had adopted a student drug-

testing policy increased signicantly from 2006 to 2012

such that more than one third (37.5%) have such a program.

Although the eectiveness of such programs is controversial

(63), it is generally agreed that if testing is used, it should

not be a stand-alone drug use prevention strategy (64).

During 2000 to 2012, many tobacco-related policies

increased, such as prohibiting students from wearing

tobacco brand-name apparel or carrying merchandise

with tobacco company names, logos, or cartoon characters

on it, as well as numerous policies related to tobacco

use among faculty and sta and among school visitors.

Further, most districts prohibited the use of electronic

vapor products (e.g., e-cigarettes, e-cigars, e-pipes, vape

pipes, vaping pens, e-hookahs, and hookah pens) among

students (81.8%), among faculty and sta during any

school-related activity (77.3%), and among visitors (75.7%).

In spite of these positive tobacco-related ndings,

however, during 2006 to 2012, the percentage of districts

that provided funding for professional development or

oered professional development for school faculty and

sta on how to implement school-wide policies and

programs related to alcohol use prevention, illegal drug

use prevention, and tobacco use prevention decreased,

and the percentage of districts with a district-level council,

committee, or team that addressed alcohol or other drug use

prevention, HIV prevention, and tobacco use prevention

decreased. In 2012, 61.0% of districts had a district-level

school health council, committee, or team, but since 2000,

the percentage of districts that during the two years before

the study had provided any funding for or oered to help

schools establish a school health council, committee,

or team decreased signicantly. rough school health

councils, schools can work with community partners to

identify and nd solutions to health problems and concerns,

not just for substance use, but for any school health topic

the school and community determines to be a priority (65).

e 2015 Step it up! e Surgeon General’s Call to Action to

Promote Walking and Walkable Communities recognizes the

benets of active school transport and encourages walking

to school through community-wide approaches that

address safety concerns (66). e percentage of students

who walk or bike to school is inuenced by the distance

students live from school and school programs and policies

that support walking or biking to school (65). Despite a

signicant increase since 2006 in the percentage of districts

that support or promote walking or biking to and from

school, in 2016 only 32.9% of districts did this. Recognizing

the health benets of physical activity and the need for

more active school transport, the National Center for Safe

Routes to School provides resources related to building

a safe routes to school program that involves school and

community partners (http://www.saferoutesinfo.org).

Physical Environment

EPA developed their School Siting Guidelines (42) for

school districts considering new school construction. e

document recommends a variety of environmental and

public health factors to be considered such as community

involvement, environmental evaluation of candidate

sites and nearby environments, environmental justice,

possibilities for renovation, transportation alternatives

(e.g., walking, biking, and public transit), community

uses of the school, and costs and benets of various

design and construction decisions (42). In line with these

guidelines, SHPPS examined factors that are inuential

in deciding whether to build a new school facility rather

than renovating an existing facility, where to build a new

school facility, formal consultation policies related to

new school construction, and green building policies.

Among districts that had initiated the construction of a

school facility on a new school site during the ve years

before the study, only three factors were deemed “very

inuential” among 50% or more districts in deciding to

build a new school rather than renovate an existing school:

the need to support current or future educational programs,

the need to accommodate population growth, and the

cost of repairing the existing facility. In deciding where to

build the new school facility, the only factor deemed “very

inuential” by more than half of districts was that the site

was already owned. Among all districts, the public was

the most common group with which districts required

formal consultation or input on new school construction

(67.5%) and where to build a new school (55.8%). Finally,

although the percentage of districts that had a policy to

include green design when building new school buildings

or renovating existing buildings more than doubled since

2006, only 28.0% of districts had such a policy. Even so,

more than half of districts had adopted specic green

building policies, even if not part of a more general green

building design policy. ese specic policies included

the use of energy ecient lighting and electrical systems,

the implementation of recycling programs, and the use

of procedures or systems to protect indoor air quality.

Eventually all school districts will nd themselves faced

with a decision about renovating existing schools and

building new schools. e U.S. EPA’s voluntary School

Siting Guidelines (42) and Smart School Siting Tool (67)

can assist schools faced with the decision about where to

build a new school and oer insights into improving the

extent to which the environment and public health are

inuencing factors in school siting and building decisions.

Although the percentage of districts that had an indoor air

quality management program decreased signicantly since

2006, less than half (48.9%) of districts had such a program

in 2016, suggesting that many districts could benet from

EPA’s resources developed to help school districts and

schools address indoor air quality (68). According to EPA,

“good indoor air quality management includes control

of airborne pollutants, introduction and distribution of

adequate outdoor air, and maintenance of acceptable

temperature and relative humidity” (68). SHPPS examined

many policies related to indoor air quality and found wide

variation in how common the policies were. For example,

77.0% of districts required schools to conduct periodic

inspections of the heating, ventilation, and air conditioning

system and 71.3% required schools to conduct periodic

inspections of the building foundation, walls, and roof for

cracks, leaks, or past water damage. However, only about

one third required purchase of low-emitting products for

use around the school and on school grounds and required

schools to test for radon. Radon is a colorless, odorless

radioactive gas determined by EPA to be one of the most

serious environmental health problems facing people

today (69). EPA recommends that all schools nationwide

be tested for radon and provides resources to address

radon measurement, mitigation, and prevention (69).

Engine idling reduction programs are another way

schools can address indoor air quality. Such programs

were implemented in 49.2% of districts for buses and in

16.5% of districts for cars. Idling reduction programs are

meant to address exhaust from buses, cars, and trucks

and are an important part of both outdoor air quality

and indoor air quality because exhaust can inltrate

a school through windows, doors, and vents (70).

An integrated pest management (IPM) approach to pest

management addresses pests’ sources of food, water, and

shelter so that pest infestation is minimized or prevented

entirely, and the need for pesticides is limited (71). is

study found 87.4% of districts used an IPM approach

to pest management, though requirements for specic

IPM strategies varied considerably. SHPPS 2016 found

signicant improvements since 2006 in the percentage

of districts that provided funding for professional

development or oered professional development for

school faculty and sta during the two years before the

study on how to implement school-wide policies and

programs related to integrated pest management.

Part of a safe and healthy school environment includes

access to safe drinking water because of both the health

and academic consequences of exposure to lead or other

contaminants that can be found in school drinking water

(72). In particular, lead is of concern because even if

water enters the school site lead free, lead can leach into

school water once it comes in contact with the plumbing

materials on the school site (72, 73). Unfortunately, only

half (50.0%) of districts required schools to conduct

periodic inspections that test drinking water outlets for

lead. Less than one third of districts required schools to

test drinking water at least once per year for bacteria,

coliforms, or other contaminants. Running tap water or

“ushing” can reduce lead levels in water by removing

the water with the most lead from the drinking water

system (73), but only 18.3% of districts required

schools to ush drinking water outlets aer periods of

non-use (e.g., aer weekends or school vacations).

For many communities, not only can schools oer a safe,

accessible, and aordable place for community members

to engage in physical activity outside of school hours

(74), but they also can host a variety of student and

community social services and amenities (75). SHPPS

dened a formal joint use agreement as a formal written

agreement between the school district and another

public or private entity to jointly use or share either

school facilities or community facilities to share costs

and responsibilities. More than half (54.6%) of districts

had such an agreement that allows community members

or groups to use school facilities and 29.3% had such an

agreement allowing students to use community facilities

such as a park or recreation center. Joint use agreements

applied to a variety of uses with the three most common

being indoor recreation, outdoor recreation, and emergency

response (e.g., emergency food or shelter). ChangeLab

Solutions provides strategies to address some common

concerns schools have in implementing such agreements

such as costs, liability, security, or maintenance (74).

Because such a diverse set of strategies is needed to

keep the school environment healthy and safe, trained

personnel are critical. SHPPS found that 57.6% of districts

required a newly hired person who oversees custodial,

maintenance, and environmental issues to have any formal

training in issues related to the physical environment of

buildings and health hazards likely to be encountered

in schools. Since 2012, a signicant decrease was found

in the percentage of districts that provided funding for

training or oered training to custodial or maintenance

sta on how to reduce the use of hazardous materials.

Relatedly, the percentage of districts that had one or more

school health councils, committees, or teams that include

representatives from school maintenance sta and school

transportation sta decreased signicantly between 2012

and 2016. ese results indicate room for improvement in

the training and utilization of school maintenance sta.

Conclusion

is discussion has highlighted some of the key results

from SHPPS 2016, but the results presented in the tables of

this report provide a much more detailed view of district-

level school health policies and practices. Although these

tables provide 95% condence intervals, allowing for

quick comparisons of dierences between variables, more

sophisticated analyses of these data also are possible. ose

wanting to conduct secondary analyses can nd all datasets

and documentation at www.cdc.gov/shpps. Results in this

report will be used by CDC and others working in the

eld of school health, including state education and health

agencies, to help public school districts strengthen their

school health policies and practices, which in turn can

help improve health outcomes for the millions of young

people attending public schools in the United States.

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Appendix 1: National Reviewers

Melissa Abelev

U.S. Department of Agriculture

Marice Ashe

ChangeLab Solutions

Claire Barnett

Healthy Schools Network

Laurie Beck

Centers for Disease Control and Prevention

Nathaniel Beers

American Academy of Pediatrics

Martha Dewey Bergren

National Association of School Nurses/

University of Illinois College of Nursing

Amanda Birnbaum

Montclair State University

Kelly Bishop

Centers for Disease Control and Prevention

Mark Bishop

Healthy Schools Campaign

Anita Boles

National Organization for Youth Safety

Jessica Boyer

Sexuality Information and Education

Council of the United States

Charlene Burgeson

Let’s Move Active Schools

Rebekah Saul Butler

WISE Initiative, Grove Foundation

Tracy Caravella

University of Wisconsin - La Crosse

Dana Carr

Moringa Policy Consulting

Franck Chaloupka

University of Illinois at Chicago

Beth Chaney

East Carolina University

Jerey Charvat

National Association of School Psychologists

Marc Clark

Administration for Children and Families, U.S.

Department of Health and Human Services

Dewey G. Cornell

Curry School of Education, University of Virginia

Laura Cunlie

U.S. Department of Agriculture

Nicole Cushman

ANSWER

Linda Dahlberg

Centers for Disease Control and Prevention

Rochelle Davis

Healthy Schools Campaign

Brenda Doroski

U.S. Environmental Protection Agency

Pamela Drake

ETR Associates

Kip Duchon

Centers for Disease Control and Prevention

Gary English

Western Kentucky University

Anjie Emanuel

Council on Sports Medicine and Fitness,

American Academy of Pediatrics

Joyce Epstein

Center on School, Family, and Community Partnerships

Erima Fobbs

National Association of State Boards of Education

Tracy Fox

Food, Nutrition & Policy Consultants, LLC

Jessica Gerdes

Illinois State Board of Education

Ellie Gladstone

ChangeLab Solutions

Sherry Glick

U.S. Environmental Protection Agency

Susan Goekler

Directors of Health Promotion and Education

Emily Greytak

GLSEN

Madra Guinn-Jones

American Academy of Pediatrics

Joanne Guthrie

U.S. Department of Agriculture

Joe Halowich

SHAPE America

Cicily Hampton

Society for Public Health Education

Diane Harris

Centers for Disease Control and Prevention

Christina Hecht

University of California Nutrition Policy Institute

Jennifer Hofman

YMCA of the USA

Iris Joi Hudson

Centers for Disease Control and Prevention

Kayla Jackson

AASA, e School Superintendent’s Association

John Jereb

Centers for Disease Control and Prevention

Estell Lenita Johnson

Injury Free Coalition for Kids

Lloyd Kolbe

Indiana University (retired)

Emily Kujawa

Kujawa Consulting

Michael Lionbarger

Centers for Disease Control and Prevention

Lauren Marchetti

National Center for Safe Routes to School

Erin Maughan

National Association of School Nurses

Erin McGuire

National Farm to School Network

Jonathan Midgett

U.S. Consumer Product Safety Commission

James Morrow

University of North Texas

Linda Morse

American School Health Association

Amy Moyer

Action for Healthy Kids

Tina Namian

U.S. Department of Agriculture

Libby Nealis

NEA Healthy Futures

Blaise Nemeth

Council on Sports Medicine and Fitness,

American Academy of Pediatrics

Lydia O’Donnell

Education Development Center, Inc.

Larry Olsen

American Public Health Association

Sohyun Park

Centers for Disease Control and Prevention

Heather Parker

National PTA

Russell Pate

American College of Sports Medicine/

University of South Carolina

Olga Price

Center for Health and Health Care in Schools

Katherine Pruitt

American Lung Association

Erin Reiney

Health Resources and Services Administration

Daniel Rice

ANSWER

Ellen Schmidt

Children’s Safety Network National Resource

Center, Education Development Center

Sandra Schneider

American College of Emergency Physicians

David Schonfeld

National Center for School Crisis and Bereavement

Marlene Schwartz

Rudd Center for Obesity and Food Policy

Denise Seabert

Ball State University

Kari Senger

Alliance for a Healthier Generation

Alisa Smith

U.S. Environmental Protection Agency

Danene Sorace

WISE Initiative

Ronald Stephens

National School Safety Center

Cynthia Symons

Kent State University

Judith Teich

Substance Abuse and Mental Health Services Administration

Lindsey Turner

Boise State University

Kathleen Watson

Centers for Disease Control and Prevention

Meg Watson

Centers for Disease Control and Prevention

Mark Weist

Center for School Mental Health

Arthur Wendell

Centers for Disease Control and Prevention

Katherine Weno

Centers for Disease Control and Prevention

Wendy Weyer

School Nutrition Association

Laurie Whitsel

American Heart Association

David C. Wiley

Texas State University

Christine Wood

Association of State and Territorial Dental Directors

Margo Wootan

Center for Science in the Public Interest

CS 278248-A

For more information please contact

Centers for Disease Control and Prevention

1600 Clion Road NE, Atlanta, GA 33029-4027

Telephone: 1-800-CDC-INFO (232-4636)

TTY: 1-888-232-6348

E-mail: [email protected]ov

Web: www.cdc.gov

Publication date: August 2017