Michael & Susan Dell Center for Healthy Living, The University of Texas Health Science Center at Houston (UTHealth), Austin, TX 78701, USA.
Center for Medical Ethics & Health Policy, Baylor College of Medicine, Houston, TX 77030, USA.
Int J Environ Res Public Health. 2022 Apr 20;19(9):4979. doi: 10.3390/ijerph19094979.
Schools signal health priorities through policies. Using a repeated cross-sectional study design, we compare the presence and strength of policies related to four topics-physical activity, nutrition, mental health, and bullying-described in elementary school Campus Improvement Plans (CIPs; also called school improvement plans) within Texas, across four Texas Public Health Regions (PHRs), and between 2016 and 2020. CIPs were collected using a multi-stage probability-based survey approach, scored using an adapted WellSAT tool, and analyzed to determine associations between PHR or year and health topic. Across 170 CIPs, bullying was the most frequently addressed topic, followed by mental health, physical activity, and nutrition. On average, schools addressed 2.7 ± 1.3 topics within their CIP; 38.2% of schools addressed all four, 26.5% addressed three, 12.4% addressed two, 15.3% addressed one, and 7.6% addressed none. CIPs in the same district had high levels of clustering (ICCs = 0.28-0.55). The mostly rural Panhandle PHR included the fewest topics in their CIPs and used the weakest policy language. Between 2016 and 2020, there was a decrease in the proportion of CIPs that addressed nutrition; the strength of language for mental health and bullying also decreased. Regional and time trends reveal opportunities for more robust school health policy interventions.
学校通过政策表明健康重点。我们采用重复的横断面研究设计，比较了德克萨斯州四个德克萨斯州公共卫生区域（PHR）内小学校园改进计划（CIP；也称为学校改进计划）中与四个主题相关的政策的存在和力度——身体活动、营养、心理健康和欺凌，并在 2016 年至 2020 年之间进行了比较。使用多阶段基于概率的调查方法收集 CIP，使用经过改编的 WellSAT 工具进行评分，并进行分析以确定 PHR 或年份与健康主题之间的关联。在 170 个 CIP 中，欺凌是最常涉及的主题，其次是心理健康、身体活动和营养。平均而言，学校在其 CIP 中解决了 2.7 ± 1.3 个主题；38.2%的学校解决了所有四个问题，26.5%的学校解决了三个问题，12.4%的学校解决了两个问题，15.3%的学校解决了一个问题，7.6%的学校一个问题都没有解决。同一地区的 CIP 聚类程度很高（ICC = 0.28-0.55）。大部分农村的 Panhandle PHR 在其 CIP 中涉及的主题最少，使用的政策语言也最弱。在 2016 年至 2020 年期间，解决营养问题的 CIP 比例有所下降；心理健康和欺凌问题的语言力度也有所下降。区域和时间趋势揭示了更有力的学校健康政策干预的机会。
