The prevention and control of chronic diseases remains an important public health issue due to their contribution to worldwide morbidity and mortality and the considerable social and economic costs associated with these conditions. Early adolescence is a critical period for fostering healthy habits associated with chronic disease prevention, including physical activity and eating a healthy diet. Physical activity and diet are frequent targets of school-based public health programs because early adolescents spend a large portion of their time in the school setting and are shaped by processes in this social context. However, current trends in public education have resulted in the de-prioritization of issues not directly related to school accountability and academic achievement. As such, health promotion efforts are often cobbled together in non-institutionalized ways and there is incomplete understanding of the influence of the broader school health environment on early adolescents’ health behaviors.
Using a mixed methods approach, three separate but related studies were conducted in order to understand the relationship between the school health environment and early adolescent health behaviors related to long-term chronic disease prevention. The research was guided by the Biopsychosocial Model of Adolescent development, Ecological Systems Theory, and the life course perspective, focusing on both individual and contextual factors that shape behavior.
The first study examined changes in and determinants of early adolescents’ physical activity and dietary behaviors during middle school. This study used quantitative, longitudinal data (i.e., surveys conducted during students’ 7th and 8th grade years) from Project SHAPE, a school-based intervention study. In general, this study found that participation in daily physical activity and consumption of fruits and vegetables was low in both seventh and eighth grade. In addition to the low rates themselves, declines in physical activity and diet quality during this period were also a cause for concern. This study found, on average, a 7.2% decline in the number of days of 60 minutes of physical activity among girls, a 5.3% decline in the number of days of muscle-strengthening physical activity among boys, and a 17% decline in the number of days of muscle-strengthening physical activity among girls. Individual- and school-level factors helped to explain the changes in physical activity and dietary behaviors from seventh to eighth grade found in this study.
Using the same Project SHAPE data from 8th grade only, the second study examined the relationship between the perceived school health environment and early adolescents’ physical activity and dietary behaviors. This study found that few eighth grade students met recommendations for daily or muscle-strengthening physical activity, that intake of fruits and vegetables was also below recommendations, and that intake of unhealthy food items (i.e., soda, diet soda, sugar-sweetened beverages, salty snacks, sweets, and fast food) was high relative to healthy food intake. Differences in these behaviors were observed by individual- and school-level factors. On average, students’ perceptions of the school health environment were quite low (3.9 out of 9), suggesting that they did not find the environment to be supportive of healthy behaviors. No individual factors were found to be associated with these perceptions in this study. More positive perceptions of the school health environment were associated with a higher likelihood of meeting the muscle-strengthening physical activity recommendation and marginally associated with a higher likelihood of meeting the daily physical activity recommendation. Depending on the level of meal program participation at the school, more positive perceptions of the school health environment were also associated with higher intake of fruit and vegetables, but were not associated with intake of unhealthy food items.
The third study investigated educators’ perspectives on the ways in which schools influence the health of early adolescents. This study used additional qualitative data collected from staff and administrators from the same Project SHAPE study schools. Several of the findings of this study were related to the perception that students today are growing up in a “different world” than the one interviewees themselves had experienced in childhood and adolescence, and these perceptions factored into the ways in which interviewees conceptualized health and safety at school. For example, interviewees described observing high levels of stress, anxiety, and trauma among their student populations. Interviewees described an increase in conversation or action around mental health and social emotional learning in their schools; however, there were also several examples of ways in which health promotion was de-prioritized at the school, even for administrators who strongly believed it was important. Physical education (PE) and provision of food at school were by and large viewed as the two main sources of health promotion in the school. However, interviewees also brought up a plethora of issues associated with PE and school meals, such as having class time taken away from PE or students not liking the food provided. Overall, interviewees felt that in an ideal world, health promotion would be naturally and implicitly woven in to the culture and mission of the school.
Findings of the three studies contribute to our understanding of the school health environment, including the ways in which both physical and social aspects of the environment are associated with early adolescents’ health behaviors.