Family & Community Students & Families
Student Support, Career & Education Services

Health Protection Fund - Year V: 1998

Appendix

School districts were asked to indicate how student behaviors in the areas of tobacco use, alcohol use, drug use, and engaging in physical violence had changed over the four years of the Health Protection Fund (HPF) from 1993 to 1997. Categories of greatly decreased, slightly decreased, slightly increased, greatly increased, or stayed the same were self-chosen by districts for each of the four behaviors. The slightly and greatly categories were combined, thus three groups of decreased, stayed the same, and increased were formed and are called CHANGE GROUPS. Only districts having accurate information on the change in behavior were included in these analyses (113 or 39%). As averaged across all behaviors, twenty-five percent of these districts reported decreases, thirty-five percent reported behaviors stayed the same, and forty percent reported increases. As districts could indicate change for each behavior separately, different patterns emerged on direction of change.

The main body of the report focuses on the differences in health education program implementation between the districts that reported that student behaviors decreased or increased. Following this section of the appendix, the stayed the same group is compared to the increased and decreased groups on program practices. Data from these program implementation practices came from the1996 School Health Education Profile (SHEP) developed by CDC and completed by randomly selected lead health teachers and principals and the 1997 Telephone Interview Project (TIP) developed by Health, Safety and Student Support Services at the Department of Elementary and Secondary Education completed by health coordinators. The change group data came from the TIP and was based on data collected at the district level to provide needs assessment information for yearly HPF grant applications.

A prerequisite to analyses was that a match be present between change group status and having responded to each particular question on the TIP or SHEP. This resulted in different size groups (Ns) and sometimes groups of small size. Multivariate analyses were done first and interactions among variables ruled out. Consequently, univariate analyses were used to study relationships in the data. The influence of two demographic variables, amount of Health Protection Fund monies and type of community (rural, suburban, urban), on change group were checked. There was no relationship with money, but a relationship between type of community and tobacco on some of the SHEP items was present. The relationship was between urban and suburban and urban and rural, but not between suburban and rural; therefore, suburban and rural districts were combined. To control for the influence of this demographic variable on the tobacco change group, analyses for these items were done within the two types of community (urban and suburban/rural) on those seven SHEP items where it was applicable. Analyses revealed the relationships between program practices and student behavior held in four cases for urban districts, but not suburban/rural; and in three cases for suburban/rural districts, but not urban.

Overall statistical tests of the relationships between the items on the instruments and the change groups were conducted first. If a relationship was present, statistical follow-up tests to determine differences between the decreased group and the increased group on that item of the instrument were carried out. The TIP was analyzed using anova, with post-hoc comparisons follow-up. Two questions on the TIP were treated with a factor analysis and then the above procedure applied. The SHEP was analyzed using independent samples t-test, with binomial comparisons follow-up.

For follow-up tests to determine differences between the change groups; for the TIP, a statistically significant relationship represents a higher mean for one group compared to the other group on that program practice. For the SHEP, a statistically significant relationship represents that one group was implementing a particular program practice in a proportion that was significant and the other group was not implementing that same practice in a proportion that was significant.

The majority of the statistically significant relationships were with the SHEP. The statistical tests chosen are very robust to threats of data normality. For the binomial test on the SHEP (used for almost all the analyses), the only assumption, randomization, was met. The binonmial test is also able to handle variations in N sizes. Additionally, for all analyses on both the SHEP and the TIP, the results generated using the more conservative unequal variances are reported. The 1996 SHEP report is available at the Department's web site: www.doe.mass.edu. The TIP results are presented at the end of this Appendix.

The nature of this study is exploratory. These findings represent associations and do not answer questions of cause and effect. All the program practices investigated in the evaluation are naturally occurring as a part of local level implementation of comprehensive school health education. Therefore, context validity is enhanced as the decreases in risk behavior are associated with programs already in place as opposed to implementations that were put into place expressly for the purpose of evaluation.

A statement of the relationship between the risk behavior and the health education program practice is presented and followed by a table with the following information: Behavior: The risk behavior that the program component is referencing.
Instrument: The name of the instrument and the question that represents the program practice.
Proportion or Mean: The proportion is the number of schools in each of the Change Groups answering yes to implementing the program practice (the proportion that answered no is the remainder adding to 100). The mean is the district's average score derived from adding responses and dividing by the number of cases.
N: The number of cases (schoolsfor SHEP, districts for TIP).
Significance: The significance level gives an assurance that the finding did not occur by chance. The actual p value (probability that the finding is by chance) is given as well as asterisk(s) to indicate the range of probability. The lower the p value, the less likely the finding is by chance. The majority (17 out of 23, 76%) of the findings were significant (p = .05). A FEW (SIX OUT OF 23, 24%) SELECTED MARGINAL RELATIONSHIPS (p = .06 to .10) are presented where especially relevant. For proportion, when a high enough number of the respondents said yes compared to saying no to that practice being in place, the difference was significant. While each change group was implementing that component, one group was doing it to a significantly or marginally significantly greater degree. The p value reported is for the group presented first in the table; showing that after finding overall significance for a relationship between that program practice and change group status, that group was implementing that program practice to a statistically significant degree while the p value for the other group is non-significant and is not shown. Further, it is the group with the significant p value that is driving the overall significant relationship.

Health Curriculum Framework

Locally required to use state health curriculum framework (suburban and rural districts but not urban)**

Combined lack of district and non-health staff support as less of an obstacle to implementing the health curriculum framework*

Combined lack of time for curriculum planning and scheduling of courses as less of an obstacle to implementing the health curriculum framework*

Required a health education course for graduation or promotionmar

More hours per year ofrequired middle school health education (6th through 8th grades)*

More hours per year of received high school health education (9th through 12th grades)mar

Taught health as courses divided between health education and one other subject (such as health education and physical education)mar

Higher percentage of the health curriculum that is commercially developedmar

Used trained peer educatorsmar

Used trained peer educators to teach about health in conflict resolution or mediation sessions***

Used trained peer educators to teach about health in assembly programs*

Used trained peer educators to teach about health in discussion or support groups***

Students represented on the school health advisory council**

Students represented on the school health advisory council (urban districts but not suburban or rural)*

Parents participate in health education curriculum development and review to involve them in health education****

Sent educational materials to parents to involve them in health education**

Included parents in homework assignments to involve them in health education (urban districts but not suburban and rural)**

Included parents on the school health advisory council to involve them in health education (suburban and rural districts but not urban)**

Health education teachers plan or coordinate health-related projects or activities with school counseling or psychological services**

Health education teachers plan or coordinate health-related projects or activities with physical education teachers (urban districts but not suburban and rural)mar

Health education teachers plan or coordinate health-related projects or activities with school health services (urban districts but not suburban and rural)*

Included community-based organizations on the school health advisory council*

Stayed the Same Group
The Stayed the Same Group was more like the Decreased Group in half of the relationships presented above and more like the Increased Group in half of the relationships. This group is holding steady in light of the increases nationally and locally seen in participation in risk behavior. They are implementing many, but not all of the same health education components to a similar degree as the Decreased Group.

How the Stayed the Same Group is like the Decreased Group:
As does the Decreased Group, the Stayed the Same Group is implementing the local requirement to use the state health curriculum framework, is providing a higher number of high school hours received (not required), has strong peer and student participation, and involves parents and the community on the school health advisory council. (See table below for specific questions).

How the Stayed the Same Group is like the Increased Group: While the program components are in place, they are not in place to as high a degree as the Decreased Group. Similar to the Increased Group, the Stayed the Same Group does not require health for graduation or promotion, divides health among subjects, uses fewer commercially developed health curricula, is weaker with respect to parent and school involvement outside of school advisory council, has less peer involvement, and has more obstacles to implementing the health curriculum framework. (See table below for specific questions)

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