Abstract
Background:
The Whole School, Whole Community, Whole Child (WSCC) model suggests wellness councils, ongoing review of wellness policy, and a plan for evaluating set objectives are some of the key features needed to support school wellness infrastructure. This study explored the relationship between implementation of these infrastructure features and overall school wellness environment assessment scores among a sampling of Pennsylvania schools.
Methods:
The Healthy Champions program provides Pennsylvania schools an opportunity to self-assess their wellness environments across several school wellness topics. Staff enrolled their school in the program by completing a self-report electronic assessment. Enrollment data from the 20/21 program year were analyzed using the Kruskal Wallis test and Linear Fixed Model to identify the impact of varied implementation levels across three wellness infrastructure activities. Interactions between these variables and overall assessment score were also analyzed.
Results:
Of the 645 Pennsylvania schools enrolled and analyzed, we observed higher mean wellness environment assessment scores (Δ 0.74 95% CI 0.40–1.07; p<0.001) among schools that reported some frequency of all three wellness infrastructure activities, compared to schools that reported no frequency for the activities.
Implications:
Schools with existing policies and practices related to the three wellness infrastructure activities should consider the degree of implementation to best support overall wellness in their school setting. Additional research to explore implementation barriers and supports is needed.
Conclusions:
Analyses indicated that overall wellness environment assessment scores are impacted by implementation thresholds for wellness council meeting frequency, revision of wellness policy, and review of student health promotion objectives.
Keywords: School climate, Systems analysis and systems change, school health program planning, school health program evaluation
Healthy youth behaviors are linked to better academic achievement and lifetime health benefit.1–2 Because youth spend a significant amount of time in the school setting, establishing a health school environment is paramount.3–4 As such, leading health experts and agencies have developed and revised models and supportive strategies for school wellness environments over the past century; the currently accepted model is the Whole School, Whole Community, Whole Child (WSCC) model, developed by ASCD (formerly the Association for Supervision and Curriculum Development) and the Center for Disease Control (CDC) in 2014.5 The WSCC model posits a 10-component approach with a strong integration of health, safety, engagement, support, and appropriate academic challenge for school-aged youth.6–8 Importantly, the model brings together priorities of the health and education sector to put the child at the center.
Incorporated within the WSCC model, and highlighted within previous models,5 are several features identified as critical to supporting school wellness infrastructure, such as wellness councils (i.e., WSCC teams, wellness teams, school health teams), wellness policies (i.e., local school wellness policies), and an established plan for evaluating progress on set objectives.8–9
The CDC suggests schools assess their wellness environments and plan for improving student health.10 The Healthy Champions program, launched in 2013 by Penn State PRO Wellness11, was designed to provide Pennsylvania K-12 schools with a simple, high-level, free mechanism for evaluating their school wellness environment, wellness infrastructure, and student/family engagement, as explained by Francis et al.12 This program supports participating schools with resources that align to the WSCC model. Schools enrolled in the program complete a brief assessment, based on WSCC components, and are provided a tailored report identifying areas for improvement. Enrollment allows schools access to tools and low- and no-cost strategies to address areas identified for improvement, with the goal of improving school wellness environments and student health promotion.
This study summarizes data describing the overall wellness environment for Pennsylvania schools enrolled in the 2020/21 Healthy Champions program year, and the relationship between key wellness infrastructure elements (i.e. wellness councils, wellness policy, and student health promotion objectives) and overall wellness environment scores.
METHODS
Participants
K-12 schools across Pennsylvania were invited to participate in the Healthy Champions program during the 2020/21 school year. Notification of program open enrollment was distributed via our organization’s listserv of approximately 4,000 school representatives, through the Penn*Link listserv (Pennsylvania Department of Education official communication channel), and through the Pennsylvania Association of School Nurses and Practitioners official listserv. Any employee (i.e. teacher, nurse, food service professional, principal) of the school was encouraged to enroll. All school types (public, private, charter, etc.) were eligible to participate. Overlap exists between these invitation lists, however communication about the program was delivered to all 500 school districts in Pennsylvania. Some schools were re-enrollments from the 2019/2020 school year and responded through a tailored email invitation to review their previous assessment results and reenroll for the 2020/21 program year. Program enrollment opened in spring 2020 and closed at the beginning of the 2020/21 school year for the program period of September 2020 through June 2021.
Instrumentation and procedures
Program enrollment began with the completion of a school wellness environment assessment. The assessment described by Francis et al12 was revised for the 19/20 program year and beyond to have greater alignment with the holistic approach of the WSCC model. Revised assessment categories included 1) nutrition & physical activity, 2) psychological & social services, 3) school health environment, 4) school health & wellness policy, and 5) health promotion. Questions in categories 1–4 (Table 2 & Appendix A) included three response options reflecting a best, moderate/average, and needs improvement practice option. The health promotion category included an open-text field for schools to report one or more initiatives related to school health promotion. Responses in each category were used to calculate a school’s overall wellness environment score.
Table 2.
Healthy Champions Assessment Data 2020/21 Program Year – Average Scores by Assessment Category (n=645).
| Category/Questions within the categorya | Needs Improvement | Moderate/ Average | Best |
|---|---|---|---|
| 1. Nutrition & Physical Activity Category average wellness environment score 4.04 (SD = 0.91) |
|||
| Does your school offer school-sponsored intramural programs or physical activity programs for boys and girls outside of school hours (i.e. sports teams that do not require try outs or walking clubs, martial arts, etc.)? | 170 (26.4%) | 213 (33%) | 262 (40.6%) |
| Does your school identify healthier food and beverage choices with signs and/or symbols? | 132 (20.5%) | 322 (49.9%) | 191 (29.6%) |
| Out of all fund-raising efforts, how many food related fund-raising activities were held during the previous academic year? | 317 (49.1%) | 271 (42.0%) | 57 (8.8%) |
| Does your school withhold physical activity (PA) (i.e. recess) or physical education (PE) class as punishment? | 43 (6.7%) | 230 (35.7%) | 372 (57.7%) |
| Are classroom physical activity (PA) breaks utilized by teachers in your school (i.e. GoNoodle, Active Academics, open gym during lunch/study periods etc.)? | 80 (12.4%) | 210 (32.6%) | 355 (55.0%) |
| Does your school allow community members to utilize recreational equipment outside of school hours? | 173 (26.8%) | 149 (23.1%) | 323 (50.1%) |
| 2. Psychological & Social Services Category average wellness environment score 4.36 (SD= 0.86) |
|||
| Does your school educate students about their mental health (i.e. seminars, health education curriculum, information sent home, etc)? | 45 (7.0%) | 176 (27.3%) | 424 (65.7%) |
| Does your school conduct mental health screenings? | 131 (20.3%) | 436 (67.6%) | 78 (12.1%) |
| Does your school offer in-school psychological counseling for students (i.e. therapist, licensed counselor, psychologist, or social worker)? | 23 (3.6%) | 169 (26.2%) | 453 (70.2%) |
| Does your school provide any training to teachers and staff on student mental health and/or suicide? | 18 (2.8%) | 172 (26.7%) | 455 (70.5%) |
| Does your school notify students and/or parents of available mental health hotlines (Suicide Hotline, YouthSpace, Crisis Call Center, etc.)? | 76 (11.8%) | 156 (24.2%) | 413 (64.0%) |
| 3. School Health Environment Category average wellness environment score 3.71(SD= 0.93) |
|||
| Does your school educate students about vaccines or vaccine science? | 251 (38.9%) | 189 (29.3%) | 205 (31.8%) |
| Does your school educate parents about the importance of their student(s) receiving vaccinations? | 88 (13.6%) | 372 (57.7%) | 185 (28.7%) |
| Does your school offer a provisional period for students without required vaccinations to attend school? | 145 (22.5%) | 160 (24.8%) | 340 (52.7%) |
| Does your school educate students about substance use and/or abuse? | 61 (9.5%) | 272 (42.2%) | 312 (48.4%) |
| Does your school educate students about sexual health? | 167 (25.9%) | 361 (56%) | 117 (18.1%) |
| How does your school share BMI (Body Mass Index) screening results with parents? | 42 (6.5%) | 152 (23.6%) | 451 (69.9%) |
| 4. School Health & Wellness Policy Category average wellness environment score 4.02 (SD= 1.03) |
|||
| How does your school communicate with parents about school related activities? | 0 (0%) | 115 (17.8%) | 530 (82.2%) |
| How often does your school review its wellness policy? | 43 (6.7%) | 262 (40.6%) | 340 (52.7%) |
| How often does your school Wellness Council meet? | 142 (22%) | 182 (28.2%) | 321 (49.8%) |
| Does your school’s Wellness Council include members of the community in addition to school staff (i.e. parents, youth agencies, other stakeholders)? | 297 (46%) | 149 (23.1%) | 199 (30.9%) |
| How often does your school review and/or revise objectives for student health promotion? | 118 (18.3%) | 194 (30.1%) | 333 (51.6%) |
| Does your school make any health promotion programs available to employees and their families? | 114 (17.7%) | 175 (27.1%) | 356 (55.2%) |
| How often does your school partner with any outside health promotion organizations (i.e., local health department, mental health clinics, American Lung Association) to increase health education and promotion to students, families, or staff? | 118 (18.3%) | 308 (47.8%) | 219 (34%) |
See appendix A for detailed response options.
Participants completed the assessment on behalf of their school. Each school was instructed to complete one assessment. In the event two assessments were completed for one school, the program team gave priority to the participant who completed the assessment first. The duplicate entry was marked as such, and the participant was added as a secondary contact for that school. To promote collaboration, the program team sent an email communication connecting the school representatives, encouraging them to work together to implement health and wellness tools and events. For schools who reenrolled from the previous year using the tailored email invitation, respondents were provided the response details of their previous year’s assessment alongside each question for the 2020/21 assessment.
Study data were collected and managed using REDCap (Research Electronic Data Capture) hosted at Penn State College of Medicine.13–14 REDCap is a secure, web-based application designed to support data capture for research studies.
Data analysis
Average scores for each assessment category (out of 5) were calculated using response data from questions within that category (5–7 questions per category, points assigned to each response level; Appendix A). The highest possible category score was 5, the lowest was 1. Completion of the open-text health promotion category question generated an automatic score of 5 for that category. Overall wellness environment scores were calculated using scores from each of the 5 categories.
Prior to inferential statistical analysis, all variables were summarized using descriptive statistics. Kruskal Wallis tests were performed to identify observable effects on overall mean wellness environment scores (out of 5) based on frequency of meeting with wellness council (monthly/quarterly, annually/less frequently, or no wellness council exists), frequency of revising wellness policy (at least annually, bi-annually/periodically, or no wellness policy exists), and frequency of revising student health objectives (at least annually, bi-annually/periodically, or no objectives exist). These variables were removed from the overall mean score calculation prior to analysis in order to observe the differences in overall wellness environment score between the groups of variables. In addition, a linear fixed effects model was employed that included factors for all three frequency variables as well as two-way and three-way interactions to identify three-way interactions of these variables and their impact on overall wellness environment score. For this model, to allow for an appropriate number of observations per analysis category, the possible response options were collapsed to binary “some” versus “none” categories. For example, respondents that indicated convening wellness councils monthly/quarterly, or annually/less frequently were collapsed into “some”, and those who reported not having a wellness council were categorized as “none”. All analyses were performed using SAS version 9.4 (SAS Institute, Cary, NC).
RESULTS
In spring 2020, 645 Pennsylvania schools enrolled for the 2020/21 program year (Table 1) with an average assessment score of 4.2 (out of 5; SD= 0.61). Enrolled schools scored highest in the psychological & social services category (4.36/5; SD= 0.86) and lowest in the school health environment category (3.71/5; SD= 0.93), which focused on health practices and health education (Table 2).
Table 1.
Healthy Champions Program enrollment demographic data for 2020/21 program year
| Champion Title | 2020/2021 (n=645) |
|---|---|
| Nurse | 476 (74%) |
| Health/Physical Education Teacher | 57 (9%) |
| Administrator | 39 (6%) |
| Food Service | 21 (3%) |
| Other/Unknown | 52 (8%) |
| State | |
| Pennsylvania | 645 (99.4%) |
| Region of Pennsylvania | |
| Northcentral | 36 (6%) |
| Northeast | 81 (13%) |
| Northwest | 52 (8%) |
| Southcentral | 148 (23%) |
| Southeast | 208 (32%) |
| Southwest | 120 (19%) |
| School Type a | |
| Elementary | 384 (59.6%) |
| Middle | 145 (22.5%) |
| High | 132 (20.5%) |
| K-12 or multiple levels | 46 (7.1%) |
| Other/Specialty School | 30 (4.7%) |
Question allowed for more than one selection
Within each overarching category, individual question results varied (Table 2). Notably, only 8.8% of schools (n=57) reported best practices related to the utilization of food fundraisers and only 12.1% of schools (n=78) indicated best practices in mental health screening for students. In addition, nearly half (46%, n=297) of schools reported needing improvement with including members of the community on their school’s wellness council. In contrast, approximately 70% of schools reported best practices for providing in-school psychological counseling for students (n=453), providing mental health and/or suicide training for teachers and staff (n=455), and providing body mass index screening results to parents (n=451).
Relationship between wellness council, wellness policy, and student health promotion objectives, and overall wellness environment score
Schools enrolled in the 2020/21 program year with wellness councils that meet monthly or quarterly had higher overall wellness environment scores (4.41 95% CI 4.35–4.47) as compared to schools who meet annually or less frequently (4.09, 95% CI 4.00–4.18; p<.001), or did not report having a wellness council (3.85, 95% CI 3.76–3.93; p<.001). Schools who reviewed annually or less frequently also had wellness environment scores that were significantly higher than those who did not report having a wellness council (p<.001).
Enrolled schools that reported reviewing their wellness policy at least annually had higher overall wellness environment scores (4.32 95% CI 4.26–4.39) as compared to schools who review every other year or less (4.10 95% CI 4.03–4.17; p<.001), or did not report having a wellness policy (3.74 95% CI 3.55–3.94; p<.001). Schools who review every other year or less frequently also had wellness environment scores that were significantly higher than those who did not report having a wellness policy (p=.0012).
Enrolled schools that reported reviewing or revising objectives for student health promotion at least annually had higher overall wellness environment scores (4.39 95% 4.33–4.45) when compared to schools who review every other year or less frequently (4.16 95% CI 4.08–4.24; p<.001), or did not report setting objectives (3.61 95% CI 3.61–3.81; p<.001). Schools who review every other year or less frequently also had wellness environment scores that were significantly higher than those who did not report setting objectives (p<.001).
Interaction of wellness council, wellness policy, and student health promotion objectives
We observed a significantly higher mean score (Δ 0.74 95% CI 0.40–1.07; p<.001) for 2020/21 program year schools that reported having some frequency of all three wellness infrastructure activities (i.e., meeting with a wellness council, reviewing wellness policy, and revising student health promotion objectives), as compared to schools who reported no frequency for the activities (Figure 1, Table 3). Having some frequency of all three activities also resulted in significantly higher mean scores than only having some frequency of revising wellness policy (Δ 0.65 95% CI 0.39–0.92; p<0.0001) or only having some frequency of meeting with a wellness council (Δ 1.10 95% CI 0.26–1.94; p=.002). However, having some frequency of all three activities did not result in significantly different mean scores when compared to schools who only reported some frequency of revising student health promotion objectives (Δ 0.18 95% CI 0.31–0.68; p=0.948).
Figure 1.
Mean Score by Combination of Wellness Council, Wellness Policy, and Student Health Objective Activities for 2020/21 Program Year.a
WC=Wellness Council; WP=Wellness Policy; HO=Student Health Objectives
aCalculated using adjusted overall wellness environment score after removing variables measuring wellness council, wellness, policy, and student health objectives.
Table 3.
Comparison of mean overall wellness score for combinations of Wellness Council, Wellness Policy, and Health Objectives for 2020/21 Program Year (N=645)
| Combination 1 | Combination 2 | Difference of means (95% CI)a | P-value | ||||
|---|---|---|---|---|---|---|---|
| Wellness Council | Wellness Policy | Health Objectives | Wellness Council | Wellness Policy | Health Objectives | ||
| None | None | None | None | None | Some | −0.55 (−1.14, 0.03) | 0.083 |
| None | None | None | None | Some | None | −0.08 (−0.50, 0.34) | 0.999 |
| None | None | None | None | Some | Some | −0.37 (−0.76, 0.03) | 0.086 |
| None | None | None | Some | None | None | 0.37 (−0.54, 1.27) | 0.922 |
| None | None | None | Some | None | Some | −0.38 (−2.10, 1.33) | 0.997 |
| None | None | None | Some | Some | None | −0.21 (−0.62, 0.21) | 0.797 |
| None | None | None | Some | Some | Some | −0.74 (−1.07, −0.40) | <.001 |
| None | None | Some | None | Some | None | 0.47 (−0.08, 1.02) | 0.158 |
| None | None | Some | None | Some | Some | 0.18 (−0.35, 0.71) | 0.967 |
| None | None | Some | Some | None | None | 0.92 (−0.05, 1.89) | 0.080 |
| None | None | Some | Some | None | Some | 0.17 (−1.58, 1.92) | 1.000 |
| None | None | Some | Some | Some | None | 0.34 (−0.20, 0.89) | 0.538 |
| None | None | Some | Some | Some | Some | −0.18 (−0.68, 0.31) | 0.948 |
| None | Some | None | None | Some | Some | −0.29 (−0.62, 0.05) | 0.158 |
| None | Some | None | Some | None | None | 0.45 (−0.43, 1.33) | 0.780 |
| None | Some | None | Some | None | Some | −0.30 (−2.00, 1.40) | 0.999 |
| None | Some | None | Some | Some | None | −0.12 (−0.48, 0.23) | 0.965 |
| None | Some | None | Some | Some | Some | −0.65 (−0.92, −0.39) | <.001 |
| None | Some | Some | Some | None | None | 0.73 (−0.13, 1.60) | 0.168 |
| None | Some | Some | Some | None | Some | −0.02 (−1.71, 1.68) | 1.000 |
| None | Some | Some | Some | Some | None | 0.16 (−0.17, 0.49) | 0.815 |
| None | Some | Some | Some | Some | Some | −0.37 (−0.60, −0.14) | <.001 |
| Some | None | None | Some | None | Some | −0.75 (−2.63, 1.13) | 0.928 |
| Some | None | None | Some | Some | None | −0.57 (−1.45, 0.30) | 0.493 |
| Some | None | None | Some | Some | Some | −1.10 (−1.94, −0.26) | 0.002 |
| Some | None | Some | Some | Some | None | 0.18 (−1.52, 1.88) | 1.000 |
| Some | None | Some | Some | Some | Some | −0.35 (−2.03, 1.33) | 0.998 |
| Some | Some | None | Some | Some | Some | −0.53 (−0.79, −0.27) | <.001 |
Differences of means, confidence limits, and p-values from a 3-way interaction between wellness council (None, Some), wellness policy (None, Some), and Health Objectives (None, Some) included in a linear fixed effects model for star score.
DISCUSSION
For schools who enrolled in the Healthy Champions program, analysis indicated association between key practices (wellness policy, wellness council, health promotion objectives) and increased overall wellness environment assessment results. Schools that reported holding monthly or quarterly wellness council meetings, annually reviewing school wellness policy, and annually revising student health promotion objectives generally performed better across the assessed WSCC domains. These practices align with several strategies promoted by Raspberry et al.5 as integral to the infrastructure of WSCC implementation.
The CDC describes one to three years as a common timeframe for wellness policy review, but final determination on review timing is managed by each state.15 In Pennsylvania, policies are required to be reviewed and revised every three years.16 Results from our program indicate that annual reviews are associated with higher overall assessment scores, but schools who make it a priority to review on any regular interval had higher scores than those who did not report having a wellness policy. We saw similar trends for schools who review or revise objectives for student health promotion. Reviewing annually resulted in the highest scores, though reviewing on any interval resulted in significantly higher scores than those schools who did not report setting objectives.
There is substantial literature describing the importance of school wellness councils.5, 17 Though, less guidance is available to schools on the frequency of council meetings or strategies for implementation activity. In our program, schools who reported meeting monthly or quarterly with their wellness councils exhibited higher overall wellness scores. The data also highlighted that meeting only annually had some positive impact.
School wellness councils provide infrastructure in terms of human capital and time to assess wellness environments (i.e., the Healthy Champions assessment), plan implementation of supportive activities, and evaluate progress. However, schools who reported completing activities with the wellness council infrastructure (i.e., policy review and student health promotion objectives) experienced an additive effect of higher overall scores. The data suggests that of the three activities, having some frequency of meeting with a wellness council contributes the least of these three activities toward overall assessment score, while having some frequency of revising student health objectives is most impactful even if schools have some of all three activities (Figure 1).
Collectively, these data support previous suggestions for schools to implement and convene wellness councils, set and regularly review wellness policy, and form actionable objectives for student health promotion.5, 8 However, they also indicate areas for improvement in the guidance available to schools for implementing these strategies. First, more is better. Frequent wellness council meetings provide dedicated time to discuss and assess the school wellness environment, and develop guiding documents, such as wellness policy and action plans for student health promotion. Regular meetings also create accountability in the time-strapped world of education. Because schools also experience teacher turnover at about 16%, both from teachers changing schools and leaving the profession18, active councils may weather the storm of departing and incoming council members better than councils that meet less frequently. Similarly, a more frequent review of policy can create a regular reminder of the intended school wellness environment.
Finally, and perhaps most importantly, more emphasis is needed on the value of goal setting and action planning for school wellness improvements to help schools move from understanding their school wellness needs to implementing strategies that will improve student health outcomes, alongside their academic priorities. Rooney and colleagues described the importance of assessing implementation of policies and progress on wellness program goals.19 Schools enrolled in the Healthy Champions program receive a tailored score report with a summary of their performance in the five assessment categories related to the WSCC model (wellness environment score). The score report describes specific areas of improvement based on the categories with the lowest scores, providing a springboard from which schools can initiate actionable plans, supporting a school’s future growth and development. Reviewing the results from the tailored school report is most effective within the context of a health or wellness council who can create meaningful and measurable objectives for improvement in future school years.20–21
Results can also be used by schools to satisfy assessment requirements for additional education funding. The Every Student Succeeds Act of 2015 elevated the importance of physical and mental health in the education arena by integrating health and physical education into the category of a “well-rounded education”, making those topics eligible for certain types of education funding.22–23 It should be noted, though, that while several national health and wellness organizations released information to encourage schools to include wellness strategies in school improvement plans, the conversation has effectively stalled with few resources having been updated in the last several years.24–25 Supporting schools in their endeavors to both assess and use assessment information to develop actionable priorities is an important consideration for organizations in the school health promotion space.
Implications for School Health Policy, Practice, and Equity
Results of this study suggest a relationship between key school wellness infrastructure components and improved wellness environments. Schools who have existing policies and practices related to wellness councils, policies, and goals for student health objectives may wish to consider the degree of implementation to best support overall wellness in their school setting. In addition, schools should consider existing opportunities to leverage wellness assessment results to secure support (monetary and non-monetary) for ongoing wellness environment improvements.
These data also present an opportunity to further explore an impact on practice. The suggested relationship between key wellness infrastructure elements does not expose the multitude of other school environment factors and barriers to implementation. Additional implementation research and associated methodologies are necessary to fully explore the implications of this work.
Limitations
Our study acknowledges several limitations. First, the data reported represents only Pennsylvania schools, though schools across all fifty states are eligible to enroll in the program. Pennsylvania-specific guidance and policy for school wellness environments may not be compatible with policy in other states. Schools interested in applying the findings from this study should consult their own state’s guidance in concert with this data. Additionally, the data reported is unstandardized for certain school environment factors, such as the presence of a full-time school nurse or the socioeconomic status of the school and its community. The collection of licensure data of our school contacts and additional demographic data about each enrolled school in future program years will allow for more detailed analyses in the future. In addition, the linear fixed effects modelling required collapsing assessment data into binary “some” versus “none” categories by combining “best” and “moderate” categories. There is the potential for masking of effect size using this strategy. Finally, we would be remis if we did not acknowledge that the 2020/2021 school year occurred during the COVID-19 pandemic. The pandemic resulted in changes to school day structure and medium of instruction (i.e. online, hybrid or in-person) and thus may have impacted the development and implementation of overarching wellness infrastructure. Despite these limitations, the Healthy Champions program provides insight into the practices of a large number of Pennsylvania schools and clarity on which practices are associated with stronger school wellness environments. This information will be useful for schools in Pennsylvania and is scalable nationally, as schools and supporting organizations consider opportunities for improving whole-child success.
CONCLUSIONS
The Healthy Champions program provides schools an opportunity to assess their school wellness environments at a high level, but additional resources may be needed to translate assessment findings into actionable plans for improved student health outcomes. In addition, results from this study indicate that there are thresholds for wellness council meeting frequency, revision of wellness policy and review of student health promotion objectives that associate with higher overall wellness environment assessment scores. The development of additional resources and support opportunities for schools in these areas are warranted, in addition to further research exploring barriers and supports for implementation.
Supplementary Material
Acknowledgements:
Funding for the Healthy Champions program was received, in part, through both the Highmark Foundation and Children’s Miracle Network. Data capture, management, and analysis was supported by the National Center for Advancing Translational Sciences, National Institutes of Health, through Grant UL1 TR002014 and Grant UL1 TR00045. The content is solely the responsibility of the authors and does not necessarily represent the official views of the NIH.
HUMAN SUBJECTS APPROVAL STATEMENT
The Healthy Champions program was reviewed and deemed “not human subjects research” by the Penn State College of Medicine Institutional Review Board.
Footnotes
CRediT author statement:
Alicia Hoke: Methodology, Investigation, Data Curation, Writing – Original Draft, Writing – Review & Editing, Visualization, Project Administration; Chelsea Keller: Investigation, Data Curation, Writing – Review & Editing; Caroline Grimm: Writing – Review & Editing, Visualization; Erik Lehman: Validation, Formal Analysis, Writing – Review & Editing, Visualization; Deepa Sekhar: Writing – Review & Editing, Supervision, Project Administration, Funding Acquisition.
CONFLICT OF INTEREST DISCLOSURE STATEMENT
Authors do not have conflicts of interest to disclose.
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