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Many schools have been in the health care reform business for several years. Throughout the U.S., state departments of education and school boards are emphasizing comprehensive school health programs to provide health education and services. The goal is to keep students healthy, prevent those behaviors that are leading causes of morbidity and mortality, and promote behaviors that lead to healthy lives. At the federal level, comprehensive school health education programs have been integrated into the national education goals under Public Law 103-446 passed in May, 1994. Programs under this law were mandated to ensure that all students receive quality comprehensive school health education by the year 2000.

Providing for the health needs of students is a special challenge for health care reform. Appropriate instruction of our children gives us a perfect medium in which to stress prevention education. This effort will lower future health care costs by means of early diagnosis, treatment, and modification of health risk behaviors.

The Centers for Disease Control and Prevention (CDC) is one of the federal agencies that works with both state departments of education and health agencies for funding and implementation of prevention education. The CDC has identified six of the most common health risk behaviors to target in adolescents in school health programs. It has provided support and funding to 10 state departments of education to establish a comprehensive school health program (CSHP) to integrate efforts to reduce risk behaviors in each of the following six categories: Behaviors that cause unintentional and intentional injuries; drug and alcohol use; sexual behaviors that encourage sexually transmitted diseases (STD's), including HIV infection, or lead to unintended pregnancies; tobacco use; inadequate physical activity; and dietary patterns that cause disease.

Each of these six behaviors should be addressed by eight identified components to ensure proper preventative health education. The following components should be addressed in each state's comprehensive school health program: health education; health services; biophysical and psychosocial environments; counseling, psychological and social services; integrated efforts of schools and communities to improve health; food service; physical education and physical activity; and health programs for faculty and staff.

Whereas the health problems of young children are often related to the conditions of their mothers and families, the leading causes of death among adolescents--injuries from motor vehicle crashes, suicide, and homicide-are mainly the result of adolescents' risk-taking behaviors. Other health problems such as sexually transmitted diseases, teenage pregnancies, substance abuse and injuries are often a result of risk behaviors, and are more common among adolescents than among younger children or adults. Similarly, many diseases and other illnesses experienced later in life are a result of behaviors begun during adolescence such as smoking, lack of exercise, and poor diet. . .

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