Health and Safety Issues

Coordinated School Health has compiled information and resources about important health and safety topics, available below.

Asthma is a chronic inflammation of the airways with reversible episodes of obstruction, caused by an increased reaction of the airways to various stimuli. Asthma breathing problems usually happen in "episodes" or attacks but the inflammation underlying asthma is continuous.

Asthma is one of the most common chronic disorder in childhood, currently affecting an estimated 7.1 million children under 18 years; of which 4.1 million suffered from an asthma attack or episode in 2009.

An asthma episode is a series of events that results in narrowed airways. These include: swelling of the lining, tightening of the muscle, and increased secretion of mucus in the airway. The narrowed airway is responsible for the difficulty in breathing with the familiar "wheeze".

Asthma is characterized by excessive sensitivity of the lungs to various stimuli. Triggers range from viral infections to allergies, to irritating gases and particles in the air. Each child reacts differently to the factors that may trigger asthma, including:

  • respiratory infections, colds
  • allergic reactions to allergens such as pollen, mold, animal dander,
  • feathers, dust, food, and cockroaches
  • exposure to cold air or sudden temperature change
  • cigarette smoke
  • excitement/stress
  • exercise

Source: American Lung Association Website 3-3-2011 “Asthma and Children Fact Sheet”

Additional Information

According to the Centers for Disease Control and Prevention (CDC), efforts to improve child and adolescent health have typically addressed specific health risk behaviors, such as early initiation of sexual intercourse, tobacco use or violence. However, results from a growing number of studies suggest that greater health impact might be achieved by also enhancing protective factors that help children and adolescents avoid multiple behaviors that place them at risk for adverse health and educational outcomes.

Protective factors are individual or environmental characteristics, conditions, or behaviors that reduce the effects of stressful life events. These factors also increase an individual’s ability to avoid risks or hazards, and promote social and emotional competence to thrive in all aspects of life, now and in the future.

Additional Information

For the first time in our country’s history, the next generation is expected to have a shorter life span than the current one. This prediction is based on the fact childhood obesity is at unprecedented levels nationwide. Tennessee has the third highest rate of pediatric obesity in the United States and ranks 44th among the 50 states in health outcomes for its adult populace. Since health habits learned during the formative years are crucial to preventing negative health outcomes later in life, early intervention among school-aged youth is necessary and essential in reducing these alarming trends.

The Centers for Disease Control and Prevention define childhood “obesity” as those children who are in the 95th percentile of all children’s combination of weight and height measurements. Children who are defined as “overweight” include children who are in the 85th to the 95th percentile of all children measured.

Tennessee is reversing the trend of childhood obesity. Excess weight is still very common among the state’s youth, however over 8,000 fewer children were classified as overweight and obese in 2008-2009 compared to the previous year.

The prevalence of overweight and obesity among the state’s children dropped from 40.9% to 39.0%.

Why is childhood overweight and obesity a concern?

Overweight and obese students face immediate health problems, such as high cholesterol, hypertension, Type 2 diabetes, insulin resistance, polycystic ovary syndrome, as well as emotional issues. Excess weight in adolescence carried into adulthood also predisposes youth for serious adult health risks such as coronary disease, stroke, gallbladder disease, some types of cancer and osteoarthritis of the weight–bearing joints. (Source: US Surgeon General, The Surgeon General’s Call to Action to Prevent and Decrease Overweight and Obesity, 2001)

Although the “bottom line” for weight gain is consuming more calories than one expends, obesity is a chronic disease with multiple factors contributing to its prevalence. The increase in obesity among children and youth is linked to environmental and social conditions and poor nutritional habits.

  • Consumption of a high fat, high calorie diet
  • Ever-increasing portion sizes
  • Overindulgence or reliance on “fast foods”
  • Skipping breakfast and lunch and eating the majority of calories at night
  • Eating when anxious or depressed for mood control (“food as friend”)
  • Eating in association with sedentary activities, such as watching television
  • Decreased physical activity (“couch potatoes”)*

* Source: National Institute of Diabetes and Digestive and Kidney Diseases, Take Charge of You Health: A Teenager’s Guide to Better Health (2000)

Resources & Additional Information

In April 2013, Tennessee became the 44th state to pass a sports concussion law designed to reduce youth sports concussions and increase awareness of traumatic brain injury. The legislation has three key components:

  1. To inform and educate coaches, youth athletes and their parents and require them to sign a concussion information form before competing.
  2. To require removal of a youth athlete who appears to have suffered a concussion from play or practice at the time of the suspected concussion.
  3. To require a youth athlete to be cleared by a licensed health care professional before returning to play or practice.

Read more at the Tennessee Department of Health's website.

Prevention oral health is integral to general health and means much more than healthy teeth. Several areas of concern are:

  • Good nutrition and diet habits: Many teens are not receiving the benefits of fluoridated water because they are drinking bottled water, and sugared carbonated sodas and sports drinks may contribute to tooth decay.
  • Oral piercing: Oral piercing can cause infection, chipped or cracked teeth and interference with dental x-rays.
  • Tobacco use: Using spit tobacco, also known as “chew” or “smoke” can result in gum recession, tooth decay, oral lesions and oral cancers as well as nicotine addiction.
  • Sports injuries and protective mouth gear: About one third of all dental injuries and approximately 19 percent of head and face injuries are sports-related.
  • Eating disorders: Anorexia and bulimia also can result in damage to teeth. Poor nutritional intake associated with anorexia means a loss of calcium. Stomach acids from the constant vomiting symptomatic of bulimia erode the enamel on the teeth.

Experts have suggested the following steps as a start to improving access to oral health services for adolescents:

  • Improve access to dental care by expanding preventive care to poor inner-city and rural youth through school-based programs.
  • Improve Medicaid coverage for patients and reimbursements for dentists, and provide incentives for dentists to practice in underserved areas.
  • Extend dental office hours or provide an on-call service to answer questions.

Additional Resources

Diabetes is a disease in which the body does not produce or properly use insulin. Insulin is a hormone that is needed to convert sugar, starches and other food into energy needed for daily life. The cause of diabetes continues to be a mystery, although both genetics and environmental factors such as obesity and lack of exercise appear to play roles.

There are 20.8 million children and adults in the United States, or 7% of the population, who have diabetes. While an estimated 14.6 million have been diagnosed with diabetes, unfortunately, 6.2 million people (or nearly one-third) are unaware that they have the disease.

In Tennessee, 3,367students were diagnosed with some form of diabetes in school year 2009-2010.

Major Types of Diabetes

Type 1 Diabetes results from the body's failure to produce insulin, the hormone that "unlocks" the cells of the body, allowing glucose to enter and fuel them. It is estimated that 5-10% of Americans who are diagnosed with diabetes have type 1 Diabetes.

Type 2 Diabetes results from insulin resistance (a condition in which the body fails to properly use insulin), combined with relative insulin deficiency. Most Americans who are diagnosed with diabetes have type 2 Diabetes.

Gestational Diabetes affects about 4% of all pregnant women - about 135,000 cases in the United States each year.

Pre-Diabetes is a condition that occurs when a person's blood glucose levels are higher than normal but not high enough for a diagnosis of type 2 diabetes. There are 54 million Americans who have pre-diabetes, in addition to the 20.8 million with diabetes.*

* Source: American Diabetes Association

Additional Information

CDC – Managing Diabetes at School

National Diabetes Education Program – Helping Students with Diabetes Succeed: A Guide for School Personnel

American Diabetes Association – Living with Diabetes-Parents and Kids

It is difficult to predict when the next influenza pandemic will occur or how severe it will be. In addition, a pandemic may come and go in waves, each of which can last months at a time. The effects of a pandemic can be lessened if preparations are made ahead of time.  For information on ways that your district, school or center can prepare for the Pandemic Flu, you can download Pandemic Influenza Preparedness:  A Planning Guide for Tennessee School Districts which was developed by the Tennessee Department of Education in collaboration with the Tennessee Department of Health.

School staff should work closely with local public health officials as well as local government officials when making decisions regarding school dismissal, closings and reopening.

According to the Centers for Disease Control and Prevention (CDC), food allergies are a growing food safety and public health concern that affect an estimated 4%–6% of children in the United States. Allergic reactions can be life threatening and have far-reaching effects on children and their families, as well as on the schools or early care and education (ECE) programs they attend. Staff who work in schools and ECE programs should develop plans for preventing an allergic reaction and responding to a food allergy emergency.

Additional Information

According to the Centers for Disease Control and Prevention (CDC), the head louse, or Pediculus humanus capitis, is a parasitic insect that can be found on the head, eyebrows, and eyelashes of people. Head lice are not known to spread disease. Head lice are found worldwide. In the United States, infestation with head lice is most common among pre-school children attending child care, elementary schoolchildren, and the household members of infested children. Although reliable data on how many people in the United States get head lice each year are not available, an estimated 6 million to 12 million infestations occur each year in the United States among children 3 to 11 years of age.

Additional Information

Note: This section contains HIV prevention messages that may not be appropriate for all audiences. If you are not seeking such information or may be offended by such material, please exit this website.

HIV/AIDS Prevention

As a part of Coordinated School Health, our HIV/AIDS goal is to increase the classroom teacher’s capacity to provide effective, science-based HIV Prevention education to school-age youth as required by Tennessee State Board of Education’s Lifetime Wellness Standards.  In this section you will find frequently asked questions, federal and state rules and regulations, resources, and information on our teacher training cadre at Middle Tennessee State University.

HIV/AIDS Prevention Education is a part of the Coordinated School Health Plan:

  • Health Education: HIV Education/Curriculum
  • Physical Education/Physical Activity: Physically active kids are lower risk factors and girls in sports lower their risk of HIV
  • Health Services: Treating students with HIV or STD/STI's or refer them to providers
  • Nutrition Services: Students with HIV need good nutrition
  • Health Promotion of Staff: Treating staff with HIV or STD/STI's/counseling staff with relationship problems/staff being good role models for students
  • Counseling and Psychological Services: Counsel students affected by HIV/healthy relationships also prevention
  • Healthy School Environment: Policies on HIV prevention/caring surroundings
  • Parent/Community Involvement: Parent/child communication involving families in HIV education

Additional Information

Family Life Curriculum Laws

  • TCA 49-6-1301 - Family Life Curriculum - Part Definitions
  • TCA 49-6-1302 - Curriculum for Family Life Education
  • TCA 49-6-1303 - Assistance in Teaching Family Life
  • TCA 49-6-1304 - Family Life Instruction
  • TCA 49-6-1305 - Notification of Parents and Legal Guardians - Excusing Students from Family Life Instruction
  • TCA 49-6-1306 - Complaint by Parent or Legal Guardian - Cause of Auction by Parent or Guardian
  • TCA 49-6-1307 - Instruction of Sexual Education to Comply With Part - Scientific Study of Reproductive System Permitted

Teen Pregnancy Prevention Resources

Preventing tobacco use among youth is critical to ensuring healthy adults because tobacco use and subsequent addiction most frequently take root in adolescence. More than 20% of all deaths in the United States are attributable to tobacco, making tobacco use the chief preventable cause of death. Teens who smoke are also more likely than nonsmokers to use alcohol, marijuana and cocaine.

Every year, 14,600 Tennessee youth under 18 years of age become daily smokers.  At this rate, 128,300 Tennessee youth alive today will die an early, preventable death because of a decision made as a child. Also, 488,000 youth are exposed to secondhand smoke at home and 21.7 million packs of cigarettes are bought or smoked by Tennessee youth each year. (Source: National Center for Tobacco-Free Kids, fact sheet,

Additional Information