Cardiometabolic Disease Education and Health Services Among Public High Schools

There is a paucity of research on school-based health education and services for cardiometabolic conditions, particularly at the national level.

To describe the health education and health services related to cardiometabolic health provided by US public high schools.

This survey study included US public high schools who responded to the principal and lead health education teacher surveys as part of the School Health Profiles data collection in 2022. Data were analyzed between September 2025 and July 2026.

School-level characteristics included enrollment size, urbanicity, region, neighborhood income-to-poverty ratio, and racial and ethnic composition.

Primary outcomes were health education provided to students (and separately) to parents and families on chronic disease prevention, nutrition, and physical activity and provision of school-based health services. These services included identifying and tracking students with a current diagnosis of diabetes, hypertension, or obesity; providing referrals for those confirmed or suspected to have these cardiometabolic conditions; and providing a full- or a part-time registered nurse, a school-based health center, daily medication administration for students with chronic conditions, case management for students with chronic conditions, and an insurance protocol for students with chronic conditions.

A total of 3371 high schools were included in the principal survey (776 small, 1422 medium, and 1173 large) and 3044 high schools were included in the teacher survey (641 small, 1321 medium, and 1082 large). In 2022, 89.0% (95% CI, 87.4%-90.3%), 95.5% (95% CI, 94.3%-96.4%), and 98.1% (95% CI, 97.3%-98.7%) of schools provided health education on chronic disease prevention, nutrition, and physical activity, respectively, to students, while 43.5% (95% CI, 41.3%-45.7%), 50.9% (95% CI, 48.7%-53.1%), and 50.8% (95% CI, 48.6%-53.0%) provided information on chronic disease prevention, nutrition, and physical activity, respectively, to families. Schools tracked diabetes (96.3%; 95% CI, 95.5%-97.0%) more frequently than hypertension (64.9%; 95% CI, 63.0%-66.6%) and obesity (38.6%; 95% CI, 36.8%-40.4%); similarly, schools provided referrals for diabetes (52.1%; 95% CI, 50.3%-54.0%) more frequently than for hypertension (48.5%; 95% CI, 46.6%-50.4%) and obesity (41.6%; 95% CI, 39.8%-43.5%). Most schools reported having a full- or part-time registered nurse (90.9%; 95% CI, 89.8%-91.9%), but only 29.3% (95% CI, 27.7%-31.1%) reported having a school-based health center.

In this survey study of US public high schools, gaps in cardiometabolic health education and services were identified. These findings may inform future programs to improve cardiometabolic health among adolescents.