Objective: Measure the association between School Health Index (SHI) scores and student health outcomes related to physical activity (PA) and nutrition.

Design: Cross-sectional design utilized to collect SHI scores and administer questionnaires regarding nutrition and PA behaviors, knowledge and the home environment in 5 counties of southwest Virginia.

Participants: Staff, administrators and students (grades 4, 7, 10; n = 1094) in 27 schools in 5 school divisions.

Main Outcome Measures: SHI scores were obtained from school surveys while LWP score, student BMI percentile and fitness (mile run, PACER) measures were obtained from school data. The School Physical Activity and Nutrition questionnaire was used to measure student nutrition, PA behaviors and knowledge, and the home food environment was measured through a validated questionnaire.

Analysis: Two-sided Pearson's correlation (p<0.05) measuring associations between SHI score and student health outcomes of BMI percentile, one mile/PACER, nutrition and PA behaviors and health knowledge and beliefs.

Results: SHI was negatively correlated with BMI percentile for 4th grade students (-0.472, p<0.001) and positively correlated with BMI percentile for 8th grade students (0.679, p<0.001). SHI was positively correlated with 4th grade mile run (0.412, p<0.001), 8th grade mile run (0.218, p<0.001) and 4thgrade PACER (0.414, p<0.001).

Conclusion: Behavioral influences are multifactorial and factors outside the school environment may affect the correlations between these variables.

Application: Data concerning the influence of the school health environment can be used towards making evidence-based changes to school health programs.