Students In Intervention Schools Research Articles

Impact of a School Health Coordinator Intervention on Health-Related School Policies and Student Behavior

Health-related, school-based interventions may serve to prevent disease and improve academic performance. The Healthy Maine Partnerships (HMP) initiative funded local school health coordinators (SHCs) as a part of Maine's Coordinated School Health Program (CSHP) beginning in January 2001. SHCs established school health leadership teams and implemented annual work plans to address health risk behaviors. This study evaluates the impact of the Healthy Maine Partnerships SHC (HMPSHC) intervention on school policies and student risk behaviors after its first 5 years. Data sources include the Maine School Health Profiles Survey and the Maine Youth Drug and Alcohol Use Survey/Youth Tobacco Survey. Cross-sectional analyses were performed on 2006 data to assess physical activity, nutrition, and tobacco-related policy associations with the HMPSHC intervention. Finally, policy and student behavior analyses were conducted to assess associations. Intervention schools were more likely to be associated with physical activity intramural offerings, improved nutritional offerings, and tobacco cessation programs. In intervention schools, supportive school policies were associated with decreased soda consumption, decreased inactivity, and decreased tobacco use. Required school health education curricula were more predictive of decreased risk behavior in intervention schools than in nonintervention schools. In schools with SHCs, there exists a stronger association with improved school programs. Improved policies and programs were associated with decreases in risk behavior among students in intervention schools. The HMPSHC intervention may be a viable CSHP model to replicate and evaluate in other settings.

A Fresh Fruit and Vegetable Program Improves High School Students' Consumption of Fresh Produce

Low fruit and vegetable intake may be associated with overweight. The United States Department of Agriculture implemented the Fresh Fruit and Vegetable Program in 2006-2007. One Houston-area high school was selected and received funding to provide baskets of fresh fruits and vegetables daily for each classroom during this period. This study assessed the impact of the program on students' fruit and vegetable intake. At program end (May 2007), fruit and vegetable intake surveys were distributed to students at the intervention school as well as at a comparison high school that did not receive the program. Surveys, which were completed anonymously, were received from 34% of intervention and 42% of comparison school students. The students were classified as to whether they met the recommended daily intake of fruit, 100% fruit juice, and vegetables. The probability of meeting the recommendations was assessed with logistic regression analyses, controlling for sex, age, and ethnicity. Compared with the comparison control school students, intervention school students were more likely to report eating fruit and drinking 100% fruit juice at least two times per day (39.3% vs 27.3%; P<0.05) and consuming total fruit, juice, and vegetables (22% vs 18.4%; P<0.05) five or more times per day in the preceding 7 days. More intervention school students (59.1%) than comparison school students (40.9%) reported eating fruit at least one time per day ( P<0.05). There were no group differences in vegetable intake. Fresh fruit and vegetable distribution programs provide the opportunity for students to taste a variety of fruits and vegetables, and may improve consumption of these foods by adolescents.

A Multimedia Educational Program That Increases Science Achievement Among Inner-City Non-Asian Minority Middle-School Students

To test the effectiveness of a middle school, multimedia health sciences educational program called HEADS UP in non-Asian-minority (Hispanic and African American), inner-city students. The program designers hope to increase the number of these students entering the health sciences pipeline. The program includes video role-model stories featuring minority scientists and students, hands-on activities, and teacher resources. Collaborators from The University of Texas Health Science Center at Houston, Spring Branch Independent School District, and the Health Museum developed the modules. From 2004 to 2007, the authors used a quasi-experimental, two-group pretest/posttest design to assess program effects on students' performance and interest in science, their science self-efficacy, their fear of science, and their science-related careers self-efficacy. An independent third party matched the intervention school to a comparison school by test scores, school demographics, and student demographics and then matched pairs of sixth-grade students (N = 428) by fifth-grade science scores, gender, ethnicity, and participation in the free or reduced lunch program. The authors collected data on these students for three years. At eighth grade (2007), the intervention school students scored significantly higher (F = 12.38, P < .001) on the Stanford Achievement Test 10 in science and reported higher interest in science (F = 11.08, P < .001) than their matched, comparison-school pairs. Students in neither group reported an increase in their confidence to choose a science-related career, but students in one high-implementing teacher's class reported decreased fear of science. HEADS UP shows potential for improving inner-city, non-Asian-minority middle school students' performance and interest in science.

Differences in fruit and vegetable exposure and preferences among adolescents receiving free fruit and vegetable snacks at school

Low fruit and vegetable (FV) intakes are associated with excess body weight. The United States Department of Agriculture sponsors a Free Fruit and Vegetable Program in schools whereby students receive free FV snacks daily. This study assessed whether the program improved student exposure to and preferences for FV in a Houston high school in 2006–2007. Anonymous, post-intervention only FV exposure and preference surveys were completed by 2000 intervention school students and 1600 students in a comparison school during May, 2007. Differences in FV exposure and preferences were assessed, as well as differences in preferences between those students who tasted the item for the first time at school compared to those who had tasted the item before. The comparison school average scores for prior FV exposure and vegetable preferences were significantly higher than the intervention school scores. Intervention school students who had tasted the item previously reported significantly higher preferences than students who had tasted it for the first time at school. Access to the Free Fruit and Vegetable Program did not appear to improve high school student reported FV exposure and preferences. Future research should investigate the connection between food exposure, preferences and consumption in adolescents.

Improvements in Health-Related Quality of Life Among School-Based Health Center Users in Elementary and Middle School

To examine the role of school-based health centers (SBHCs) on changes in student health-related quality of life (HRQOL) over a 3-year period among elementary and middle school students. Three-year longitudinal prospective study. Four elementary schools with newly implemented SBHCs and 4 elementary comparison schools matched for rural/urban and state, percentage of nonwhite students, and percentage of free or reduced-price lunch-eligible students. Randomly selected student-parent dyads (n = 579) who responded in all 3 years from 4 intervention schools and 4 comparison schools randomly selected from school enrollment lists. Students in intervention schools were further divided into SBHC users and nonusers. SBHC. The outcome, HRQOL, was measured annually by student self-reported and parent proxy-reported scores using the PedsQL 4.0. School covariates included region and state; individual covariates included child age, gender, race, health insurance, chronic health conditions, family income, and parental marital status. Adjusting for school- and individual-level covariates, there was a significant improvement in student-reported HRQOL over the 3 years for the SBHC user group compared with the comparison school group. Other significant predictors of student-reported HRQOL included student age, gender, health insurance, and household income. There were no differences across groups by using parent proxy reports of HRQOL. The SBHC model of health care delivery improves student-reported HRQOL among younger, elementary, and middle school children. Moreover, it appears to have more influence on those children that generally have impeded access to care and who can most benefit from it, specifically those without private health insurance and with lower income levels.

A Randomized, Controlled Trial to Teach Middle School Children to Recognize Stroke and Call 911

Underutilization of acute stroke therapy is driven by delay to hospital arrival. We present the primary results of a pilot, randomized, controlled trial to encourage calling 911 for witnessed stroke among middle school children and their parents. This project occurred in Corpus Christi, an urban Texas community of 325,000. Three intervention and 3 control schools were randomly selected. The intervention contained 12 hours of classroom instruction divided among sixth, seventh, and eighth grades. Parents were educated indirectly through homework assignments. Two-sample t tests were used to compare pretest and posttest responses. Domain 1 test questions involved stroke pathophysiology. Intervention students improved from 29% to 34% correct; control students changed from 28% to 25%. Domain 2 test questions involved stroke symptom knowledge. Intervention school students changed from 28% correct to 43%; control school students answered 25% correctly on the pretest and 29% on the posttest. Domain 3 test questions involved what to do for witnessed stroke. Intervention school students answered 36% of questions correctly on the pretest and 54% correctly on the posttest, whereas control students changed from 32% correct to 34%. A comparison of change in the mean proportion correct over time between intervention and control students was P<0.001 for each of the 3 individual domains. A poor parental response rate impaired the ability to assess parental improvement. A scientific, theory-based, educational intervention can potentially improve intent to call 911 for stroke among middle school children. A different mechanism is needed to effectively diffuse the curriculum to parents.

Program ENERGY: Successful dissemination to an isolated high-risk rural location Cortez, CO.

Program ENERGY is a science/health-inquiry learning enrichment classroom program (body science, health, nutrition) designed to prevent obesity and type 2 diabetes. Effectiveness of Program ENERGY-Cortez (PE-C) for 2nd and 3rd graders and their parents in a rural, low-income (54% free or reduced school lunch), high Native American and Hispanic population in Southwestern CO was determined. The principals and classroom educators approved the program after reviewing its objectives and methods. PE-C was delivered by an experienced graduate student and volunteers recruited from the community. Volunteers included both high school and nursing students. In kind donations were provided by several small local businesses, providing materials for teaching aids, rewards and snacks. The intervention school students received the Program ENERGY curriculum including 16 bi-weekly classroom lessons (topic introduction, a hands-on inquiry science activity, and a healthy snack). A comparison school did not receive the program. Effectiveness was evaluated by pre-/post-assessments (beginning and end of school year). Results of pre- and post-tests show statistically significant improvements in the intervention school compared to the comparison school: health and science knowledge, attitudes (e.g. healthy food-selection), behaviors (increased body acceptance), and increased interest in science/health-related careers. These improvements were similar to those observed in the initial implementation in Fort Collins, CO. PE-C is an effective elementary school/family-based intervention with high rates of enrollment/retention, positive evaluations by children/educators that produced significant positive outcomes in health/science knowledge, attitudes, behaviors and increased interest in science- and health-related careers.

The Effectiveness of the Olweus Bullying Prevention Program in Public Middle Schools: A Controlled Trial

Purpose To examine the effectiveness of a widely disseminated bullying prevention program. Methods A nonrandomized controlled trial with 10 public middle schools (7 intervention and 3 control) was conducted. Student-reported relational (e.g., spreading rumors, social exclusion) and physical victimization, and whether the program improved student attitudes and perceptions toward bullying were assessed pre- and post-implementation using available school survey data. Results Regression analyses controlling for baseline prevalence and school characteristics showed no overall effect on student victimization. However, when stratified by ethnicity/race, reports of relational and physical victimization decreased by 28% (RR = .72, 95% CI: .53–.98) and 37% (RR = .63, 95% CI: .42–.97), respectively, among white students relative to those in comparison schools. No similar effect was found for students of other races/ethnicities; there were no differences by gender or by grade. Students in intervention schools were more likely to perceive other students as actively intervening in bullying incidents, and 6th graders were more likely to feel sorry and want to help victims. Conclusions The program had some mixed positive effects varying by gender, ethnicity/race, and grade but no overall effect. Schools implementing the program, especially with a heterogeneous student body, should monitor outcomes and pay particular attention to the impact of culture, race and family influences on student behavior. Future studies of large-scale bullying prevention programs in the community must be rigorously evaluated to ensure they are effective.

Effectiveness of School-Based Influenza Vaccination

Vaccination of children in school is one strategy to reduce the spread of influenza in households and communities. We identified 11 demographically similar clusters of elementary schools in four states, consisting of one school we assigned to participate in a vaccination program (intervention school) and one or two schools that did not participate (control schools). During a predicted week of peak influenza activity in each state, all households with children in intervention and control schools were surveyed regarding demographic characteristics, influenza vaccination, and outcomes of influenza-like illness during the previous 7 days. In all, 47% of students in intervention schools received live attenuated influenza vaccine. As compared with control-school households, intervention-school households had significantly fewer influenza-like symptoms and outcomes during the recall week. Paradoxically, intervention-school households (both children and adults) had higher rates of hospitalization per 100 persons than did control-school households. However, there was no difference in the overall hospitalization rates for children or adults in households with vaccinated children, as compared with those with unvaccinated children, regardless of study-group assignment. Rates of school absenteeism for any cause (based on school records) were not significantly different between intervention and control schools. Most outcomes related to influenza-like illness were significantly lower in intervention-school households than in control-school households. (ClinicalTrials.gov number, NCT00192218.)

Dietary Effects of Universal-Free School Breakfast: Findings from the Evaluation of the School Breakfast Program Pilot Project

Objective To determine the effects of offering universal-free school breakfast in elementary schools on students’ dietary outcomes. Design Experimental study with random assignment of 153 matched elementary schools in six school districts. Treatment schools offered universal-free school breakfast, and control schools continued to operate the traditional means-tested School Breakfast Program. Twenty-four–hour dietary recalls were collected from sample students near the end of the first year. Subjects About 30 students in second through sixth grades were randomly selected from each school (n=4,358). Intervention Free school breakfasts were made available to all students in treatment schools, regardless of family income, for three consecutive school years (2000-2001 to 2002-2003). Main outcome measures Breakfast consumption and food and nutrient intake. Statistical analyses Hierarchical mixed-models and logistic regression, adjusting for age, sex, minority status, and income eligibility for the regular school meal programs, were used to estimate effects. Results Despite a significant increase in school breakfast participation among sample students in treatment schools (from 16% to 40%, P<0.01), the rate of breakfast skipping did not differ between groups (4% overall). Treatment school students were more likely to consume a nutritionally substantive breakfast ( P<0.01), but dietary intakes over 24 hours were essentially the same. Conclusions Making universal-free school breakfast available in elementary schools did not change students’ dietary outcomes after nearly 1 year. To improve children’s diets overall, efforts should focus on ensuring all students have access to a healthful breakfast, at home or at school.

Influencing healthful food choices in school and home environments: Results from the TEENS study

Background. The purpose of this research is to examine the effects of an intervention designed to increase the availability of fruits, vegetables and lower fat foods in homes and schools. This research is part of the TEENS study, a school-based intervention study. Methods. Sixteen schools in Minnesota were recruited to be in the study, and approximately 3600 middle school students in the eight intervention schools were exposed to a multi-component intervention. The TEENS intervention included classroom-based curricula, family newsletters, and changes in the school food environment including increasing more healthful options on a la carte and on the school lunch line. In addition to student-level outcomes, changes in availability of fruits, vegetables, and lower fat snacks in home and school environments were evaluated. The TEENS study was conducted from 1997 to 2000. Results. Parents of students in intervention schools reported making healthier choices when grocery shopping as compared to parents of students in control schools ( P = 0.01). No intervention effects were evident from a home food inventory. Compared to control schools, intervention schools offered ( P = 0.04) and sold ( P = 0.07) a higher proportion of healthier foods on a la carte, but no effects were seen for fruit and vegetables sales as part of the regular meal pattern lunch. Conclusion. Our results show mixed results for positively influencing adolescents' school and home environments.

Does the introduction of a simple wedge to school seating reduce adolescent back pain?

Back pain in adolescence is an increasingly common problem. The objective of this study was to assess the effects of a change in seating position for students suffering from back pain. Volunteer students between the ages of 16 and 18 years were recruited from two schools. Students completed pain diaries on a twice daily basis. After the first week, the intervention school students were given a high density foam wedge to use on normal school chairs. In total, 48 students took part in the study: 26 in the control and 22 in the intervention school. Use of the wedge was associated with a significant reduction in both intensity and frequency of back pain recorded in the intervention school (P &lt;0.001). The results of this study demonstrate that a change in seating position appears to reduce back pain in school students. A randomized cluster study is planned to investigate this further.

Design, implementation, and quality control in the Pathways American-Indian multicenter trial

Background Pathways was the first multicenter American-Indian school-based study to test the effectiveness of an obesity prevention program promoting healthy eating and physical activity. Methods Pathways employed a nested cohort design in which 41 schools were randomized to intervention or control conditions and students within these schools were followed as a cohort (1,704 third graders at baseline). The study's primary endpoint was percent body fat. Secondary endpoints were levels of fat in school lunches; time spent in physical activity; and knowledge, attitudes, and behaviors regarding diet and exercise. Quality control (QC) included design of data management systems which provided standardization and quality assurance of data collection and processing. Data QC procedures at study centers included manuals of operation, training and certification, and monitoring of performance. Process evaluation was conducted to monitor dose and fidelity of the interventions. Registration and tracking systems were used for students and schools. Results No difference in mean percent body fat at fifth grade was found between the intervention and control schools. Percent of calories from fat and saturated fat in school lunches was significantly reduced in the intervention schools as was total energy intake from 24-hour recalls. Significant increases in self-reported physical activity levels and knowledge of healthy behaviors were found for the intervention school students. Conclusions The Pathways study results provide evidence demonstrating the role schools can play in public health promotion. Its study design and QC systems and procedures provide useful models for other similar school based multi- or single-site studies.

A school based programme reduced dating violence in adolescents

Foshee Va, Bauman Ke, Arriaga Xb , Et AL. An evaluation of Safe Dates, an adolescent dating violence prevention program. Am J Public Health1998 Jan; 88 : 45 –50. [OpenUrl][1][CrossRef][2][PubMed][3][Web...

Process Evaluation Measures Used to Assess a Multi-component Dietary Intervention: 5 a Day in Minnesota Elementary Schools

LEARNING OUTCOME: Identify Process Evaluation procedures that can be used to assess the effectiveness, quality and quantity of implementation of a multi-component intervention program.The purpose of the 5 a Day Power Plus study is to implement and assess the effectiveness of a school-based intervention for promoting increased consumption of fruits and vegetables among multicultural urban elementary school children to reduce future risk of cancer. Twenty schools from one urban school district were randomly assigned to Intervention and Control conditions. A cohort of students, originally in the fourth grade, participated in the program during two school years (1994-96). The Intervention components included school foodservice environmental changes, classroom curricula, family involvement, and food industry support. Process Evaluations were one of the methods used to assess the effectiveness, quality and quantity of implementation of these four inter-dependent areas. Trained observers recorded student choices of fruits and vegetables at lunch and also observed the implementation of the food service intervention. Teachers were observed in classrooms and completed questionnaires and weekly checklists. Students used self-reported scorecards and were asked for their opinions using a survey. Home involvement was assessed by parent return cards. Industry support was assessed by teacher, student and industry surveys. Results were similar in both 4th and 5th grades. Standardized lunch room observations conducted monthly in all schools proved an effective method to follow the progress of the program. Results showed, on average, students in Intervention Schools chose 0.5 more servings of fruit and vegetables at lunch than students in Control Schools. Teachers rated taste testing, snack preparations and home snack packs as the most effective parts of the curricula. The industry component was also highly rated. 45% of the students reported they liked taste testing and snack packs best, while only 5% rated the incentives as most important. However, only 33% of the parents sent return cards to verify they were involved. Process Evaluation is a valuable tool to verify that the program was completed according to protocol, to determine the level of participation and to explain impact on eating habits. Effective, easy-to-use Process Evaluations, such as described here, are feasible and critical for evaluation of all nutrition education programs.