School Health Assessment Research Articles

Evaluating the Wellness School Assessment Tool for Use in Public Health Practice to Improve School Nutrition and Physical Education Policies in New York

Addressing the limitations of existing Local Wellness Policies (LWPs) and promoting their implementation remain priorities for health and education agencies. One gap has been the absence of a standard assessment to support LWP revision. During planning for an initiative to improve school nutrition and physical education policy, the Wellness School Assessment Tool (WellSAT) was evaluated. Five public health practitioners used WellSAT to assess 50 LWPs. A randomized, counterbalanced design ensured each LWP was coded twice by separate raters. Models evaluated the extent to which WellSAT ratings reflected differences in the LWPs and order, familiarity and rater effects. During field testing, 18 public health practitioners used WellSAT as part of a statewide public health initiative. In pilot testing the majority of the variability in WellSAT scores (median = 88%; range = 76% to 100%) was attributable to differences between policies. Correlations between independent raters' strength and comprehensiveness scores were strong, r = .88 and r = .77, respectively. During field testing, WellSAT was well accepted by public health practitioners and members of the school community. WellSAT represents a reliable and feasible tool for health and education agencies to use in improving LWPs and aligning them with recognized standards.

Child body mass index, obesity, and proximity to fast food restaurants

Objectives. Using a sample of elementary and middle school students, we examined the associations between body mass index (BMI), obesity, and measures of the proximity of fast food and full service restaurants to students' residences. We controlled for socioeconomic status using a novel proxy measure based on housing values. Methods. We used BMI and obesity measures based on height and weight data collected as part of a school health assessment along with geocoded data on addresses of residences and food establishments. We constructed a proxy measure of socioeconomic status from public records of residential property assessments. These data were used to estimate logistic regression models of overweight and ordinary least squares models of BMI. Results. Students residing in homes with higher assessment values were significantly less likely to be obese, and had significantly lower BMIs. Upon controlling for socioeconomic status and other characteristics, the associations of BMI and obesity with proximity to food service establishments were reduced. Nonetheless, students who resided within one-tenth or one-quarter of a mile from a fast food restaurant had significantly higher values of BMI. The proximity of full service restaurants to residences did not have a significant positive association with either BMI or overweight. Conclusion. Public health efforts to limit access to fast food among nearby residents could have beneficial effects on child obesity. Public data on property value assessments may serve as useful approximations for socioeconomic status when address data are available.

Validation of the Perceptions of Teasing Scale (POTS) in a Preadolescent Sample: Associations With Attitudes Toward Physical Activity

This study investigated the construct validity of the Perceptions of Teasing Scale (POTS) in a sample of 381 preadolescent children (mean age = 10.8 years). Children completed the POTS and self-report measures of attitudes toward physical activity (PA). Anthropometric data were collected as a part of a standard school health assessment. Confirmatory factor analysis and structural equation modeling supported the validity of the POTS. Children who experienced more teasing about abilities and competency reported increased negative attitudes and fewer positive attitudes toward PA. Children who reported more appearance-related teasing endorsed more negative attitudes about PA. Results indicate that the POTS is a valid measure of teasing among preadolescent children and that teasing may be an important target for prevention and intervention efforts to increase PA among children.

Negative Attitudes Toward Physical Activity: Measurement and Role in Predicting Physical Activity Levels Among Preadolescents

To describe the development and validation of a measure of negative attitudes toward physical activity and examine the association between these attitudes and self-reported physical activity among preadolescents. A school-based sample of 382 fifth and sixth graders (mean age = 10.8) completed measures of attitudes toward physical activity and self-reported physical activity. Body mass index data for the participants was collected as a part of a standard school health assessment. Exploratory factor analysis, confirmatory factor analysis, and structural equation modeling were utilized to test the factor structure and predictive value of attitudes toward physical activity. Results supported the reliability and concurrent validity of the negative attitudes measure and found a significant association between negative attitudes and physical activity. Negative attitudes was found to be a stronger predictor of physical activity than positive attitudes, which have been the focus of previous research in this area. The results suggest that negative attitudes toward physical activity can be reliably measured and may be an important target for intervention efforts to increase physical activity among children and adolescents.

Asthma screening as part of a routine school health assessment in the Australian Capital Territory.

To determine the feasibility and performance of a routine screen for childhood asthma in new entrants to primary school relative to diagnosis by a paediatrician. Cross-sectional study with a validation substudy. All 4539 new primary school entrants (mean age, 5.72 years; 95% CI, 5.71-5.74) in the Australian Capital Territory (ACT) in 1999; 180 of these children (73% of the 248 contacted) participated in the validation substudy. Performance of the screening test relative to a paediatrician's diagnosis of current asthma (defined as a history of wheeze suggestive of a clinical diagnosis of asthma within the past 12 months) based on history and examination. 3748 of the 4539 new primary school entrants (83%) returned completed asthma and respiratory questions. The screening test was positive in 38% of children. Estimated sensitivity was 92% (95% CI, 75%-99%); specificity, 76% (95% CI, 72%-80%); positive predictive value, 51% (95% CI, 41%-63%); negative predictive value, 98% (95% CI, 90%-100%); positive likelihood ratio, 3.8 (95% CI, 2.8-4.8); and negative likelihood ratio, 0.14 (95% CI, 0.02-0.33). It is feasible to conduct population screens for asthma that have good diagnostic test performance against a specialist paediatrician's diagnosis through school health programs. This approach could facilitate monitoring changes in asthma prevalence over time.

Clinical description of children with developmental coordination disorder.

Occupational therapists working within School Health Support Services are receiving increasing numbers of referrals, relative to past rates, for children who are experiencing motor problems and may have developmental coordination disorder. Based upon clinical experience, therapists indicate that these children are typically referred in the early school years and that most have handwriting difficulties; to date, however, there has been little empirical evidence to support these observations. In this paper, descriptive information is presented for 556 children who may be presumed to have developmental coordination disorder and who had been referred to school-based health services in two centres. Typical reasons for referral, co-morbidity information, and assessment practices are presented. Findings confirmed the presence of many occupational performance issues in this population, including handwriting difficulties, and challenge therapists to broaden the current scope of school health assessment and intervention practices.

High Prevalence of Attention Deficit Hyperactivity Disorder: Catalyst for Development of a School Health Coalition

A regional study of ADHD medication use was conducted to address community concerns about an apparently high prevalence of attention deficit hyperactivity disorder (ADHD). The study documented that the use of ADHD medication among elementary school children in two southeastern Virginia school districts was two to three times higher than published prevalence estimates. This study contributed to community leaders' desire for a regional school health coalition to ensure continued community involvement in school health assessment and planning. The case history of this coalition, the School Health Initiative for Education (SHINE) is presented as an example of effective community collaboration.

Prevalence of self-reported food hypersensitivity among school children in The Netherlands

To provide national figures on the prevalence of self-reported food hypersensitivity (S-FH), and the association with socio-demographic variables and some health indicators in schoolchildren in The Netherlands. As part of the Child Health Monitoring System, data were collected from 4450 children, who were invited for a routine health assessment (response 97%). A questionnaire on food hypersensitivity was completed by the parents of the children in primary school and by the children in secondary school themselves. The measurements on health status were taken by the school physician or nurse during the school health assessment. Children aged 4-15 y in The Netherlands in three groups in primary school, and in the second year of secondary school. The prevalence of S-FH was 7.2%. Food additives and chocolate were most frequently avoided. Of the children with S-FH, 40% avoided food exclusively either on their own accord or on advice of relatives. School absence due to illness, use of medication, and medical treatment were more prevalent in children with S-FH, and their health status was more often considered moderate or poor by the school physician or nurse. Seven percent of school-aged children avoid certain types of food or ingredients because of S-FH. The prevalence of food allergy or food intolerance is probably lower, since many children with S-FH had not undergone any diagnostic tests. To prevent unnecessary food restriction, more information for parents is needed about the possible effects of food restriction on the health of their children, and they should be encouraged to seek further diagnosis.

Leads from the MMWR. School health assessment, planning, and evaluation project--New York City

Leads from the MMWR. School health assessment, planning, and evaluation project--New York City

The Effectiveness of Health Screening in a School Program for Migrant Children

This program shows again the price paid for fragmented health services. The provision of screening teams outside of normal channels of health care resulted in the discovery of many health defects, but in the treatment of less than half of them. Several ways might be found to improve the program. At the present time we believe that an effective school health assessment can be made without physical examinations. Instead, if it is felt that heart disease should be detected in school, heart-sound screening could be added to the test battery. Teacher observation should be utilized by emphasizing the teacher-nurse conferences. This would result in referral not only of physical abnormalities, but of children with behavioral symptoms, and children with such conditions as hyperactivity and dyslexia. Such a procedure has been advocated for nearly 30 years. It would leave unsuspected hernias, which are rare, and inapparent otitis without pain, fever, or hearing loss which is probably of little significance, as the major abnormalities liable to be overlooked in health assessment. The program described here would have been far more effective had nursing time been used in the follow-up of health defects rather than in physical examinations. For instance, two of the four nurses on the screening teams might have worked with community nurses and school personnel to reach the parents. In our opinion, abandoning physical examinations and redirecting nursing time into coordination and follow-up would result in better health care for the children in the program.