Effects of a school-based smoking prevention program among subgroups of adolescents

In autumn 1995 The Norwegian Cancer Society in cooperation with The Research Center for Health Promotion, University of Bergen started a study of school-based interventions aiming at preventing smoking among pupils in Norwegian secondary schools. The study comprised a nationwide sample of 4441 students at 99 schools (195 classes). This panel of students is followed through annual data collections till they graduate in spring 1997. Written consensus from students and parents was obtained from 95%. Schools were systematically allocated to one of four groups: Group A, control; Group B, intervention, containing classroom program, involvement of parents and teacher courses; Group C, like B, but without teacher courses; Group D, like B, but without parental involvement. Baseline data were collected by questionnaires administered in class in November 1994 and the first follow-up survey was carried out in May 1995. At follow-up the proportion of smokers had increased by 8.3 percentage points in Group A (control) and by 1.9 percentage points in Group B (most extensive intervention). As expected, the recruitment of smokers was higher in Groups C and D than in the ideal intervention, but lower than in the control group. Effects of the most extensive program among subgroups of students were examined by comparing Groups A and B. Students are categorized as high risk or low risk based on scores on scales measuring sensation seeking, physical maturity, antisocial behavior and parental smoking. The effect of the program on recruitment of smokers seems to have been at least as strong or even stronger among 'high-risk' students than among other students.     

Tuberculosis risk for hospital employees: analysis of a five-year tuberculin skin testing program.

This study of hospital employee tuberculin conversion rates was undertaken in a 516-bed urban general hospital to determine if employment in such a hospital placed employees at risk of infection with tuberculosis. Data collected on the tuberculin status of employees from 1971 through 1976 indicated that the five-year conversion rate for all employees in a hospital-wide testing program was 7.1 per cent. Employees at greatest risk for conversion were non-White, age 46 through 64, in the lowest socioeconomic quintile, and employed in the Laundry, Housekeeping, and Engineering and Maintenance Departments. It was concluded that the higher than expected employee conversion rate was not attributable to exposure to infectious patients, but to a combination of the booster effect in serial tuberculin testing, use of a multiple puncture device for skin tests, and exposure to tuberculosis in the community.     

YouthFriends: outcomes from a school-based mentoring program

This evaluation explores the effectiveness of school-based mentoring as a universal prevention strategy. The impact of mentoring on students displaying risk factors is also addressed. The evaluation of YouthFriends, a school-based mentoring program, employed a pretest-posttest control group design. Students (n = 170) across five school districts provided data on eight dependent variables. At posttest, there was a statistically significant difference favoring YouthFriends over controls on sense of school membership. In addition, for students who had low scores at baseline, results indicated a statistically significant improvement unique to YouthFriends on community connectedness and goal-setting. Analyses of students’ academic performance also indicated a positive effect for those YouthFriends who had low grades at baseline.Editors’ Strategic Implications: Important lessons are provided for school administrators and mentoring program staff and evaluators. As a universal prevention program, school-based mentoring may produce few (and small) short-term effects. A greater understanding of the effects of dosage and quality of the mentoring is needed as we seek to evaluate the efficacy of school-based mentoring across a variety of student risk levels.     

Evaluation of a school-based sealant program in New York State.

This study evaluated the outcome of a targeted dental sealant program by comparing the survival probabilities of sealed high-risk first molar tooth sites to unsealed low-risk tooth sites in 1,122 children enrolled in a school-based sealant program. A comparison of the survival probabilities between low-risk first molar teeth that did not receive sealants and the sealed high-risk first molar teeth did not show significant differences. The results suggest that the protocol used by the program provides a satisfactory method for identification of children who could best benefit from sealants in a school-based situation.     

The cost-effectiveness of a school-based overweight program

Background  

This study assesses the net benefit and the cost-effectiveness of the Coordinated Approach to Child Health (CATCH) intervention program, using parameter estimates from the El Paso trial. There were two standard economic measures used. First, from a societal perspective on costs, cost-effectiveness ratios (CER) were estimated, revealing the intervention costs per quality-adjusted life years (QALYs) saved. QALY weights were estimated using National Health Interview Survey (NHIS) data. Second, the net benefit (NB) of CATCH was estimated, which compared the present value of averted future costs with the cost of the CATCH intervention. Using National Health and Nutrition Examination Survey I (NHANES) and NHANES follow-up data, we predicted the number of adult obesity cases avoided for ages 40–64 with a lifetime obesity progression model.     

Creating a successful school-based mobile dental program

BACKGROUND: Dental disease is one of the leading causes of school absenteeism for children. This article describes the creation and evolution of the St. David's Dental Program, a mobile school-based dental program for children. METHODS: The dental program is a collaboration of community partners in Central Texas that provides free dental care to low-income children in schools without relying on reimbursements or government funding. RESULTS: Since 1998, the program has provided 132,791 screenings for oral health treatment needs and 38,634 encounters for sealants or treatment. In 2005, the program provided $2.1 million worth of services at a cost of $1.2 million (not including donated services). Factors important to the program's success included sustained funding for general operating costs; well-compensated clinicians to deliver care and experienced human service workers to manage program operations; the devotion of resources to maximize consent form return rates; and the development of strong relationships with school district and individual school staff. CONCLUSIONS: By removing cost, time, transportation, and bureaucratic barriers, the program was able to reach more children than fixed-site clinics. The program was a merging of private and public health dentistries. This model can be useful to other communities in light of the unmet need for dental care and tighter federal, state, and local government budgets.     

Improving physical fitness and emotional well-being in adolescents of low socioeconomic status in Chile: results of a school-based controlled trial

Regular physical activity is associated with a reduced risk of all-cause mortality, and mortality due to cardiovascular disease and cancer. Among adolescents, physical activity is associated with benefits in the prevention and control of emotional distress, and improvement of self-esteem. Countries in transitional epidemiological scenarios, such as Chile, need to develop effective strategies to improve physical activity as a way to face the epidemic of chronic diseases. The objective of this study was to evaluate the effects of a school-based physical activity program on physical fitness and mental health status of adolescents living in a low socioeconomic status area in Santiago, Chile. A quasi-experimental design was used to evaluate the effects of the program over one academic year. The study included 198 students aged 15 years old. Two ninth grade classes were randomly selected as the intervention group, with two classes of the same grade as controls. A social planning approach was used to develop the intervention. The program was designed and implemented based on student preferences, teachers' expertise and local resources. Changes in physiological and mental health status were assessed. After the intervention, maximum oxygen capacity achieved a significant increase of 8.5% in the intervention versus 1.8% in the control group (p < 0.0001). Speed and jump performance scores improved significantly more in the intervention versus the control group (p > 0.01). Anxiety score decreased 13.7% in the intervention group versus 2.8% in the control group (p < 0.01), and self-esteem score increased 2.3% in the intervention group and decreased 0.1% in the control group after the end of the program (p < 0.0001). No significant change was observed in the depressive score. Student participation and compliance with the program was > 80%. To conclude, a school-based program to improve physical activity in adolescents of low socioeconomic status, obtained a high level of participation and achieved significant benefits in terms of physical fitness and mental health status.     

Economic analysis of a school-based obesity prevention program

OBJECTIVE: To assess the cost-effectiveness and cost-benefit of Planet Health, a school-based intervention designed to reduce obesity in youth of middle-school age children. RESEARCH METHODS AND PROCEDURES: Standard cost-effectiveness analysis methods and a societal perspective were used in this study. Three categories of costs were measured: intervention costs, medical care costs associated with adulthood overweight, and costs of productivity loss associated with adulthood overweight. Health outcome was measured as cases of adulthood overweight prevented and quality-adjusted life years (QALYs) saved. Cost-effectiveness ratio was measured as the ratio of net intervention costs to the total number of QALYs saved, and net-benefit was measured as costs averted by the intervention minus program costs. RESULTS: Under base-case assumptions, at an intervention cost of $33,677 or $14 US dollars per student per year, the program would prevent an estimated 1.9% of the female students (5.8 of 310) from becoming overweight adults. As a result, an estimated 4.1 QALYs would be saved by the program, and society could expect to save an estimated $15,887 USD in medical care costs and $25,104 USD in loss of productivity costs. These findings translated to a cost of $4305 USD per QALY saved and a net saving of $7313 USD to society. Results remained cost-effective under all scenarios considered and remained cost-saving under most scenarios. DISCUSSION: The Planet Health program is cost-effective and cost-saving as implemented. School-based prevention programs of this type are likely to be cost-effective uses of public funds and warrant careful consideration by policy makers and program planners.     

Outcomes for a comprehensive school-based asthma management program

This article describes the evaluation of a comprehensive school-based asthma management program in an inner-city, largely African-American school system. All 54 elementary schools (combined enrollment 13,247 students) from a single urban school system participated in this study. Schools were randomly divided between immediate and delayed intervention programs. The intervention consisted of 3 separate educational programs (for school faculty/staff, students with asthma, and peers without asthma) and medical management for the children with asthma (including an Individual Asthma Action Plan, medications, and peakflow meters). Children with asthma were identified using a case detection program and 736 were enrolled into the intervention study. No significant differences were observed in school absences, grade point average, emergency room visits, or hospitalizations between the immediate and delayed intervention groups. Significant increases in knowledge were observed in the immediate intervention group. This study of a school-based asthma management education and medical intervention program did not show any differences between the intervention and control groups on morbidity outcomes. Our experience leads us to believe that such measures are difficult to impact and are not always reliable. Future researchers should be aware of the problems associated with using such measures. In addition, connecting children with a regular source of health care in this population was difficult. More intensive methods of medical management, such as school-based health centers or supervised asthma therapy, might prove more effective in inner-city schools.     

New Moves: a school-based obesity prevention program for adolescent girls

BACKGROUND: This study tests the feasibility of an innovative school-based program for obesity prevention among adolescent girls. New Moves was implemented as a multicomponent, girls-only, high-school physical education class. METHODS: Six schools were equally randomized into intervention and control conditions. Data were collected at baseline, postintervention, and 8-month follow-up to assess program impact on physical activity, eating patterns, self-perceptions, and body mass index (BMI) among 89 girls in the intervention and 112 girls in the control conditions. Program evaluation also included interviews with school staff, parent surveys, and participant interviews and process evaluation surveys. RESULTS: The feasibility of implementing New Moves was high, as indicated by strong satisfaction among participants, parents, and school staff, and by program sustainability. Participants perceived a positive program impact on their physical activity, eating patterns, and self-image. Girls in the intervention significantly progressed in their stage of behavioral change for physical activity from baseline to follow-up. However, for the majority of outcome variables, differences between intervention and control schools at postintervention and follow-up were not statistically significant. CONCLUSIONS: New Moves was well received and fills a needed niche within school physical education programs. An expanded intervention and evaluation is needed to enhance and assess long-term program effectiveness.