Assessing the efficacy of a school-based asthma education program for children: a pilot study

BACKGROUND: Asthma diminishes the health-related quality of life for many school-aged children. This study sought to explore the effect of a School-Based Asthma Education Program (SBAEP) on quality of life. METHODS: Children with asthma who attended grades 1-5 at two selected schools were requested to participate in this pilot study. Participants at one school were provided with a SBAEP, those at another school (control group) were provided with written educational material about asthma. The children completed the Paediatric Asthma Quality of Life Questionnaire (PAQLQ) before and one month after the educational interventions. RESULTS: There were clinically important improvements in the SBAEP group in quality of life, specifically in the symptom subdomain. CONCLUSIONS: The "Air Force" SBAEP appears to result in a favourable trend in quality of life for children. A larger scale trial is required following revisions to the program.     

Preventing adolescent drug abuse and high school dropout through an intensive school-based social network development program

Purpose. The hypothesis tested was that experimental subjects, relative to controls, would demonstrate significant increases in school performance and decreases in drug involvement at program exit (5 months) and at follow-up (10 months). Design. A two-group, repeated-measures, intervention trial was the design used. Setting. The study involved four urban Northwest high schools. Subjects. Participants included 259 youth at high risk of potential school dropout, 101 in the experimental group and 158 in the control group. Intervention. The Personal Growth Class experimental condition was a one-semester, five-month elective course taken as one of five or six regular classes. It had a 1:12 teacher-student ratio, and integrated group support and life-skills training interventions. The control condition included a regular school schedule. Measures. School performance measures (semester GPA, class absences) came from school records. Drug use progression, drug control, and adverse consequences were measured by the Drug Involvement Scale for Adolescents. Self-esteem, school bonding, and deviant peer bonding were measured using the High School Questionnaire: Inventory of Experiences. All multi-item scales had acceptable reliability and validity. Results. As predicted, trend analyses revealed significantly different patterns of change over time between groups in drug control problems and consequences; in GPA (but not attendance); and in self-esteem, deviant peer bonding, and school bonding. The program appeared to stem the progression of drug use, but group differences only approached significance. Conclusion. Program efficacy was demonstrated particularly for decreasing drug control problems and consequences; increasing GPA and school bonding; and desired changes in self-esteem and deviant peer bonding. Program effects on progression of drug use were less definitive.     

A school-based program to increase seatbelt use

To improve rates of seatbelt use in young school children and their parents, a curricular intervention was evaluated in a before-after trial over a 15-week period. A public school for pre-kindergarten through second grade (ages 4 to 8 years) in Yonkers, New York, was studied; all of 422 students were included and finished the study. A sequential group of parent drivers were also evaluated, although they were not subject to active intervention. All students were involved in a month-long curricular intervention to raise their awareness of seatbelt use and car safety ("May is Buckle-up Month"). Independent professional observers measured seatbelt use in a nonblinded manner before the intervention, after the intervention, and 1 month after the intervention. Belt use among students increased from 46% to 66% (P less than .01), and stayed at 63% at follow-up, although boys showed an insignificant change. Parent use improved from 47% to 61% (P less than .01), and remained at 62% at follow-up. Intensive curricular exposure to the use of seatbelts can measurably improve the use of belts by young school children. Parental behavior also shows a marked improvement. Such interventions can be organized by community health practitioners, including those in full-time practice, with minimal funding.     

Effectiveness of an intensive, school-based intervention for teen mothers

PURPOSE: This study evaluated the effectiveness of a secondary teen pregnancy prevention intervention that includes school-based social work services coordinated with comprehensive health care for teen mothers and their children. METHODS: A prospective cohort study compared subsequent births to teen mothers followed for at least 24 months or until age 20 years (whichever was longer) compared with matched subjects from state data. Analyses were based on intent to treat and included chi(2), survival, and cost-benefit analysis. RESULTS: Subjects included 63 girls (97% eligible, 99% African-American, mean age 16 years). A propensity-matched comparison group (n = 252) did not differ from subjects. Participation in program components was good: (1) group meetings: 76%; (2) case management: 95%; (3) coordinated medical care: 63%. The majority of subjects used contraception (93%), with greater use of medroxyprogesterone associated with participation in coordinated medical care (80% vs. 50%, p = .0145). Subsequent births were more common in the comparison group (33%) than among subjects (17%) (p = .001), and survival curves were significantly different (p = .007) (hazard ratio = 2.5). There was a trend toward fewer births with increased participation in medical care (p = .08) and case management (p = .08) but not with group meetings. Cost savings were calculated as $19,097 per birth avoided or $5,055 per month. CONCLUSIONS: The intervention was effective in reducing subsequent births to teens; however selection bias of school enrollment cannot be excluded by this study. The cost savings of delayed births outweigh the expenses of this intensive model.     

Development of a school-based prevention program for children in alcoholic families

The systematic development of a preventive intervention for elementary-aged children of alcoholics (COAs) is described. First, the risk status of children of untreated alcoholics was established. Second, risk and protective factors that appeared to be mediators of mental health status for COAs were identified. Third, a preventive intervention was designed to teach coping skills and enhance self-esteem. Fourth, the intervention was pilot tested to assess its feasibility and potential. Finally, plans for a large scale experimental field trial of the revised curriculum are outlined. The advantages of following a systematic intervention development plan are demonstrated.Work on this study was funded in part by the National Institute of Mental Health Grant P50-MH39246 to Support a Preventive Intervention Research Center and T32-MH18387-02 Postdoctoral Prevention Training Grant. The authors wish to recognize the significant contributions of our Community Advisory Board, composed of Laurel Cappo, Frank Diaz, Julie Edmonson, and Joyce Heddleson, to the development and implementation of this prevention program.     

Inmate must take HIV test if he wants to enroll in program

An inmate cannot sue the Taylorville Correctional Center in Illinois under the Americans with Disabilities Act (ADA) for requiring an HIV test for enrollment in a prison program. Robert Murdock wanted to participate in the prison's culinary arts program, but did not want to take the HIV test. The 7th U.S. Circuit Court of Appeals ruled that Murdock was not a "qualified individual with a disability" and therefore could not sue under ADA. The policy justification for the HIV test, which is required of all inmates enrolling in the program, was not addressed by the court.     

Evaluation of a school-based education program to promote bicycle safety

Of the 500,000 children in the United States who are injured in bicycle crashes annually, 252 die--97% of whom were not wearing a helmet. Although many intervention programs promote the use of helmets by children, a paucity of school-based evaluation studies exist that report students' knowledge retention or behavioral changes. The purposes of this study were to identify associations between student-reported knowledge of safety-related behaviors, reports of current safety-related practices, and students' participation in the Safety Central program while in the 4th grade. The sample consisted of 284 students currently enrolled in 5th and 6th grades. Findings showed a statistically significant association between participation in the Safety Central program and retention of knowledge and enactment of safety messages after a 1- and 2-year period. Motivators and barriers for helmet use were also identified. Implications for modifications to the content and delivery of the program and future evaluations are addressed.     

Long-term weight maintenance after an intensive weight-loss program

OBJECTIVE: This prospective study assessed long-term weight maintenance of patients completing an intensive very-low-calorie diet (VLCD) weight-loss program. SUBJECTS: Individuals who had completed the 12-week core education program and lost > or = 10 kg were recruited. RESULTS: Of 154 eligible subjects, follow-up weights were obtained at > or = 2 years in 112 subjects (72.7%, 72 women, 40 men). Subjects had an average initial body mass index of 37.3 kg/m2 and an average weight loss of 29.7 kg in five months. Six hundred and forty-five follow-up weights (median, five per subject) were obtained over two to seven years of follow-up from clinic visits (70%) and self-report by telephone or mail (30%). Subjects regained an average of 2.5% per month of their lost weight during the first two to three years of follow-up; however, their weight stabilized over the next four years. Subjects regained an average of 73.4% of their weight loss during the first three years. The average weight loss maintained for 112 subjects was 22.8% of initial weight loss after an average of 5.3 years of follow-up. When successful weight maintenance was defined as maintaining a weight loss of 5% or 10% of initial (pre-treatment) body weight, 40% were maintaining a 5% weight loss at five years and 25% were maintaining a weight loss of 10% at 7 years. Multiple regression analyses suggested that age had a significant (p=0.004) and positive effect on weight maintenance. CONCLUSIONS: This study suggests that weight maintenance after an intensive VLCD program is improving but still needs intensive efforts to enable most individuals to maintain a substantial percentage of their weight loss long-term.     

Response to health insurance by previously uninsured rural children.

OBJECTIVE: To examine the healthcare utilization and costs of previously uninsured rural children. DATA SOURCES/STUDY SETTING: Four years of claims data from a school-based health insurance program located in the Mississippi Delta. All children who were not Medicaid-eligible or were uninsured, were eligible for limited benefits under the program. The 1987 National Medical Expenditure Survey (NMES) was used to compare utilization of services. STUDY DESIGN: The study represents a natural experiment in the provision of insurance benefits to a previously uninsured population. Premiums for the claims cost were set with little or no information on expected use of services. Claims from the insurer were used to form a panel data set. Mixed model logistic and linear regressions were estimated to determine the response to insurance for several categories of health services. PRINCIPAL FINDINGS: The use of services increased over time and approached the level of utilization in the NMES. Conditional medical expenditures also increased over time. Actuarial estimates of claims cost greatly exceeded actual claims cost. The provision of a limited medical, dental, and optical benefit package cost approximately $20-$24 per member per month in claims paid. CONCLUSIONS: An important uncertainty in providing health insurance to previously uninsured populations is whether a pent-up demand exists for health services. Evidence of a pent-up demand for medical services was not supported in this study of rural school-age children. States considering partnerships with private insurers to implement the State Children's Health Insurance Program could lower premium costs by assembling basic data on previously uninsured children.     

The graduate technical assistance program: an alternative to traditional training for health administration students.

This paper presents a discussion of current modes of field training for graduate students in health services administration and details the educational goals and structural elements of the Graduate Technical Assistance Program (GTAP) at Arizona State University. The program's unique features include an emphasis on provider defined problems and projects, timely response to these problems by students, and the involvement of students, throughout their training, in consultant relationships with providers. The program also places the student in a new set of collaborative relationships with program faculty. The profiles of the 21 organizations requesting technical assistance, the skills required for project completion, and the range of projects are detailed.     

Chronic illness among poor children enrolled in the temporary assistance for needy families program

OBJECTIVES: This study assessed chronic child illness among recipients of Temporary Assistance for Needy Families (TANF) benefits and poor families not receiving benefits. METHODS: Data from the 1998 National Health Interview Survey were used to examine chronic child illness, enrollment in TANF, health insurance status, and selected access indicators. RESULTS: One quarter of TANF-enrolled children had chronic illnesses. Unenrolled children were 3 times as likely as TANF-enrolled children to be uninsured. Among the chronically ill, 31.7% of unenrolled and 14.3% of enrolled children experienced gaps in insurance coverage that were associated with access barriers. CONCLUSIONS: Welfare policies should consider the effects of chronic illness and gaps in insurance coverage on the health of poor children.     

某农村地区学校预防性侵犯教育对儿童知识和技能的影响

评价学校预防儿童性侵犯教育对农村学龄儿童自我保护知识和技能的影响,为今后在农村地区开展预防儿童性侵犯教育提供参考.方法 本研究在东北某农村地区2所学校二至五年级进行,儿童以班级为单位分为教育组和对照组,由学校教师进行教育.分别于教育前和教育后对学生进行问卷调查,通过比较2组教育前后知识和技能得分的变化评价教育效果.有365名学生参与并完成了教育前后问卷调查.二至五年级学生分别为110,104,88和63名;教育组171名,对照组194名.结果 与教育前比较,教育后教育组和对照组知识和技能得分均有显著增长(P值均<0.01).教育后教育组儿童知识、告诉技能和总技能得分增长值分别为(3.49±3.50)(1.54±1.98)(1.99±2.51),明显高于对照组的增长值[分别为(1.05±3.64)(0.61±1.78)(1.11±2.23)],差异有统计学意义(t值分别为6.50,4.67,3.50,P值均<0.01).结论 学校预防儿童性侵犯教育有助于提高农村儿童的自我保护知识和技能水平.应继续完善预防儿童性侵犯教育和评价方法.     

Formative research in a school-based obesity prevention program for Native American school children (Pathways)

This paper describes how formative research was developed and implemented to produce obesity prevention interventions among school children in six different Native American nations that are part of the Pathways study. The formative assessment work presented here was unique in several ways: (1) it represents the first time formative research methods have been applied across multiple Native American tribes; (2) it is holistic, including data collection from parents, children, teachers, administrators and community leaders; and (3) it was developed by a multi-disciplinary group, including substantial input from Native American collaborators. The paper describes the process of developing the different units of the protocol, how data collection was implemented and how analyses were structured around the identification of risk behaviors. An emphasis is placed on describing which units of the formative assessment protocol were most effective and which were less effective.