Features of the built environment related to physical activity friendliness and children's obesity and other risk factors.

OBJECTIVES: We investigated the relationships among environmental features of physical activity friendliness, socioeconomic indicators, and prevalence of obesity (BMI status), central adiposity (waist circumference, waist-height ratio), and hypertension. DESIGN AND SAMPLE: The design was cross-sectional; the study was correlational. The sample was 911 kindergarteners through sixth graders from three schools in an urban school district residing in 13 designated neighborhoods. MEASURES: Data from walking environmental community audits, census data for socioeconomic indicators, body mass index, waist circumference, waist-height ratio, and blood pressure were analyzed. A modified Alfonzo's Hierarchy of Walking Needs model was the conceptual framework for environmental features (i.e., accessibility, safety, comfort, and pleasurability) related to physical activity. RESULTS: Accessibility was significantly and negatively correlated with prevalence of obesity and with prevalence of a waist-height ratio >0.50. When neighborhood education was controlled, and when both neighborhood education and poverty were controlled with partial correlational analysis, comfort features of a walking environment were significantly and positively related to prevalence of obesity. When poverty was controlled with partial correlation, accessibility was significantly and negatively correlated with prevalence of waist-height ratio >0.50. CONCLUSIONS: The built environment merits further research to promote physical activity and stem the obesity epidemic in children. Our approach can be a useful framework for future research.

Overweight and central adiposity in school-age children and links with hypertension.

The purpose of this study of school-age children was to estimate prevalence and interrelationships of overweight, central adiposity, and hypertension. It included 1,070 children in kindergarten through sixth grade (67% Hispanic, 26% African American, mean age = 8.9 years). Measures included body mass index (BMI), waist circumference (WC), systolic and/or diastolic hypertension identified by measurements on three separate occasions. Percentage overweight (BMI >or=95th percentile) was 28.7%, 17.9% were at risk of overweight, 28.8% had WC >or=90th percentile, and 9.4% had elevated (>or=90th percentile) systolic and/or diastolic blood pressure (BP). If we had screened only for BMI and examined those with BMI >or=85th percentile or underweight for hypertension, we would have missed 26% of the children with persistently elevated BP. WC explained variance in elevated BP not explained by BMI (p < .001). Measurement of WC is easily incorporated in a school-based screening protocol.

Faculty workload calculation.

Faculty members and nursing education administrators have long examined faculty workloads and documentation thereof but have had difficulty quantifying the work faculty members accomplish in academia. Workloads become even more complicated as faculty members incorporate many activities into their roles of teaching, research, clinical practice, and community service. A form that was simple yet fairly complete was developed at the University of Texas Health Science Center at Houston School of Nursing. The purpose of this article is to describe our workload documentation and issues surrounding its use. This form has been a useful beginning for discussions about accomplishing the work of the mission areas of the school. Our experience and documents may be useful to others.

The cost of screening adolescents for overweight and hypertension using a community partnership model.

OBJECTIVES: (1) Determine the prevalence of overweight and high blood pressure (BP) among middle and high school students over a 2-year period and, (2) measure the cost and initial outcomes of screening. DESIGN: Cost and outcome description using a cross-sectional design sample. The target population was 12- to 19-year-old healthy students attending grades 7 through 12 at 3 proximal schools located in a large urban school district in Texas. RESULTS: Of 2,338 students screened, 925 (39.6%) had a body mass index (BMI)>or=85th percentile and 504 (21.6%) had BMIs>or=95th percentile for age and gender. There were 346 students (14.8%) with BMIs>or=85th percentile and systolic blood pressure (SBP)>or=95th percentile for age, gender, and height. The cost of the 2-year screening program was $66,442, and the cost per student was $28. The cost to identify a student with increased BMI or high SBP was $72 and $107, respectively. CONCLUSIONS: This study offered an objective framework to examine the cost and outcomes of screening children for overweight and increased BP. The study has implications for discussion and informed decision making about school-based screening for these conditions.

A framework for developing a coding scheme for meta-analysis.

The prominence of systematic reviews as bases for evidence-based practice is increasingly recognized and has significance for practice disciplines such as nursing. Synthesizing research findings is key to informing the clinical care of individuals burdened with health problems. A major issue in conducting such reviews involves developing reliable and valid coding procedures for extracting data from the research literature. A formalized process is described for developing coding instruments that have been used in five separate studies. Initial instrument development for a diabetes self-management education meta-analysis is described, followed by a discussion of adapting the instruments for subsequent meta-analytic studies of self-management interventions in diabetes care and of interventions to reduce caregiver burden of individuals with Alzheimer's disease dementia. Although time and effort are required for development of coding processes for research synthesis, these instrument development activities are one of the critical elements of producing reliable and clinically useful information.

A structured, interactive method for youth participation in a school district-university partnership to prevent obesity.

BACKGROUND: The involvement of school-age children in participatory research is described in the context of a school district-university partnership to prevent obesity in children. The purpose of this study was to elicit, from children in kindergarten (K) through sixth grade, perceptions of foods and activities that would inform the design of developmentally appropriate interventions to prevent and reduce childhood obesity. METHODS: Children (N = 218) were selected through a random sample of K through sixth grade classrooms in 3 schools. They participated in structured, interactive, small group exercises focused on perceptions of foods (taste and healthy/unhealthy) and activities (fun and active/sedentary). High school students in the same school district were trained to facilitate the children's groups in collaboration with university faculty and students. RESULTS: Qualitative data analysis was used to discern patterns across grade levels. There were grade-level differences in perceptions of the taste and healthfulness of foods. Younger children (K-1) equated foods that tasted good with foods that were "good for you." Older children were more discriminating and gave reasons for their perceptions. For activities, fun was positively associated with the number of people involved and the amount of movement. There were fewer differences across grade levels in preferences for types of sedentary activities, compared with sports and other activities that "make you move." CONCLUSIONS: The findings have implications for developmentally appropriate health promotion interventions to prevent obesity. These structured but highly interactive methods could be used by school personnel to assess the unique needs of a school population.

Effects of a diabetes self-management program on glycemic control, coronary heart disease risk, and quality of life among Thai patients with type 2 diabetes.

Uncontrolled diabetes is a major health problem in Thailand. The objective of this study was to determine the effects of a diabetes self-management program on glycemic control, coronary heart disease (CHD) risk, and quality of life in 147 diabetic patients (aged 56.8 +/- 10.2 years). Type 2 diabetic patients who met the research criteria were randomized into two groups for a period of 6 months: the experimental group received the diabetes self-management program and the control group received the usual nursing care. The findings indicated that the experimental group demonstrated a significant decrease in the hemoglobin A(1c) level and CHD risk, with an increase in quality of life (QOL) compared to the control group. The diabetes self-management program was effective for improving metabolic control and the QOL for individuals with diabetes. Further studies should be replicated using larger groups over a longer time frame.

Student nurses participate in public health research and practice through a school-based screening program.

Obesity has reached epidemic proportions among children in minority populations, placing them at risk for diabetes and hypertension. The importance of educating a generation of nurses who have the knowledge, skills, and passion to address this public health need is crucial to the profession and to America's health. This article describes the use of a Community Partnership Model to frame baccalaureate nursing students' (B.S.N.) service learning within the context of a research study to screen middle- and high-school students for health risks. The missions of education, research, and practice are linked together in the model by three processes: evidence-based practice, service learning, and scholarly teaching. The aim of the project was early identification of obesity, hypertension, and type 2 diabetes and their predictors in a high-risk student population, between 12 and 19 years of age. Early evidence indicates that the model is feasible and effective for directing student learning and addressing public health problems in the community.