Covariates of tooth-brushing frequency in low-income African Americans from grades 5 to 8.

PURPOSE: The purpose of this study was to examine tooth-brushing frequency in 575 urban and nearby suburban African American children as part of a comprehensive risk-reduction study for students at high risk for violence, drugs, school delinquency, and unsafe sexual behaviors to determine which covariates predicted tooth-brushing frequency. METHODS: Students were surveyed 5 times, from the beginning of grade 5 and the end of each year through grade 8, and parents were surveyed at the beginning of grade 5. Peer influence, importance of being liked, self-esteem, attitudes towards tooth-brushing, oral health knowledge, self-efficacy, parental attitudes, and other covariates were examined for the ability to predict self-reporting of tooth-brushing frequency. RESULTS: In the fifth grade, peer influence, the importance of being liked, and physical self-esteem were the significant predictors, and peer influence continued to predict tooth-brushing in the eighth grade. Oral health knowledge and parental influence were not significant. CONCLUSION: Peer influence is an important factor in tooth-brushing behavior in metropolitan African American preadolescent children.

Differences in reported sleep need among adolescents.

Increased lifestyle demands and reduced sleep are reported to result in daytime sleepiness and impaired functioning for teenagers. A sample of 612 freshman urban high school students completed a questionnaire describing their sleep patterns and problems, along with sociodemographic information, daily activities, pubertal development, depressive mood, and morning-evening preference. About 63% of the respondents felt they needed more sleep on weeknights (MS group), experienced sleepiness that interfered with their schoolwork, and had problems with sleeping. The other group reported they got sufficient sleep on weeknights (SS group) and did not experience sleepiness problems to the same degree. However, both had similar weeknight sleep and daily activity patterns. The MS group reported an ideal sleep time of 9.2 h, about 2 h more than they were getting and 1 h more than the SS group ideal, and had a higher preference for later bed and waking times. In our sample, individual differences in biologic sleep need and quality of sleep may be emerging as early as 14 years of age.

Dilemmas in assessing the health status of children with learning disabilities.

There has been little research directed at the evaluation of the general health status of children in mainstream settings with learning disabilities. The purpose of this study was to describe the effectiveness of a teacher-referral instrument in comparing the health status of children with learning disabilities and nondisabled children. Health records were reviewed to validate the findings of the teacher assessments. Students with learning disabilities were found to have increased frequency of health problems on the teacher-referral instrument. The health records did not serve to validate the teacher assessments, however, as a result of missing information and format inconsistencies. Policy implications are identified and discussed.

Cardiovascular risk stability: from grade school to high school.

School-based, cardiovascular risk reduction programs have increased dramatically over the past decade. Though a wide range of evaluation plans have been implemented, limited longitudinal data are available to estimate the effectiveness of these risk reduction programs. The purposes of this study were to describe the stability of risk factors, the changes in cardiovascular risk from grade school to high school, and the differences in risk between gender. The sample (N = 195) of high school students was developed from three cohorts of elementary school students who participated in a risk reduction program in the sixth grade. Three to six years had elapsed since the students participated in the risk reduction program, thus providing a longitudinal view of participants' risk. Subject risk for obesity and high cholesterol level was stable although significant changes were noted for heart rate recovery and blood pressure. The only gender difference in risk was for elevated cholesterol level among female students. Nursing implications are presented.

Health services utilization and special education: development of a school nurse activity tool.

Increasing competition exists for resources to support health services for children receiving special education. Consequently, management tools to document services when claiming these resources need to be developed. The purposes of this study were to develop a time study instrument based on nursing activities in the school, compare nursing time provided to special education children and their nondisabled peers in general education settings, compare nursing process activities in traditional settings and in special education settings, and elicit feedback from nurses to improve the validity and reliability of the time study process. Eighteen nurses representing rural, urban, and suburban schools completed a time study for two weeks, quantifying services provided in the health room. Nurses recorded student educational status, special education category or not, nursing process activity, and the time utilized per student contact. Results indicated 48.2% of school nursing time was attributed to services for special education students during the study period. Most nursing process activities for both settings were in assessment of problems and in direct services. Findings indicate the instrument can provide objective documentation of special education health services, providing a base for claiming important resources for school health services.

Surveying public health nurses' continuing education needs: collaboration of practice and academia.

In the last twenty years, entry level requirements for public health nursing have shifted to less and less educational preparation. Many agencies hire registered nurses with associate degree or diploma preparation who have no experience. The shift in entry level requirements has challenged public health nursing administrators and educators to examine continuing education needs to meet knowledge deficits among public health nurses. The study reported here presents findings from a national survey of 56 state and territorial health departments. The results clarify the continuing education needs and issues related to the educational gaps of public health nurses of the 1990s.

The school nurse development program: an experiment in off-site delivery.

The purpose of this study was to evaluate the effectiveness of a teleconferenced program by comparing multiple program outcomes of learners enrolled at three off-campus sites to Chicago-based learners. An adaptation of the Stake (1967) countenance model guided the evaluation. The data analysis consisted of descriptive statistics, cross-tabulations, and content analyses of comments. The results indicated no statistical differences between groups in grade point average, satisfaction with the program generally or with the teleconferencing process, tenure in school nursing, job stability, adoption of management strategies, and school health programs directed to aggregates.

School health services: a Hub of Services to children and their families.

The Corporate/Community Schools of America (C/CSA) is a not-for-profit coalition of business executives, concerned educators, and community leaders working to reform urban public education in the United States. This article reports on the C/CSA Chicago and the Hub of Services, which is a central component of the school design. The Hub of Services concept is described and compared to traditional school health program management models. Selected outcomes of the program are summarized as well as replication issues. Given the competing demands for increased school-based services and increased fiscal constraints, this unique experiment provides a school health service model that offers a solution for both of these demands.

Southeast Asian refugee children: violence experience and depression.

The United Nations High Commission for Refugees (UNHCR) reports that there were approximately 8.2 million refugees world wide in 1980. Estimates today place the number of refugees to be at least 44 million. Although most refugees remain within the boarders of their homelands, others who are granted asylum immigrate to host countries. The largest number of refugees to enter the United States during the past 20 years are from Southeast Asia, following the end of the Viet Nam War in 1975. The majority of immigrating Southeast Asian refugees were children and adolescents. Empirical study of refugee children, who are known to have experienced catastrophic violence during war, escape from homelands and in camps of asylum, is relatively scarce. Some studies that have addressed this issue document association between violence experience, depression and post traumatic stress disorder. Even so, the findings are not always clear. The purpose of this paper is to document the frequency of pre-migration and post-migration violence experiences reported by Southeast Asian refugee children in the U.S. and their relationship to depression. This study also addresses the emotional impact of violence experiences as described by the children. Previous studies have often neglected this important variable in accounting for variations in children' 5 mental health status. Nurses, internationally, will want to consider the multiple facets of violence experience when assessing children who may be at high risk for psycho-social adaptation problems following resettlement.

Southeast Asian refugee women and depression: a nursing intervention.

Globally, conflicts continue to result in large numbers of refugees and displaced persons, the majority are women. At present, there is scant literature on the mental health status of refugee women following resettlement in countries that grant asylum. We do know that adaptation following migration is a complex cultural, psychological and social process. Some studies have suggested a high prevalence of depression symptoms related to premigration and post-migration experiences. The purpose of this paper will be to describe the mental health status of Southeast Asian (S.E.A.) refugee women in the United States, before home visit interventions by school nurses and bilingual teachers, and at 10, 20 and 33 weeks following the intervention. A comparison group of S.E.A. refugee women, who did not receive the intervention, were evaluated for mental health status on two occasions ten weeks apart. The identified needs and problems identified by the women, the interventions implemented by the school nurses and the success of the interventions will also be discussed. The underlying problem for the majority of women was poverty and social isolation. The study demonstrates that indeed, refugee women in the U.S., are experiencing needs and problems related to basic survival issues in multiple areas of their lives. The findings suggest that home visit interventions by nurses may be a valuable means of reducing depression in S.E.A. refugee women.

Cardiovascular risk among middle school children: implications for primary care.

Cardiovascular risk reduction programs for school-aged children are based primarily in schools. Primary care providers, however, have not routinely included active cardiovascular risk reduction efforts in their practice. The research reported here supplies providers with evidence that can readily guide interventions augmenting cardiovascular risk reduction information and skills that children may be learning in schools.

Immunization rates: a community assessment approach for diagnosis.

Concerned about low immunization rates, school nurses, nursing school faculty, and public health nursing graduate students formed a partnership to identify the problems underlying the low rate of immunizations. Utilizing a representative school district within a large metropolitan area, the process was expedited by an assessment of the community, including a windshield survey, resource survey, collection of demographic data, and generation of mapping software to highlight relationships within census tracts. These relationships emphasized immunization rates within census tracts by concentrations of single-parent families, residential mobility, or foreign nationality. In addition, interviews were held with key informants in the community and with parents. In this instance, communication with the parents was a critical factor in determining that the problems were neither access issues nor parental lack of concern but instead communication problems. A simplified communication strategy to parents that is well timed can be a low-cost solution to the concern over low immunization rates.

Development and evaluation of a Mexican immigrant family support program.

A report to Congress in the fall of 1998 warned that immigrant children are in a state of emergency regarding access to health care. This article presents the three phases involved in developing, implementing, and evaluating a Mexican American Problem Solving (MAPS) program designed to promote the mental health of families. Methods were Phase 1 focus groups to identify concerns and desired approaches for intervention; Phase 2 instrument assessment and prevalence assessment of mental health; and Phase 3 intervention testing. In Phases 1 and 2, 67% of mothers and 59% of children had mental health scores that required referral for evaluation. Participating mothers and children reported positive views of the intervention and showed significant improvements in mental health scores.

The effects of violence on health and adjustment of Southeast Asian refugee children: an integrative review.

Public health nurses have historically been on the front line in meeting the needs of refugees in their practice communities. Little nursing research has been focused on the needs of refugees, however. The purpose of this integrative literature review was to clarify research focused on the needs of one refugee group, southeast Asian. The integrating factors reviewed were the instruments used, sampling procedures, statistical methods, and clarification of independent and dependent variables. Power analyses were computed on three of the studies to critique further the appropriateness of sample size. Findings indicate that premigration experiences, especially violence, play an important role in health status and adaptation after settling in the United States. Since health problems are often manifested in cultural ways different from Western norms, public health nurses would benefit from continued research clarifying the needs of individuals from other cultures.

Cardiovascular risk assessment in school-age children: a school and community partnership in health promotion.

There is little doubt that the primary prevention of cardiovascular disease is a pediatric problem that nursing must address. Cardiovascular health-promotion activities for children have generally used an ecologic model, providing community-based education programs in the schools. The purpose of this study was to identify changes in cardiovascular risk among sixth-grade cohorts over eight years. Four variables known to be associated with such risk--weight (obesity), pulse rate recovery index, blood pressure, and total cholesterol level--were measured on 4900 students, and changes in their prevalence were analyzed. The data presented in this paper were compiled from a screening program conducted by a local health department in partnership with a school district's health-education program. Although the school-based health-education program has been in existence for eight years, the prevalence of cardiovascular risk in sixth-grade students has not declined, suggesting the need for nurses to target the children at risk, and address more directly the motivational and affective domains in addition to cognitively focused programs.

Cardiovascular risk prevalence among diverse school-age children: implications for schools.

Cardiovascular risk reduction programs in school-aged populations must be based on accurate assessments of risk. This cross-sectional, descriptive study presents the prevalence of cardiovascular risk with respect to blood pressure, obesity, and fitness in 4th, 5th, and 6th grade children. School nursing research assistants conducted 358 interviews and clinical risk assessments with children and their parents. A total of 180 children (53%) were found to have one or more cardiovascular risk factors. Our findings of a high level of risk illustrate the need for school nurses to take a leadership role to reduce risk and foster "heart-healthy" school environments.

Effects of family disruption on Southeast Asian refugee women.

Identifying refugee women at a high risk of depression, anxiety and post-traumatic stress is an important role of the nurse, so that appropriate interventions--including family and community support--can be implemented. Below, an assessment of Southeast Asian refugee women experiencing emotional distress from the disruption of family ties that occurred during war, escape and resettlement.

The Health Self-Determinism Index for Children.

A convenience sample of 501 children 7 to 13 years old completed the newly developed Health Self-Determinism Index for Children (HSDI-C), a measure of intrinsic motivation in health behavior. Construct validity was supported through the factorial isolation of four theory-consistent subscales, and the correlation of the total HSDI-C (r = .36, p less than or equal to .009) with a general measure of intrinsic motivation. Alpha coefficients in three separate trials ranged between .79 and .88 for the total scale, and .78 to .88, .87 to .92, .78 to .86, and .63 to .77 on the respective subscales. Test-retest reliability for the total scale was .83 at 2 weeks and .48 at 1 year. A nominated population of 21 third- through seventh-grade children known to practice positive health promotion behaviors had an HSDI-C mean score of 106.5 versus 76.5 in the general sample of children.