Participation in a School-Based Wellness Initiative Associated With Improved K-12 Student Body Mass Index Trends.

BACKGROUND: Associations between school participation in an academic medical center-supported school-based wellness initiative and programmatic components implemented with change in average student body mass index (BMI) over time were examined. METHODS: This was an observational study of 103 K-12 South Carolina schools over school years 2014-2018, classified as participating (n = 87 schools, 27,855 students) or non-participating (n = 16 schools; 3608 students). Associations between students' BMI z-score (BMIz) and school participation were evaluated by linear multilevel mixed-effects modeling using data from FitnessGram and the School Wellness Checklist© (SWC), respectively. RESULTS: One-third of the students had a BMI percentile ≥85. Average student BMIz decreased in participating schools (p = .026) and increased in non-participating schools (p = .004) over time. For schools that participated two or more years, there was an inverse relationship between SWC score and student BMIz (p = .002) that did not differ by school type, rural/urban location, Title 1 status, or student sex. Physical activity and stress management interventions for students, as well as employee wellness and establishing a wellness committee at the school level were significantly associated with decreased average student BMIz (all p < .05). CONCLUSION: Implementation of similar comprehensive school-based wellness programs focused on improving physical activity, stress management, and employee engagement may help prevent and reduce pediatric obesity in diverse communities.

Practice guidelines for the diagnosis, treatment and prevention of childhood and adolescent obesity.

Obesity affects one third of children and adolescents, many of whom already have serious medical consequences. Therefore primary care providers must deliver clinical service that incorporates preventive practices, improves early diagnosis, and evaluates co-morbid conditions. In addition physicians must become more knowledgeable about changing practice in treating overweight and obese children.

Community and school-based interventions to prevent obesity in children and adolescents.

Public health initiatives in community and school settings are complementary to clinical medicine and are necessary in times of health crisis, such as the current epidemic of obesity. In addition to providing health care for individuals, physicians need to regard their community as their patient and participate in multidisciplinary, collaborative efforts to turn the tide of obesity in children and adolescents.

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.

Efficacy of a secondary adolescent pregnancy prevention program: an ecological study before, during and after implementation of the Second Chance Club.

Teen mothers are at increased risk of subsequent adolescent births. Interventions to reduce secondary teen pregnancies are expensive and difficult to evaluate. An ecological evaluation compared change in the repeat teen birth rate in an intervention community in Charleston, South Carolina over time to state birth certificate data to determine the efficacy of a school-based pregnancy prevention program. Evaluation included comparison of birth rates for multigravida teens in the program's school catchment area (intervention zip codes) to selected state and community data before, during and after program implementation. The intervention community demonstrated a decrease in repeat teen births during the intervention period of the program with a rebound after it was discontinued. This trend differed from a 50% linear decrease across these time periods in the state. This low cost evaluation method may be useful for evaluation of teen pregnancy prevention programs with limited resources for program evaluation.

Family-focused smoking cessation:enhanced efficacy by the addition of partner support and group therapy.

While partner support has been found to be an important factor in smoking cessation, programs with partner training have not demonstrated improved efficacy. The goal of this project was to evaluate the effectiveness of a smoking cessation treatment program that included partner support in an innovative education/therapy model similar to alcohol and drug treatment programs. Subjects included 23 smokers, 71% with a support partner. The program consisted of a smoking cessation curriculum, combined with facilitated group therapy for participants and partners, and individualized medication evaluation. Smoking abstinence was 87% at program completion and 80% at one month follow up, 100% abstinence in participants with support and 50% in participants without support (p < 0.05). Smoking Stage of Change at enrollment was: contemplation 22%, preparation 70%, and action 8%, with 87% movement toward action stage. In the present study, partner support enhanced short-term abstinence from smoking.

Identification of resident and attending physicians: do parents know who is caring for their hospitalized child?

OBJECTIVE: Correct identification of a physician or resident is an essential first step in developing a good relationship between physicians, patients, and their families. However, many parents are unfamiliar with the individuals responsible for their children's care. This study was conducted to determine how often parents/guardians of hospitalized children could identify the residents and attending physicians caring for their children and what factors they considered important in physician identification. METHODS: This was a cross-sectional study with a convenience sample of the parents/guardians of hospitalized pediatric patients admitted to a university teaching hospital over a 2-month period; we used a self-administered, confidential questionnaire. RESULTS: Subjects were 144 parents/guardians of hospitalized children (100% of subjects asked to participate, 19.3% of all hospitalized children); parents had the following characteristics: mean age, 30 years; 51% Caucasian, 43% African American; 82% female. Physician identification was 76% for attending physicians and 73% for residents. The factors rated as most important to parents were physician introduction (50%-76%), prior relationship (27%-13%), wearing of a white coat (2%-8%), wearing of a name tag (4%-10%), and wearing of a stethoscope (0%-2%). Physician introduction was ranked higher for first hospitalizations. Subsequent hospitalizations increased identification of attending physicians but not residents. CONCLUSIONS: This study indicates that up to a quarter of parents could not identify the physician responsible for their children's care during a hospitalization. Improving physician identification may enhance other aspects of physician-family communication.

Teen pregnancy in South Carolina: a local needs assessment of Charleston County.

Although there has been recent improvement, teen pregnancy continues to be a significant problem, especially in South Carolina where the birth rate to adolescents is higher than the national average. As this is a complex issue, many different interventions including both primary and secondary prevention as well as modification of programs to fit each individual community will be necessary. One initial approach to pregnancy prevention program implementation is a needs assessment of current interventions compared with teen birth rates in a community. This report of a needs assessment for Charleston County revealed a discrepancy between the location of most pregnancy prevention programs (urban areas of the county) and the higher teen birth rates (rural areas of the county,) establishing areas that will be targeted for additional services. Other counties throughout South Carolina may find this approach useful in coordination of community efforts to reduce teen pregnancy.

Missed opportunities for prevention: failure to identify smoking in the parents of adolescent patients.

Smoking is an addiction that often begins in childhood or adolescence. Factors associated with early smoking initiation include parental smoking and socialization about smoking with their children. Previous studies evaluating the history obtained during routine pediatric appointments have not focused on parental smoking history and counseling. In this study, seventy-three (73) adolescents (mean age: 15.2 years; 77% female; 64% African-American) seen for medical care in a primary care clinic and their accompanying parent(s) (mean age: 43.5 years; 91% female) were surveyed about smoking followed by a review of each chart measuring documentation of adolescent and parent smoking history and counseling. Although the majority of adolescents were questioned about smoking (92%), parents were rarely questioned (1%) (p < 0.05). Adolescents were counseled about smoking (7%) and other risk-taking behaviors (44%); however, no parents were counseled about smoking or smoking socialization. Physicians frequently overlook an important factor in the prevention of smoking initiation at a young age, parental smoking history and counseling.

Reduced emergency department utilization associated with school-based clinic enrollment.

PURPOSE: To evaluate the change in emergency department utilization before and after enrollment in a school-based clinic (SBC). METHODS: This study was a retrospective cohort study comparing emergency department visit rate before and after SBC enrollment based on chart review. An initial cohort of 10- to 15-year-olds who used a local emergency department was divided into two samples: those who had been enrolled in the SBC and those who had not. Emergency department charts were reviewed for visits that occurred during the initial year and two subsequent school years. The change in visit rate for each sample group was measured for each school year evaluated. RESULTS: The initial cohort consisted of 2852 youth, 344 of whom who lived in the high school attendance zone. Of these, the number of students enrolled in both the high school and the SBC was 43; the number enrolled in the high school but not in the clinic was 48. The emergency department visit rate decreased for both groups for each school year evaluated; however, this decrease was significant only for the SBC sample with a 41% to 57% decrease in emergency department utilization, 18% greater than the decrease in students who did not use the SBC. CONCLUSIONS: Accessible, prevention-oriented health care provided in a SBC can decrease the utilization of episodic health care in an emergency department.