(Read this Excerpt from a Research Review, Identified by the ISHN information service for its members) Taken from this report; National Collaborating Centre for Determinants of Health. (2012). Assessing the impact and effectiveness ofintersectoral action on the social determinants of health and health equity: An expedited systematic review. Antigonish, NS: National Collaborating Centre for Determinants of Health, St. Francis Xavier University. See our school-related excerpts from the report by clicking on the Read More link (lower right side, below this posting)
Six interventions that occurred within school settings were identified in this review.34,36,39,43,44,47 .
Freeman et al.34 assessed the effectiveness of a school-based break-time snacking initiative on the oral health of children attending schools in areas with low socio-economic status (SES) in Northern Ireland. This intervention was intended to change health behaviours and improve health outcomes by altering the school environment. School representatives, public health professionals (health promoters and dietitians), academics, and dairy farmers developed a break-time policy called Boost Better Breaks, which addressed unhealthy break-time snacks and drinks at the intervention schools. The study matched intervention and control schools by location, coeducation, and SES. The sample consisted of three hundred and sixty-four 9-year-olds, 189 in the intervention schools and 175 in the control schools. The outcome of interest, childhood dental disease, was determined in terms of the percentage of children who were free of tooth decay and fillings and had no evidence of extracted teeth due to decay (i.e., cariesfree), based on the clinical index known as DMFT (total number of decayed, missing due to caries, and
filled teeth). At the end of the study, the intervention group (low SES) had a mean DMFT score of 1.58, CI [1.28, 1.89]), whereas the control group (high SES) had a mean DMFT score of 0.065, CI [0.38, 0.93]. In addition, the DMFT in the intervention group (n = 99) changed from 1.13, CI [0.85, 1.40] in year 1 to 1.58, CI [1.28, 1.89] in year 2. There was also an increase in the number of filled permanent teeth among students from lower SES schools over time: mean 0.49, CI [0.20, 0.77] in year 1 and 1.05, CI [0.69, 1.14] in year 2.
Hollar et al.36 conducted a controlled clinical trial of an elementary school–based obesity prevention program in Florida. Study partners included academia, the educational sector (school administration and cafeteria), district food services, district wellness committee members, the US Department of Agriculture Food and Nutrition Service, and a magazine. The study involved a sample of 3,769 students (50.2% Hispanic, 33.4% white, 8.0% Black, and 8.4% other), 3,032 students in four intervention schools and 737 in one control school, with an average age of 8 years (range 4 to 13). The intervention consisted of (a) modification of dietary offerings to include nutritious ingredients and whole foods in school provided meals, (b) nutrition and lifestyle educational curricula, (c) a physical activity component, and (d) wellness projects. Data were reported at two points in time; the longest follow-up is reported here. In year 2, mean body mass index (BMI) declined by 1.73 (SD = 13.6) in the intervention schools and by 0.47 (SD = 12.1) in the control school (p = .007). Girls in the control group had an increase in mean systolic blood pressure, from 98.37 to 101.44 mm Hg (p < .001), and boys in both groups had an increase in systolic blood pressure (100.83 to 101.94 mm Hg in the intervention group and 99.28 to 101.93 mm Hg in the control group) (p < .0001). Diastolic blood pressure increased in both boys and girls in the intervention and control groups (p < .0001). A sub-sample of low-income students
(n = 1,197; 68 % Hispanic, 15% white, 9% Black, and 8% other) received free or reduced-cost school lunches. In this sub-sample, children in the intervention schools were more likely to reduce their BMI (p = .0013) and their weight (p < .011) than children in the control school over the 2-year intervention period. Math scores of students in the intervention group improved (p < .0005), and Hispanic and white children in intervention schools were more likely to have higher math scores (p < .001) than their counterparts in the control school. There was no observed change in math scores among Black students. Children in the intervention schools had higher reading scores than those in the control school in both years of the intervention (p < .08).
A controlled clinical trial measured the impact of a school-based asthma intervention for low- income ethnic minority families in New York City.39 Schools were randomly assigned in pairs to either the intervention or control groups; control schools received the intervention after the evaluation. School nurses and physicians worked with families and primary care providers to encourage the development of asthma management plans.Nurses (a) called families to confirm case-detection information, to further assess children’s asthma severity and health care needs, and to provide caregivers with asthma education as needed; (b) sent sample treatment plans to primary care providers on the basis of students’ asthma severity, consistent with National Heart, Lung and Blood Institute guidelines, and blank treatment plans; (c) encouraged caregivers and primary care providers to complete required forms when medication was needed at school; and (d) referred families for medical care as needed. At 2 years post-intervention, control students had had fewer admissions to hospital in the previous 12 months (control 0.1 [SD = 0.3] vs. intervention 0.2 [SD = 0.6], p < .05).39
One study described the establishment of a school-based mental health service for refugee children in the UK.43 Using a pre/post survey design, Fazel et al. assessed the impact of the service on students’ mental health using a 25-item Strengths and Difficulties Questionnaire (SDQ). The core activity of the service was a weekly consultation at each school with the key mental health worker and the link teacher. This teacher was usually a language support or special needs teacher who typically had good existing knowledge of the refugee children. The link teacher liaised with other teachers and generally acted as a conduit between the school and the mental health service. The intervention group (n = 47) was made up of refugee students. Students in each of the control groups (ethnic, n = 47; white, n = 47) received no intervention. There were overall differences between the three groups (with refugee children scoring
higher, but no significant difference between the two control groups) in SDQ total score (F [2, 138] = 6.6, p = .002) and in the scales for emotional symptoms (F [2, 138] = 11.5, p < .001) and peer problems (F [2, 138] = 4.2, p = .017). Over the study period (pre- vs. post-treatment), the total SDQ score in all groups decreased (F [1, 138] = 5.9, p = .016), with the greatest changes evident in the peer problems scale (F [1, 138] = 8.1, p = .005) and the hyperactivity scale (F [1, 138] = 3.9, p = .05). Hyperactivity scores decreased more in the refugee group than in the control groups (mean change –0.96 [SD = 2.40] vs. –0.10 [SD = 1.98]; t = 2.12, p = .037), with a suggestion of an effect in the emotional symptoms score (mean change –0.72 [SD = 2.63] vs. 0.03 [SD = 2.02]; t = 1.73, p = .088). At the end of the 1-year study period, refugee children continued to have significantly higher SDQ total scores (F [2, 138] = 4.7, p = .011), emotional symptom scores (F [2, 138] = 8.6, p < .001), and peer problem scores (F [2, 138] = 6.3, p = .002) than those in the control groups.
A study of a school-based oral health program examined the impact of providing dental services to refugee students in the US.44 As part of the intervention, a dental hygienist examined health records at school, conducted a visual dental screen, and arranged for students to see a community dentist. Transportation and translation were provided as needed. Melvin assessed the provision of preventive, restorative, and emergency care over 2 years of the program. In year 1, the program served 1,144 students and in year 2 it served 353 children. The percentage of children receiving preventive care increased from 52% in year 1 to 60% in year 2. In year 2, 212 children (60%) received preventive care, and 39 children (11%) received restorative care. The number of children receiving restorative care decreased by 11% in year 2 (no p values provided).
Macnab et al.47 conducted a cross-sectional study of a school-based dental health program in a rural, remote Aboriginal community in Canada (population 300). All children attending the community school (n = 26 at baseline and n = 40 at follow-up) participated in an oral health program that consisted of daily school-based brush-ins after lunch supervised by teachers and/or the community health director; a weekly fluoride rinse; fluoride varnish application for those under 9 years of age; and classroom presentations by pediatric residents about a variety of health topics, including oral health. At the start of the program, the mean DMFT score was 5.5 (SD = 6.2) and at 3-year follow-up the mean score was 6.1 (SD = 8.5) (p < .05). Children assessed both before and after the intervention, (n = 13) had improvements in dmfs/DMFS (total number of decayed, missing due to caries, and filled surfaces : primary/permanent) (p < .005) and dmft/DMFT (p < .05) scores.
One systematic review met the inclusion criteria for this Canadian review.33 The systematic review assessed the impact oforganizational partnerships on public health outcomes and health inequalities in England and included 15 studies related to six interventions: Health Action Zones, Health Improvement Programmes, New Deal for Communities, Health Education Authority Integrated Purchasing Programme, Healthy Living Centres, and National Healthy School Standard. All interventions were multi-sectoral, and each was designed to address a range of social determinants of health (e.g., employment, poverty, social exclusion, housing, education). One intervention (National Healthy School Standards) focused on children in school settings, and all other interventions occurred at the local, neighbourhood, or community level.
References
34. Freeman R, Oliver M, Bunting G, Kirk J, and Saunderson W. Addressing children’s oral health inequalities in Northern Ireland: a researchpractice- community partnership initiative. Public
Health Rep. 2001;116(6):617-25.
36. Hollar D, Lombardo M, Lopez-Mitnik G, Hollar TL, Almon M, Agatston AS, and Messiah SE. Effective multi-level, multi-sector, school-based obesity prevention programming improves weight, blood pressure, and academic performance, especially among low-income, minority children. J Health Care Poor Underserv. 2010;21(2:Suppl):S93-108.
39. Bruzzese JM, Evans D, Wiesemann S, Pinkett-Heller M, Levison MJ, Du Y, Fitzpatrick C, Krigsman G, Ramos-Bonoan C, Turner L, and Mellins RB. Using school staff to establish a
preventive network of care to improve elementary school students’ control of asthma. J Sch Health. 2006;76(6):307-12.
43. Fazel M, Doll H, and Stein A. A school-based mental health intervention for refugee children: an exploratory study. Clin Child Psychol Psychiatry. 2009;14(2):297-309.
44. Melvin CS. A collaborative community-based oral care program for school-age children. Clin Nurse Spec. 2006;20(1):18-22.
47. MacNab AJ, Rozmus J, Benton D, and Gagnon FA. 3-year results of a collaborative school-based oral health program in a remote First Nations community. Rural Remote Health. 2008;8(2):-7p.
Read the full report.
Freeman et al.34 assessed the effectiveness of a school-based break-time snacking initiative on the oral health of children attending schools in areas with low socio-economic status (SES) in Northern Ireland. This intervention was intended to change health behaviours and improve health outcomes by altering the school environment. School representatives, public health professionals (health promoters and dietitians), academics, and dairy farmers developed a break-time policy called Boost Better Breaks, which addressed unhealthy break-time snacks and drinks at the intervention schools. The study matched intervention and control schools by location, coeducation, and SES. The sample consisted of three hundred and sixty-four 9-year-olds, 189 in the intervention schools and 175 in the control schools. The outcome of interest, childhood dental disease, was determined in terms of the percentage of children who were free of tooth decay and fillings and had no evidence of extracted teeth due to decay (i.e., cariesfree), based on the clinical index known as DMFT (total number of decayed, missing due to caries, and
filled teeth). At the end of the study, the intervention group (low SES) had a mean DMFT score of 1.58, CI [1.28, 1.89]), whereas the control group (high SES) had a mean DMFT score of 0.065, CI [0.38, 0.93]. In addition, the DMFT in the intervention group (n = 99) changed from 1.13, CI [0.85, 1.40] in year 1 to 1.58, CI [1.28, 1.89] in year 2. There was also an increase in the number of filled permanent teeth among students from lower SES schools over time: mean 0.49, CI [0.20, 0.77] in year 1 and 1.05, CI [0.69, 1.14] in year 2.
Hollar et al.36 conducted a controlled clinical trial of an elementary school–based obesity prevention program in Florida. Study partners included academia, the educational sector (school administration and cafeteria), district food services, district wellness committee members, the US Department of Agriculture Food and Nutrition Service, and a magazine. The study involved a sample of 3,769 students (50.2% Hispanic, 33.4% white, 8.0% Black, and 8.4% other), 3,032 students in four intervention schools and 737 in one control school, with an average age of 8 years (range 4 to 13). The intervention consisted of (a) modification of dietary offerings to include nutritious ingredients and whole foods in school provided meals, (b) nutrition and lifestyle educational curricula, (c) a physical activity component, and (d) wellness projects. Data were reported at two points in time; the longest follow-up is reported here. In year 2, mean body mass index (BMI) declined by 1.73 (SD = 13.6) in the intervention schools and by 0.47 (SD = 12.1) in the control school (p = .007). Girls in the control group had an increase in mean systolic blood pressure, from 98.37 to 101.44 mm Hg (p < .001), and boys in both groups had an increase in systolic blood pressure (100.83 to 101.94 mm Hg in the intervention group and 99.28 to 101.93 mm Hg in the control group) (p < .0001). Diastolic blood pressure increased in both boys and girls in the intervention and control groups (p < .0001). A sub-sample of low-income students
(n = 1,197; 68 % Hispanic, 15% white, 9% Black, and 8% other) received free or reduced-cost school lunches. In this sub-sample, children in the intervention schools were more likely to reduce their BMI (p = .0013) and their weight (p < .011) than children in the control school over the 2-year intervention period. Math scores of students in the intervention group improved (p < .0005), and Hispanic and white children in intervention schools were more likely to have higher math scores (p < .001) than their counterparts in the control school. There was no observed change in math scores among Black students. Children in the intervention schools had higher reading scores than those in the control school in both years of the intervention (p < .08).
A controlled clinical trial measured the impact of a school-based asthma intervention for low- income ethnic minority families in New York City.39 Schools were randomly assigned in pairs to either the intervention or control groups; control schools received the intervention after the evaluation. School nurses and physicians worked with families and primary care providers to encourage the development of asthma management plans.Nurses (a) called families to confirm case-detection information, to further assess children’s asthma severity and health care needs, and to provide caregivers with asthma education as needed; (b) sent sample treatment plans to primary care providers on the basis of students’ asthma severity, consistent with National Heart, Lung and Blood Institute guidelines, and blank treatment plans; (c) encouraged caregivers and primary care providers to complete required forms when medication was needed at school; and (d) referred families for medical care as needed. At 2 years post-intervention, control students had had fewer admissions to hospital in the previous 12 months (control 0.1 [SD = 0.3] vs. intervention 0.2 [SD = 0.6], p < .05).39
One study described the establishment of a school-based mental health service for refugee children in the UK.43 Using a pre/post survey design, Fazel et al. assessed the impact of the service on students’ mental health using a 25-item Strengths and Difficulties Questionnaire (SDQ). The core activity of the service was a weekly consultation at each school with the key mental health worker and the link teacher. This teacher was usually a language support or special needs teacher who typically had good existing knowledge of the refugee children. The link teacher liaised with other teachers and generally acted as a conduit between the school and the mental health service. The intervention group (n = 47) was made up of refugee students. Students in each of the control groups (ethnic, n = 47; white, n = 47) received no intervention. There were overall differences between the three groups (with refugee children scoring
higher, but no significant difference between the two control groups) in SDQ total score (F [2, 138] = 6.6, p = .002) and in the scales for emotional symptoms (F [2, 138] = 11.5, p < .001) and peer problems (F [2, 138] = 4.2, p = .017). Over the study period (pre- vs. post-treatment), the total SDQ score in all groups decreased (F [1, 138] = 5.9, p = .016), with the greatest changes evident in the peer problems scale (F [1, 138] = 8.1, p = .005) and the hyperactivity scale (F [1, 138] = 3.9, p = .05). Hyperactivity scores decreased more in the refugee group than in the control groups (mean change –0.96 [SD = 2.40] vs. –0.10 [SD = 1.98]; t = 2.12, p = .037), with a suggestion of an effect in the emotional symptoms score (mean change –0.72 [SD = 2.63] vs. 0.03 [SD = 2.02]; t = 1.73, p = .088). At the end of the 1-year study period, refugee children continued to have significantly higher SDQ total scores (F [2, 138] = 4.7, p = .011), emotional symptom scores (F [2, 138] = 8.6, p < .001), and peer problem scores (F [2, 138] = 6.3, p = .002) than those in the control groups.
A study of a school-based oral health program examined the impact of providing dental services to refugee students in the US.44 As part of the intervention, a dental hygienist examined health records at school, conducted a visual dental screen, and arranged for students to see a community dentist. Transportation and translation were provided as needed. Melvin assessed the provision of preventive, restorative, and emergency care over 2 years of the program. In year 1, the program served 1,144 students and in year 2 it served 353 children. The percentage of children receiving preventive care increased from 52% in year 1 to 60% in year 2. In year 2, 212 children (60%) received preventive care, and 39 children (11%) received restorative care. The number of children receiving restorative care decreased by 11% in year 2 (no p values provided).
Macnab et al.47 conducted a cross-sectional study of a school-based dental health program in a rural, remote Aboriginal community in Canada (population 300). All children attending the community school (n = 26 at baseline and n = 40 at follow-up) participated in an oral health program that consisted of daily school-based brush-ins after lunch supervised by teachers and/or the community health director; a weekly fluoride rinse; fluoride varnish application for those under 9 years of age; and classroom presentations by pediatric residents about a variety of health topics, including oral health. At the start of the program, the mean DMFT score was 5.5 (SD = 6.2) and at 3-year follow-up the mean score was 6.1 (SD = 8.5) (p < .05). Children assessed both before and after the intervention, (n = 13) had improvements in dmfs/DMFS (total number of decayed, missing due to caries, and filled surfaces : primary/permanent) (p < .005) and dmft/DMFT (p < .05) scores.
One systematic review met the inclusion criteria for this Canadian review.33 The systematic review assessed the impact oforganizational partnerships on public health outcomes and health inequalities in England and included 15 studies related to six interventions: Health Action Zones, Health Improvement Programmes, New Deal for Communities, Health Education Authority Integrated Purchasing Programme, Healthy Living Centres, and National Healthy School Standard. All interventions were multi-sectoral, and each was designed to address a range of social determinants of health (e.g., employment, poverty, social exclusion, housing, education). One intervention (National Healthy School Standards) focused on children in school settings, and all other interventions occurred at the local, neighbourhood, or community level.
References
34. Freeman R, Oliver M, Bunting G, Kirk J, and Saunderson W. Addressing children’s oral health inequalities in Northern Ireland: a researchpractice- community partnership initiative. Public
Health Rep. 2001;116(6):617-25.
36. Hollar D, Lombardo M, Lopez-Mitnik G, Hollar TL, Almon M, Agatston AS, and Messiah SE. Effective multi-level, multi-sector, school-based obesity prevention programming improves weight, blood pressure, and academic performance, especially among low-income, minority children. J Health Care Poor Underserv. 2010;21(2:Suppl):S93-108.
39. Bruzzese JM, Evans D, Wiesemann S, Pinkett-Heller M, Levison MJ, Du Y, Fitzpatrick C, Krigsman G, Ramos-Bonoan C, Turner L, and Mellins RB. Using school staff to establish a
preventive network of care to improve elementary school students’ control of asthma. J Sch Health. 2006;76(6):307-12.
43. Fazel M, Doll H, and Stein A. A school-based mental health intervention for refugee children: an exploratory study. Clin Child Psychol Psychiatry. 2009;14(2):297-309.
44. Melvin CS. A collaborative community-based oral care program for school-age children. Clin Nurse Spec. 2006;20(1):18-22.
47. MacNab AJ, Rozmus J, Benton D, and Gagnon FA. 3-year results of a collaborative school-based oral health program in a remote First Nations community. Rural Remote Health. 2008;8(2):-7p.
Read the full report.
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