School-based obesity prevention: Opinions, beliefs & current practices of licensed school nurses. Findings from the Minnesota School Nurse Survey

School of Nursing Annual Spring Research Day

April 21, 2006

Martha Y. Kubik, PhD RN School of Nursing, University of Minnesota

Mary Story PhD, RD School of Public Health, University of Minnesota

Problem: Childhood Obesity

Institute of Medicine (2004) Critical public health threat National public health priority

Prevalence of @risk of overweight & overweight among 2-19 year olds (NHANES: 2003-2004)*

All: 34% (17%) Non-Hispanic Whites: 33% (16%) Non-Hispanic Blacks: 35% (20%) Mexican Americans: 37% (19%)

* Ogden et al, JAMA, 2006( ) = % > 95th %

Schools

In US, 95% children & youth enrolled in school

Considerable time spent at school 6 hours/day 5 days/week 36 weeks/year 13 years

Primary location to reach ALL children & youth

School Nurses: Primary Providers of School Health Services

Nationwide, 45,000 school nurses provide care to more than 53 million school children

Opportunity to intervene at multiple levels of prevention 1 prevention:

Promote healthy lifestyle practices for ALL 2 prevention:

Case finding & referral for targeted programs

Well-positioned to assume a lead role in school-based obesity prevention

Are school nurses ready & prepared to assume role?

Study Overview: Minnesota School Nurse Survey

Purpose: To determine current roles and responsibilities

of MN school nurses in delivering school-based services that target the prevention & treatment of overweight among students

To assess school nurses’ knowledge, beliefs & attitudes about school-based preventive health services targeting obesity prevention that include both individual & population level strategies

Study Overview:Minnesota School Nurse Survey

Sample: School Nurse Organization of Minnesota (SNOM)

Licensed school nurses Active members

Data Collection: Mailed self-administered survey

64 items 10-15 minutes to complete $1 bill incentive

Fall 2005 Response rate: 80% (221/275)

Study Overview:Minnesota School Nurse Survey

Sample Characteristics: Mean age: 50 (SD 7.3); range: 25-66 Gender: 97% female Race/Ethnicity: 99% Caucasian Education:

65% bachelor’s degrees 31% master’s degrees

Median Yrs Current Position: 6 (range: 0.08-30) Median Total Yrs School Nursing: 9 (range: 1-40) Median Total Yrs Nursing Experience: 25 (range: 2-

41.5)

School Nursing Practice

1. Assessment of non-acute health conditions (MOST COMMON)

2. Case management of students with chronic health needs3. Assessment of acute health conditions4. Supervision of ancillary staff5. Medication administration6. Immunization monitoring7. Hearing & vision screening8. Skilled care9. Health education in group setting10. Paperwork11. Height & weight screening (LEAST

COMMON)

Health Screening

Screened Parents NotifiedIf not normal All No

Vision 99% 84% 15% ---

Hearing 96% 82% 17% ---

Height & Weight

37% 41% 15% 35%

BMI 3% 17% 33% 17%

BMI % 3% 57% 14% ---

77% provided on an annual basis

Obesity Prevention:Student-level intervention

NEVER RARELY SOMETIME

SOFTEN

Contact parent about a child-related weight concern?

10% 57% 31% 2%

Provide consultation to teachers about a student-related weight concern?

18% 40% 39% 2%

Check BP of an overweight child?

34% 43% 20% 3%

Check BMI of a child you think might be overweight?

62% 25% 10% 2%

Use BMI% to assess a child’s weight status?

59% 23% 12% 5%

Obesity Prevention:School-level intervention

NEVERRAREL

Y SOME-TIMES

OFTEN

Provide consultation to school administrators about health-related school policy?

11% 19% 43% 27%

Participate as a member of a school health council?

39% 17% 23% 20%

Monitor school nutrition practices, like food used in fundraising & as rewards for students?

39% 29% 26% 6%

Assess the nutrient quality of food & drinks sold to students at school from a la carte, vending machines, school stores & fundraising?

38% 24% 29% 8%

Monitor school physical activity practices, like student access to space & equipment for play before/after school?

49% 29% 17% 4%

Obesity Prevention:School Health Services & Nursing

Strongly Disagree/ Disagree

Uncertain

Strongly Agree/Agree

School health services should not be used for obesity prevention efforts.

73% 16% 7%

School administrators will support obesity prevention efforts at school.

10% 45% 42%

School nurses have adequate time to oversee & monitor obesity prevention efforts at school.

86% 7% 5%

School nurses are prepared to oversee & monitor obesity prevention efforts at school. 44% 26% 28%

Overall Findings:Nursing & School-based Obesity Prevention

Most reported limited involvement in delivering school-based services that target the prevention & treatment of overweight among students

Student level: > 50% never or rarely reported contact or counseling with parents or teachers about student-related weight concerns, checking BP or BMI in overweight child or using BMI% as an assessment tool

School level: > 65% never or rarely monitored school nutrition and physical activity practices or assessed nutrient quality of food & beverages sold to students at school

Overall Findings:Nursing & School-based Obesity Prevention

Most (73%) believed school health services should be used for obesity prevention.

Subset of schools nurses currently providing student & school-level interventions sometimes

Need for time & preparation to oversee & monitor obesity prevention efforts at school.

Clarification & development of role & responsibilities Support from school & nursing leaders

Research:Strengths & Limitations

Strengths: First survey to assess school nursing & obesity

prevention Statewide sample of licensed school nurses 80% response rate

Limitations: Self-report Response Bias Generalizeable beyond MN LSNs?

Conclusions:School Nursing & Childhood Obesity

Well-positioned to assume a key role in school-based obesity prevention efforts

Local State National

Require support to develop, integrate & sustain role Time Education & training Administrative

School Nursing

Further research Formative Intervention