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 overweight & overweight among 2-19 year olds (NHANES: )*  All: 34% (17%)  Non-Hispanic Whites: 33% (16%)  Non-Hispanic Blacks: 35% (20%)  Mexican Americans: 37% (19%) * Ogden et al, JAMA, 2006 ( ) = % > 95 th %

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  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: Gender: 97% female Race/Ethnicity: 99% Caucasian Education:  65% bachelor’s degrees  31% master’s degrees Median Yrs Current Position: 6 (range: ) Median Total Yrs School Nursing: 9 (range: 1-40) Median Total Yrs Nursing Experience: 25 (range: )

School Nursing Practice 1. Assessment of non-acute health conditions (MOST COMMON) 2. Case management of students with chronic health needs 3. Assessment of acute health conditions 4. Supervision of ancillary staff 5. Medication administration 6. Immunization monitoring 7. Hearing & vision screening 8. Skilled care 9. Health education in group setting 10. Paperwork 11. Height & weight screening (LEAST COMMON)

Health Screening Screened Parents Notified If not normal All No Vision99%84%15%--- Hearing96%82%17%--- Height & Weight 37%41%15%35% BMI3%17%33%17% BMI %3%57%14%--- 77% provided on an annual basis

Obesity Prevention: Student-level intervention NEVER RARELYSOMETIMESOFTEN 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 NEVER RARELY 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