In the largest study of its kind, child-health researchers in four states set out over a three-year period to see whether they could improve the health and behavior of schoolchildren by altering their diet and exercise.
This month, they reported a limited but potentially far-reaching victory: Children in the targeted schools ate better and were more active than students at schools where no such effort was made.
They found no significant decreases, however, in blood cholesterol levels or blood pressure among the students in the intervention group compared with the control students.
The researchers say that even without such a finding, the healthy habits cultivated in the schools could bring about lifelong benefits. 鈥淭hese changes,鈥� the study concludes, 鈥渨hen spread across the entire school-based population, have the potential to produce long-term cardiovascular health benefits.鈥�
The study by researchers at several universities involved 5,106 students in 96 public schools from 12 districts in California, Louisiana, Minnesota, and Texas.
Over the course of three school years--starting in 1991, when the students were 3rd graders--the researchers overhauled school lunches and physical education classes at the 56 schools targeted for intervention. The efforts also included curricula addressing eating habits, exercise, and cigarette smoking. The costs to the schools were minimal.
Forty schools were treated as 鈥渃ontrols鈥� and underwent no program or curriculum changes related to the study.
At the end of the study, the researchers found that the programs at the 56 schools had significantly lowered the fat and cholesterol the children ate and boosted the amount of class time devoted to moderate and vigorous physical activity. The new eating pattern did not appear to slow the children鈥檚 growth.
The study, called the Child and Adolescent Trial for Cardiovascular Health, was designed to explore ways to prevent heart disease. It was the largest field trial of a school-based health promotion ever, the researchers said in reporting their findings in the March 13 Journal of the American Medical Association.
The study was conducted by researchers from the University of California at San Diego, the University of Minnesota in Minneapolis, the University of Texas at Houston, and the school of public health and tropical medicine at Tulane University in New Orleans. It was paid for by the National Heart, Lung, and Blood Institute in Bethesda, Md.
Students at high schools with health clinics apparently were more likely to make frequent use of comprehensive health-care services than their peers at schools without such facilities, according to a study of such clinics in Denver.
Researchers from the University of Colorado school of medicine in Denver also found that school-based health centers at three public high schools met the goal of enhancing access to health care among low-income students.
The study found that students who used the centers were more likely to obtain medical help than the national average for all students.
More than 90 percent of the students who used the centers--regardless of whether they had health insurance--reported at least one contact with a medical provider each year.
Recent studies have shown that, nationwide, 77 percent of adolescents with health insurance had had at least one physician visit within the preceding year compared with only 58 percent of uninsured adolescents.
The study, which looked at how 3,818 students used the clinics between 1988 and 1992, appeared in the March issue of the journal Pediatrics.
Overall, about 68 percent of the total student population at the schools obtained the necessary parental permission to use the health centers. Of those, 63 percent or 3,818 of the students who signed up made at least one visit.
The researchers found that the clinics in Denver made proportionately more diagnoses related to mental health than school-based clinics elsewhere. The Denver clinics reported that emotional problems were the single most frequently made diagnosis, representing 29 percent of all diagnoses.
The researchers say that was probably because each site had a full-time mental-health professional. Other school health centers studied did not devote as much staff time to mental health.
Findings about the clinics鈥� effectiveness are important for public policy, the authors note, because school health centers have been increasing in popularity. In 1993, there were 418 such centers, the study says, nearly four times as many as in 1989.
Homeless children have reasoning ability as sharp as that of children with homes, but they do not perform as well academically, a study by researchers at two New York City universities has found. The findings highlight the need for educators to promote a stable school environment for the homeless, the study published in the March Pediatrics concludes.
Researchers compared 102 homeless children, ages 6 to 11, from New York City public schools with a group of 178 children from the same classrooms who lived in homes. The study was conducted between 1990 and 1992 by researchers from the Albert Einstein College of Medicine and Columbia University鈥檚 college of physicians and surgeons.
Only 24 percent of the homeless children scored at or above grade level on a reading test, while 52 percent of the housed children read at those levels. An arithmetic test proved more manageable for the homeless group. About 46 percent of those students performed at or above grade level. Housed students still outpaced them, however, with 78 percent scoring at or above their grade levels.
The homeless children had missed more days of school in the previous year than the housed children. But researchers said the dramatic differences in the homeless students鈥� performance on the reading, spelling, and arithmetic tests could not be explained by such factors as medical problems or the length of time spent without a home. Instead, they came as a result of frequent school changes and having to repeat grade levels, the study said.
Elementary school educators should warn of the dangers of sniffing glue and other inhalants in all substance-abuse curricula, the American Academy of Pediatrics recommends in this month鈥檚 Pediatrics.
Inhalant abuse involves sniffing volatile substances such as gasoline, paints, and butane in order to get high. Its incidence is on the rise, and surpasses marijuana use among 8th graders, surveys by the National Institute on Drug Abuse have found. The academy urges that preventive efforts start in kindergarten and continue throughout elementary school.
--Millicent Lawton
mlawton@epe.org
