ASSOCIATIONS BETWEEN SCHOOL HEALTH INFRASTRUCTURE AND STUDENTS’ BODY MASS INDEX

Abstract

Schools provide an excellent venue in which to promote student’s health and academic outcomes. School health offers many health services for students, and school nurses are well-positioned to play an essential role in improving many of school students’ health and educational outcomes. Increasing the prevalence of not healthy students can have negative social and financial consequences. However, there is a dearth of studies addressing the relationship between school health factors and students’ health outcomes. This work addressed different factors and outcomes, and mainly focusing on school nurses as an infrastructure component and elevated BMI as a health outcome, addresses that knowledge gap. An integrative systematic review of the literature from 2000 to 2017 was done to investigate the association of school nurses’ level of position, availability, and ratio to students with elementary, middle, and high school students’ absenteeism, return to class, services and attendance of students with asthma, and BMI. A limited number of articles were found, and the majority supported a positive association for school nurses with students’ health and educational outcomes. However, there are methodological limitations and insufficient evidence about the importance of school nurses’ role in student outcomes. There is a need for many studies with rigorous designs assessing the selected associations. A secondary analysis study focused on school health and a vital health outcome which is overweight and obesity. It explored associations between three components of school health infrastructure (staff, services, and budget) and the proportion overweight or obese 1st, 3rd, and 6th graders, after controlling for selected intrapersonal, interpersonal, and community factors. Those associations were tested using multiple regression analysis with county-level data obtained from different government entities from all 67 Florida counties. Study results supported an independent association between elevated BMI and school health staff (non-RNs). Additionally, independent associations between elevated BMI and the following covariates were supported: household income, race, and parents' educational level. There is an ultimate need for studies with more rigorous research designs, larger sample sizes, using data at the level of schools or individuals, and enrolling some schools that meet the recommended number of school nurses.