Executive Summary

Multi-Level Information Systems and Health Promotion Interventions for Milwaukee's School Children

Center for Urban Population Health and Milwaukee Public Schools System

UWM Institute for Urban Health Partnerships

4/9/2007

Key Investigators and Staff

Center for Urban Population Health (CUPH):  Ron Cisler (PI), Loren Galvao (Co-PI), Susan Partington (Co-PI), Jessica Bergstrom (Project Coordinator)

Milwaukee Public Schools (MPS):  M. Kathleen Murphy (Community Partner Liaison)

UWM Institute for Urban Health Partnerships:  Elizabeth Fayram (Consult), Sally Lundeen (Consult), Paula Lucey (Consult), Mary Jo Baisch (Consult)

Purpose and Significance

This project assessed the general health and health risks of Milwaukee youth. The main goal of this multi-level, systems-based project was to collect health data on a sample of Milwaukee Public School children with the long term goal of using that data to craft health interventions to address the most pressing health needs of the students.

The main objectives of this project were to assess the health of youth broadly and interface new health information with existing technologies, with specific goals including: (Ia) Increasing the quantity and quality of health data collected on MPS school children ages 6-11 and assessing the health of the students; and (Ib) Developing reports of the health of the students at each school to provide feedback to the school's preventive health intervention team.

Design and Methods

The design was multi-focused, multi-method with three basic activities:  (1) Implementing a child health and illness survey and brief health assessment; (2) Conducting a telephone follow-up with parents to update and add to the health information contact cards sent by MPS; (3) Linking health information collected in activities 1 and 2 with extracts of existing Electronic Student Information System (ESIS) data. The above activities were conducted at eight MPS schools to obtain a diverse sample:  Four schools on the predominantly African American north side and four schools on the predominantly Latino south side.  Data was collected from both 1st and 4th grade school children.

Results

Sample description. The overall number of consent forms returned was 658 (56%).  Of the 658 parents/guardians who returned consent forms, 553 (84%) of them gave permission for their child to participate in at least one piece of data collection, and 342 (52%) gave permission to collect all data pieces.  The student population screened was 54% Hispanic, 29% African American, and 17% all other (non-Hispanic white, Asian, American Indian) race/ethnicities combined.  Fifty percent were female, mean age was 8.7 years, and 88% were eligible for free or reduced price lunch.

Results.  Biometric screening of students found that the prevalence of risk of overweight and overweight (BMI > 85th percentile for age and gender) was 46%, significantly higher than a national sample of youth ages 6-11 with an at-risk of overweight/overweight prevalence of 37.2% (1).  Also, 21.5% of students were identified as having at least one special health care need during the phone interview with their parents/guardians.  This prevalence of children with special health care needs is higher than the national and state-wide rates of 12.8% and 13.4% respectively, but confirms previous studies showing a Milwaukee specific rate of approximately 23% (2) Of the students who completed a CHIP-CE, 73% responded that their health was very good or excellent and 77% answered that they "feel really healthy" almost always or always.  Significant relationships were seen between self-reported health, several CHIP domains and individual student academic achievement in fourth graders.

An analysis of data linking BMI of individuals to neighborhood characteristics such as distance from grocery stores and fast food restaurants showed that schoolchildren living in block groups with lower household incomes were 2.4 times as likely to be overweight or at risk of overweight compared to those living in block groups with higher incomes.  Other significant results showed that students living in block groups with the highest percentage of under-educated adults were 2.4 times more likely to be overweight or at-risk of overweight; students who lived more than 2.6 miles away from a large grocery store were 1.76 times more likely to be at risk of overweight or overweight compared to students who lived less than 1 mile from the store; and that African-American females were 2.5 times and Hispanic males 2.4 times more likely to be at-risk of overweight or overweight when compared to white females.

Conclusions

Socio-economic disadvantage may contribute more significantly to the prevalence of overweight and hypertension than ethnic minority status

Associations between overweight and blood pressure levels suggest that children overweight or at risk for overweight should be screened for elevated blood pressure

Evidence of a link between student health and school achievement support the need for community and environmental level health improvement activities.

Use of standardized screening measures such as the Children with Special Health Care Needs Screener can be used at the schools for screening purposes and for targeting of health resources and broad-based interventions.

Dissemination of Results

The dissemination plan for the project involves multiple audiences. The main dissemination effort will be presentations of the results the schools and community.  CUPH staff will facilitate these workshops to share and discuss the baseline data with the participating school staff, parents and interested community members. The findings will then be used to work with MPS and other project partners to plan and prioritize interventions to improve the health of children in Milwaukee. Data will be further disseminated to appropriate national and local audiences through professional society presentations and publications in reports and peer-reviewed journals.   Abstracts for presentations and posters have been submitted to the American Public Health Association, the National Association of School Nurses and the Wisconsin Public Health Association and several other submissions are planned.

 

1. Ogden CL, Carroll MD, Curtin LR, McDowell MA, Tabak CJ, Flegal KM. Prevalence of Overweight and Obesity in the United States, 1999-2004. JAMA 2006;295(13):1549-1555.
2. Partington SN, Cisler RA, Blair KA. Prevalence of Children with Special Health Care Needs in Milwaukee, Wiscosnsin: Data from the Milwaukee Metropolitan Statistical Area. Wisconsin Medical Journal 2006;105(3):30-35.