Developing School-based BMI Screening & Parent Notification Programs: Findings from Focus Groups with Parents of Elementary School Students November 7, 2006 American Public Health Association Meeting Boston, MA Martha Y. Kubik, PhD, RN University of Minnesota, School of Nursing Mary Story, PhD, RD University of Minnesota, School of Public Health Gayle Rieland, MS, RN, LSN ISD #191

Problem: Childhood Obesity Prevalence among children & youth 2-19 years of age 17 % overweight risk of overweight NHANES (Ogden et al, JAMA, 2006) School-based strategy to decrease obesity prevalence Conduct annual assessments of student’s height, weight & BMI & make information available to parents Recommendation: Institute of Medicine, 2004

School-based BMI Screening Programs PRO Individual Primary prevention Secondary prevention Family Promote healthy lifestyle practices Population Surveillance Policy & Practice Budget appropriation CON Individual Weight stigmatization Body image dissatisfaction & disordered eating Family Victim blaming Lack of effective interventions Population Cost Oversight

Study Purpose To determine the opinions & beliefs of parents of elementary school-aged students regarding school-based height, weight & BMI screening To develop a parent notification program sensitive to parent needs and convey supportive messages about weight & healthy weight control

Study Design: Focus Group Sample Recruitment: Schools: One suburban school district in upper Midwest 2 elementary schools participated in BMI screening pilot study Parent recruitment: October 2004 – January 2005 School’s newsletter & website Participant incentives: Free meal $50 Questioning Format: Semi-structured format School-based ht/wt/BMI screening Preferred BMI notification method Message content Health information needs Analysis: Thematic approach Review by 2 research staff

Study Sample Focus Groups 10 groups 5 to 9 participants per group Participants 71 parents 90% Female 96% Caucasian Mean age: 39 (range: 27 to 49) 50% college degree 41% worked full time; 42% worked part time

Results: Thematic Summary Provide advance notice health screening is offered, what screening encompasses & option to decline participation Confirm measurement done in private, respectful & standardized manner & steps will be taken to minimize weight-related teasing among children Notify all parents of results by mail

Results: Thematic Summary Along with BMI information, provide family-oriented healthy eating & physical activity recommendations Share aggregate school-level data describing overweight prevalence with school, community & state decision-makers

Results: Qualitative Summary GENERAL OPINIONS ABOUT HEALTH SCREENING: “If they’re going to be doing this [height/weight screening], instead of just collecting data or some poll or whatever they’re doing, they need to inform the parents so parents are aware of what’s going on with their children, if they are at risk [of obesity] or not.” CONCERNS ABOUT SCREENING: “It’s a matter of the kids confidentiality. These kids need to be respected and given the privacy they need. I’m not saying pull out the heavy kids. Treat them all the same and have it [screening] be a private matter.” BMI REPORTING : “I think if you’re going to take the time to screen them you should add the BMI, because that puts it in context and takes away the ‘you’re fat,’ ‘you’re short,’ ‘you’re whatever.’

Results: Qualitative Summary MESSAGE CONTENT: “And it shouldn’t be just focused on the kid. Maybe it could be a wake up call to the parents too. Gosh, my child’s a little bit heavier. Maybe I am too. Just to change the lifestyle of the whole household.” USES OF BMI PREVALENCE DATA: “I think having it published is helpful. It’s going to get the school board members, the legislators all aware that … whoa, look at this. What are we doing? What do we need to change?”

Study Strengths &Limitations Strengths: One of the first to examine parents opinions/beliefs about school-based BMI screening & parent notification programs Standardized data collection procedures Most parents worked outside home 50% college educated; 50% less than college Limitations: Convenience sample Self-reported views Generalizability Participants primarily Caucasian & female from one suburban school district in upper Midwest Parents of elementary school students

Conclusions Parents generally supportive of school-based BMI screening & notification programs Program support likely to be enhanced by: Assurance of student privacy during measurement Institution of a dissemination plan that informs parents and school community Next steps … Will school-based BMI screening & parent notification programs be an effective obesity prevention tool? Hypothesis merits testing Need for program evaluation