Outside of their homes, children spend more hours a day at school than any other place. School environments have great potential to shape child and adolescent health outcomes by influencing youth academic achievement, their interactions with adults and peers, and their sense of who they are and where they are going in life.
While the relationship between education and health is well documented, there is limited knowledge about how to harness that relationship to support optimal health and school function. School-based health services have the potential to reach the highly vulnerable youth to improve both their academic and health outcomes.
Current projects include:
Evaluation of the Los Angeles Unified School District’s Oral Health Initiative
Funder: Los Angeles Trust for Children’s Health
Principal Investigators:Paul Chung, MD, MS, PI; Rebecca Dudovitz, MD, MS, Co-PI
Dental decay is the most common chronic disease in childhood and is associated with poor academic and health outcomes. This is a community-partnered evaluation of a Dentaquest Foundation funded program to improve the oral health knowledge, attitudes, resources and behaviors across whole schools and communities in Los Angeles.
In addition to promoting preventative oral health behaviors, the program includes universal school-based oral health screening, fluoride varnishing, referral to a dental home, and case management. LAUSD is second largest school district in the nation and is testing their Oral Health Initiative with the goal of refining a model for school-based oral health that can be disseminated to the 10 largest school districts in the nation. Program evaluation focuses on:
We are tracking program implementation and participation, longitudinal oral health behaviors and outcomes, program costs and reimbursement models, and the impact on potential avoided school absences and restorative care.
FIT for Los Angeles
Principal Investigators: Wendelin Slusser, MD, PI; Alma Guerrero, Co-PI
The UniHealth-funded UCLA Fit for Los Angeles project, in collaboration with the LAUSD Medical Services, and Venice Family Clinic aims to build the capacity needed to fill the current gap of services for obese children. The Fit for Los Angeles project links best practices and obesity management programs with LAUSD community clinic-based physicians and nurse practitioners to build capacity. This is accomplished through a variety of methods including: in person training sessions, scheduled coaching, development of new or identification of relevant existing protocols, discussion and implementation of clinical quality improvement activities such as consistent approaches to management and follow up of the obese pediatric patients, telemedicine and access to physician-to-physician consultation in order to increase capacity to prevent and manage pediatric overweight conditions in Los Angeles. These activities are conducted both in-person (large group, small group and one-on-one) and via electronic media (telephone, teleconference, and internet). The Fit for Los Angeles project allows underserved population of obese children within LAUSD to receive a higher level of expertise and medical sub-specialty care related to their co-morbid conditions than previously has been available to them.
Understanding the Relationship between Adolescent Identity and Substance Use
Funder: Children’s Discovery and Innovations Institute
Principal Investigator: Rebecca Dudovitz, MD, MS, PI
This is an institutional career development award administered through the Clinical and Translational Science Institute (NIH/National Center for Advancing Translational Science (NCATS) UL1TR000124). By the end of high school, over 48% of teens are regularly using alcohol and 28% regularly use marijuana. Studies show that teens who think of themselves as poor students (low academic self-concept) or rule-breakers (low behavioral self-concept) are more likely to use substances.
This project seeks to determine whether adolescent identity formation, including academic and behavioral self-concept, might be targeted for substance use prevention and whether school environments have the potential to shape how adolescents see themselves. We build on the RISE and RISE Up studies (PI Wong) examining self-concept and health behaviors of low-income minority youth who applied for admission into highly supportive charter schools in Los Angeles, via random lottery. Using a mixed-methods approach, we aim to:
For Phase I, we are analyzing cross-sectional data from the RISE study to examine school-related social network factors associated with self-concept and substance use. For Phase II, we are conducting semi-structured interviews with 30-40 high-risk youth who participated in the RISE Study to explore how they developed their identities and the factors that impacted their substance use decisions.
Participants include youth with high- and low-risk self-concept profiles who engaged in and abstained from substance use. Finally, in Phase III, we are analyzing 3 waves of survey data from the longitudinal RISE Up study to test whether changes in self-concept predict changes in substance use and whether exposure to supportive school environments predict healthier self-concept profiles.
Vision to Learn Evaluation
Funder: Vision To Learn
Principal Investigators: Rebecca Dudovitz, MD, MS, PI; Wendelin Slusser, MD, Co-PI
80% of learning in elementary school is dependent on vision. Although 90% of children's vision problems are correctable with glasses, many low-income and minority children lack access to corrective lenses. These same groups are also at high risk for having poor academic outcomes. While poor vision is associated with poor school performance, there are no studies documenting whether receiving corrective lenses improves school function. Further, it remains unknown whether a school-based model of vision care can improve access to and use of corrective lenses for students with correctable visual deficits.
We partnered with Vision To Learn, a non-profit organization providing free eye exams and glasses to students attending schools in low-income communities to conduct a series of studies evaluating the impact of school-based vision care. Through this work, we aim to:
We are using both qualitative and quantitative methods to evaluate this innovative vision care model. Through focus groups with students served by Vision To Learn, their parents, and their teachers, we are describing the perceived impact of providing glasses on school function and psychosocial wellbeing. In addition, we describe how serving students in schools might help reduce the stigma associated with wearing glasses. By analyzing school records from students served by Vision To Learn and comparing their academic performance with their peers before and after they received their glasses we are quantifying the program’s impact on school function.