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etween standardized test scores (Stanford Achievement Test Ninth Edition [SAT-9]) and their fitnessscores. A dose-response effect was noted for all grades studied where the highest SAT-9 scores werereported by students who met three or more standard levels among the six physical fitness measures,particularly among females, and particularly for mathematics rather than for reading scores. Whilephysical activity may be very important for preventing obesity and diabetes in children, it most likely willalso improve academic performance.School-Based Asthma Management InterventionsThe effectiveness of programs for asthma management has been well documented in a series of welldesignedstudies. Not only was absenteeism reduced but test scores improved in a number of areas.While Texas has policies that address environmental triggers of asthmatic episodes, there is no writtenpolicy on asthma education programs for children or staff or recommendations for schools to considerthem.• Based on compelling evidence, we recommend that Texas schools adopt asthmamanagement education for affected children and support staff.Table 2 is drawn from the text in Part Three and summarizes the research findings linking schoolbasedinterventions and academic performance.E-v
Table 2. The effect of school programs on academic performanceConditionsSchool Health ProgramsLevel ofinterventionStudy DesignAcademic PerformanceIndicatorType of effectProgram and InterventionComponentsOverweight/ObesityDiabetesAfter an extensive search of the literature, no evidence-based interventions specifically for overweight/obesity were found that directly improved academicperformance.After an extensive search of the literature, no evidence-based interventions specifically for diabetes were found that directly improved academic performance.Asthma(Tinkelman et al., 2004) DSCMasthma school program.Elementaryand middleschoolsReduction in absenteeism (+) DSCM asthma school programincorporated a respiratory nurse caremanager, web-based interactiveeducational tools, and an interactiveasthma diary for students.Evans, D., Clark, N.M.,Feldman, C.H., Rips, J.,Kaplan, D., Levison, M.J.,Wasilewski, Y., Levin, B., &Mellins, R.B. (1987). A schoolhealth education program forchildren with asthma aged 8-11years. Health EducationQuarterly; 14(3):267-279.Elementary(grades 3-5)ExperimentalLongitudinalIntervention. Randomassignment of schoolswithin matched pairs.Pretest-posttestanalysis of change inachievement.Academic grades /Mathematics / Science /Oral expression /Standardized test scores forreading/ Standardized testscores for math / Teacherratedclassroom behavior /Attendance(+/+/+/+/NE/NE/NE/NE)Asthma self-management programconsisting of six 60-minute sessionson asthma management skills;parents received written informationabout curriculum and activities.Christiansen et al., 1997. Absenteeism (NE) Five-session bilingual, interactivecurriculum teaching about asthma ina school setting.Clark et al., 2004.Randomized controlledtrial.Science grades / reading /math / physical education /absences(+/NE/NE/NE/D)Mild emotionaldisordersGall at al., 2000.High school(13-18 yrsold)Reduction in absenteeism /Reduction in tardiness(+/+) Students received school-basedmental health and counselingservices for two months.PhysicalInactivitySPARK Sallis JF, McKenzieTL, Kolody B, Lewis M,Marshall S, Rosengard P(1999). Effects of health-relatedphysical education onacademic achievement:Project SPARK. ResearchQuarterly for Exercise andSport; 70(2):127-34.ElementaryExperimentalLongitudinalIntervention. Randomcontrol study of a 2-year intervention.Metropolitan AchievementTest: Reading / Language /Math / Composite basicbattery scores(+/-/NE/NE) Project SPARK: implemented in 7public elementary schools inCalifornia that incorporatedmoderate to 30 minute classes: 15minutes of health-fitness activity(high intensity aerobic) and 15minutes of a skill-fitness activity for aminimum of 3 days per weekthrough the school year (36 weeks).Dwyer T, Coonan WE, WorsleyLA, Leitch DR (1979). Anassessment of the effects oftwo physical activity programson coronary heart disease riskfactors in primary schoolchildren. Community HealthStudies; 3:196-202 and DwyerT, Coonan WE, Leitch DR,Hetzel BS, Baghurst RA (1983).An Investigation of the effectsof daily physical activity on thehealth of primary schoolstudents in South Australia.International Journal ofEpidemiology; 12:308-313.ElementaryExperimentalLongitudinalIntervention. Randomassignment of studentsto control or to a 14-week intervention:three groupcomparison (Fitness;Skill; and Control).Two Australian educationstandardized tests: ACERarithmetic test/GAP readingtest; and teachers’ ratings ofclassroom behavior.(+/NE/+)The Fitness and Skill groupsengaged in organized activity dailyfor 15 minutes in a morning classand 60 minutes in an afternoon classperiod—the Fitness group engagedin aerobic activity; the Skill groupengaged in non-strenuous motorskills ; the control group receivedthree 30-minute periods of usualphysical education per week.UndernourishedMurphy MJ, Pagano ME,Nachmani J, Sperling P, KaneS, Kleinman RE (1998). Therelationship of school breakfastto psychosocial and academicfunctioning: Cross-sectionaland longitudinal observations inan inner-city school sample.Archives of Pediatrics &Adolescent Medicine;152(9):899-907.Elementaryand middleschoolsQuasi-experimentalNRNC study.Measures taken atbaseline and 4 monthsafter exposed tointervention, assessedchange in breakfastprogram participationand outcomes amongstudents whoseparticipation was often,sometimes, rare, ornever.Math grades / attendance /tardiness(+/+/+) Universally Free school breakfastprogram (UFSBP). ParticipatedOften (ate 80% or more meals whenpresent at school); Sometimes (ate20% to 79%); or Rarely (ate lessthan 20% of meals when present atschool).Meyers AF, Sampson AE,Weitzman M, Rogers BL,Kayne H (1989). Schoolbreakfast program and schoolperformance. AmericanJournal of Diseases ofChildren; 143:1234-1239.ElementaryschoolsQuasi-experimental(NRC) conducted forone school year: pretestmeasured in 2ndsemester of 1986-7school year; post-testmeasured in 2ndsemester of 1987-88.CTBS total score / languagesubscore / math / reading /tardiness reduction(+/+/+/+/+) School Breakfast Program (SBP)offered to low-income studentsenrolled in public elementaryschools.Kleinman et al., 2002. Reduction of Absenteeism /math scores / reading /social sciences / science(+/+/NE/NE/NE)School Breakfast Programimplemented.CTBS, Comprehensive Tests of Basic Skills battery; NE, no effect; D, disputable - parents of treatment children reported fewer absences attributable to asthma in the past threemonths, but no differences in school absences were noted in school records.E-vi
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Appendix ATask Force Members and St
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Hector Balcazar, Ph.D.Regional Dean
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Charles Haley, M.D., M.S.Medical Di
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Michael McKinney, M.D.Senior Execut
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M. Roy Wilson, M.D.PresidentTexas T
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Appendix BMedicaid and the State Ch
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services. There are two broad types
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Mandatory and Optional Covered Popu
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• Nurse-midwife services;• Fede
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Disproportionate Share Hospital Pro
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March 13, 2001, that limited the am
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year from FFY 2002-2004, $4.05 bill
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Medicaid beneficiaries. Section 191
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started in 2001 and 2002 to curb in
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urban and with fewer than 250,000 p
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Protection Act of 2000 and the Medi
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orientation). Recipients of Supplem
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enrollee is assigned a primary care
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Table 7. Texas Medicaid Policy Chan
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Table 8. Texas SCHIP Policy Changes
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families (through the employer’s
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share of the match must come from t
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Reinstating the Medically Needy Spe
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Endnotes1 Texas Health and Human Se
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35 Powers, Pyles, Sutter, and Vervi
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73 Office of Management and Budget,
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113 TexCare, Children’s Health In
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150 Lyndon B. Johnson School of Pub
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States by Groupings with Current El
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Medicaid and the State Children’s
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Graduate Medical Education ProgramA
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needs, however, there is a shortage
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15 Texas Association of Counties,
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ecording and evaluation; physical e
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Medicaid and the State Children’s
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ReferencesAmerican Academy of Pedia
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downloads/bipa.pdf#search='Medicare
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Texas Health and Human Services Com
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Appendix CAn Analysis of Reform Opt
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Encouraged by these low rates, Cong
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Establishing state-only tax incenti
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New York passed the Health Care Ref
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Hospital Cost Containment — Maryl
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dollar spent. 237 Texas spent almos
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Another option for small businesses
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• Medical equipment and supplies,
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pay the premiums for Medicaid benef
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Medicaid to children born after Sep
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Bill of Rights or “TABOR”; and
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The federal share for CHP+ is 65 pe
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SCHIP: increased eligibility in CHP
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• Medical equipment and supplies
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6. Funds obtained through the recov
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Status ReportMaineCare Program Expa
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the federal poverty level. 404 Sinc
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need their jobs as a source of empl
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Endnotes191 Deborah Chollet, Issue
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225 Ibid.226 Maryland Health Care C
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259 Kaiser Family Foundation, State
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SCHIP&subcategory=Medicaid+Spending
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325 Kaiser Family Foundation, State
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361 State Coverage Initiatives, Sta
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SCHIP&subcategory=SCHIP&topic=Feder
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An Analysis of Reform Options Devel
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ReferencesAdvantage Insurance and F
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Page 136 and 137: Kaiser Family Foundation. Demograph
Page 138 and 139: State Coverage Initiatives. Profile
Page 140 and 141: Appendix DLocal Initiatives to Expa
Page 142 and 143: with more coordinated services that
Page 144 and 145: FinancingSources of revenue include
Page 146 and 147: AdministrationThe Health and Hospit
Page 148 and 149: Until 1993, Denver Health (DH) was
Page 150 and 151: different benefit plans are offered
Page 152 and 153: Cost SharingPatient cost-sharing is
Page 154 and 155: management programs. I-Care promote
Page 156 and 157: the county indigent care plan. Bene
Page 158 and 159: Firstplan xxvi,12Moore County, Mich
Page 160 and 161: Benefits and ServicesEnrollees can
Page 162 and 163: EligibilityAs of 2005, enrollment i
Page 164 and 165: etween $23 and $120 per month. Ther
Page 166 and 167: Healthcare Accountability Act xxxvi
Page 168 and 169: Coordination - When health care age
Page 170 and 171: subsidized initiatives offer exposu
Page 172 and 173: arriers, two health plans attempted
Page 174 and 175: xxi Simmons, Sandy Coe, Gionfriddo,
Page 176 and 177: Table 1 (Continued). Local Care Ini
Page 178 and 179: Table 2 (Continued). Local Coverage
Page 180 and 181: Appendix EEducation and Health:A Re
Page 182 and 183: The human capital approach suggests
Page 186 and 187: INTRODUCTIONEducation plays a wide
Page 188 and 189: of children with chronic health con
Page 190 and 191: Implications. Given the current pre
Page 192 and 193: DiabetesPrevalence. Diabetes in chi
Page 194 and 195: Limitations. The cross-sectional de
Page 196 and 197: chronic lung disease, cystic fibros
Page 198 and 199: significant differences between tho
Page 200 and 201: Table 1. Prevalence of Selected Chr
Page 202 and 203: findings of lower test scores are b
Page 204 and 205: al (McKewen et al., 1998) report a
Page 206 and 207: Section 3. School-Based Interventio
Page 208 and 209: mathematics, science and oral expre
Page 210 and 211: Table 4. Summary of Research Findin
Page 212 and 213: etween SES and health is a dose-res
Page 214 and 215: Self-Rated Health. Evidence accumul
Page 216 and 217: economic hardship. One of the skill
Page 218 and 219: Education also improves the stabili
Page 220 and 221: sex in the expectation of a more pr
Page 222 and 223: TABLE 6. SUMMARY OF EXPLANATIONS FO
Page 224 and 225: According to the Census 2000 data,
Page 226 and 227: Policy Reports Recommendations (Tot
Page 228 and 229: Section 2. Recommendations on Schoo
Page 230 and 231: Childhood ConditionsSchool-based Pr
Page 232 and 233: Childhood ConditionsDiabetes (n=11)
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eduction in reading test scores com
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Table 10. Estimates of the Cost of
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National Asthma Education and Preve
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REFERENCESAck, M., Miller, I., & We
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Elo, I. T., & Preston, S. H. (1996)
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Kaemingk, K. L., Pasvogel, A. E., G
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Miller, D. S., & Miller, T. Q. (199
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Ross, C. E., & Wu, C. L. (1996). Ed
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Williams, D. R. (1990). Socioeconom
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SAMPLE, DESIGN, & INTERVENTIONACHIE
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SAMPLE, DESIGN, & INTERVENTIONStudy
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SICKLE CELL ANEMIAArmstrong(1996)SA
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SAMPLE, DESIGN, & INTERVENTIONSickl
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SAMPLE, DESIGN, & INTERVENTIONhemog
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SAMPLE, DESIGN, & INTERVENTIONStudy
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Curriculum Content: Statute §28.00
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• HEALTH PROMOTING ENVIRONMENTSch
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• COORDINATION/IMPLEMENTATIONCoor
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Education and Health: A Review and
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Appendix FState Regulation of Healt
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coverage they offer. 14 By 2004 onl
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poor health may make coverage more
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account for most, or even much, of
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More active state intervention in t
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Table 3 (GAO Appendix IV) shows whi
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Appendix GEmergency and Trauma Care
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The treatment of shock prior to sur
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the EMS needs in rural areas of the
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Level IV trauma centers should be a
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Table 2. Trends in Trauma Severity,
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the hospitals were on diversion or
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Representative Delisi was successfu
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Mental Health Access ChallengesCare
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fhttp://www.techproservices.net/his
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oohttp://www.saveourers.org/reports
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Appendix HBrief: Consulate ClinicDe
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In addition, the roundtable discuss
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clinic(s) affiliated with medical s
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Appendix ICommon Abbreviations
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HMOHRQOLHRSAICF/MRIHCTAIOMISSLBBLIU
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Appendix JPresentersDate/Location:
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Appendix KProvider Taxes: A Differe
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were previously categorized as char
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