COD E R E D

of children with chronic health conditions. In this context, we will inventory the recommendations and payspecial attention to the current status of state policy in Texas.Recommendations forChild Health InterventionsSchool-BasedRecommendationsEvidence-BasedRecommendationsPolicy-BasedRecommendationsReportRecommendationsA simple illustration for this paringdownprocess is provided by the funnel on theleft. We begin with recommendations over thepast five years that address chronic healthconditions in children. These are thennarrowed to include only thoserecommendations that propose school-basedhealth interventions. At the next lower level,we screen out all of those recommendationsthat have not been shown by adequateresearch to affect academic achievement. Theevidence-based recommendations that remainare chiefly a product of the researchassessment completed in Part One. Finally,we screen the evidence-basedrecommendations relative to state policies thatare already in place. Our final set includes onlythose few that are expected to be effective andto alter current practices.Health researchers, agencies and advocates have not been alone in advancing recommendationsfor school-based interventions; the K-12 educational community has also played a large role. One of theirkey concerns relates to the impact that chronic health conditions have on attendance, since attendancehas implications not only for academic performance but also for a particular school district’s revenue fromstate education funds. In effect, absenteeism translates into a cost borne by districts in terms of lost staterevenue. To the extent that chronic conditions increase absenteeism, they also represent a measurablecost burden for schools. The same argument can then be turned to justify expenditures on school-basedhealth interventions to reduce absenteeism. We present two tables on this issue: one illustrating the basisof the calculation and the other comparing estimates of per-pupil/per-day costs from several independentsources, including our own.Since much of the narrative is dense with citations, we condense the relevant findings into a seriesof summary, stand-alone tables. Some are accompanied by extensive notes to clarify sources and terms.In addition to the three parts of our discussion, we have added several appendices for readers wantinggreater detail. The first appendix provides more extensive detail on the studies reviewed in Part One.Appendix II summarizes the state statutes relevant to school health. Appendix III offers summaries ofstate policies on asthma and nutrition. Appendix IV offers an update on recent school-health initiativesfrom the 79 th Regular Legislative Session that ended in May, 2005.PART ONE: Childhood Health Conditions, Academic Performance and School-Based InterventionsThis first section reviews the prevalence data for chronic conditions and examines the evidence for a linkbetween each of these conditions and academic performance. The discussion is organized by chroniccondition and includes an assessment of limitations and a discussion of implications for each.Section 1. Prevalence of Chronic Conditions and Their Links to Academic PerformanceIn the short term, chronic health conditions among children may affect school attendance, cognitionand behavior in the classroom, test-taking abilities, and social relationships. In the long term, chronichealth conditions in childhood may affect academic achievement, grade advancement, and schoolE-3