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Applying Findings to PracticeSusan Praeger, APRN, EdD, BC, NCSN, FNASN, is a professor of nursing at Wright State University, Dayton, OH, and a school nurse in Yellow Springs, OH
Zenk, S. N., & Powell, L. M. (2008). US secondary schools and food outlets. Health & Place, 14, 336–346. In response to the issue of obesity among youth, the researchers looked at the placement of fast-food outlets and convenience stores near schools, concerned that these venues could be a deterrent to healthy eating behaviors. Proximity was considered walking distance within 0.5 mile or 805 meters of the school. The final sample size was 31,243 "regular and operational" secondary schools whose latitude and longitude location in the United States were determined from the National Center for Education Statistics for schools in all 50 states and Washington, D.C. Separate analyses were done using 1,718 schools from the 20 largest U.S. cities. Convenience stores could be independent or chain stores. The fast-food outlets were classified as "fast-food restaurants and stands" (p. 338) and did not include coffee shops. They could be snack shops, drive-in restaurants, hot dog stands, sandwich and submarine shops, and delicatessens. Researchers found that 37% of public secondary schools nationwide had at least one fast-food restaurant nearby, and 33% had at least one convenience store. African American neighborhoods had fewer fast-food venues but similar numbers of convenience stores when compared with "White" neighborhoods; other racial/ethnic neighborhoods had more fast-food outlets and convenience stores than either of the above neighborhoods. Schools in the highest income neighborhoods had the fewest fast-food venues and convenience stores, followed by the middle-income and lowest income neighborhoods. Within 0.25 mile or 402 meters, high schools had more fast-food restaurants than did middle schools nationwide, whether independent or chain. Urban schools in the 20 largest cities had one or more fast-food restaurants (68%) and convenience stores (56%) in the neighborhood and had more convenience stores within 0.25 mile than did schools nationally. Urban high schools had more fast-food restaurants within walking distance than did middle schools.
Zenk and Powell’s work reminds us that school-based approaches to stemming the rising tide of obesity need to incorporate community values, demographics, and policy consideration. School nurses can advocate for healthy foods in schools, but students and their families need to learn how to make healthy food choices and to understand the consequences of all food choices. Neighborhood stores can be places where children learn how to make purchasing decisions, spend money, and establish relationships with merchants—important steps in developmental tasks leading to autonomy. These venues also serve as social gathering places and even havens for children and teens. With reduced school funding, the proximity of convenience stores and fast-food outlets can result in planned health lessons incorporating exercise. Planning budgets, making healthy choices by examining and comparing food choices, learning to read labels, calculating fat content, exploring proper skills for interacting with merchants, and handling change, for example, can be integrated throughout the curriculum, resulting in field trips into the neighborhood. Working with local merchants to plan for such activities can build a sense of community partnership and promote better communication among schools, families, and the community. This study raises the issue of school nurses’ role in policy. Understanding how and when decisions are made to permit the location of businesses in close proximity to schools is important for the school system in terms of traffic safety patterns and exposure to risks. These research findings remind us that commercial ventures target populations where commerce can be successful. Being community-based, school nurses are in an ideal position to remind school system officials that involvement in community affairs is important when considering the health and education of students. Wu, L. T., Pilowsky, D. J., & Patkar, A. A. (2008). Non-prescribed use of pain relievers among adolescents in the United States. Drug and Alcohol Dependence, 94, 1–11. Using data from the 2005 National Survey on Drug Use and Health, the authors examined responses from 18,678 adolescents between the ages of 12 and 17 years. Data were collected through a standardized interview format. Of the 9.8% of adolescents reporting a history of non-prescribed pain reliever use, the rates varied according to different variables. Older adolescents aged 16 and 17 (16%) reported higher rates than younger ones aged 12 and 13 years (5%). In order of prevalence, the following groups reported non-prescribed pain reliever use: marijuana use before age 13 (41%), booked for criminal activity (29–40%), nonstudents (30%), recent hospitalization (25%), three or more emergency room admissions (17%), history of foster care placement (17%), recent mental health services (16%), and perceived poor health (15%). Of those reporting use of nonprescribed pain relievers, 61% used them before the age of 15, 18% reported weekly use, and 26% used three or more categories of pain relievers. Females were more likely than males to use stimulants and tranquilizers.
This study is rich in data about the kinds of non-prescribed pain relievers used as well as data about important subsets of variables. By providing information from a national database, the researchers have alerted school nurses to potential risky behaviors in which students may engage. The obvious concern is the early onset and prevalence of nonprescribed drug use among adolescents and the incidence of multidrug use with a number of students. From a nursing perspective, it is essential to assess students for any and all drug use when they present to the clinic. Complaints of fatigue, weight gain or loss, behavior problems, sleep disruptions, elimination changes, social problems, headaches, stomachaches, difficulty breathing, or epistaxis should include an assessment of risk behaviors. Because the study focused on pain relievers, a thorough assessment of the presence, perception, and treatment of pain in adolescents should be routinely undertaken. Although the researchers acknowledge that some students may use nonprescribed prescription medications for appropriately treating pain from a situational injury versus for "feeling good," it is important to assess how the decision was made. Was a responsible adult aware of the decision to use and monitoring that use, was the decision appropriate, and should a health care provider be informed? The body mass of an adolescent could be significantly different from that of the person for whom the pain reliever was prescribed. As Wu et al. point out, issues of addiction, overdose, and adverse reactions need to be considered. Teaching pain management techniques and responsible self-care is within the scope of school nursing practice and includes not only students but also parents and community members. Students who self-treat as a result of sport participation injuries should be assessed in terms of how the decision was made to self-treat rather than to seek health provider care. The coordinated school health team should be aware of school-based athletic training and sport coaches’ practices and work with those individuals to clarify district drug use policy, risks for self-treatment with non-prescribed pain relievers, and the potential for interactions with other prescribed or non-prescribed substances a student may be taking. School nurses need to be aware of popular trends of prescription and nonprescription drug use among adolescents in their community. Being able to recognize substances and teaching staff about the signs of possible drug use and what to do when substances are identified in the school can begin to create a climate of supportive vigilance to prevent further problems. Although the illegal sale of prescription pain relievers may occur in communities and needs to be addressed by law enforcement agencies, school nurses can educate teachers, parents, grandparents, and the community about the risks involved in having prescription medications available in home cabinets, purses, automobiles, or other accessible storage places. Adolescents living in or visiting homes can have access to medicine cabinets, kitchen cabinets, bedside tables, or other unsecured sites for medication storage. As a society, we do not have equivalent access deterrents, such as safety caps, in place for adolescents as we do for toddlers and children. Consequently, there is a need to inform the community of the risk of adolescents’ accessing prescribed pain relievers and other medications that may be available in the home.
The Journal of School Nursing, Vol. 24, No. 4,
249-251 (2008)
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