Learning Objective #1: Observe the use of the Healthy People 2010 Determinants of Health Model as a guide for community-based clinical research

Learning Objective #2: Identify the social determinants related to BMI screening of children ages 6-12 in school settings

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Child obesity among school age populations has increased over the past few decades. National School Nurse Association defends BMI screening for early detection. No research describes school nurse practice of BMI screening, facilitating factors or barriers in schools. This descriptive/exploratory pilot study explored this issue via a two-hour, audio-taped focus group with eight school nurses from five school systems. Seventy- five percent of the participants were members of a regional school nursing association for greater than 10 years and had 5-10 years full time experience in elementary schools. Twenty-five percent were members between three and five years and had two years experience in elementary schools. Fifty percent were bachelor's prepared; 50% held masters degrees. Eighty-seven percent were certified in school nursing. An adapted Healthy People 2010 Social Determinants of Health Model guided this study. Semi-structured focus group questions addressed the role of federal, state, and school policies, school physical and social environments, school risk factors, and access to quality care in terms of BMI screening. Data, which were analyzed for themes and trends, included transcriptions, field notes and mediator-observer dialogue. Overall, school nurses were engaged in screening practice, especially in terms of BMI data collection. Barriers to BMI screening included lack of school system policies regarding data collection, referral, and follow-up. School size, location/size of clinic, and privacy were components of school physical environment that influenced BMI screening practice. Gym teachers, parent involvement and community interplay were important components of social environment. Risk factors influencing BMI screening included students' grade level and age. School nurse workload/time demands and affordable referral sources were access barriers. Implications for practice include identification of strategies to improve screening. Additional focus groups are needed to more comprehensively identify school nurse BMI screening practices and barriers/facilitating factors to those practices.