Schools and the Health of Children: Protecting Our Future
Publication Year: 2000
With school budgets seeming to be inexorably contracting, and with welfare reform looming, the future of school health programs is both important and uncertain. Jennie Jacobs Kronenfeld begins by clearly defining the key issues in the debate and outlining the history of school health programs. She then turns to more contemporary examples of school health care delivery, with a special emphasis on the Arizona model—crucial due to its being the first state to go to a managed care Medicaid program. Finally, she theorizes on the likely future of school health care in the light of proposed changes to Medicaid and other welfare initiatives. Schools and the Health of Children will be of great interest to scholars and professionals in the area of public health, educational ...
- Front Matter
- Back Matter
- Subject Index
- Chapter 1: Introduction
- Chapter 2: History of Child Health and School Health Programs: Background and Current Roles of School Health Programs
- Chapter 3: Health Status of Children: Past and Present
- Chapter 4: Models of School Health Delivery: The Growth of School-Based Clinics and Centers
- Chapter 5: Experiences in Arizona: The Development of New Clinics in a State with a Managed-Care Medicaid System
- Chapter 6: The Need to Protect the Future: The Impact of Changes in Welfare and Health Policies and Linkages with School Health Issues
[Page ii]Dedicated to the memory of Marcia Lynn Whicker, my friend and colleague with whom I wrote many books, analyzed many colleagues, and shared many special times (both good and bad). You are missed.
Copyright © 2000 by Sage Publications, Inc.
All rights reserved. No part of this book may be reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, or by any information storage and retrievalÿ20system, without permission in writing from the publisher.
Sage Publications, Inc.
2455 Teller Road
Thousand Oaks, California 91320
Sage Publications Ltd.
6 Bonhill Street
London EC2A 4PU
Sage Publications India Pvt. Ltd.
Greater Kailash I
New Delhi 110 048 India
Printed in the United States of America
Library of Congress Cataloging-in-Publication Data
Kronenfeld, Jennie J.
Schools and the health of children: Protecting our future / by Jennie Jacobs Kronenfeld.
Includes bibliographical references and index.
ISBN 0-7619-1113-8 (cloth: alk. paper)
ISBN 0-7619-1114-6 (pbk.: alk. paper)
1. School health services—United States. 2. School children—Health and hygiene—United States. 3. Health education—United States. I. Title.
LB3409.U5 K76 1999
00 01 02 03 04 05 06 7 6 5 4 3 2 1
Acquiring Editor: Peter Labella
Editorial Assistant: Renée Piernot
Production Editor: Diana E. Axelsen
Editorial Assistant: Patricia Zeman
List of Tables[Page vi]
- TABLE 3.1 Leading Causes of Death by Selected Age Groups of Children 33
- TABLE 5.1 Application of Dryfoos's Categories to Selected Arizona Projects 63
- TABLE 5.2 Categorization of Projects by the Strength of the Initial Role of Each Health Partner as Compared to the School Partner in Beginning the Project 64
Children occupy unique positions in modern American society. On one hand, we idealize children and childhood, viewing it as the most innocent and carefree time of life, a time free from everyday worries about the necessities of life. However, this is not the reality of childhood for a substantial number of American children. Almost one quarter of US children live in poverty, and children are the age group in American society most likely to live in poverty. Also, children under the age of 18 account for most of the loss of dependents being covered through health insurance plans at the workplace. Thus, the topic of this book, the health of children and school health programs, are an important issue in American society.
In many ways, schools are an underused resource in the lives of children. At a time when two-parent families generally have both adults working most of the day, and the majority of children will spend part of their childhood in a single-parent home, many schools have not acknowledged this change in the lives at home of most children. Most children in the US from ages 5–18 now spend a major part of their days in schools, but many localities still have a limited view of what schools can provide for children. Obviously, they are to provide education. Federally funded food programs have created a societal agreement that schools should provide an opportunity to buy lunch for all children, and the provision of free lunches and breakfast for many poor children. Increasingly, some elementary schools are providing extended care for younger children, to deal with the issue of “latchkey” children who have no adult at home when the child returns from a typical school day. Many schools, however, do not view their roles as dealing with [Page viii]the “whole” child, including whether they have food to eat at home, school supplies, clothing, an adult to help them in the afternoon, and medical care if they need it. This statement is not meant to castigate schools, or caring individual teachers or principals. In fact, we all know that many schools are filled with caring teachers who give lunch money to a child who forgets it, buy supplies for children who seem to have less than others, and bring in gently used clothing and toys from their own children to distribute to certain children in their classes.
In my own experience as a parent of school-aged children, first in South Carolina and now in Arizona, I have talked to principals who told me about the extra parts of their job. Often, the principal at the end of the day ended up delivering children home because a parent never showed to pick the child up. Sometimes principals allowed a child to stay and work in the library at school until all staff left because they knew the child was fearful of going home to a cold, empty apartment until closer to the time the parent arrived from work.
These examples of caring, individual teachers and principals can be found across the nation. They are examples of the best models of caring and concern in American society. As a formal system, however, schools often are only able to deal with limited needs of children. Health care in a school setting has ranged from as little as the placement of bandaids and taking of temperatures to better trained nurses who have tried to advocate for the children in their school and call doctors’ offices to try and help children obtain health care.
This book is about expanded models for schools in the lives of children, especially focused on the health care needs of children. As part of a local foundation's goal to help provide health care services for more children in Arizona, I became the evaluator of a project of school-based health clinics in the state of Arizona. These were not the first of such clinics in the nation, nor even the very first in Arizona (although there were only a few fledgling examples before the project was begun that is described in detail in Chapter 5 of this book). As I worked with these projects and helped them to develop data systems to collect information, as well as conducted interviews with school nursing and educational personnel, I realized that my previous experience in health prevention projects and projects with child injury had provided important background for this project. My research on issues of access to care and health insurance was also important, because one of the advantages of school based clinics for many children and their families is the immediate availability of help and the ability of school nurses to help serve as advocates for the interest of their children.
For some parents, the health care system is a complicated place, one difficult to access not only due to lack of money and transportation, but due to language limitations and lack of knowledge of health care. Parents have to learn to use the school system (it is required by law that children attend, generally to age 16, and most parents view schools as very important for the chances of children to have a better life as adults). Although some areas have busing to schools, most children in the nation attend elementary schools near their homes and in places where the [Page ix]staff develop some understanding of the needs to their area. This book presents examples of how school-based clinics have worked in one state with several different types of models. These models are presented after a review of child health and school health programs. As a new program to help provide health insurance to some of the working poor (Child Health Insurance Program - [CHIP]) began in many states in 1999, a book that examines the health of children and roles that schools can play in improving the health of children addressed a topic that is especially timely. The topic is also, in some ways, timeless, because the health of children should also be of special concern in a caring society. Children represent the future of any country, and access to health care provides children with an opportunity for a decent start in life.[Page x]
I would like to acknowledge the assistance of several groups and people who helped to make this book possible. Without the grant from the Flinn Foundation, I would not have become so involved in the issue of school-based health services. I wish to thank the Flinn Foundation both for helping to stimulate my interest and for providing the funds for the many site visits that I conducted to each of the projects. Special thanks within the Flinn Foundation goes to Myra Millinger, the program officer with whom I worked most closely. She always helped with thoughtful comments while the grant was underway, and she is most knowledgeable about issues of school health and adolescent health in the state of Arizona.
I would also like to thank my university, Arizona State University, Larry Penley, dean of my College of Business, and Eugene Schneller, the chairperson of my unit, the School of Health Administration and Policy, during the years I was most involved in writing this book, for helping to facilitate the sabbatical that made the completion of the book possible. For detailed support, I am most appreciative to Matthew Brown, my graduate assistant, who was always willing to try and hunt down more references and statistics, whether in the library or over internet.
I would also like to thank my family for their patience, as I often stated that I needed to go write and not be bothered with other details. My husband, Michael Kronenfeld, has always been supportive and has read outlines of the proposed book [Page xii]and versions of several of the chapters. My sons, Shaun, Jeffrey, and Aaron, though less patient, generally did respect my need for my materials to be left alone (aided during this project by the addition of computers in their bedrooms).
References[Page 103]1997). The effects of poverty on child health and development. Annual Review of Public Health, 18, 463–483. http://dx.doi.org/10.1146/annurev.publhealth.18.1.463, , , & (1993). At Risk in America. San Francisco: Jossey-Bass.(Allensworth, D., Wyche, J., & Nicoloson, L. (Eds.). (1995). Defining a comprehensive school health program: An interim statement. Washington, DC: National Academy Press.1980). The epidemiology of myopia. American Journal of Epidemiology, 11, 220–228., & (Arizona Department of Health Services. (19%). Togetherwe care: School-based, school-linked community services. Directory. Phoenix, AZ: Bureau of Community and Family Health Services.Arizona Department of Health Services. (1997). Togetherwe care: School-based, school-linked community services. Directory. Phoenix, AZ: Bureau of Community and Family Health Services.1995). Attention-deficit disorders. In H. I.Kaplan & B. J.Saddock (Eds.), Comprehensive Book of Psychiatry/VI (Vol. 2,, & (6th ed), Baltimore: Williams & Wilkins.1991). A comparison of users and non-users of a school based health and mental health clinic. Journal of Adolescent Health, 12, 240–246. http://dx.doi.org/10.1016/0197-0070%2891%2990017-G, , & (1997, December 11). Legislature must work to broaden health care for kids. The Arizona Republic, p. B6.(1991). Infant mortality among Hispanics. Journal of the American Medical Association, 265, 217–221. http://dx.doi.org/10.1001/jama.1991.03460020071031, , , & (1996). Overview of pediatrics. In R. E.Behrman, R. M.Kliegman, & A.Arvin (Eds.), Nelson textbook of pediatrics. Philadelphia: W. B. Saunders Company.([Page 104]1995). Politics and practice: Introducing Norplant into a school based health center in Baltimore. American Journal of Public Health, 85, 309–311. http://dx.doi.org/10.2105/AJPH.85.3.309, , & (1965). Aid to Dependent Children. New York: Columbia University Press.(1994). Curing child poverty in the United States. Papers and Proceedings From the American Economics Association, 84, 76–80.(1980). Creating the welfare state: The political economy of twentieth-century reform. New York: Praeger., & (1996). Patterns of ICD-9 diagnoses among adolescents using school-based clinics: Diagnostic categories by school level and gender. Journal of Adolescent Health, 18, 203–210. http://dx.doi.org/10.1016/1054-139X%2895%2900013-I, , , & (1996). Immunization status of children on school entry: Area analysis and recommendations. Clinical Pediatrics, 25, 237–242. http://dx.doi.org/10.1177/000992289603500502, , , & (1997). The school nurse as health educator. Journal of School Health, 67, 3–8. http://dx.doi.org/10.1111/j.1746-1561.1997.tb06287.x(1995). Promising approaches for adolescent reproductive health service delivery. Western Journal of Medicine, 163(Suppl.), 50–56.(1995). The impact of health insurance status on adolescents’ utilization of school-based clinic services: Implications for health services reform. Journal of Adolescent Health, 16, 18–25. http://dx.doi.org/10.1016/1054-139X%2895%2994069-K, , , & (1982). American medicine's golden age: What happened to it?Science, 215, 1474–1479. http://dx.doi.org/10.1126/science.7038876(1987). Ensuring access to health care for children with disabilities. New England Journal of Medicine, 317, 162–165. http://dx.doi.org/10.1056/NEJM198707163170309, , & (1993). A community coalition for prevention and health promotion. Health Education Research, 8, 315–330. http://dx.doi.org/10.1093/her/8.3.315, , & (1997, November 17). 86 percent of uninsured kids in NM eligible but not enrolled in Medicaid. American Medical News, p. 4.(Centers for Disease Control and Prevention. (1996). Guidelines for school health programs to promote lifelong healthy eating. Morbidity and Mortality Weekly Report, 45 (RR-9), 1–41.Centers for Disease Control and Prevention. (1994). Guidelines for school health programs to prevent tobacco use and addiction. Morbidity and Mortality Weekly Report, 43 (RR-2), 1–18.Center for the Future of Children. (1992). Recommendations and analysis. Future of Children, 2(2), 6–25. http://dx.doi.org/10.2307/16025581993). Child poverty: Overview and outlook. In J. A.Chafel (Ed.), Child poverty and public policy. Washington, DC: Urban Institute Press.(Children's insurance programs gain new popularity. (1997, April). State Initiatives in Health Care Reform, 13(No. 23), 4–7, 12.1994). Health of our nation's children. (Vital and Health Statistics, Series 10, No. 191). Hyattsville, MD: National Center for Health Statistics., , & (1996). Health and selected socioeconomic characteristics of the family, United States, 1988–90. (Vital and Health Statistics, Series 10, No. 195). Hyattsville, MD: National Center for Health Statistics., & (1990). The differential effects of traditional risk factors in infant birth weights among blacks and whites in Chicago. American Journal of Public Health, 80, 679–681. http://dx.doi.org/10.2105/AJPH.80.6.679, & ([Page 105]1995). School health education. Journal of School Health, 65, 302–311. http://dx.doi.org/10.1111/j.1746-1561.1995.tb03378.x, , , , , , & (1997). The Way We really Are: Coming To Terms with America's Changing Families. New York: Basic Books.(1989). Child psychiatric disorders and their correlates: A primary care pediatric sample. Journal of the American Academy of Child and Adolescent Psychiatry, 28, 851–855. http://dx.doi.org/10.1097/00004583-198911000-00007(1993). Accomplishments in comprehensive school health education. Journal of School Health, 63, 21–23. http://dx.doi.org/10.1111/j.1746-1561.1993.tb06053.x(1994). Program management: A necessary component for the comprehensive school health program. Journal of School Health, 64, 400–404. http://dx.doi.org/10.1111/j.1746-1561.1994.tb03259.x, & (1997, February 23). A sharp decrease in welfare cases is gathering speed. New York Times, p. 1, 12.(1980). Exploration in quality assessment and monitoring: Vol. 1. The definition of quality and approaches to its assessments. Ann Arbor, MI: Health Administration Press.(1994). Full-service schools: A revolution in health and social services for children, youth and families. San Francisco: Jossey-Bass.(1988). Has children's poverty become more consistent?American Sociological Review, 56, 538–550. http://dx.doi.org/10.2307/2096273, & (Exploring national issues and priorities. (1996). Journal of School Nursing, 12, 23–36.1989). Trends and current status in childhood mortality, U.S., 1900–1985. (Vital and Health Statistics, Series 2, No. 26). Hyattsville, MD: National Center for Health Statistics., & (1992). School based adolescent health care: A review of a clinical service. American Journal of Diseases of the Child, 146, 615–621., , , , & (1993). Educating Immigrant Children. Washington, DC: Urban Institute Press., & (1996). School-based mental health services in the United States: History, current models and needs. Community Mental Health Journal, 32, 341–352. http://dx.doi.org/10.1007/BF02249452, , & (1996). Who dispenses pharmacueticals to children at school?Journal of School Health, 66, 355–358. http://dx.doi.org/10.1111/j.1746-1561.1996.tb03390.x, , , , & (1996). Functions of school nurses and health assistants in U.S. school health programs. Journal of School Health, 66, 55–63. http://dx.doi.org/10.1111/j.1746-1561.1996.tb07909.x, & (1989). School based clinic use and other factors affecting adolescent contraceptive behavior. Journal of Adolescent Health Care, 10, 506–512. http://dx.doi.org/10.1016/0197-0070%2889%2990013-2, & (1988). National survey of prevalence of asthma among children in the United States. Pediatrics, 81, 1–7., , & (1988). Ideology and welfare reform under the Reagan administration. In D.Tomaskovic-Devey, (Ed.), Poverty and Social Welfare in the United States. Boulder, CO: Westview Press.(1995). Rethinking the organization of children's programs: Lessons from the elderly. The Milbank Quarterly, 73, 565–597. http://dx.doi.org/10.2307/3350286, & (1964). Reactions to the threatened loss of a child: A vulnerable child syndrome. Pediatrics, 34, 58–66., & ([Page 106]1990). Childhood injuries in the U.S. American Journal of Diseases of Children, 144, 659–652., & (1996). Integrating school-based health centers into managed care in Massachusetts. Journal of School Health, 66, 317–321. http://dx.doi.org/10.1111/j.1746-1561.1996.tb03408.x(1994). A nationwide survey of school health services delivery in urban schools. Journal of School Health, 64, 279–283. http://dx.doi.org/10.1111/j.1746-1561.1994.tb03307.x, , , & (1982). More medical care! Better health? In J.Hadley (Ed.), Economic Analysis of Mortality Rates. Washington, DC: The Urban Institute.(1983). Epidemiology of childhood disease. In D.Mechanic (Ed.), Handbook of Health, Health Care and the Health Professions, (pp. 101–119). New York: Free Press.(1995). The Poverty of Welfare Reform. New Haven, CT: Yale University Press.(1991). The Moral Construction of Poverty: American Welfare Reform. Newbury Park, CA: Sage., & (1995). The impact of legislation on the role of the school nurse. Nursing Outlook, 43, 57–61. http://dx.doi.org/10.1016/S0029-6554%2805%2980044-2, , & (1993). School-based clinics: A response to the physical and mental health needs of adolescents. Health and Social Work, 18, 65–74., & (1994). School nursing in America – 1902–1994: A Return to public health nursing. Public Health Nursing, 11, 416–425. http://dx.doi.org/10.1111/j.1525-1446.1994.tb00208.x, , & (1991). When the Bough Breaks. New York: Basic Books.(1993). The 101st Congress: An emerging agenda for children in poverty. In J. A.Chafel (Ed.), Child Poverty and Public Policy. Washington, DC: Urban Institute Press.(1994). School nursing. Nursing Clinics of North America, 29, 443–58.(Institute of Medicine. (1989). Research on Children and Adolescents with Mental, Behavioral and Developmental Disorders: Mobilizing a National Initiative. Washington, DC: National Academy Press.1986). Biopsychosocial correlates of risk-taking behavior in adolescence. Journal of Adolescent Health Care, 7, 82s-92s., & (1984). Use of Licit and Illicit Drugs by America's High School Students. (DHHS Publication No. 85-1394). Rockville, MD: National Institute of Drug Abuse., , & (Joining Hands: News From the National Assembly on School-Based Health Care. (1995). (Vol. 1, No. 1). McLean, VA: National Assembly on School-Based Health Care.1995). The School Health Policies and Programs Study (SHPPS): Rationale for a nationwide status report on school health programs. Journal of School Health, 65, 291–294. http://dx.doi.org/10.1111/j.1746-1561.1995.tb03376.x, , , , , & (1995). School-based health centers: Primary care in high school. Pediatric Annals, 24, 192–200.(1996). School-based health centers: Students’ access, knowledge and use of services. Archives of Pediatric and Adolescent Medicine, 150, 175–180. http://dx.doi.org/10.1001/archpedi.1996.02170270057008, , , & (Kids care tests whether states can handle big-time responsibility. (1997, November 10). American Hospital Association News, 33, 3.[Page 107]1997, September 21). States to provide health insurance to more children. The New York Times, pp. 1, 22.(1993). Children's Health in America. New York: Maxwell Macmillan International.(1992). Research Methods For Assessing and Evaluating School-Based Clinics. Washington, DC: Center for Population Options.(1997). Effect of prenatal and infancy home visitation on pregnancy, outcomes, childhood injuries, and repeated childbearing. Journal of the American Medical Association, 278, 644–652. http://dx.doi.org/10.1001/jama.1997.03550080054039, , , , , , , , , , , , & (1995). School-based health clinics in the mid 1990s. Current Opinion in Pediatrics, 7, 353–359. http://dx.doi.org/10.1097/00008480-199508000-00002, & (1995). The effect of gaps in health insurance on continuity of a regular source of care among preschool-aged children in the United States. Journal of the American Medical Association, 274, 1430–1435. http://dx.doi.org/10.1001/jama.1995.03530180023025, , , , , & (1993). Developing a plan of action to institutionalize school health education programs in the United States. Journal of School Health, 63, 12–13. http://dx.doi.org/10.1111/j.1746-1561.1993.tb06051.x(1993). Racism, sexism, and social class: Implications for studies of health, disease and well-being. American Journal of Preventive Medicine, 9(Suppl. 6), 82–122., , , , & (1984). US National Health Policy: An Analysis of the Federal Role. New York: Praeger., & (1998). The Changing Federal Role in U.S. Health Care Policy. Westport, CT: Praeger Publishers.(1996). Flinn Final Report: Evaluation of School Health Projects and Extended Evaluations As New Projects Were Added. Flinn Foundation: Phoenix, AZ.(1993). Comprehensive school health education: barriers and opportunities. Journal of School Health, 63, 24–27. http://dx.doi.org/10.1111/j.1746-1561.1993.tb06054.x(1996). Key issues affecting school-based health centers and Medicaid. Journal of School Health, 66, 83–88., , , & (1991). Reorganizing health care for adolescents: The experience of the school-based adolescent health care program. Journal of Adolescent Health, 12, 450–458. http://dx.doi.org/10.1016/1054-139X%2891%2990022-P, , , & (1983). Consensus for reform: The mothers'-pension movement in the Progressive Era. Social Service Review, 47, 397–417. http://dx.doi.org/10.1086/643020(1982). The high-prevalence-low-severity developmental disorders of school children. Advances in Pediatrics, 29, 529–544.(1984). Middle Childhood: Development and Dysfunction. Baltimore: University Park Press., & (1980). Vulnerable children: Parents’ perceptions and the use of medical care. Pediatrics, 65, 956–963.(1992). Teenage childbearing. In The Future of Children, 2(2), 186–191. http://dx.doi.org/10.2307/1602569(1997). Partnerships in school care. American Journal of School Health, 87, 291–293., , , , & (1994). Successful recruitment strategies for school-based health promotion: Experiences from CATCH. Journal of School Health, 64, 405–4109. http://dx.doi.org/10.1111/j.1746-1561.1994.tb03261.x, , , , , , & ([Page 108]1986). The health of Hispanics in the southwestern United States. Public Health Reports, 101, 253–265., & (1993). Health Caring: A Process Evaluation of the Robert Wood Johnson Foundation's School-Based Adolescent Health Care Program. Princeton, NJ: Mathtech, Inc., & (1989). Design and Estimation for the National Health Interview Survey, 1985–1994. (Vital and Health Statistics, Series 10, No. 173). Hyattsville, MD: National Center for Health Statistics.(1993). Growing neglect of American children. American Journal of Diseases of the Child, 147, 259.(Maynard, R. A., (Ed.). (1997). Kids Having Kids. New York: The Urban Institute.1993). School-based clinic use and school performance. Journal of Adolescent Health, 14, 91–98. http://dx.doi.org/10.1016/1054-139X%2893%2990091-3, , , & (1989). The health of children and adolescents. In H. E.Freeman & S.Levine, (Eds.), Handbook of Medical Sociology (, & (4th ed.). Englewood Cliffs, NJ: Prentice-Hall.1993). Maternal rating of child health at school age: Does the vulnerable child syndrome persist?Pediatrics, 92, 380–388., , , & (1987). Implications of recent changes in infant mortality. In L. H.Aiken, & D.Mechanic, (Eds.), Applications of Social Science to Clinical Medicine and Health Policy, (pp. 282–306). New Brunswick, NJ: Rutgers University Press.(1993). The year 2000 initiative: Implications for comprehensive school health education. Preventive Medicine, 22, 493–498. http://dx.doi.org/10.1006/pmed.1993.1041(Michigan Model for Comprehensive School Health Education - Implementation Plan for the Year 1991. (1991). East Lansing, MI: State of Michigan.1989). Monitoring Children's Health Care: Key Indicators (, , & (2nd ed.). Washington, DC: American Public Health Association.1997). The Triumph of Meanness: America's War Against Its Better Self. Boston: Houghton Mifflin.(1997). Helping poor mothers and children. Journal of the American Medical Association, 278, 680–681. http://dx.doi.org/10.1001/jama.1997.03550080090046(1984). Losing Ground: American Social Policy, 1950–1980. New York: Basic.(National Association of State School Nurse Consultants. (1996). Delegation of school health services to unlicenced personnel: A position paper. Journal of School Health, 66, 72–74. http://dx.doi.org/10.1111/j.1746-1561.1996.tb07913.xNational Commission on Children. (1991). Beyond Rhetoric: A New American Agenda for Children and Families. Washington, DC: National Commission on Children.1996). School-based programs for preventing eating disturbances. Journal of School Health, 66, 64–71. http://dx.doi.org/10.1111/j.1746-1561.1996.tb07912.x(1994). Health status and income: The impact of poverty on child health. Journal of School Health, 64, 229–233. http://dx.doi.org/10.1111/j.1746-1561.1994.tb06191.x, , & (1988). Morbidity and use of ambulatory care services among poor and non-poor children. American Journal of Public Health, 78, 927–933. http://dx.doi.org/10.2105/AJPH.78.8.927, & (1994). Prevalence and impact of multiple childhood chronic illnesses. The Journal of Pediatrics, 124, 40–48. http://dx.doi.org/10.1016/S0022-3476%2894%2970252-7, & (1992). Childhood chronic illness: Prevalence, severity and impact. American Journal of School Health, 82, 364–371. http://dx.doi.org/10.2105/AJPH.82.3.364, & ([Page 109]New York tests limits of benefit package and affordability as it aims to double size of children's insurance plan. (1997, July) State Health Watch, 4(No. 7). pp. 2, 8.1995). The role of race/ethnicity and social class in minority health status. Health Services Research, 30 (No. 1, Part II), 151–161.(1991). Hispanic health: Time for data, time for action. New England Journal of Medicine, 265, 254–255., , & (The number of Americans. (1995, March-April). State Initiatives in Health Care Reform, 11, 1–3.Number of school-based health centers increasing. (1997, April). The Nation's Health p. 11.1994). America's Children: Triumph or Tragedy. Washington, DC: American Public Health Association., , & (1997). Long-term effects of home visitation on maternal life course and child abuse and neglect. Journal of the American Medical Association, 278, 637–643. http://dx.doi.org/10.1001/jama.1997.03550080047038, , , , , , , , , & (1965). Counting the poor: another look at the poverty profile. Social Security Bulletin, 28, 3–29.(1993). The increasing disparity in mortality between socioeconomic groups in the United States, 1960 and 1986. New England Journal of Medicine, 329, 103–109. http://dx.doi.org/10.1056/NEJM199307083290207, , , & (1994). School nursing: Trends for the future. Journal of School Health, 64, 141–149. http://dx.doi.org/10.1111/j.1746-1561.1994.tb03284.x(1979). Methods of sociomedical research. In N.Freeman, H. E.Levine, & L. G.Reeder (Eds.), Handbook of Medical Sociology (, & (3rd ed.), (pp. 483–500). Englewood Cliffs, NJ: Prentice-Hall.1981). America 's Struggle Against Poverty, 1900–1980. Cambridge, MA: Harvard University Press.(1992). Health care services for children and adolescents. The Future of Children, 2(2), 59–77. http://dx.doi.org/10.2307/1602562, , & (1990). Public Health: Administration and Practice. St. Louis, MO: Times Mirror/Mosby College Publishing., & (1971). Regulating The Poor: The Functions of Public Welfare. New York: Academic Press., & (1971). Childhood illness and its consequences: Observations based on three epidemiological surveys. The Journal of Pediatrics, 79, 351–359. http://dx.doi.org/10.1016/S0022-3476%2871%2980141-5, & (1994). The first school nurse. Journal of School Nursing, 10, 34–36.(1993). School Nursing Practice: Roles and Standards. Scarborough, ME: National Association of School nurses., , & (Quick updates - making the grade in school health. (1997). Journal of the American Medical Association, 277, 1270. http://dx.doi.org/10.1001/jama.1997.035404000200071992). Effectiveness of health care services for pregnant women and infants. The Future of Children, 2(2), 40–57. http://dx.doi.org/10.2307/1602561, , & (1996). The nurse practitioner in the school setting. Advanced Practice Nursing, 31, 507–518.(1997). Rural school-based clinics: Are adolescents willing to use them and what services do they want?Journal of School Health, 67, 144–148. http://dx.doi.org/10.1111/j.1746-1561.1997.tb03435.x, , & ([Page 110]1973). Examination and health history findings among children and youth 6–17 years. (Vital and Health Statistics, Series 11, No. 129). Hyattsville, MD: National Center for Health Statistics.(1922). The nutrition and care of children in a mountain county of Kentucky. Children's Bureau Publication (No. 10). Washington, DC: U. S. Department of Health, Education, Welfare, and Rehabilitation Services.(1994). School health nursing in the era of health care reform: What is the outlook?Journal of School Health, 64, 137–140. http://dx.doi.org/10.1111/j.1746-1561.1994.tb03282.x(1988). A test of the new structural critique of the welfare state. In D.Tomaskovic-Devey (Ed), Poverty and Social Welfare in the United States, (pp. 130–161). Boulder, CO: Westview Press.(1996). School-based health centers and adolescent use of primary care and hospital care. Journal of Adolescent Health, 19, 267–275. http://dx.doi.org/10.1016/S1054-139X%2896%2900088-2, , & (1993). Who are the poor: A demographic perspective. In J. A.Chafel (Ed.), Child Poverty and Public Policy. Washington, DC: Urban Institute Press.(1995). State initiatives to support school-based health centers: A national survey. Journal of Adolescent Health, 17, 68–76. http://dx.doi.org/10.1016/1054-139X%2895%2900060-6, , , & (1992). Mortality among infants of black as compared with white college-educated parents. New England Journal of Medicine, 326, 1522–1526. http://dx.doi.org/10.1056/NEJM199206043262303, , , & (School-Based Health Centers Can Expand Access for Children. (1994, December). Report to the Chairman, Committee on Government Operations, House of Representatives. Washington, DC: General Accounting Office, HEHS 95093.School-based centers search for funding: Eye managed care organizations as partners. (1994, September-October). State Initiatives in Health Care Reform, 10(No. 14), pp. 7–9.1994). Wasting's America's Future: The Chidlren 's Defense Fund Report on the Costs of Child Poverty. Boston: Beacon Press.(1992). Protecting Soldiers and Mothers: The Political Origins of Social Policy in the United States. Cambridge, MA: Harvard University Press.(1982). Health Education: A Conceptual Approach to Curriculum Design. St. Paul, MN: 3M Education Press.(1995). School health services. Journal of School Health, 65, 319–325. http://dx.doi.org/10.1111/j.1746-1561.1995.tb03381.x, , , , , , & (Society for Adolescent Medicine. (1992). Access to health care for adolescents: A position paper of the Society for Adolescent Medicine. Journal of Adolescent Health, 13, 162–170. http://dx.doi.org/10.1016/1054-139X%2892%2990084-O1983). The Economics and Politics of Race: An Economic Perspective. New York: William Morrow.(States experiment with using welfare as leverage to get preventive care for children. (1997, July). State Health Watch, 4, pp. 3, 11.States hustling to get their share of $24 billion for kids’ coverage. (1997, November 10). American Hospital Association News, 33, 5–6.Status report on the childhood immunization initiative. (1997). Morbidity and Mortality Weekly Report, 46, 57–664.[Page 111]1985). The Effectiveness of Medical Care Validating Clinical Wisdom. Baltimore, MD: Johns Hopkins University Press.(1991). Childhood morbidity: Comparisons, clusters, and trends. Pediatrics, 88, 519–526.(1993). Adolescent health status measurement: Development of the child health and illness profile. Pediatrics, 91, 430–435., , , , , , , , & (1996). Health status of well versus ill adolescents. Archives of Pediatric and Adolescent Medicine, 1, 1249–1256. http://dx.doi.org/10.1001/archpedi.1996.02170370027003, , , , , & (1995). The adolescent child health and illness profile. Medical Care, 33, 553–566. http://dx.doi.org/10.1097/00005650-199505000-00008, , , , , , , & (The state of school nursing today. (1995). Journal of School Health, 65, 371–389. http://dx.doi.org/10.1111/j.1746-1561.1995.tb06235.x1994). Early access to health care services through a rural school-based health center. Journal of School Health, 64, 284–289. http://dx.doi.org/10.1111/j.1746-1561.1994.tb03309.x(1995). Healthier times at Ridgemont High. Hospitals and Health Networks, 69, 36–38.(1988). Poverty and Social Welfare in the United States. Boulder, CO: Westview Press.(U.S. Congress, Office of Technology Assessment. (1991). Adolescent Health, Volume 1: Summary and Policy Options. (OTA-H-468). Washington, DC: U.S. Government Printing Office.U.S. Department of Health and Human Services. (1991). Healthy People 2000: National Health Promotion and Disease Prevention Objectives. Washington, DC: Public Health Service.1996). The evolution of the school nurse practitioner: Past, present and future. Journal of School Nursing, 12, 6–9. http://dx.doi.org/10.1177/105984059601200202, , , & (1996). Characteristics of user and nonusers of school clinics in inner city junior high schools. Journal of Adolescent Health, 18, 344–348. http://dx.doi.org/10.1016/1054-139X%2895%2900171-N, , , , , & (1997). The end of work and the end of welfare: Review of the Personal Responsibility and Work Opportunity Reconciliation Act of 1996. Contemporary Sociology, 26, 409–412. http://dx.doi.org/10.2307/2655075(1996). Treatment outcome of school-based mental health services for urban teenagers. Community Mental Health Journal, 32, 149–157. http://dx.doi.org/10.1007/BF02249752, , , & (1996). A school-based clinic for elmentary schools in Arizona. Journal of School Health, 66, 125–127.(1993). School nursing: History, present practice, and possibilities reviewed. Journal of Advanced Nursing, 18, 1202–1211. http://dx.doi.org/10.1046/j.1365-2648.1993.18081202.x, & (1995). School nurses’ experience with children with chronic conditions. Journal of School Health, 65, 234–236. http://dx.doi.org/10.1111/j.1746-1561.1995.tb03371.x, & (1994a, February). Integration with new models of health service delivery. Journal of School Nursing, 10(No. 1), 10–14.(1994b, April). School health delivery programs throughout the United States. Journal of School Nursing, 10(No. 2), 31–36.(1996). Is health vision screening effective?Journal of School Health, 66, 171–175. http://dx.doi.org/10.1111/j.1746-1561.1996.tb06269.x, , , & ([Page 112]1990). Developmental, learning and emotional problems: Health of our nation's children, United States, 1988. (Advance Data From Vital and Health Statistics, No. 190). Hyattsville, MD: National Center for Health Statistics., & (1995). School-based health centers and managed care health plans: Partners in primary care. Journal of Public Health Management Practice, 1(1), 33–39., & (
About the Author[Page 116]
Jennie Jacobs Kronenfeld is a Professor in the School of Health Administration and Policy, College of Business, Arizona State University at Tempe. She holds a doctorate (1976) and a master's (1973) in sociology from Brown University and a BA (1971) in sociology and history at the University of North Carolina, Chapel Hill. Before coming to Arizona, she held faculty positions at the University of Alabama in Birmingham and the University of South Carolina. She has published over 80 articles in public health, medicine, and sociology. She has authored or coauthored 12 books, one in 1981 on the social and economic aspects of coronary artery bypass surgery; one in 1984 on the federal role in health policy; one in 1986 on the impact of technology on sex roles and social change; one in 1990 on social policies and privatization issues in the care of the young, the sick, the imprisoned, and the elderly; one in 1993 on controversial issues in health policy, and several relating to career strategies in academe (tenure, ethical concerns, and the job search). Several recent edited books are part of the research annual series of Research in the Sociology of Health Care, for which she has served as the editor or co-editor since 1993. She has held numerous national offices in various professional sociological and health association. She currently teaches courses on health care policy; social, economic, and political factors in health care; and methodological issues in health care research.