578 - Diet Quality and School Attendance: Cost Analysis Informing Absence-Reduction Strategies in Schools with Underserved Students

Poster Number: 578
Publication Number: 578.241

Micah G. Ernst, Meharry Medical College - Medical Student, Nashville, TN, United States; Sharon Kukla-Acevedo, Central Michigan University, East Lansing, MI, United States; Evan C. Sommer, VUMC, Nashville, TN, United States; Shari Barkin, Vanderbilt University Medical Center, Nashville, TN, United States

Background: Students’ school attendance is known to have positive associations with short and long-term academic outcomes; and, absenteeism also has notable links to children’s health. This interrelationship between health and education has significant implications. School districts are actively evaluating strategies and implementing programs to reduce absenteeism; yet, health-related methods are still largely underutilized in districts across the nation.

Objective: To conduct a cost-effectiveness analysis (CEA) of improved diet quality measured by their Healthy Eating Index (HEI) score to a higher category to reduce absenteeism and compare to other school absenteeism interventions.

Design/Methods: A novel database linking the Growing Right Onto Wellness (GROW) RCT with longitudinal diet data (3-day diet recalls conducted annually for three years) from low SES diverse school-aged children and Metro Nashville Public Schools (MNPS) capturing school absenteeism was used (Nf 354). Incremental cost-effectiveness ratios (ICERs) were calculated to determine the costs of improving children’s HEI based on estimates of monthly food cost for each student from the database and informed by the quadratic regression models used in the Seattle Obesity Study (SOS). Descriptive cost comparison to other absenteeism interventions were conducted.

Results: Improved total HEI scores corresponded with a marginal increase in daily food costs for the improvement in a student’s diet quality and a decrease in absences (Table 1). Associated food cost for improving a child’s HEI from “poor” (45) to “needs improvement” (51) is $0.67/student/day and $120.60/student/year. Improving HEI from 55 to 60 had the lowest estimated cost per incremental school day attended per student ($5.16), as compared to other absence-reduction programs (Table 2). School absenteeism interventional costs varied from $5.16 - $474.55 per incremental school day attended/student (2021 $). Improved diet quality had superior overall outcome effectiveness.Conclusion(s): Increasing children’s HEI could improve school attendance. It is an especially low-cost method among students with low average HEI scores. This data can inform policy makers regarding allocation of scarce resources that would potentially improve both health and education outcomes.
Micah G. Ernst, MD Candidate, MPH - CV 2022MicahGErnst_MDCandidate_MPH_CV22.pdf
Estimated Costs for Early Childhood School Attendance InterventionsNote: School nurses are recognized as an important component of school health and student success, as evidenced by the Center for Disease Control’s “Healthy People 2020” initiative recommending a 1:750 student to nurse ratio in elementary and secondary schools (USDHHS, 2020). Despite this, there is very limited research linking the effect of school nurses on attendance and providing cost estimates (Allison & Attisha, 2019). Therefore, we are unable to include this type of intervention on attendance in our cost analysis.