Economic Performance of School Health Programs in a Rural State – A Data Envelopment Analysis (DEA) Approach

The CDC's Coordinated School Health (CSH) Programs integrate education and health services to improve academic achievement and health status. Efficient operation of CSH programs is critical for their sustainability.

The objective of this study is to measure the relative efficiency of CSH programs in10 pilot middle school systems in Tennessee using Data Envelopment Analysis (DEA). Programs were implemented in 2001.

We analyzed program-level input and output data for 2006. Input data (staffing, budget allocations, staff development time) and output data (risky behaviors, Body Mass Index, academic performance) were derived from the CSH administrative database, Youth Risk Behavior Survey, and Department of Education records.

All sites had a full-time CSH coordinator. Only one had a certified health educator. Composite ratio of physical education teachers to students was 1:395; nurse to student ratio was 1:672. Budget allocations related to school health were 2.5% on average. YRBS data indicated that 1 in 10 middle school students smoked cigarettes daily, 40% had had an alcoholic drink, 20% sexual intercourse, and only 50% engaged in regular physical activity. Input and output data varied by site. DEA is underway and will be supplemented with socio-demographic and epidemiological data.

This study evaluates the school health programs internally and benchmark against similar programs externally to identify the most efficient program. The results will inform the expansion of CSH programs in Tennessee and nationally and could be used to create a statewide school health chart, matching available resources to the student population and its health needs.