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Scoliosis Screening Spurs Disagreement

A study of scoliosis screening in schools by researchers in Minnesota is unlikely to quell the debate over the significance of the practice.

The illustration at left shows a normal spinal cord; the other depicts a marked curvature.

Currently, 26 states mandate that students be screened for scoliosis. Supporters of scoliosis screening argue that the simple tests are necessary for early identification of the disease that causes a curvature of the spine. Opponents, however, say the incidence of uncovering scoliosis severe enough to require treatment is so low that such testing is unnecessary.

In the study of Minnesota schoolchildren, researchers found that screening identified some youngsters who went on to receive treatment, but it referred many more for treatment who did not need it. But the co-authors came to different conclusions over whether schools should carry on with the test.

"Screening is valuable for those who are identified," said Dr. William Shaughnessy, a pediatric orthopedic surgeon at the Mayo Clinic and a co-author. Dr. Shaughnessy disagreed with the study’s lead investigator, Dr. Barbara Yawn, the director of research at the Olmsted Medical Center in Rochester, Minn., who recommended that screenings be stopped.

"The results show that scoliosis is not terribly uncommon even though the number of children requiring treatment is relatively small," Dr. Shaughnessy said.

But, Dr. Yawn said, schools should reconsider whether to continue screening because doing so turns up so few children who need treatment. "In this age of limited budgets for schools, money could be better spent by switching to other conditions that impact learning, such as asthma or vision screening," she said.

The researchers followed Rochester, Minn., students who began kindergarten and 1st grade during the early 1980s and remained in the city for at least three yearly school scoliosis screenings, which begin in the 5th grade.

Children were followed up to the age of 19 or until they left the area. All Rochester public and private schools participated in the same screening program. Examinations were conducted by public-health nurses and supervised by an orthopedic surgeon. Boys and girls in grades 5-9 were screened annually during physical education class. The examination consisted of a visual inspection of the back for asymmetry.

The final cohort comprised 2,242 students. Of those, 92 were referred one or more times for further evaluation of possible scoliosis. Sixty-eight of the students who were referred had mention of scoliosis evaluation in one or more of their medical records. Another 328 children were sent a "watch letter," notifying parents that their child should be screened every six months instead of yearly.

By 19 years of age, 27 of the 92 referred students were known to have scoliosis with curves of more than 10 degrees—the baseline used to diagnose the condition. Of the 328 children who received watch letters, all but three were found to have gone to a doctor or chiropractor, and 62 of them, or 19 percent, were further evaluated for scoliosis. None of these children, however, had to be treated, and five had documented scoliosis of more than 10 degrees.

The results show that children who were candidates for the disease were not identified by other methods, said Dr. Shaughnessy. "Candidates for smaller curves don’t get picked up very well by routine health visits," he said.

The research also indicates that students most at risk— those in grades 5-9—are not going for routine health visits, he added.

At-Risk Youths:

Many students who attend alternative high schools engage in behaviors that place them at risk for serious health problems at a higher rate than their regular high school peers, according to a report from the U.S. Centers for Disease Control and Prevention.

Some 280,000 students in grades 9-12 now attend such schools because they are in jeopardy of failing or dropping out of high school or have been expelled because of illegal activity or behavioral problems.

"Such settings provide important opportunities for delivering health-promotion education and services to these youth," says the report, which was described as the first such national examination of the alternative high school population.

Researchers compared the 1998 "National Alternative High School Youth Risk Behavior Survey" with the results from the 1997 "Youth Risk Behavior Surveillance"—both CDC reports. The latter is an annual compilation of all high school students’ behavior.

The survey measured such behaviors as wearing a seat belt or carrying a weapon; using tobacco, alcohol, or illicit drugs; engaging in sexual behavior that contributes to unintended pregnancy and sexually transmitted diseases; and eating an unhealthy diet and limiting physical activity.

The study found that in the 30 days prior to survey, 64.5 percent of the students attending an alternative school had drunk alcohol, 53 percent had used marijuana, 51.9 percent had ridden with a driver who had been drinking, 25 percent had driven after drinking alcohol, and 32.9 percent had carried a weapon. In the 12 months preceding the survey, 15.7 percent had attempted suicide, and 29 percent rarely or never wore a seat belt.

In addition, the survey found that 87.8 percent of those students had engaged in sexual intercourse; more than half, 54 percent, who were sexually active said they had not used a condom the last time they had sexual intercourse. In addition, 64.1 percent had smoked cigarettes 30 days before the survey, and 81 percent had not attended physical education class daily.

In each case, the alternative school students were more likely to engage in the potentially harmful behavior than their peers in traditional high schools.

—Adrienne D. Coles

Vol. 19, Issue 12, Page 10

Published in Print: November 17, 1999, as Health Update
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