Appropriate Use of Health Risk Appraisals with School-age Children Rick zyxwvuts Petosa, Gerald Hyner, Christopher Melby ABSTRACT: zyxwvutsrqpon Health Risk Appraisals (HRAs) use personal risk assessment as an educational approach to encourage adoption zyxwvutsrq of positive health-related behavior. An individual’s behavior and health history are compared to morbidity and mortality tables to estimate a level of personal risk. Current trends suggest HRAs will continue to be popular with school health educators. Appropriate use of HRAs requires an understanding of the assumptions, interpretations, and limitations of these instruments. This article reviews the development, validity, and reliability of HRA methodology. The educational usefulness of HRAs designed for school-age populations zyxwvut is examined. Recommendations are offered to optimize the instructional benefits of HRAs while minimizing potential deficiencies. (J zyxwvutsrqp Sch Health 1986:56(2):52-55) zyxw ealth risk appraisals (HRAs) initially were devel- H oped to assess consumer health status and to en- courage adoption of health enhancing behaviors. Since they were introduced by Robbins and Hall’ in the early 1970s, HRAs have been developed for various popula- tions, including school-age children. HRAs are instru- ments that compare users’ known risk factors with those of the same age, gender, and racial group in the general population. Because HRAs typically are inexpensive, noninvasive, personalized health assessment tools, health educators realized their potential use in the class- room. With an HRA, users could establish their respec- tive levels of risk and project an estimated life expect- ancy, or calculate a “risk score” based on family his- tory and health-related lifestyles. Health educators viewed HRAs as effective educational tools with poten- tial to reinforce the relationship between lifestyle and personal health status. Another educational innovation, the microcomput- er, enhanced the use of HRAs by classroom teachers. The development of HRAs for microcomputers was understandable because sophisticated HRAs require extensive mathematical formulas and cumulative computations to estimate health risk and longevity. A microcomputer can lead a student through an HRA pro- gram, eliciting accurate responses and quickly providing personalized information. Ellis and Raines*enthusiasti- cally describe how a microcomputer program not only estimates risk age but presents information in a manner they believe motivates behavior change. Goulding and Peterson’ developed an HRA specifically for adolescent populations that is being distributed widely. The Rhode Island Dept. of Health‘ is collecting data regarding high school students’ health-related behaviors through their Wellness Check HRA program. Much of the popularity of HRAs is supported by interest in microcomputers and interactive programs written for them. Current trends suggest HRAs will be used frequently by school health educators in the future. This article describes the logic and assumptions upon which HRAs are based and offers recommendations for appropriate use of HRAs with school-age children. Specific ways are Rick Petosa, PhD, Gerald Hyner, PhD, and Christopher Melby, MPH, DHSc, Dept. of Health Promotion and Education, Purdue University, West Lafayette, IN 47907. suggested to optimize the instructional benefits of HRAs while minimizing possible shortcomings. DEVELOPMENT zyx OF HRAs Health Risk Appraisals are based on assessment of risk factors for premature morbidity and mortality identified from prospective studies such as the Framing- ham Heart Study5 and other epidemiological investiga- tion~.~~’ Robbins and Hall1identified characteristics that placed patients at high risk for common causes of death. These characteristics have been described as risk factors, precursors, prognosticators, and health risks. Dunton’ suggested that a risk factor is a quantitative weight allocated to a precursor to estimate the degree to which it may influence an individual’s risk of death. Robbins and Hall9 selected precursors they felt were recognized by authoritative national organizations. Two examples are heart disease precursors offered by the American Heart Association or cancer precursors identified by the American Cancer Society. Precursors include family history or disease, smoking, obesity, inactivity, excessive alcohol use, and related factors. Values are assigned to each precursor to calculate a composite risk score. These quantitative values, which convert precursors to risk factors, rely on prospective studies, life insurance actuarial data, and professional judgment. The first tables of risk factors, developed by actuary Norman Gesner, often are referred to as Gesner Tables. Risk factor values adjust mathematically ten-year mortality probabilities for leading causes of death within each gender, race, and five-year age group. Life table methods are applied to National Center for Health Statistics mortality reportsio to calculate probability tables. First prepared by biostatistician Harvey Geller, these are the Geller Tab1es.l Together, Gesner/Geller tables provide the computational base by which most HRAs calculate an “appraised” or “risk” age. For example, an appraised age of 55 in a 40-year-old male indicates a 15-year disparity between chronological age and risk age. Similarly, HRAs can calculate the poten- tial for reducing risk by estimating an “achievable” age, assuming the HRA user changed specific disease pro- moting behaviors. The 40-year-old male might achieve the risk status of a 35-year-old if he stopped smoking, ~~ 52 Journal of School Health February 1986, Vol. 56, No. 2