Parent involvement with children's health promotion: the Minnesota Home Team

[Study of parental participation in curricular and extracurricular activities]

This preliminary study of parental participation in curricular and extra-curricular activities was conducted in the general framework of the healthy heart project in St. Louis du Parc, an underprivileged and multiethnic neighbourhood in Montreal. A general understanding of this type of participation is essential in order to adapt the role parents play in health programs developed in conjunction with the school. A conceptual framework was developed to help understand how and why parents of primary school children participate in school activities. Qualitative analysis of 15 semi-directed interviews conducted with various schools and other organizations revealed those obstacles to parental involvement, and the factors that encourage parents to participate. It was clear that there were wide social and cultural gaps between parents and schools. An important factor is how people perceive those barriers. Teachers stressed organizational and language communications difficulties. Others pointed to the lack of knowledge of the community, to poor communications skills and the parents' lack of those skills that would allow them to participate actively. A more open-minded attitude by school authorities and a more proactive and positive attitude of teachers toward parents are essential requirements, but not the only ones. Further interviews with parents should help provide more details and information.

Behavioral research contributions and needs in cancer prevention and control: dietary change

This paper summarizes key behavioral research contributions to the promotion of healthful diets and identifies the outstanding behavioral research needs that could lead to positive dietary changes in the United States. Nutrition plays an important role in the initiation, promotion, and progression of cancer. Dietary guidelines for health promotion and cancer prevention recommend diets that are lower in fat and higher in fiber, fruits, and vegetables. Behavioral research on dietary change has become more rigorous and sophisticated in the past decade, with noteworthy contributions in four areas: behavioral research within clinical trials, self-help or minimal contact intervention strategies, school nutrition programs and services, and advances in the development of measures. Work in progress includes large-scale randomized intervention trials, with the majority of funding for studies to increase fruit and vegetable consumption. There are many needs for further research. Six priority areas for behavioral research are identified and discussed: (1) determinants of dietary behavior and change processes; (2) policy, environmental, and organizational interventions; (3) studies of dietary change and exercise and interventions with persons at high risk for diet-related cancers; (4) methodological research; (5) research on diffusion and dissemination; and (6) systematic behavioral research on dietary change in clinical trials. A concerted research effort in the area of dietary change has great potential benefits for cancer prevention and control and for public health in general.

Food preferences predict eating behavior of very young Mohawk children

OBJECTIVE

To collect baseline data on energy and nutrient intake and nutrition knowledge, attitudes, and behavior of very young Mohawk children to assist the community in planning an appropriate, targeted nutrition and exercise intervention.

DESIGN

Energy and nutrient intake data were collected from 24-hour recalls conducted in the children's homes. Nutrition knowledge, attitudes, and behavior were assessed using a 38-item questionnaire that asked children to report on what foods they like the best, eat most of the time, and think are healthful. The questionnaire was completed in an elementary school on the reservation. Before data collection, we hypothesized that the average diet of the Mohawk children would not meet national dietary recommendations.

SUBJECTS

One hundred forty-three children, prekindergarten through third grade (aged 4 to 9 years), completed the 24-hour recalls and the questionnaire. An additional 136 children, also prekindergarten through third grade, completed the questionnaire (n = 279).

STATISTICS

Analysis of variance with a Scheffe's multiple-comparison test was used to test for differences among grades and genders for energy and nutrient intake and questionnaire scores. Multiple regression analysis was used to assess the relationship between eating behavior and selected variables.

RESULTS

A mean daily energy intake of 1,980 kcal consisted of 34% fat, 13% protein, and 52% carbohydrate with 13 g fiber and 235 mg cholesterol. Food preferences were the strongest predictor of behavior, they explained 71% of the variation in the behavior score.

APPLICATIONS

The major finding of this study, that food preferences are the strongest predictor of reported eating behavior in very young Mohawk children, has implications for behavior change interventions. Focusing on changing what children like to eat, through repeated exposure to new foods in a positive social context, is more likely to change what foods they choose than is simple nutrition education.

Patterns of health risk behaviors for chronic disease: a comparison between adolescent and adult American Indians living on or near reservations in Montana

PURPOSE

To compare the chronic disease health risk behavior patterns of adolescents and adults among American Indians living on or near reservations in Montana.

METHODS

We analyzed data from the 1993 Youth Risk Behavior Survey of American Indians in Grades 9-12 living on or near Montana reservations. Risk factors included tobacco use, low physical activity, attempted weight loss, and low consumption of fruits, vegetables, and green salad. Similar data were analyzed from a 1994 Behavioral Risk Factor Survey of American Indian adults living on or near reservations in Montana.

RESULTS

The prevalence of most adolescent health risk behaviors was high, especially cigarette smoking (45% for males, 57% for females), smokeless tobacco use (44% for males, 30% for females), and infrequent consumption of salad or vegetables (59-76%). With the exception of daily cigarette smoking and inadequate fruit consumption among adolescents of both genders and physical inactivity among adolescent males, the prevalence of chronic disease health risk behaviors among adolescents was similar to or higher than the prevalence of the same risk behaviors among adults.

CONCLUSIONS

Many health risk behaviors for chronic diseases are common by the time this group of American Indians in Montana has reached adolescence. Possible reasons may include modeling of familial behaviors, peer pressure, advertising, or age cohort effects. If these risk behavior patterns continue into adulthood, morbidity and mortality from chronic diseases are likely to remain high. Substantial efforts are needed to prevent or reduce health risk behaviors among adolescents and adults in this population.

Reducing ultraviolet radiation exposure in children

BACKGROUND

Project SUNWISE evaluated the effectiveness of a multicomponent intervention in reducing children's ultraviolet radiation (UVR) exposure.

METHODS

Across four YMCAs, 48 aquatics classes (N = 169 children, mean age = 7) were randomly assigned to either the intervention or the control condition. The 6-week intervention included a UVR reduction curriculum presented at poolside by aquatics instructors and home-based activities for children and their parents. Outcome measures were (a) tanness-associated skin color dimensions assessed with a colorimeter, (b) specific daily solar protection behaviors of children as reported by parents, and (c) general solar protection behaviors.

RESULTS

Controlling for intraclass clustering in all analyses, at posttest, no statistically significant between-group differences were found in tanness, daily solar protection scores, or general sunscreen use. The intervention group showed significantly greater general hat use relative to controls.

CONCLUSIONS

The intervention failed to impact most of the outcome measures. Supplementing the behavior-focused intervention package with environmental supports may be warranted.

School-based programs for health-risk reduction

Based on implications from the pediatric studies of cardiovascular risk, it has become imperative that practical methods be developed to begin prevention of heart disease early in life. Schools provide an excellent setting for introducing comprehensive health education and promotion as a public health approach to the general population. A number of school-based health education programs have been developed (Heart Ahead/Heart Smart, CATCH, Gimme 5) for children in kindergarten through high school, in which education and environmental changes have been shown to be effective in promoting healthful behaviors. The effective implementation of health education depends to a large extent on the training and motivation of teachers, administrators, and food service staff. Training Institutes can be important for increasing personal awareness, disseminating information and materials, motivating health education efforts for teachers, food service staff and their students, and evaluating the health risk of school personnel.

[Study of parental participation in curricular and extracurricular activities]

This preliminary study of parental participation in curricular and extra-curricular activities was conducted in the general framework of the healthy heart project in St. Louis du Parc, an underprivileged and multiethnic neighbourhood in Montreal. A general understanding of this type of participation is essential in order to adapt the role parents play in health programs developed in conjunction with the school. A conceptual framework was developed to help understand how and why parents of primary school children participate in school activities. Qualitative analysis of 15 semi-directed interviews conducted with various schools and other organizations revealed those obstacles to parental involvement, and the factors that encourage parents to participate. It was clear that there were wide social and cultural gaps between parents and schools. An important factor is how people perceive those barriers. Teachers stressed organizational and language communications difficulties. Others pointed to the lack of knowledge of the community, to poor communications skills and the parents' lack of those skills that would allow them to participate actively. A more open-minded attitude by school authorities and a more proactive and positive attitude of teachers toward parents are essential requirements, but not the only ones. Further interviews with parents should help provide more details and information.

Safety behaviors of mothers of young children: impact of cognitive, stress and background factors

We explore the relative contribution of cognitive, stress, and background variables as factors that explain safety behaviors of parents of young children. The data set was a probability sample of mothers of young children ( N= 1247). The focus of survey questions was predominantly home safety, a setting where young children are at highest risk for injury. We tested hypotheses using structural equations models. Our analyses indicate that stress and coping are important mediating factors between cognitive factors of perceptions of risk and safety behaviors practiced by parents of young children. Use of both cognitive and situational variables may be particularly important in understanding preventive health behaviors of mothers with young children. We also explore differences in models between African-American and white parents. We view this research as representing the continued development of health behavior research, extended to include parents and their children, since most health behavior research has not examined parental health behavior linked to protection of young children.

Effects of an obesity prevention program on the eating behavior of African American mothers and daughters

Cardiovascular disease (CVD) is the number one cause of death in the United States. Obesity is highly related to CVD risk, especially in African American women. This study explored the efficacy of a culturally specific obesity prevention program. Designed for low-income, inner-city African American girls and their mothers, the program addressed the importance of eating a low-fat, low-cholesterol diet and increasing activity. Mother-daughter dyads were randomly assigned to a 12-week treatment or an attention placebo group. Participants were assessed at pre- and posttreatment on dietary intake, including daily fat intake, daily saturated fat intake, percentage of daily calories from fat, and daily cholesterol intake. Results showed significant differences between the treatment and control mothers for daily saturated fat intake and percentage of calories from fat. Differences among treatment and control groups were also noted for the daughters on percentage of daily calories from fat. Implications of the findings for developing culturally specific health risk reduction programs are discussed.

Guidelines for school health programs to promote lifelong healthy eating

Healthy eating patterns in childhood and adolescence promote optimal childhood health, growth, and intellectual development; prevent immediate health problems, such as iron deficiency anemia, obesity, eating disorders, and dental caries; and may prevent long-term health problems, such as coronary heart disease, cancer, and stroke. School health programs can help children and adolescents attain full educational potential and good health by providing them with the skills, social support, and environmental reinforcement they need to adopt long-term, healthy eating behaviors. This report summarizes strategies most likely to be effective in promoting healthy eating among school-age youths and provides nutrition education guidelines for a comprehensive school health program. These guidelines are based on a review of research, theory, and current practice, and they were developed by CDC in collaboration with experts from universities and from national, federal, and voluntary agencies. The guidelines include recommendations on seven aspects of a school-based program to promote healthy eating: school policy on nutrition, a sequential, coordinated curriculum, appropriate instruction for students, integration of school food service and nutrition education, staff training, family and community involvement, and program evaluation.

Promotion of cardiovascular health in children by nurse practitioners and physicians in family practice

The purpose of this study was to describe cardiovascular (CV) health promotion practices of nurse practitioners (NPs) and physicians (MDs). Clinical practice was described for three age groups of children both with and without parental premature heart disease. Differences in clinical practice by type of provider and by age and risk level of the child were examined. A 42-question survey was mailed to all family NPs in North Carolina and to MDs randomly selected from the roster of the North Carolina Academy of Family Physicians; 94 responded. A high level of blood pressure measurement for all children and counseling regarding smoking for 13 to 19 year olds was found among all participants. Fewer health promotion activities were reported for other risk factors for the oldest group and for the younger children in general. Health promotion practices increased with the age of the child. Nurse practitioners had significantly higher total CV health promotion scores than did MDs, regardless of the age or risk level of the child. An increase in counseling about prudent diet and increased physical activity is needed for all children, regardless of risk level. In addition, there should be an increase in CV health promotion activities with younger children.

Change in nutrient intakes, number of servings, and contributions of total fat from food groups in 4- to 10-year-old children enrolled in a nutrition education study

OBJECTIVE

To determine change in nutrient intakes, number of servings, and contributions of total fat from food groups in children who lowered their dietary fat intake.

DESIGN

A research and demonstration study designed to lower plasma low-density lipoprotein cholesterol level. There were four study groups: two intervention and two control groups. All children had hypercholesterolemia except for those in one control group. There 24-hour dietary recalls were collected on randomly assigned days over a 2-week period at baseline and 3 months after the intervention.

SUBJECTS

Three hundred three 4-to 10-year old children from suburbs north of Philadelphia, Pa.

INTERVENTIONS

One intervention involved a home-based, parent-child autotutorial program (PCAT group) with audiotaped stories and print materials for the children and their families; the other intervention involved one face-to-face counseling session with a registered dietitian (counseling group).

OUTCOME MEASURES

Change in mean nutrient intakes compared with the Recommended Dietary Allowance (RDA); change in number of servings and mean grams of total fat contributed from 10 different food groups.

STATISTICAL ANALYSES PERFORMED

Analyses of variance and chi 3 analyses.

RESULTS

Children in every study group had mean intakes of all nutrients (except vitamin D) greater than 67% of the RDA 3 months after the baseline measurement. Several food groups (ie, meats, dairy products, fats/oils, and desserts) provided less total fat to the diets of children who reduced their dietary lipid intake after 3 months (i.e., PCAT and counseling groups). These children also reduced the mean number of servings selected from these food groups. Within these same food groups, some children consumed fewer servings of higher fat foods and more servings of lower fat foods.

APPLICATIONS/CONCLUSIONS

Children who lowered their dietary fat intake after intervention reported both quantitative and qualitative changes in food choices from several food groups. These choices did not significantly reduce their nutrient intakes.

Project Northland: outcomes of a communitywide alcohol use prevention program during early adolescence

OBJECTIVES

Project Northland is an efficacy trial with the goal of preventing or reducing alcohol use among young adolescents by using a multilevel, communitywide approach.

METHODS

Conducted in 24 school districts and adjacent communities in northeastern Minnesota since 1991, the intervention targets the class of 1998 (sixth-grade students in 1991) and has been implemented for 3 school years (1991 to 1994). The intervention consists of social-behavioral curricula in schools, peer leadership, parental involvement/education, and communitywide task force activities. Annual surveys of the class of 1998 measure alcohol use, tobacco use, and psychosocial factors.

RESULTS

At the end of 3 years, students in the intervention school districts report less onset and prevalence of alcohol use than students in the reference districts. The differences were particularly notable among those who were nonusers at baseline.

CONCLUSIONS

The results of Project Northland suggest that multilevel, targeted prevention programs for young adolescents are effective in reducing alcohol use.

Key issues regarding lifestyle in the prevention and treatment of hypertension

Lifestyle is a major determinant of hypertension and its complications in populations. This paper highlights some of the key issues relating to the gap between theory and practice in prevention and management of hypertensive cardiovascular disease. The need for new approaches and further research is emphasized.

Educational and environmental interventions for cardiovascular health promotion in socially disadvantaged primary schools

School-based cardiovascular risk-reduction programs have the potential to influence lifelong habits intrinsic to good health. Following earlier Australian Body owner's Manual (BOM) intervention trials, we examined the effects of two interventions on physiological indicators of risk of cardiovascular disease and on health knowledge: the BOM; and the BOM plus healthy life style programs for teachers and school-canteen interventions (BOM+) over two school years in socially disadvantaged primary schools. Each school was allocated to either a control condition or to one of two intervention conditions. In contrast to the findings of the earlier South Australian trials, there were no statistically-significant changes in aerobic fitness, body fatness or HDL cholesterol; there were significant reductions in diastolic blood pressure, total cholesterol and triglyceride concentration for those in the BOM+ schools. There were significant increases in health and nutrition knowledge for the BOM+ schools, and in health knowledge for the BOM schools.

Teaching safety: evaluation of a children's village in Maryland

OBJECTIVES

The purpose of this study was to evaluate Children's Village, a life safety education facility for children.

SETTING

The study took place in Washington County, Maryland, a rural county.

METHODS

Eight elementary schools with 20 second grade classrooms (410 students aged 7 and 8) were selected to participate. Using a quasiexperimental design, tests were administered to two cohorts of children before (pretest) and after (post-test) they attended the Children's Village during 1993-4. Parent and teacher surveys were also completed after the program.

RESULTS

Among children who attended in December 1993-January 1994, there was a significant improvement in average test scores between the pretest (58% correct) and post-test (78%). Among children who attended in April 1994, there also was a significant improvement in test scores between pretest (74%) and post-test (85%). Among parents, 70% reported that their child learned a great deal at Children's Village and 33% reported having made changes in their home as a result. The parent survey also revealed that 25% of children and 35% of adults did not always wear their seat belts, and 74% of children did not always wear bicycle helmets. Teachers' responses to the program were generally positive.

CONCLUSIONS

Children's Village brought together an extensive network of community leaders, parents, and teachers dedicated to safety education of children. The curriculum had a positive impact on children's knowledge and, to a lesser extent, on parents' safety practices. Program impact could be enhanced by more emphasis on automobile restraints and helmets (behaviors that parents reported were not consistently practiced) and by expanding the village services to parents as well as children. Others considering creating similar programs need to identify community leaders willing to commit the time, effort, and resources required to develop and sustain such programs.

The effects of the child and adolescent trial for cardiovascular health intervention on psychosocial determinants of cardiovascular disease risk behavior among third-grade students

PURPOSE

The Child and Adolescent Trial for Cardiovascular Health is a multi-site study of a school-based intervention designed to reduce or prevent the development of risk factors for cardiovascular disease. The goal was to change (or prevent) related risk behaviors and the psychosocial variables that theoretically influence those behaviors.

DESIGN

A nested design was used in which schools served as the primary unit of analysis. Twenty-four schools participated at each of four sites (Austin, San Diego, Minneapolis, and New Orleans). Each site had 10 control and 14 intervention schools.

SETTING AND SUBJECT

Ninety-six schools (with more than 6000 students) in the four sites were randomized to three treatment conditions: control, school-based interventions, and school-plus-family interventions. The sample included approximately equal numbers of males and females and was 67.5% white, 13.9% African-American, 13.9% Hispanic, and 4.7% other.

MEASURES

The psychosocial determinants included improvements in dietary knowledge, intentions, self-efficacy, usual behavior, perceived social reinforcement for healthy food choices, and perceived reinforcement and self-efficacy for physical activity.

RESULTS

The findings indicated significant improvements in all the psychosocial determinants measured (p < .0001). The results revealed a greater impact in the school-plus-family intervention schools for two determinants, usual dietary behavior and intentions to eat heart-healthy foods.

CONCLUSIONS

These findings support theory-based interventions for changing selected psychosocial determinants of cardiovascular disease risk behavior among children.

Evaluation of a parent child drug education program

The purpose of the study was to evaluate the effectiveness of a parent-child drug education program. One thousand four hundred and forty-seven fourth, fifth, and sixth grade students and 2,036 of their parents participated in the study. Results indicated that the program produced changes in the responses of children and their parents to questions concerning attitudes, use, perceptions of use, and intended use of drugs.

Three-year results of prevention programs on marijuana use: the New Hampshire study

The effects on marijuana use of 1) a drug prevention curriculum, or 2) this curriculum with added parent and other adult community activities in comparison with 3) a control community were investigated. Baseline information on drug-related behaviors from a sample of fourth, fifth, and sixth graders aged nine to fourteen years in rural New Hampshire (N = 1200) were obtained. The children completed these initial questionnaires in classrooms in 1987. In the comprehensive community intervention regular marijuana use was reduced by over 50 percent. No program had a significant effect on the initiation of marijuana use. The predictors of initiation were being in a higher grade, low school satisfaction, poor academic achievement, feeling unloved by one's family, feeling unpopular, and being part of a drug-using peer group. The baseline predictors of subsequent regular marijuana use were poor academic achievement, feeling unpopular, and being part of a drug-using peer group. In interviews the cultural and social contexts of marijuana use were explored. Strategies to prevent marijuana use need to take into account the profile of the marijuana-using child, the adult community's attitudes and beliefs about drugs, and the access of drug sellers and users to children.

Randomized intervention to increase children's selection of low-fat foods in school lunches

OBJECTIVE

The purpose of this study was to determine whether children would increase their selection of low-fat foods in school lunches if these foods were labeled on the menu and parents were notified of their availability.

METHODS

The 16 elementary schools in the Bellevue (Washington) School District were randomly assigned to intervention and control groups. Participants were the students eating the school lunch--an average of 2445 students per day, of whom one third received free or reduced-price lunches. In all schools, one of the two daily lunch entrees was low in fat (< or = 30% of calories from fat). After a 5-month baseline period, eight schools received a 4-month intervention. The monthly menus carried home by students began to indicate the low-fat entree and to compare the fat content of both entrees. In the first month, parents in the intervention schools (2329 households) received a mailing with a copy of the menu, an informational pamphlet on dietary fat, and a letter that described the menu changes and asked the parents to encourage their children to select low-fat entrees. A follow-up telephone survey was performed in one school 1 month after the intervention mailing to assess the recall and impact of the intervention. The main outcome, based on 249,861 student meal selections, was the proportion of students who selected the low-fat entree, and the unit of analysis was the school.

RESULTS

At baseline, there was little difference between intervention and control schools in the percentage of children choosing the low-fat entree (31.5% vs 30.8%). During the intervention, there was an increase in low-fat entree selection in the intervention schools compared with the control schools (35.5% vs 32.2%; p = 0.03). Of 221 parents surveyed, 71% recalled the mailing, 53% remembered that there were now low-fat entrees on the menu, and 10% reported that, after the mailing, they asked their child to choose a low-fat entree.

CATCH: family process evaluation in a multicenter trial

The Child and Adolescent Trial for Cardiovascular Health (CATCH) is an elementary school cardiovascular health education field trial in progress in San Diego, California, New Orleans, Louisiana, Minneapolis, Minnesota, and Austin, Texas. Because a significant part of a child's health behaviors are shaped within the home, CATCH is evaluating whether the effects of the school-based program are enhanced by the inclusion of a home-based program. A 7 x 7 x 10 randomized design with 7 school-only and 7 school-plus-family intervention schools, along with 10 control schools is implemented at each site. The CATCH family intervention is implemented during Grades 3 through 5 and consists of home-based curricula and Family Fun Nights focusing on healthier eating and increased physical activity during Grades 3 and 4, along with a smoking prevention curriculum in Grade 5. CATCH is examining the effectiveness of family (household) involvement through changes in students' dietary intake of fat and sodium. This paper describes the process evaluation methods used to document the extent of participation in the family program. Data reported for the third-grade Family Fun Nights held in the 28 family schools across all sites reflected an average student participation rate of 67%. The average family member to student ratio was approximately 2:1. Participation by all third-grade teachers and the majority of physical education specialists was observed.

Human behavior and cancer. Forget the magic bullet!

A large portion of the death, disease, and disability caused by cancers are preventable. A substantial amount of what is preventable is linked directly to our conditions of living and the way we act within that context. This paper addresses the following three questions: (1) To what extent are behavioral and social "interventions" effective in the prevention, early detection, and control of various health problems, including cancers and their selected risk factors? (2) What are the common elements of those strategies considered to be effective? (3) What actions need to be taken to enhance the benefits of social and behavioral strategies in the future? Behavioral and social strategies will not come in the form of pre-packaged, easily exported "magic bullets," complete with efficacy estimates, for the prevention and control of selected cancers. Effective behavioral and social interventions are dependent ultimately on two phenomena: (1) the competent application of basic principles that have been demonstrated to be effective and are tailored to the unique needs and circumstances of target populations, and (2) an infrastructure that is supportive of behavioral and social research, programs, and training. This article offers specific recommendations for instituting these measures.

Development and validation of the Parent Health Locus of Control scales

We describe the development and validation of the Parent Health Locus of Control (PHLOC) scales. Using factor analytic and item analytic methods, 30 items comprising six scales were extracted from a pool of 84 items. The individual scales correspond to beliefs in Child, Divine, Fate, Media, Parental, and Professional Influence over child health. Results were compared for six samples totalling 822 parents. Internal consistency reliabilities were above .70 for all scales with all samples. Test-retest correlations based on a separate sample were all above .60. Validity was assessed by means of a known groups strategy that made use of presumed differences among the six samples studied. The results generally agreed with predicted differences, offering good initial evidence of the validity for the PHLOC scales.

Parental alcohol and other drug (AOD) use and health beliefs about parent involvement in AOD prevention

Because the family plays an important role in predicting alcohol and other drug (AOD) use among youth, prevention efforts must begin in early childhood and involve parents. The purpose of this study was to determine differences between parent AOD users and nonusers in relation to health beliefs about parent involvement in AOD prevention with preschool children. A convenience sample of 200 Head Start parents in East Central Indiana completed self-report instruments measuring Health Belief Model constructs. Almost half (45%) reported alcohol use, over half (54%) smoked cigarettes, and 11% admitted using illicit drugs. Compared to nonusers, illicit drug users were more likely to perceive their children as susceptible to future AOD use, but less likely to view AOD use by their children as serious. Compared with nonsmokers, tobacco users were more likely to perceive their children as susceptible to future AOD use and had less interest in maintaining health through early prevention activities.

Process evaluation of a home-based program to reduce diet-related cancer risk: the "WIN at Home Series"

A random mailed survey (response N = 226; 75.3%) of participants in diet-related home-based learning evaluated exposure to recruitment channels and impact on salience, utility, level of participation, sharing the course with others, knowledge, and performing recommended behaviors. A post-only design, the study was conducted in a small Minnesota city (population = 20,000), part of the Cancer and Diet Intervention (CANDI) project. About 18.5% of residents (3,711) enrolled during an 8-week media campaign; women, college graduates, and those over 44 years old were overrepresented. Participants learned about the program through mass media (97%); small media (41.9%); and interpersonal sources (50%). Women were more likely to learn about the course through interpersonal sources. In analysis of variance (ANOVA) modeling, salience and utility predicted level of participation in course activities. Level of participation in turn predicted nutrition knowledge and with salience predicted performance of recommended behaviors. Although the course appealed to individuals who needed it less, there was evidence of diffusion to the unenrolled. About 57% of responding participants reported sharing it with spouses; about 67% reported sharing it with someone outside their households.

The Minnesota Heart Health Program. Education for youth and parents

Within the Minnesota Heart Health Program, all schools have participated in these programs and most have been incorporated as part of the regular school curriculum. The involvement of parents in youth programs has been challenging, but we view it as essential to making significant changes. Further, a program with appropriate underlying behavioral theory and community involvement can be successful. Such efforts seem critical to primary prevention of cardiovascular disease risk and subsequent disease in a culture where these diseases are common.

Oral health education and promotion in maternal and child health: a position paper

Oral health education and promotion are the connecting mechanisms among prevention, policy development and program implementation, maintenance and evaluation. Given the preventive procedures available today, all focus populations of women and children should have access to accurate information about such procedures as well as access to the procedures themselves. Furthermore, appropriate methodologies need to be utilized for community oral health education and these methods differ from those commonly used for individual education. In the context of maternal and child health there are unprecedented opportunities for new accomplishments in oral health. The health education model most appropriate for these groups is the public health model, an approach designed to empower as well as inform, and one that fosters shared decision making among community members and health professionals. Dental professionals have the responsibility to address this challenge, and to help correct the health information inequities that prevail, especially among the traditionally informationally disenfranchised subfocus populations discussed in this paper.

Childhood nutrition education in health promotion and disease prevention

In the last 10 to 15 years, nutrition has become a major component of health promotion and chronic disease prevention. Two widely recommended strategies for incorporating nutrition education directed toward children and youth into health promotion and disease prevention efforts are school-based nutrition education and the integration of nutritional care into health care. School-based nutrition education programs targeted toward very specific eating behaviors are showing very promising results in regard to behavior and attitude change of children and adolescents. Substantial changes in health care providers' attitudes and practices and in the funding and financing of health care will be needed if nutrition education delivered in the context of routine health care is to be a major force in health promotion and disease prevention for youth.

Parent education in youth-directed nutrition interventions

Since parents play a pivotal role in helping their children to implement eating pattern changes, interest in parent education in youth-directed nutrition interventions is likely to increase along with heightened interest in primary prevention. Previous experience indicates, however, that it may be difficult to recruit and sustain parent involvement. This article describes an evaluation of the effect on parents of two youth-directed interventions with a parent component, a classroom curriculum called Hearty Heart and Friends and a mailed-home, parent-taught approach called Hearty Heart Home Team. Using incentives, a participation rate of 85.6% was achieved in Hearty Heart Home Team. This parent-taught intervention had significantly greater impact on parent than did the school-only curriculum in the following areas: knowledge about diet and heart disease; attitudes of efficacy, intention, outcome expectation and modeling; and parent-child communication and child involvement in food or nutrition-related issues in the home. In addition, the parent-taught approach influenced foods present in the home as evidenced by Home Team groups having significantly more encouraged foods and more positive choices in six scores on a shelf inventory measure conducted by in-home interviewers.

The role of parents and older peers in school-based cardiovascular prevention programs: implications for program development

This article describes a set of studies which compare the effectiveness of innovative interventions led by older peers and which included a parent component with teacher-led interventions for nutrition, blood pressure, and smoking prevention. Information about the agreement between parents' and children's (grades six through eight) perception of the children's health behavior and family interaction was also found, by surveying parents and children in 1051 households. Both teacher-led and older peer-led interventions were successful in increasing behavioral capabilities for nutrition and blood pressure, measured one year after the interventions. Results of the parent-child survey showed reasonable agreement between parents and children for reports of the child's exercise, dieting, and fast food consumption, but poorer agreement for smoking and perceptions of family interaction. Results are discussed in relation to the planning of future programs designed to address the importance of peer and parental role models.

Synthesis of cardiovascular behavioral research for youth health promotion

The National Heart, Lung, and Blood Institute (NHLBI) has funded school and family-based research studies for more than a decade. The scientific background for focusing on the major cardiovascular health behaviors with youth is reviewed, as well as the importance of the components in the school health program as a framework for the multiple considerations in school health research. A synthesis of 10 NHLBI funded studies is presented including the sociodemographic characteristics of study populations, study designs, interventions, measures, and results. The studies address single or multiple behaviors, elementary and high school age groups, and multiple ethnic/racial groups, and test various combinations of curriculum, parental involvement, and environmental changes (including school food service).

Parent involvement with children's health promotion: a one-year follow-up of the Minnesota home team

This study compares the long-term outcomes of a school-based program to an equivalent home-based program with 2250 third-grade students in 31 urban schools in Minnesota and North Dakota in order to detect changes in dietary fat and sodium consumption. The school-based program, The Adventures of Hearty Heart and Friends, involved 15 sessions over five weeks in the third-grade classrooms. The home-based program, the Hearty Heart Home Team, involved a five-week correspondence course with the third graders, where parental involvement was necessary in order to complete the activities. Outcome measures included anthropometric, psychosocial, and behavioral assessments at school, and dietary recall, food shelf inventories, and urinary sodium data collected in the students' homes. Participation rates for all aspects of the study were notably high. Eighty-six percent of the parents participated in the Home Team and 71% (almost 1000 families) completed the five-week course. Students in the home-based program reported more behavior change at posttest, had reduced the total fat, saturated fat, and monounsaturated fat in their diets and increased their complex carbohydrate consumption. The changes derived from the dietary recall data did not maintain after one year. The data converge to suggest the feasibility and importance of parental involvement for initiating health behavior changes with children of this age.