Adolescent perceptions of family health behavior: a tenth grade educational activity to increase family awareness of a community cardiovascular risk reduction program

Impact of a simple educational intervention on awareness regarding cardiovascular disease among school-going adolescents in a rural area of Bengaluru district, India

BACKGROUND

Cardiovascular disease (CVD) is the number one cause of death in India. Atherosclerosis begins in the second decade of life; thus, preventive efforts beginning in adolescence are crucial. Yet, there are no national or regional school-based educational programs in India for the prevention of CVD. We aimed to assess the impact of a simple educational intervention on the awareness regarding CVD among school-going adolescents in a rural area of Bengaluru.

MATERIALS AND METHODS

This study was conducted using a convenience sample of school-going adolescents of classes 8, 9, and 10 in three schools in a rural area of Anekal subdistrict, Bengaluru, with a sample size of 170. A standardized, validated questionnaire testing CVD awareness was administered, followed by a simple lecture with audio-visual aids on key aspects of CVD. Three weeks later, the same questionnaire was administered to the same students. The results were then analyzed using appropriate descriptive (mean, percentage) and inferential analyses (Chi-square, paired t-test).

RESULTS

The mean (SD) age was 14.5 (1.0) years, and 54% (n = 100) were boys. 75% (139) belonged to privately funded schools. 23% (43) belonged to class 8, 37% (69) to class 9, and 40% (74) to class 10. The mean (SD) total score on baseline assessment was 27.4 (9.3) out of 100, with girls and students of private schools scoring higher. The mean (SD) post-test total score was 48.5 (15.7), with significant increases in all domains of awareness, and in all categories of students.

DISCUSSION

Awareness regarding CVD among adolescents from rural Bengaluru was poor, highlighting the need for educational interventions to aid preventive efforts. A simple educational intervention resulted in significant improvements in CVD awareness, even after 3 weeks.

Reduction in incidence of type 2 diabetes by lifestyle intervention in a middle eastern community

BACKGROUND

Very few studies have used community-based interventions for primary prevention of Type 2 diabetes, and the direct effect of such interventions on diabetes incidence is relatively unknown.

PURPOSE

This study aims to assess the effect of lifestyle modification on risk factors for noncommunicable diseases (NCDs) and the development of Type 2 diabetes at the community level.

DESIGN

A cluster-controlled trial was conducted.

SETTING/PARTICIPANTS

In all, 3098 and 5114 individuals in intervention and control groups, respectively (mean age=43 years), recruited from District 13 of Tehran, Iran, participated in the baseline examination in 1999-2001. Among these individuals, a total of 1754 and 2993 individuals in the intervention and control groups, respectively (58%), completed a follow-up examination in 2002-2005.

INTERVENTION

The study intervention involved improvement in diet, increase in the level of physical activity, and reduction in cigarette smoking through educational interviews, lectures, and publications.

MAIN OUTCOME MEASURES

Incident Type 2 diabetes was measured by fasting plasma glucose (FPG) and 2-hour plasma glucose (2hPG) and change in NCD risk factors.

RESULTS

The mean follow-up time was 3.6 years. The incidence of diabetes in the control and intervention groups was 12.2 and 8.2 per 1000 person-years, respectively, with a relative risk reduction of 65% (95% CI=30%, 83%, p<0.003). The adjusted difference in mean change of risk factors between the intervention and control groups was significant for weight (-0.5 kg in men); BMI (-0.18 kg/m(2) in men); waist circumference (-1.0 cm in women); systolic and diastolic blood pressure (-1.1 and -0.6 mmHg, respectively, in women); FPG (-2.1 and -2.3 mg/dL in men and women); 2hPG (-4.6 mg/dL in women); total cholesterol (-2.8 mg/dL in women); triglycerides (-7.6 and -5.2 mg/dL in men and women); and high-density lipoprotein cholesterol (1.1 mg/dL in women; all p<0.05).

CONCLUSIONS

Lifestyle intervention resulted in a significant decrease in the incidence of Type 2 diabetes and better control of NCD risk factors in a population-based setting. ISRCTN TRIAL REGISTRATION #: ISRCTN52588395.

Formative development of an intervention to stop family tobacco use: the Parents and Children Talking (PACT) intervention

Intervening with families is a promising strategy for addressing the continuing problem of adult and youth tobacco use. A four-step formative process was used to develop an innovative self-directed family-based intervention: (1) planning and strategy development through structured telephone interviews, a focus group, and a literature review; (2) development and pretesting of concepts, messages, and materials by using feedback from children and adults on prototypic materials; (3) implementing the program by mailing 6 modules to 50 families (composed of at least one adult smoker and a 9-12-year-old) with overall high levels of engagement; and (4) assessing effectiveness and making refinements by measuring the intervention effect on smoking-related communication, skills, and attitudes. Inconsistent intervention effects related to the difficulty of cessation and the influence of parental smoking suggested needed refinements. Engaging smokers willing to make a quit attempt during the intervention time frame may augment children's appreciation for the difficulty of cessation. Content related to stress management may need greater emphasis. Enhancing the personal context in which the influence of parental behavior is conveyed may be needed. Although the family context offers the opportunity to address the parent-child reciprocal nature of tobacco use, it requires sensitivity to the challenges of addressing this topic.

[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.

School-based care: clinical challenges and research opportunities

PURPOSE

To explore clinical challenges and research opportunities in one school-based clinic in a faculty practice model of health care delivery CLIENT POPULATION: Ninth-through twelfth-graders at an Eastern urban high school, 80% of the students are from ethnic minorities

CONCLUSIONS

Clinical, administrative, and research challenges need to be addressed on a larger scale through practice-based research networks across the country in order to have an impact on policy

PRACTICE IMPLICATIONS

School-based care required integration of primary care and management of psychosocial and developmental needs. Practice in this setting includes primary, secondary, and tertiary prevention as intervention.

Concordance of parental and adolescent health behaviors

This paper reports upon an empirical study of health behaviors in adolescents and their parents. The study aimed at assessing: effects of parental health behaviors on that of their adolescent child; whether mother's and father's health behaviors have additive effects on the respective health behaviors of their child; and whether eventual effects of parental health behaviors decrease with increasing age of the child. The data stemmed from the Norwegian national Health Survey in 1985 and comprised separate interviews with two parents and an adolescent child in 337 families. Results from logistic regression analyses showed that the strongest association found between parental and adolescent health behaviors was for fat intake, and the probability of having a low fat intake was 5 times higher if the mother had a low fat intake than if she did not. With the exception of mother's frequency of exercise, all other parental health behaviors were positively and statistically significantly associated with the corresponding health behavior of their adolescent child. Parental fat intake, smoking behavior and alcohol consumption appeared to have additive effects on the corresponding behaviors of their children. No statistically significant interaction between any of the parental health behaviors and age of the adolescent was found. Hence, the effect of parental health behaviors on that of their adolescent child does not seem to decrease with increasing age of the adolescent. The results are discussed with reference to the functions of modeling.

Multiple influences on the acquisition and socialization of children's health attitudes and behavior: an integrative review

An overview and synthesis of the literature documenting various influences on the socialization and acquisition of children's health attitudes and behavior is the focus of this review. Cognitive-developmental approaches to understanding children's health attitudes are presented, followed by an exploration of an individual differences perspective on children's acquisition of health attitudes and behavior. The influence of various socialization agents, including families, peers, schools, and the media, on children's acquisition of health attitudes and behavior is considered. Implications of these findings for social policy, future research, and modeling of child health attitudes and behavior are examined.

How women's adopted low-fat diets affect their husbands

OBJECTIVES

One way of promoting a reduction in dietary fat intake is by changing the diet of family members. This study investigated the long-term effects of a low-fat dietary intervention on husbands of women who participated in the Women's Health Trial (WHT).

METHODS

An average of 12 months after the end of the WHT, a randomly selected sample of participants' husbands was sent dietary and health questionnaires as part of a follow-up study of the maintenance of the low-fat diet among WHT participants.

RESULTS

We found an absolute difference in fat intake between groups of 4 percentage points (32.9% energy from fat among intervention husbands [n = 188] vs 36.9% among control husbands [n = 180]). The wife's attitude and fat intake were among the most important predictors of her husband's fat intake, indicating that the effect of the WHT intervention on the husbands of participants was more likely due to their acceptance of lower-fat foods being served at home than to overt actions by the men.

CONCLUSIONS

Our results suggest that a dietary intervention aimed at women can have an effect on their husbands and may be a cost-effective approach to healthy dietary change for both women and men.

Cardiovascular risk assessment in school-age children: a school and community partnership in health promotion

There is little doubt that the primary prevention of cardiovascular disease is a pediatric problem that nursing must address. Cardiovascular health-promotion activities for children have generally used an ecologic model, providing community-based education programs in the schools. The purpose of this study was to identify changes in cardiovascular risk among sixth-grade cohorts over eight years. Four variables known to be associated with such risk--weight (obesity), pulse rate recovery index, blood pressure, and total cholesterol level--were measured on 4900 students, and changes in their prevalence were analyzed. The data presented in this paper were compiled from a screening program conducted by a local health department in partnership with a school district's health-education program. Although the school-based health-education program has been in existence for eight years, the prevalence of cardiovascular risk in sixth-grade students has not declined, suggesting the need for nurses to target the children at risk, and address more directly the motivational and affective domains in addition to cognitively focused programs.

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.

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

This study compares the efficacy of a school-based program to an equivalent home-based program with 2,250 third grade students in 31 urban schools in Minnesota in order to detect changes in dietary fat and sodium consumption. The school-based program, Hearty Heart and Friends, involved 15 sessions over five weeks in the third grade classrooms. The home-based program, the 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 per cent of the parents participated in the Home Team and 71 per cent (nearly 1,000 families) completed the five-week course. Students in the school-based program had gained more knowledge at posttest than students in the home-based program or controls. Students in the home-based program, however, reported more behavior change, had reduced the total fat, saturated fat, and monounsaturated fat in their diets, and had more of the encouraged foods on their food shelves. The data converge to suggest the feasibility and importance of parental involvement for health behavior changes with children of this age.

Smoking behaviour of student nurses enrolled in diploma, associate degree and undergraduate nursing programmes

Because the literature shows that cigarette smoking is a major causative factor in the occurrence of chronic illness, lung cancer is becoming more common in women than breast cancer, nurses smoke more than any other group of health care providers and studies have not examined differences of smoking among the associate degree, undergraduate and diploma levels of nursing, this study was designed to examine selected health behaviours and their relationship to cigarette use among Alabama senior student nurses, and to determine smoking prevalence by level of educational preparation. A sample of senior associate degree, undergraduate and diploma student nurses in Alabama responded to an 87-item questionnaire which was personally administered by the investigator in a classroom setting. Twenty-two of the 87 items were used to compile the demographics, prevalences and health behaviours reported here. The remaining items were used to develop a sequence of information required to test Ajzen and Fishbein's Theory of Reasoned Action and are beyond the scope of this article. Though there was no significant difference of smoking prevalence among educational levels, there was a trend for increased smoking from undergraduate to diploma level with prevalences of: total sample, 26.2%; diploma, 30%; associate degree, 26%; and undergraduate, 24%. Health behaviours which were significantly different between smoking and non-smoking student nurses were breakfast frequency and coffee consumption. Having a regular exercise routine was not significant. Males smoked significantly more than females. More older nurses (over 40 years) smoked than younger nurses. The findings reported here are useful to the development of health education strategies designed to reduce and prevent cigarette use among student nurses.(ABSTRACT TRUNCATED AT 250 WORDS)