Cardiovascular risk factors among black schoolchildren: comparisons among four Know Your Body studies

Baseline cardiovascular risk factor variables were obtained from 1,041 black District of Columbia children in Grades 4-6 as part of a Know Your Body evaluation project. Screening included height, weight, triceps skinfold measurements, systolic and diastolic blood pressures, step-test for fitness, serum cholesterol, high-density lipoprotein cholesterol and thiocyanate. Results were compared with those in three other Know Your Body studies, Bronx, New York, Westchester, New York, and Los Angeles, and indicated that District of Columbia black children are more likely to have high cholesterol levels and to fail the fitness test than black children in the other studies. In the District of Columbia, obese children had significantly higher total serum cholesterol, systolic, diastolic, and high-density lipoprotein levels, and were less fit than other District of Columbia children; almost three-fourths of all of the children had one or more risk factors. Socioeconomic status was negatively correlated with diastolic blood pressure, skinfold thickness, and cholesterol levels and was positively correlated with high-density lipoprotein cholesterol. Rates of obesity and diastolic blood pressure were consistent with Bronx and Westchester comparisons suggesting that socioeconomic status interacts with ethnicity to determine risk factor levels. The existence of children with multiple risk factors in all of the Know Your Body studies supports the need for early intervention.     

The Know Your Body program in Italy

Two hundred and ninety-five boys and two hundred and fourteen girls aged 11 to 15 years, attending a senior elementary school in Mugnano, a suburb of Naples, Italy, participated in the “Know Your Body” program as part of an international collaborative health project. Mean cholesterol levels were 148 mg/dl in boys and 152 mg/dl in girls; fourteen children (3.6%) had serum cholesterol levels above 180 mg/dl. Eighteen children (3.4%) had blood pressure equal to or greater than $\text{140}\text{90}$ mm Hg. Twenty-two percent of the children reported being current smokers (one or more cigarettes per week) and 20% reported being occasional smokers (less than one cigarette per week).     

Baseline chronic disease risk factors in a racially heterogeneous elementary school population: The "Know Your Body" program, Los Angeles

The Los Angeles "Know Your Body" (KYB) program is an organized health education activity for children designed to encourage positive health behavior and discourage or interrupt behavioral patterns that are linked to illness, injury, disability, or death. Components of KYB include a 20-week curriculum; a survey of health knowledge, attitudes, and behaviors; in-service training for elementary school teachers; and a clinical screening that provides feedback to students on selected indices. As part of a KYB field demonstration in Los Angeles conducted by the UCLA Division of Cancer Control, Jonsson Comprehensive Cancer Center, 1,503 Los Angeles and Santa Monica-Malibu children ages 9-11 in grades 4 and 5 underwent baseline health screening evaluations in March 1981, measuring height, weight, triceps skinfold thickness, serum cholesterol, pulse rate recovery following exercise, and blood pressure. The population mean for serum cholesterol was 182.6 mg/dl, with no significant racial/ethnic, sex, or age differences. Significant racial/ethnic differences were found in obesity, with Hispanics having the highest prevalence, Asians the lowest. Black students scored significantly higher in pulse rate recovery following exercise, suggesting better relative cardiovascular fitness, and Asians scored lowest. Blacks were more likely to exceed the 95th percentile in diastolic and systolic blood pressure. Overall, 48% of the children had one or more chronic disease risk factors.     

The Know Your Body program: a review of evaluation studies.

Know Your Body is a comprehensive school health promotion program for kindergarten through six grades, initially developed in the 1970s by the American Health Foundation. The impact of the KYB program has been evaluated in three field trials, the results of which have been reviewed in this article. Across the three studies, at 3-year follow-up, consistent positive intervention effects were reported for systolic blood pressure, diastolic blood pressure, smoking, HDL-cholesterol, and health knowledge. Results for total blood cholesterol, fitness score, heart-healthy snacks, fruit/vegetable intake, whole milk intake, and health attitudes were mixed. For body mass index, triceps skinfold, all remaining dietary variables, self-esteem/self-efficacy, and locus of control no significant effects were observed. Overall, significant treatment effects were reported for 19 of the 40 variables assessed at 3-year follow-up, an effects ratio of 48%. Consistent positive results at 5-year follow-up were reported for smoking and health knowledge. Mixed results were obtained for total blood cholesterol, diastolic blood pressure, and percent kilocalories from saturated fat. Consistent null results were reported for HDL-cholesterol, systolic blood pressure, body mass index, triceps skinfold, fitness score, percentage kilocalories from fat, cholesterol intake, and fiber intake. Overall, significant treatment effects were reported for 7 of 36 variables at 5-year follow-up, an effects ratio of 19%. Although reported program effects were largely mixed, they seem consistent with other health education evaluations. Null results may have been related to insufficient teacher implementation as well as weaknesses in design and assessment. Additional research is needed to determine the effect of the program on a broader range of outcomes, to what degree increasing the "dose" produces larger and more enduring treatment effects, and the relative impact of the various components that comprise the program.     

A Process Evaluation of the District of Columbia "Know Your Body" Project

A process evaluation was conducted of the effectiveness of the "Know Your Body" curriculum in reducing coronary heart disease risk factors among black elementary and junior high school students. The evaluation, part of a five-year longitudinal study, linked effectiveness of teachers' implementation with student outcomes and identified program weaknesses during implementation. Teachers with higher effectiveness scores had significantly more favorable student outcomes in systolic blood pressure, diastolic blood pressure, HDL cholesterol, HDL/cholesterol ratio, serum thiocyanate, and fitness. Of 82 teachers, 38 (46%) had scores reflecting effective teaching. Lack of time and commitment and inadequate use of the behavioral teaching approach demanded by the curriculum contributed most to implementation failure. Teachers as insufficient role models emerged as an important factor. Future research needs appropriate reinforcement of teacher participation and measurement of the environmental factors and personal teacher characteristics that may affect program implementation. School health education programs need an intensive training component that will enable teachers to adopt behavioral teaching approaches, promote teacher's examination and change of their personal risk factors, and stress the classroom dynamic of teachers as role models.     

Behavioral risk factor and illness day changes with workplace health promotion: two-year results

PURPOSE. The impact of a workplace health promotion program was evaluated to determine changes in the number and level of seven behavioral risks and self-reported illness days. DESIGN. The study employed a pretest/posttest intervention group (N=7,178) with a two-year follow-up and a time-lagged, nonequivalent comparison group (N=7,101). SETTING. The study population was drawn from a large manufacturing company with more than 100 United States locations. SUBJECTS. Approximately one half of the study population was 40 years of age or older, 75% were males, 90% were white, and about 40% were hourly manufacturing employees. INTERVENTION. The program consisted of 1) training and support of coordinators; 2) health risk appraisals; 3) on-site classes, safety meetings, and self-help options; 4) environmental changes, e.g., smoking policy, cafeteria offerings, and blood pressure machines; and 5) recognition. MEASURES. A 38-item health appraisal included self-report of illness days and behavioral risks, as well as information from company physical examinations. RESULTS. Both the number and the level of behavioral risk factors improved over two years. The proportion of employees with three or more risk factors decreased by 14% (p less than .001). The number of self-reported illness days in this group decreased by 12% during the same period (p less than .001). No change in illness days was observed in the group with fewer than three risk factors. Risk levels improved (range = 4.5% to 79%) for six of seven factors among high-risk individuals. CONCLUSIONS.(ABSTRACT TRUNCATED AT 250 WORDS)     

Physical inactivity: the "Cinderella" risk factor for noncommunicable disease prevention

There is strong evidence demonstrating the direct and indirect pathways by which physical activity prevents many of the major noncommunicable diseases (NCD) responsible for premature death and disability. Physical inactivity was identified as the 4th leading risk factor for the prevention of NCD, preceded only by tobacco use, hypertension, and high blood glucose levels, and accounting for more than 3 million preventable deaths globally in 2010. Physical inactivity is a global public health priority but, in most countries, this has not yet resulted in widespread recognition nor specific physical activity-related policy action at the necessary scale. Instead, physical inactivity could be described as the Cinderella of NCD risk factors, defined as "poverty of policy attention and resourcing proportionate to its importance." The pressing question is "Why is this so?" The authors identify and discuss 8 possible explanations and the need for more effective communication on the importance of physical activity in the NCD prevention context. Although not all of the issues identified will be relevant for any 1 country, it is likely that at different times and in different combinations these 8 problems continue to delay national-level progress on addressing physical inactivity in many countries. The authors confirm that there is sufficient evidence to act, and that much better use of well-planned, coherent communication strategies are needed in most countries and at the international level. Significant opportunities exist. The Toronto Charter on Physical Activity and the Seven Investments that Work are 2 useful tools to support increased advocacy on physical activity within and beyond the context of the crucial 2011 UN High-Level Meeting on NCDs.     

Digital risk analysis of cardiovascular diseases: new opportunities for the patients. Cardiovascular prevention program in the praxis

Authors constructed a software helping the prevention programme of coronary and vascular diseases as the classical risk factors are used for graphic presentation of coronary risk as compared to "normal" risk. By repeated estimation alterations in coronary risk status can be compared to previous ones and thereby help evaluating the changes. This programme is highlighted by the presentation of changes in coronary risk of a patient during a 4-year-long period of her medical history. It is also shown how graphic presentation of risk can support the more effective treatment and patient care.     

Prevalence of selected cardiovascular and cancer risk factors in a pediatric population: The “Know Your Body” project,New York

The “Know Your Body” health education program attempts to reduce children's risk for future disease through a multidimensional approach that combines health screening, a Health Passport that provides feedback to students on their results, teacher training, and curriculum materials on behavior-oriented learning activities, and special activities for high-risk students. As part of an international collaborative project with 14 other nations, more than 3,600 New York City area children age 12 to 15 years underwent health screening evaluations consisting of height, weight, triceps skinfold thickness, blood pressure, plasma total cholesterol and HDL cholesterol, pulse rate recovery index after exercise, and cigarette smoking history. This report provides mean, standard deviations, 90th and 95th percentiles for these measurements by age and sex of the child. These values could be useful in evaluating risk factor levels in childhood.     

Cardiovascular prevention in the community: the plurisectorial program of the canton of Tessin

Summary It describes the primary prevention of cardiovascular diseases carried out in Tessin (Italian-speaking Switzerland). Every single action is adressed to the entire population, activelyinvolving professional associations (doctors), pharmacists, nurses, shop-keepers, etc.) and making use in particular of the collaboration of the mass-media (daily press, radio, television). The described actions concern the struggle against the cardiovascular risk factors through the daily diffusion of tv advertisements, free measurement of arterial pressure, and the possibility of disposing in the majority of regional restaurants of a Health menu with a low content of saturated fats and cholesterol. In 1984 every citizen of Tessin has been reached by an average of 24 preventive messages.

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Riassunto E' descritto il programma di prevenzione primaria contro le malattie cardiovascolari attuata nel Canton Ticino (Svizzera). Le singole azioni si rivolgono a tutta la popolazione, coinvolgendo attivamente associazioni professionali (medici, farmacisti, infermieri, esercenti, ecc.) e si avvalgono soprattutto della collaborazione dei mass-media (stampa quotidiana, radio, e televisione). Le azioni descritte concernono la lotta ai fattori di rischio cardiovascolari tramite la diffusione quotidiana di spots pubblicitari televisivi, la misurazione gratuita della pressione arteriosa e la possibilità di disporre nel più gran numero di ristoranti del Cantone di un Piatto della Salute con un basso contenuto di grassi saturi e di colesterolo. Ogni abitante del Cantone é stato in media raggiunto nel corso del 1984 da 24 messaggi preventivi.

     

"Dine to Your Heart's Content": an assessment of the program in Virginia

The "Dine to Your Heart's Content" program in Virginia was examined from the perspectives of both patrons and restaurateurs. Both groups were tested on knowledge of food composition relative to fats and oils. Additionally, restaurateurs responded to questions concerning the need for nutrition education for their personnel. Eighty-eight percent of the 178 patrons expressed an interest in following a heart-healthy diet: 55% maintained that they always or often were motivated by health-related considerations when selecting menu items. The most important characteristics of the menu items (5-point scale, 1 = least important) were reported to be low cholesterol (3.85 +/- 1.01), low saturated fat (3.77 +/- 1.05), low total fat (3.76 +/- 1.03), low sodium (3.69 +/- 1.15), and low calorie (3.57 +/- 1.13). Fifty-seven percent of the patrons were aware of the program, but most of them dined in participating restaurants less than half of the time they dined out. There were no significant differences between the scores of patrons and restaurant personnel regarding knowledge of fat and oil content of foods. The overall mean score for the entire group was 6.09 +/- 3.4 points out of a possible 13 points. Restaurateurs cited nutrition education for waitstaff and assistance in the identification of appropriate menu items as aspects of the program most in need of further development. The major disadvantage of the program cited was potential negative attention drawn to some menu items. Overall, however, restaurateurs concurred that the advantages of participation in the program outweighed the disadvantages. All of them stated that the major advantage of the program was the ease with which a public service could be provided to their patrons while, simultaneously, the image of the restaurant was enhanced.     

Cardiovascular risk reduction in preschool children: the "Healthy Start" project

OBJECTIVE: To evaluate the impact of a multicomponent cardiovascular health intervention ("Healthy Start") which included a food service modification in a largely minority Head Start preschool population. The primary outcome measure was the change in serum cholesterol from the beginning to the end of the school year. METHODS: Nine Head Start centers in Upstate N.Y. were assigned to either food service modification or control conditions. In addition, half of the centers assigned to the food service modification received supplemental nutrition education (FS/NU--food service modification/nutritional education), while the remaining centers were provided with supplemental safety education materials (FS--food service modification only). The control preschool centers (CON) also received supplemental safety educational curricula for children but their food services remained unchanged. Children had serum cholesterol, as well as height and weight measured at the beginning and end of the school year. A generalized linear univariate procedure was used with percent change in total serum cholesterol as the outcome variable and intervention group as the primary independent variable. RESULTS: There was a significant decrease in total serum cholesterol among preschool children in food service intervention groups, (FS/NU and FS), compared to Controls (-6.0 versus -0.4 mg/dL). In addition to the significant difference in group means, children with elevated cholesterol at baseline were significantly more likely to have a cholesterol level in the normal range (<170 mg/dL) at follow-up if they attended a preschool in the food service modification group. There was a 30% reduction in risk of elevated cholesterol in the latter compared to controls. Participation in the dietary intervention did not affect short-term growth. CONCLUSIONS: A preschool heart health intervention, "Healthy Start," designed to reduce the total and saturated fat content of snacks and meals to recommended levels was effective in reducing serum cholesterol in the study population as a whole and specifically children 'at risk'; i.e., those with initial elevated serum cholesterol.     

Differences in modifiable cardiovascular disease risk factors in Australian schoolchildren: the results of a nationwide survey

Two thousand four hundred schoolchildren ages 9, 12, and 15 years were randomly selected to participate in the Health and Fitness Survey of Australian Schoolchildren in 1985. Data on blood lipids, aerobic fitness, blood pressure, and obesity were obtained through physical measurement. Information on socioeconomic status and ethnic origin was collected via questionnaire. Serum total cholesterol and low and high-density lipoprotein cholesterol were lowest in the oldest age group. Girls had significantly higher serum lipid levels, the difference being greatest at 15 years. However, comparison of the total cholesterol/high-density lipoprotein cholesterol ratio showed a trend in the direction of decreasing risk with increasing age for girls, with the reverse being found in boys. Fifteen-year-old girls were also the fattest and least fit of all the children, but had significantly lower systolic and diastolic blood pressures than their male peers. Children of Asian ethnic origin had significantly lower systolic and diastolic blood pressures and a significantly higher mean high-density lipoprotein cholesterol and were less likely to be overweight compared with other ethnic groups. Children from Mediterranean/Middle-East countries were significantly fatter and had a higher mean diastolic blood pressure than the other ethnic groups. These differences were detectable at age 9 years. Children from lower socioeconomic backgrounds were fatter and had a significantly lower mean high-density lipoprotein cholesterol and higher mean serum triglyceride levels. As with ethnic origin, these differences were detectable at age 9 years. The results demonstrate that age, sex, ethnic origin, and socioeconomic status can be used as variables to describe mean differences in the levels of cardiovascular risk factors in the national population of children. As some elevations in risk factors appear to be present in the youngest age group and these levels correlate with fatty streak and fibrous plaque formation in young adulthood, preventive programs should aim at intervention prior to puberty.     

Cardiovascular and pulmonary risk factors in Berlin (West) schoolchildren: Findings of an exploratory study

In preparation for a comprehensive intervention project concerned with smoking behavior, physical activity, nutrition, and alcohol, an exploratory study of 800 public school and gymnasium pupils in the seventh and ninth grades (12–16 years old) was undertaken. The median of total serum cholesterol dropped from 4.8 mmol/liter in 12-year-old pupils to 4.2 mmol/liter in 16-year-olds. The decrease was greater in boys than in girls (0.7 versus 0.4 mmol/liter). The systolic and diastolic blood pressures rose slightly with age in boys and girls. The prevalence of occasional and daily smokers was 19.8 and 21%, respectively. The proportion of daily smokers was 36.4% among public school students (lower socioeconomic status) versus 4.1% among gymnasium pupils (higher socioeconomic status). Similar differences were found for the serum thiocyanate levels.     

Cardiovascular risk factor status of Greek adolescents in Athens

The presence of risk factors for cardiovascular disease in adolescents aged 10–15 years was investigated in 15 countries participating in a research program coordinated by the American Health Foundation. The agency responsible for this program in Greece was the Institute of Child Health in Athens. A total of 1,113 Greek boys and girls aged 10–15 years who attended public schools in the area of Athens were examined. Schools were selected to represent all socioeconomic categories. Information about health knowledge and health habits was collected by a self-administered questionnaire and demographic data were recorded by an interviewer. For all children, blood pressure, pulse rate, postexercise pulse rate, and anthropometric measurements were taken, and plasma cholesterol was estimated. One or more risk factors [hypertension, hypercholesterolemia, smoking, and obesity (weight above the 90th percentile)] were present in 34% of the Greek adolescents. Nine percent of the children admitted to occasional smoking and 1% to daily smoking; both percentages are considered to be underreported. The scores achieved by the Health Knowledge Questionnaire varied from 36% for the question on blood pressure to 60% in the area of general health knowledge. The high incidence of risk factors in the adolescents found in the present study may increase morbidity and mortality in future generations.     

Cardiovascular risk factor self-assessment program: using the general clinical research center to provide a clinical experience for third-year medical students

An educational program at the University of Iowa has been designed to provide medical students with the opportunity to do a self-assessment of their personal risk factors for developing cardiovascular disease. The University of Iowa Hospital and Clinic's General Clinical Research Center (GCRC) provided the personnel and resources to work with students in small groups to allow them to experience the diagnostic testing that is a standard part of cardiovascular assessment procedures. This report presents preliminary data from the first 88 students to participate in the program.     

Primary prevention of chronic disease beginning in childhood: The “Know your body” program: Design of study

A controlled study is described for chronic disease risk factor identification and intervention among 3000 (of 4600 eligible) school children, 11 to 14     

One-year follow-up results of the STARS for Families alcohol prevention program

This study examined the 1-year follow-up effects of the STARS (Start Taking Alcohol Risks Seriously) for Families program, a 2-year preventive intervention based on a stage of acquisition model, and consisting of nurse consultations and parent materials. A randomized controlled trial was conducted, with participants receiving either the intervention or a minimal intervention control. Participants included a cohort of 650 sixth-grade students from two urban middle schools-one magnet (bused) and one neighborhood. Trained project staff administered questionnaires to students following a standardized protocol in the schools. For the magnet school sample, significantly fewer intervention students (5%) were planning to drink in the next 6 months than control students (18%), chi2 = 11.53, 1 d.f., P = 0.001. Magnet school intervention students also had less intentions to drink in the future, greater motivation to avoid drinking and less total alcohol risk than control students, Ps < 0.05. For the neighborhood school, intervention students (m = 7.90, SD = 1.87) had less total alcohol risk than control students (m = 8.42, SD = 1.83), F(1,205) = 4.09, P = 0.04. These findings suggest that a brief, stage and risk/protective factor tailored program holds promise for reducing risk for alcohol use among urban school youth 1 year after intervention, and has the unique advantage of greater 'transportability' over classroom-based prevention programs.