The Effects of Priming on a Public Health Campaign Targeting Cardiovascular Risks

Public health interventions are cost-effective methods to reduce heart disease. The present study investigated the impact of a low-cost priming technique on a public health campaign targeting cardiovascular risk. Participants were 415 individuals (66% female) ages 18 and older recruited through clinics and churches. The study consisted of three phases. In Phase I, participants completed a brief survey to assess knowledge of the cardiovascular health indicators. The survey served as the prime (intervention) for the study. At Phase II, participants were provided with access to a public health campaign consisting of an education brochure on cardiovascular health. Following the educational campaign, all participants completed a post-campaign survey in Phase III of the study. Participants who completed the surveys in both Phase I and III were placed in the intervention condition (26%) and those who only completed the Phase III survey were placed in the control condition (74%). Participants who were primed reported greater awareness of the public health campaign. Additionally, more intervention participants reported they had knowledge of their own and the normal ranges for cholesterol, glucose, and body mass index. For participants who were aware of the health promotion campaign, more participants in the primed group indicated they had knowledge of their own cholesterol and glucose levels and had made positive lifestyle changes as a result of the campaign. Results suggest the presence of a priming effect. Public health campaigns may benefit from the inclusion of a low-cost prime prior to intervention.     

Dissemination and adoption of the Child and Adolescent Trial for Cardiovascular Health (CATCH): a case study in Texas.

The total impact of a health promotion program can be measured by the efficacy of the intervention multiplied by the extent of its implementation across the target population. The Child and Adolescent Trial for Cardiovascular Health (CATCH) was a school-based health promotion project designed to decrease fat, saturated fat, and sodium in children's diets, increase physical activity, and prevent tobacco use. This article describes the dissemination of CATCH in Texas, including the theoretical framework, strategies used, and lessons learned. To date (Fall 2000), CATCH materials have been adopted by more than 728 elementary schools in Texas.     

Institutionalization of a school health promotion program: background and rationale of the CATCH-ON study.

Research is lacking on how to make effective programs available on a large scale and how to maintain levels of implementation. CATCH: A Study of Institutionalization (CATCH-ON) was designed to help us understand the conditions under which such programs are institutionalized after the trial has ended. The Child and Adolescent Trial for Cardiovascular Health (CATCH) was the largest field trial of school-based health promotion in the United States conducted in 96 schools in four geographic areas of the United States: California, Louisiana, Minnesota. and Texas. The intervention was multicomponent, targeting school policy and practices in nutrition, physical activity, health education, and smoking. This report provides background on the CATCH study design, the conceptual framework for research on institutionalization of the CATCH program, and an overview of the seven original reports that present results from the CATCH-ON study in this theme issue.     

School-based health education programs can be maintained over time: results from the CATCH Institutionalization study

BACKGROUND: Developing and evaluating interventions to influence students' opportunities for healthful choices has been a focus of school-based health promotion research; however, few studies have examined the sustainability of these programs and viability of continued organizational implementation. METHODS: The purpose of this study was to determine the maintenance of Child and Adolescent Trial for Cardiovascular Health (CATCH) school-level changes in former intervention (n = 56) and former comparison (n = 20) schools 5 years post-intervention. Twelve schools unexposed to CATCH were measured as controls. Macronutrient content of 5 days of school lunch menus, amount and type of physical education (PE) classes, and health instruction practices in the classroom were assessed. An institutionalization score for schools was developed, using program maintenance variables: % kcal from fat and saturated fat in school lunches, % PE class spent in vigorous and moderate-to-vigorous physical activity, and class time devoted to CATCH topics. RESULTS: Menus from 50% of former intervention cafeterias met the Eat Smart guidelines for fat, compared to 10% of former control cafeterias and 17% of unexposed school cafeterias (P < 0.005). There were no significant differences in implementation of CATCH PE goals between conditions. Although the total time spent teaching CATCH was low in former CATCH schools, the former intervention schools spent significantly more time teaching CATCH and taught more lessons as compared to former comparison schools. Former intervention schools had a higher mean institutionalization score than former comparison schools (P < 0.001). Training had the greatest impact on maintenance of CATCH. CONCLUSIONS: Results from this study suggest that changes in the school environment to support healthful behaviors can be maintained over time. Staff training is an important factor in achieving institutionalization of these programs.     

School climate and the institutionalization of the CATCH program.

School climate refers to various physical and psychosocial structures that shape schools' social and physical environments. The Child and Adolescent Trial for Cardiovascular Health (CATCH) study provided an opportunity to study how aspects of school climate are associated with continued implementation of the CATCH program. Nutrient analysis of menus, observations of physical education (PE) classes, and teacher and staff self-reports were used to measure CATCH program components. Results of this study indicate that aspects of school climate were associated with continued implementation of the CATCH classroom component but not the CATCH food service or PE components. These findings have implications for how we plan for the progression of innovative school health promotion programs from the initial trial stage to institutionalization. Measures of school climate may be useful in determining a school's readiness to adopt and implement an innovative health promotion curriculum.     

Maintenance of the classroom health education curricula: results from the CATCH-ON study.

Maintenance of the interactive Child and Adolescent Trial for Cardiovascular Health (CATCH) third- to fifth-grade curricula was studied in the 56 original intervention schools and 20 of the original control schools 5 years postintervention in four regions of the United States. Target grade teachers completed a self-administered survey that included questions regarding use of the CATCH materials, training in CATCH or other health education, barriers and perceived support for health education, and amount of health education currently taught. Percentage of teachers who continued to teach CATCH in the classroom was low; however, percentages were significantly higher in former intervention compared with control schools, even though control schools received training and materials following the main field trial. The results of this study can provide useful information for future development of classroom health promotion materials with a higher level of sustainability.     

A Conceptual Approach to School-Based Health Promotion

Health and health promotion have become salient topics in American society in the 1980's. Still there is little consensus on what is meant by the term "health promotion," in what ways children and adolescents should be a targeted group, or whether such activities are appropriate for schools. This paper proposes a concept of health promotion as an intervention modality, based on a clarification of the notion of health and the efforts needed to foster improved health. The relevance of health promotion efforts to the school setting is argued from three perspectives. Three levels of analysis for conceptualizing school health promotion programs are then proposed and involve the school environment, student personality characteristics, and student behavior. The question of accomplishing changes in health-related behavior through the schools is addressed through changes that are accomplished at each of these three levels. The exploration of this change process through particular theoretical attributes at each of these levels forms the basis for designing and evaluating strategies for effective school health promotion programs. Finally, the relationship between the school and the extra-school environment is proposed as a final area for research in school health promotion.     

Factors influencing implementation of the Coordinated Approach to Child Health (CATCH) Eat Smart School Nutrition Program in Texas

The purpose of this research was to evaluate factors influencing the implementation of the Coordinated Approach to Child Health (CATCH) Eat Smart School Nutrition Program in Texas using data from the CATCH dissemination study. A mail survey was sent to school foodservice personnel (N=213) who attended a CATCH training from August 2000 through January 2002. A response rate of 40% (n=85) was achieved. The mean score for the percentage of CATCH Eat Smart guidelines implemented was 80.44. Multivariate linear regression analysis revealed that, after adjusting for age and number of years employed in school foodservice, the following factors were significantly associated with the percentage of CATCH Eat Smart guidelines implemented: utility of CATCH and CATCH Eat Smart in meeting requirements for Coordinated School Health Programs (P=0.006), school foodservice personnel’s satisfaction with food made using the CATCH Eat Smart guidelines (P=0.008), utility of CATCH in facilitating interschool communication about children’s health (P=0.019), and perceived student satisfaction with food made using the CATCH Eat Smart guidelines (P=0.046). These results suggest that dissemination approaches for Coordinated School Health Programs should focus on ways to enhance program satisfaction, be consistent with legislated mandates, and increase interschool staff communication to increase program implementation by school foodservice personnel.     

Maintenance of a health promotion program in elementary schools: results from the CATCH-ON study key informant interviews.

To better understand the institutionalization process in Child and Adolescent Trial for Cardiovascular Health (CATCH) intervention and control schools, 199 key informant interviews were conducted with school food service staff, physical education teachers, classroom teachers, and administrators at the four CATCH-ON field centers. School personnel were asked to talk about the degree of CATCH program implementation, who at the school or school district was instrumental in promoting CATCH, and the conditions that facilitated or impeded the institutionalization of CATCH activities and philosophies. The CATCH Physical Education (PE) component appeared to have the highest level of institutionalization, and the CATCH classroom curriculum and family components appeared to have the lowest levels of institutionalization. The primary barriers expressed included the low priority for health promotion activities and time constraints of schools: lack of mechanisms for training of school staff; and lack of sufficient funds for materials, equipment, and lower fat vendor products.     

A Cardiovascular Health Education Program for Rural Schools

ABSTRACT: Public understanding of cardiovascular disease (CVD) risk factors and primary prevention has increased, due in part to community prevention efforts. However, many segments of society are difficult to reach. Such groups still need public education to acquire the knowledge that can lead to behavior change. Community intervention programs in rural areas face the challenge of disseminating health information to widely scattered populations isolated by difficult terrain and weather, and restricted by the sparsity of channels for mass communication. School health promotion programs, because of the special role schools play in rural communities, can help reach rural populations. During a five-year period, the Otsego-Schoharie Healthy Heart Program, a state-funded community intervention program, provided presentations to 18% of the combined total population of two rural counties through its school-based component. It also helped promote other program initiatives by establishing linkages in the community. Schools provide an effective channel for health promotion efforts to reach rural populations.     

Cardiovascular Health Awareness Program (CHAP): a community cluster-randomised trial among elderly Canadians

OBJECTIVE: High blood pressure is an important and modifiable cardiovascular disease risk factor that remains under-detected and under-treated. Community-level interventions that address high blood pressure and other modifiable risk factors are a promising strategy to improve cardiovascular health in populations. The present study is a community cluster-randomised trial testing the effectiveness of CHAP (Cardiovascular Health Awareness Program) on the cardiovascular health of older adults. METHODS: Thirty-nine mid-sized communities in Ontario, Canada were stratified by geographic location and size of the population aged >or=65 years and randomly allocated to receive CHAP or no intervention. In CHAP communities, residents aged >or=65 years were invited to attend cardiovascular risk assessment sessions held in pharmacies over 10 weeks in Fall, 2006. Sessions included blood pressure measurement and feedback to family physicians. Trained volunteers delivered the program with support from pharmacists, community nurses and local organisations. RESULTS: The primary outcome measure is the relative change in the mean annual rate of hospital admission for acute myocardial infarction, congestive heart failure and stroke (composite end-point) among residents aged >or=65 years in intervention and control communities, using routinely collected, population-based administrative health data. CONCLUSION: This paper highlights considerations in design, implementation and evaluation of a large-scale, community-wide cardiovascular health promotion initiative.     

Implementation of "Heart Smart:" A Cardiovascular School Health Promotion Program

The Bogalusa Heart Study, an investigation of 8,000 children, has compiled a large data bank on cardiovascular (CV) risk factors in children during the past 12 years. Precursors of heart disease begin at a young age, with many children already possessing one or more known clinical risk factors--hypertension, obesity, and adverse lipoprotein changes. Having obtained data examining the determinants, distributions, interrelationships and trends over time for CV risk factors, a foundation was provided to address additional questions directed toward intervention strategies. "Heart Smart" is a comprehensive, research-based CV health promotion program testing differential effects of a population (public health) strategy versus a high-risk approach within four elementary schools. The major goal of "Heart Smart" is to reduce CV risk factors in children with an intervention to facilitate the adoption of healthful lifestyles. Objectives, intervention modalities, and design and evaluation procedures for children and adults in a total school environment (K-6) are described.     

Cardiovascular Health Knowledge of Children and School Personnel in Louisiana Public Schools

Questionnaires describing educational and administrative practices and cardiovascular health knowledge tests for fourth, sixth, and 12th grade students, teachers, and principals were used to evaluate cardiovascular health knowledge in a carefully matched, representative sample in Louisiana public schools. Data indicated cardiovascular health knowledge of both professionals and students was low, with several correlations between knowledge and educational or administrative practices. Recommendations for improvements in school health education programs are offered.     

Encouraging Schools to Promote Health: Impact of the Western Australian School Health Project (1992 — 1995)

The Western Australian School Health (WASH) Project, a school health promotion intervention operating over a four-year period (1992-1995), provided a comprehensive, year-long intervention to help successive groups of schools develop health promotion programs. The WASH Project worked with self-selected school communities and used community development strategies to support participating schools in identifying and responding to health concerns relevant to their students. This paper reports the school impact results of the WASH Project. School impact data involved 24 variables categorized into two areas: school organizational factors supportive of health promotion, and school health promotion factors. Two methods of analysis were used: logistic regression indicating the direction of change, and linear regression indicating the magnitude of change. Results demonstrated that schools successfully made organizational changes, such as the allocation of additional time, personnel, and monetary resources, to support health promotion.     

A Cardiovascular Health Intervention for Spanish Speakers: The Health Literacy and ESL Curriculum

Spanish speakers in the United States are in need of effective interventions that address both cardiovascular disease (CVD) and health literacy. However, the literature lacks interventions that have used and evaluated a strategies that focus on both, particularly at the community level. The aim of this study was to explore the effect of a health literacy curriculum on cardiovascular health behavior among Spanish speaking adults. It used a randomized controlled pre-posttest design. Participants included Hispanic adults with a low-to-intermediate level of English proficiency. The intervention group received the health literacy and English as a second language (ESL) Curriculum with CVD specific content, while the control group received a conventional ESL curriculum. Tools included the Spanish Cardiovascular Health Questionnaire (CSC), the test of functional health literacy in adults (TOFHLA), and the Combined English Language Skills Assessment. Analysis of change scores included independent sample t test and multiple linear regression. A total of 155 participants completed the study. There was a significant greater improvement for the intervention group in change of CSC score from pretest to posttest (P?=?0.049) compared to controls. The study also found significantly improved TOFHLA (P?=?0.011), however it did not find a relationship between changes in CVD behavior and health literacy or English proficiency. The Health Literacy and ESL Curriculum constitutes a valuable resource for addressing the cardiovascular health, literacy, and language needs of Spanish-speaking adults. Interventions that take a multilevel education and health approach may be more effective in addressing the needs of immigrants. Research should further explore the interactions between CVD behavior, health literacy, and English proficiency.     

The Heart Smart cardiovascular school health promotion: behavior correlates of risk factor change.

BACKGROUND. A growing awareness of health promotion and positive lifestyle change, coupled with the knowledge that cardiovascular risk has its origins in childhood, has led to the development of health promotion programs in the elementary school. While most school-based programs target specific behaviors or enlist singular intervention modalities, the Heart Smart cardiovascular school health promotion targeted the total school environment with a multidisciplinary approach to prompt the school's varied institutions to implement changes in curriculum, school lunch, and physical education. METHODS. Components of the Heart Smart environmental intervention included: (a) a school lunch program providing cardiovascular healthful food choices, reduced in fat by 30% and in sodium and sugar by 50%; (b) a physical education program promoting personal fitness and aerobic conditioning; and (c) cardiovascular risk factor screening, measuring fasting lipids and lipoproteins, anthropometrics, and blood pressure. Changes in cardiovascular risk factor status, school lunch selections, and exercise performance were compared. RESULTS. Screening participants showed greater improvement in health knowledge than nonparticipants. School lunch choices were successfully altered, and children whose lunch choices were cardiovascular healthful evidenced the greatest cholesterol reduction. Improvements in run/walk performance were related in predicted directions to the overall cardiovascular risk profile. Increases in high-density lipoprotein cholesterol were observed at intervention schools. CONCLUSION. Observations indicate a relationship between behavior change and physiologic changes achieved in a total school health promotion to reduce cardiovascular risk.     

Integration of health management in schools using the Balanced Scorecard as a strategic management instrument

Aim  

Organizational development is crucial to health promotion in different settings. The Learn to Live Healthy intervention [German: Gesund Leben Lernen (GLL)] is a new school health promotion strategy designed to develop schools into healthy environments for all those who work and study there. GLL focuses on strengthening available health resources and reducing negative and excessive health stresses. The Balanced Scorecard (BSC), a strategic management instrument designed to support change processes, is employed in this BMBF-funded study. This research will assess the suitability of the BSC as a management and evaluation instrument for schools.     

Community-wide youth nutrition education: long-term outcomes of the Minnesota Heart Health Program

The Class of 1989 was part of the Minnesota Heart Health Program, a research and demonstration project designed to reduce cardiovascular disease in three intervention communities. This paper describes the long-term outcomes of a school- and community-based intervention on healthy eating behaviors in one intervention and matched reference community. Beginning in the sixth grade (1983), seven annual waves of behavioral measurements were taken from both communities (baseline N = 2376). Self-reported data were collected at each time period including measures of knowledge and preferences for certain foods, and food salting behavior. Data were analyzed using an ANCOVA model adjusting for baseline dependent variable differences, with the school as the unit of analysis. Knowledge, healthy food choices and restraint in food salting behavior variables were significantly higher throughout most of the follow-up period in the intervention community for females. Males also indicated greater knowledge of healthier choices in the intervention community and greater restraint in salting behavior but results are less conclusive for healthy food choices. These results suggest that multiple intervention components such as behavioral education in schools coupled with community-wide health promotion strategies can produce modest but lasting improvement in adolescent knowledge and choices of heart healthy foods and less frequent food salting practices, and that this improvement is most notable among females.