Effectiveness of a school-based intervention to increase health knowledge of cardiovascular disease risk factors among rural Mississippi middle school children

BACKGROUND: Few school-based interventions have been evaluated to assess health awareness among children in rural southern areas. The purpose of this controlled investigation was to increase health awareness among middle school-aged children residing in a racially diverse rural community in Mississippi. METHODS: This investigation assessed health knowledge before and after a 16-week school-based intervention in 205 fifth-grade students. Height, weight, BMI, body composition, waist circumference, dietary intake, blood lipids and lipoprotein concentrations, blood glucose concentrations, and resting blood pressure were measured to enhance student awareness of cardiovascular disease risk factors. Values in the intervention school were compared with those obtained simultaneously in a control school within the same community. RESULTS: The school-based intervention was effective in increasing health knowledge in the intervention as compared with the control school. Secondarily, it was effective in improving certain dietary behaviors. Utilizing health care professionals in the classroom to teach students appropriate lifestyles and actually measuring cardiovascular risk factors to increase awareness among students was effective in increasing overall health knowledge. CONCLUSIONS: Health knowledge of rural adolescents can be increased through partnerships with schools and multidisciplinary teams of health care professionals. Ongoing efforts to reduce childhood obesity and cardiovascular disease risk factors are urgently needed, and information obtained during this investigation may be used in planning school-based interventions in other diverse, rural communities.     

Parental influence on models of primary prevention of cardiovascular disease in children.

BACKGROUND: Lifestyle behaviors such as overeating and physical inactivity contribute significantly to CVD, the leading cause of morbidity and mortality among adults globally. CVD risk factors that begin in children often track into adulthood. Parents are believed to influence the health behaviors of their children. OBJECTIVE: To review the literature on parental influence on children's health beliefs and behaviors, particularly eating and exercise behaviors as indicators of CV health, school-based CVD risk reduction programs, and racial/ethnic, gender and socioeconomic considerations for models of primary prevention of CVD in children. METHODS: Seventeen studies that included parents as either a source of information, change agent or participant in a CVD risk reduction intervention were identified searching the Medline, CINAHL and PsycINFO databases from 1980 through 2002. RESULTS: Children's lifestyle health beliefs and behaviors are significantly influenced by positive parental modeling and involvement in exercise and healthy eating; parental influence on children's behavior lasts beyond adolescence; parents are effective teachers of health habits at home when prompted by health educators; and parental influences vary by ethnicity/race, socioeconomics and gender. CONCLUSIONS: A broader base of knowledge that is socioculturally sensitive must be developed about what parents and children believe is healthy, how parents model beliefs and behaviors for their children, and how to build self-efficacy for positive health behaviors.     

Result of school-based intervention on cardiovascular risk factors

Objective. To assess the effectiveness of a two-year school-based intervention, consisting of integrated and replicable physical activity and nutritional education on weight, fat percentage, cardiovascular risk factors, and blood pressure. Design and setting. Six elementary schools in Reykjavik were randomly assigned to be either intervention (n = 3) or control (n = 3) schools. Seven-year-old children in the second grade in these schools were invited to participate (n = 321); 268 (83%) underwent some or all of the measurements. These 286 children were followed up for two years. Intervention. Children in intervention schools participated in an integrated and replicable physical activity programme, increasing to approximately 60 minutes of physical activity during school in the second year of intervention. Furthermore, they received special information about nutrition, and parents, teachers, and school food service staff were all involved in the intervention. Subjects. 321seven-year-old schoolchildren. Main outcome measures. Blood pressure, obesity, percentage of body fat, lipid profile, fasting insulin. Results. Children in the intervention group had a 2.3 mmHg increase in systolic blood pressure (SBP) and a 2.9 mmHg increase in diastolic blood pressure (DBP) over the two-year intervention period, while children in the control group increased SBP by 6.7 mmHg and DPB by 8.4 mmHg. These changes were not statistically significant. Furthermore there were no significant changes in percentage body fat, lipid profile, or fasting insulin between the intervention and control schools. Conclusion. A two-year school-based intervention with increased physical activity and healthy diet did not have a significant effect on common cardiovascular risk factors.Key Words: Blood pressure, children, general practice, Iceland, intervention, nutrition, physical activity, schoolA school-based intervention, focusing on increasing physical activity and promoting a healthy diet, was conducted to have a positive impact on cardiovascular risk factors among seven- to nine-year-old children. The intervention resulted in:

• No significant reduction of age-related increase in blood pressure.
• No significant effect on fat percentage or other cardiovascular risk factors.
• No significant effect on systolic blood pressure among overweight children.

     

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.     

Healthy Families: A Family-Based Community Intervention To Address Childhood Obesity

The objective of this study was to determine the effectiveness of Healthy Families, a family-based community intervention, in improving the knowledge, self-efficacy, and health behaviors of overweight/obese children and their families as well as to explore the lessons learned. Results showed families who completed the program had significant improvements for children and parents in areas such as nutrition knowledge and self-efficacy in making healthy eating choices as well as participating in physical activity. Additionally, families reported decreasing their intake of sugar-sweetened beverages. Participating families and community partners provided valuable lessons for other communities seeking to implement a similar program.     

Result of school-based intervention on cardiovascular risk factors

Abstract

Objective. To assess the effectiveness of a two-year school-based intervention, consisting of integrated and replicable physical activity and nutritional education on weight, fat percentage, cardiovascular risk factors, and blood pressure. Design and setting. Six elementary schools in Reykjavik were randomly assigned to be either intervention (n = 3) or control (n = 3) schools. Seven-year-old children in the second grade in these schools were invited to participate (n = 321); 268 (83%) underwent some or all of the measurements. These 286 children were followed up for two years. Intervention. Children in intervention schools participated in an integrated and replicable physical activity programme, increasing to approximately 60 minutes of physical activity during school in the second year of intervention. Furthermore, they received special information about nutrition, and parents, teachers, and school food service staff were all involved in the intervention. Subjects. 321seven-year-old schoolchildren. Main outcome measures. Blood pressure, obesity, percentage of body fat, lipid profile, fasting insulin. Results. Children in the intervention group had a 2.3 mmHg increase in systolic blood pressure (SBP) and a 2.9 mmHg increase in diastolic blood pressure (DBP) over the two-year intervention period, while children in the control group increased SBP by 6.7 mmHg and DPB by 8.4 mmHg. These changes were not statistically significant. Furthermore there were no significant changes in percentage body fat, lipid profile, or fasting insulin between the intervention and control schools. Conclusion. A two-year school-based intervention with increased physical activity and healthy diet did not have a significant effect on common cardiovascular risk factors.     

L.I.F.E.: a school-based heart-health screening and intervention program.

This article describes the development and growth of Lifestyle Improvements in the Family Environment (L.I.F.E.), a school-based heart-health screening and intervention program. The primary goals of L.I.F.E. through three rounds of grant funding remained constant: (a) to identify cardiovascular risk factors in students and their families and (b) to provide counseling, education, and opportunities to change lifestyle routines that contribute to those risk factors. The program began with direct ties to a university-based research program and grew with evidence-based successes and development of community partnerships. Waves of growth were influenced by capacity-building efforts, partnership development, and resource availability. School nurses managed the screening component and partnered with appropriate others in the intervention programming. School nurses are appropriately positioned to assist families as well as school and community partners in decreasing the incidence of obesity and promoting healthy lifestyle behaviors.     

Insulin resistance and cardiovascular disease risk factors in children of parents with the insulin resistance (metabolic) syndrome

OBJECTIVE: To evaluate whether children of parents with the insulin resistance syndrome (IRS) themselves have greater insulin resistance and unfavorable patterns of cardiovascular disease (CVD) risk factors. RESEARCH DESIGN AND METHODS: This cross-sectional study included 220 white and 36 black children aged 11-15 years identified through a school-based blood pressure screening program, along with 378 of their parents. Measures of insulin resistance (glucose disposal per minute per kilogram of lean body mass in a euglycemic-hyperinsulinemic clamp [Mlbm] and fasting insulin), adiposity, and other CVD risk factors were compared in children with and without a parental history of IRS, defined according to the National Cholesterol Education Program Adult Treatment Panel III consensus definition. RESULTS: Compared with children in whom neither parent had IRS, children who had at least one parent with the syndrome had statistically significantly lower mean Mlbm (12.1 vs. 13.6 mg.kg(-1).min(-1); P=0.04) and higher fasting insulin (geometric means 99 vs. 76 pmol/l; P=0.01) after adjustment for sex, race, age, and Tanner stage. Mean BMI, waist circumference, waist-to-hip ratio, triceps and subscapular skinfolds, and percentage of body fat were also significantly higher in children of an affected parent, but there were no significant differences in lipid or blood pressure levels between the two groups. CONCLUSIONS: Insulin resistance and obesity may be the earliest manifestations of IRS in children with a parental history of the syndrome.     

家庭-学校-社区志愿合作对肥胖儿童健康教育模式的研究

目的 探讨肥胖儿童生活环境控制,为及早控制肥胖儿童的体重提供科学依据.方法 以家庭干预为主,配合学校和社区的指导和健康教育,以控制饮食、增加运动、心理健康指导为主要干预内容.结果 干预后,肥胖儿童及家长健康知识、态度和行为有明显提高(P＜0.05);肥胖儿童BMI、血压和体重明显降低(P＜0.01),肥胖组儿童每天吃杂粮、薯类、豆类、蔬菜、水果的人数增多(P＜0.01),吃甜食、油炸食物和进餐速度快的人数明显下降(P＜0.01);肥胖儿童组平均体重平均减少了6.7Kg.结论 通过“家庭-学校-社区”的综合干预,让肥胖儿童意到肥胖问题的严重性,从而达到自觉控制体重过度增加的目的,促进儿童的正常发育.     

Lipid screening in paediatrics for early detection of cardiovascular risks

The purpose of the study was to try to detect at an early stage the important cardiovascular risk factors associated with increased concentrations of blood lipids, notably cholesterol. The trial was based on the screening of 102 families, including 219 children, 8-18 years of age and their parents. A group of young adults, 19-25 years of age, was included in the study. All subjects were derived from a paediatric practice. In addition to total cholesterol, VLDL-, LDL-, HDL-cholesterol and apolipoproteins A-I and B were also measured. The study identified a significant number of school-children and adolescents with hyperlipidaemia, predominantly hypercholesterolaemias type II-A. There was a close relationship between their blood lipids and those of their parents. The study demonstrates the importance of including parents in studies of this kind. Total cholesterol proved to be a reliable parameter for screening. The value of apolipoproteins in such screening is discussed.     

Comparisons of parent cardiovascular knowledge, attitudes, and behaviors based on screening and perceived child risks

Questionnaire reports and universal screening procedures from 244 children (kindergarten, 5th grade, and 9th grade) were used to explore differences in parent health knowledge and attitudes of cardiovascular risks among children and parental involvement in promoting healthy lifestyles relative to whether their children were identified as being overweight or at risk of being overweight. The knowledge, attitudes, and behaviors of the parents of children who were identified as being at risk or overweight were further examined based on their perceptions of their children's level of risk. Parents' reports demonstrated significantly greater parent encouragement and knowledge of issues related to eating healthier foods and ways to cut calories among parents of children who were identified as being at risk or already overweight. A significant portion of parents underestimated their children's weight risks. Differences in parents' appraisals of their children's overweight risks were associated with differences in their knowledge, attitudes, and behaviors. These findings illustrate the need to address inaccuracies in parents' assessments of their children's overweight risks to improve parent investment and involvement in children's health modification programs.     

Effectiveness of a cardiovascular health promotion education intervention on the attitudes of urban African American school-age children

African American children are at risk for high rates of morbidity and mortality associated with cardiovascular (CV) disease as they become adults, yet little is known about the effectiveness of CV risk-reduction interventions in African American children. This study explored the effectiveness of a concentrated CV health promotion educational program on health-related attitudes of 76 African American children enrolled in a mid-southern school system. The Children's Cardiovascular Health Promotion Attitude Scale was used to examine differences in attitude prior to and 2 weeks following a focused health education intervention. Results demonstrate that children have preconceived attitudes regarding practice of health behaviors and that these attitudes are modifiable with age and developmental level specific educational interventions. Findings indicate the need for health care providers to assume more active roles in reducing the risk of future CV disease and death in African Americans through health promotion education of individuals who influence the development of children's attitudes.     

Family,community and clinic collaboration to treat overweight and obese children: Stanford GOALS—A randomized controlled trial of a three-year,multi-component,multi-level,multi-setting intervention

ObjectiveTo test the effects of a three-year, community-based, multi-component, multi-level, multi-setting (MMM) approach for treating overweight and obese children.DesignTwo-arm, parallel group, randomized controlled trial with measures at baseline, 12, 24, and 36 months after randomization.ParticipantsSeven through eleven year old, overweight and obese children (BMI ≥ 85th percentile) and their parents/caregivers recruited from community locations in low-income, primarily Latino neighborhoods in Northern California.InterventionsFamilies are randomized to the MMM intervention versus a community health education active-placebo comparison intervention. Interventions last for three years for each participant. The MMM intervention includes a community-based after school team sports program designed specifically for overweight and obese children, a home-based family intervention to reduce screen time, alter the home food/eating environment, and promote self-regulatory skills for eating and activity behavior change, and a primary care behavioral counseling intervention linked to the community and home interventions. The active-placebo comparison intervention includes semi-annual health education home visits, monthly health education newsletters for children and for parents/guardians, and a series of community-based health education events for families.Main outcome measureBody mass index trajectory over the three-year study. Secondary outcome measures include waist circumference, triceps skinfold thickness, accelerometer-measured physical activity, 24-hour dietary recalls, screen time and other sedentary behaviors, blood pressure, fasting lipids, glucose, insulin, hemoglobin A1c, C-reactive protein, alanine aminotransferase, and psychosocial measures.ConclusionsThe Stanford GOALS trial is testing the efficacy of a novel community-based multi-component, multi-level, multi-setting treatment for childhood overweight and obesity in low-income, Latino families.     

Comparisons of Parent Cardiovascular Knowledge,Attitudes, and Behaviors Based on Screening and Perceived Child Risks

Questionnaire reports and universal screening procedures from 244 children (kindergarten, 5th grade, and 9th grade) were used to explore differences in parent health knowledge and attitudes of cardiovascular risks among children and parental involvement in promoting healthy lifestyles relative to whether their children were identified as being overweight or at risk of being overweight. The knowledge, attitudes, and behaviors of the parents of children who were identified as being at risk or overweight were further examined based on their perceptions of their children's level of risk. Parents' reports demonstrated significantly greater parent encouragement and knowledge of issues related to eating healthier foods and ways to cut calories among parents of children who were identified as being at risk or already overweight. A significant portion of parents underestimated their children's weight risks. Differences in parents' appraisals of their children's overweight risks were associated with differences in their knowledge, attitudes, and behaviors. These findings illustrate the need to address inaccuracies in parents' assessments of their children's overweight risks to improve parent investment and involvement in children's health modification programs.     

家长营养知识—态度—行为对肥胖儿童的影响

目的:了解肥胖儿童家长营养知识-态度-行为水平及其影响因素,为制订有针对性的营养教育干预策略提供基础资料。方法:对深圳市宝安区10家社区健康服务中心790名儿童家长进行有关儿童肥胖知识-态度-行为调查。结果:儿童家长营养知识水平普遍偏低,影响营养知识知晓率的因素主要是家长的文化程度。结论:父母的生活方式、饮食习惯及对肥胖症危害的认知态度是影响儿童肥胖发生的重要因素。     

Project SMART parent program: preliminary results of a chronic disease risk reduction trail

Project SMART Parent Program is a school-based healthy lifestyle promotion program designed to reduce chronic disease risk in adults and to provide a health-conscious home environment for children through the adoption of healthy lifestyle by their parents. Parents in the high involvement condition received comprehensive health status appraisals, and a program designed to reduce dietary fat intake, and increase aerobic activity levels. Parents in the low involvement condition received only the comprehensive health status appraisals. ANCOVA, using treatment condition as the independent variable and change scores as the dependent variables, were used to assess program outcomes. At the first posttest measure, the intervention group compared to the control group had a significantly greater decrease in blood cholesterol, a greater gain in aerobic fitness, a greater weight loss, and a greater decrease in body fat. At the second posttest measure, the intervention group had significantly greater gain in aerobic fitness, a greater decrease in body fat, a greater decrease in systolic blood pressure, and a marginally significant decrease in weight. Preliminary results provide strong support for the effectiveness of the Parent Program in reducing chronic disease risks.     

Overweight and perceived health in Mexican American children: a pilot study in a central Texas community.

This study assessed actual and perceived health status of overweight Mexican American clients at a central Texas school-based health center in a predominantly Hispanic school district. It also explored the participants' interest in making lifestyle changes to promote a healthy weight. A medical records review indicated that of the Hispanic children between the ages of 7 and 12 years, 38% had a weight status at or above the 85th percentile. Assessments were conducted in a sample of these overweight Mexican American children to learn about their medical history, eating and activity patterns, perceived health and body size, and general health-risk status. Weight-related conditions, such as elevated blood pressure and cholesterol levels, were found in more than half the sample. Few consumed fruits and vegetables, and many engaged in only sedentary activities. The majority perceived themselves as "big," wanted to make changes in their body size, and wanted family members to participate in making changes with them. Although most of the sample were in the 97th body mass index percentile, many perceived themselves to be as healthy as or healthier than others. These findings substantiate the need to design and implement a culturally appropriate weight management and obesity prevention program in this community. However, the perception of being healthy in the presence of multiple indicators of poor health may pose challenges to successful intervention.     

Implementation of the NHLBI Integrated Guidelines for Cardiovascular Health and Risk Reduction in Children and Adolescents: Rationale and study design for Young Hearts,Strong Starts,a cluster-randomized trial targeting body mass index,blood pressure,and tobacco

BackgroundCardiovascular disease (CVD) and the underlying atherosclerosis begin in childhood, and their presence and intensity are related to known cardiovascular disease risk factors. Attention to risk factor control in childhood has the potential to reduce subsequent risk of CVD.ObjectiveThe Young Hearts Strong Starts Study was designed to test strategies facilitating adoption of the National, Heart, Lung and Blood Institute supported Integrated Guidelines for Cardiovascular Health and Risk Reduction in Children and Adolescents. This study compares guideline-based quality measures for body mass index, blood pressure, and tobacco using two strategies: a multifaceted, practice-directed intervention versus standard dissemination.Study DesignTwo primary care research networks recruited practices and provided support for the intervention and outcome evaluations. Individual practices were randomly assigned to the intervention or control groups using a cluster randomized design based on network affiliation, number of clinicians per practice, urban versus nonurban location, and practice type. The units of observation are individual children because measure adherence is abstracted from individual patient's medical records. The units of randomization are physician practices. This results in a multilevel design in which patients are nested within practices. The intervention practices received toolkits and supported guideline implementation including academic detailing, an ongoing e-learning group. This project is aligned with the American Board of Pediatrics Maintenance of Certification requirements including monthly physician self-abstraction, webinars, and other elements of the trial.SignificanceThis trial will provide an opportunity to demonstrate tools and strategies to enhance CV prevention in children by guideline-based interventions.     

Developing resilient children and families when parents have mental illness: a family-focused approach

There is substantial evidence supporting the need for effective intervention for children and families living with parental mental illness. However, translation of this knowledge into mental health workforce practice remains variable, with a range of clinical practices and models of care evident. Nurses, who constitute the majority of the mental health workforce, are in prime positions to support children and families and provide preventative measures, identify those at risk, and intervene early. In this paper, we provide a framework for practice for nurses working with consumer parents. We contend that traditional models of nursing practice concentrating on the consumer are insufficient in meeting the needs of children and families living with parental mental illness. A focus on families needs to be core business for mental health nurses. A family-focused approach can be used to prevent problems for children and their families, and identify their strengths as well as vulnerabilities. Family-focused care is a useful framework from which to support families and address the challenges that might arise from parental mental illness, and to build individual and family resilience.