Primary prevention of cardiovascular disease: communitywide strategies for youth.
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Adolescent↗
Biomedical subjects
C L Perry
Publications and source records attributed to C L Perry.
Parent nutrition education: a conceptual model.
Getting nutrition information to parents is beneficial for several reasons. Children need support from their parents to implement behavior changes learned in primary prevention interventions. In addition, positive eating behavior changes last longer if interventions are aimed at family attitudes and habits rather than individuals. Finally, parents also can benefit from the information. This article summarizes selected research about the impact of youth-directed nutrition education interventions on parents. A conceptual model is proposed to guide development and evaluation of future interventions with a parent component.
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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.
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Hypertension prevention through nutrition education in youth: a school-based program involving parents.
One approach to the prevention of high blood pressure may be the reduction of sodium intake early in life. To test the effect of nutrition education for salt use in third-grade students (ages 7 to 9), three teaching programs involving a classroom curriculum, a home-based curriculum, or the combination were compared to a control group. Thirty-one schools with 1,839 students were included. Measurements were made at the beginning and end of the school year. Participation rates exceeded 90% for school-based programs and 80% for those at home. Knowledge about salt increased significantly, with the classroom program showing the largest gains. However, reported salting behavior and sodium measured by 24-hr recall and overnight urines failed to show consistent and significant differences between treatments. Further analysis suggested that most ingested salt was hidden in processed foods with only a small fraction added in cooking or at meals (less than 7%). If sodium intake is to be reduced significantly in healthy children, more attention must be paid to hidden sources, particularly processed foods.
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Predictors of adolescent smoking and implications for prevention.
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Adolescent↗
The validity of smoking self-reports by adolescents: a reexamination of the bogus pipeline procedure.
Cigarette smoking was measured in a naive tenth grade population under conditions expected to influence the student's willingness to admit smoking. All students were tested for smoking both by questionnaire and by expired-air carbon monoxide assessment. The carbon monoxide data were used to test the equivalence of the study groups and to partition the sample into smokers and nonsmokers. Of the smokers those who were advised in advance of the biological test were twice as likely to admit cigarette use in the past week compared to those who were advised of the testing procedure only after they had completed their questionnaire. A live explanation and demonstration of the biological testing procedure proved as effective as a videotaped message. These data support earlier reports of the 'bogus pipeline' effect. Several methodological issues are discussed which may explain previous failures to replicate this finding.
Adolescent↗
The measurement of substance use among adolescents: when is the 'bogus pipeline' method needed?
The use of objective measures to assess cigarette smoking among adolescents has become commonplace in research studies in recent years. This trend is based on evidence that this so called pipeline methodology can increase the disclosure of socially proscribed behaviors in a setting where adolescents might otherwise feel pressure to deny that they smoke. This paper examines the effects of the pipeline methodology alone and in combination with procedures designed to ensure anonymity on the disclosure of tobacco, alcohol, and marijuana use by young adolescents. The data indicate that the pipeline procedures significantly increase disclosure of tobacco and marijuana use when students are promised confidentiality but not anonymity. However, when anonymity was assured, disclosure of cigarette use was just as high without the pipeline; for marijuana use, disclosure was higher without the pipeline. No effects were observed for alcohol disclosure. These data are interpreted for their implications for prospective and cross sectional studies.
Adolescent↗
Results of prevention programs with adolescents.
Programs for preventing smoking and alcohol and drug abuse have radically changed in the past decade. Instead of being regarded as a health or discipline problem that involves only a few deviant adolescents, drug use has begun to be viewed as social behavior that is functional for adolescents, not capricious, and is normative for that population. The most successful prevention programs have sought to delay the onset of tobacco use. Based on theoretical and etiological research, these programs target factors that have repeatedly been predictive of adolescent smoking, alcohol and drug use. The programs teach adolescents (1) why people their age smoke tobacco or use alcohol and drugs; (2) how these meanings get established by peers, older role models and advertising; (3) how to resist these influences to smoke or to use alcohol and drugs; and (4) life skills and competencies to counterbalance the functions that drug use serves. Because of the association with the onset of smoking and the onset of using other drugs, these strategies are being studied for alcohol use and other drugs. In addition, elected peer leaders are trained to conduct these activities with their classmates and act as new role models for non-use. Evaluations of these approaches are optimistic. Studies in northern California and Minnesota reveal 50-70% reductions in the onset of smoking. Botvin's 'Life Skills Training' program demonstrates success in delaying heavy alcohol and marijuana use.
Adolescent↗
Understanding and deterring tobacco use among adolescents.
This article discusses the addictiveness of tobacco and the health consequences of chronic tobacco use. Personality, environmental, and behavioral factors that promote the initiation of cigarette smoking by adolescents are identified. Age-specific interventions are suggested.
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Seventh-grade cigarette, alcohol, and marijuana use: distribution in a north central U.S. metropolitan population.
Tobacco, alcohol, and marijuana use were examined in a seventh-grade population from a north central U.S. metropolitan community. Participation exceeded 94% and biological testing was used to increase the disclosure of drug use during the survey. Drug use was related to age, gender, race, family structure, and parental occupation in a series of logit analyses to identify high-risk groups. While univariate analyses uniformly supported earlier studies, the logit analyses revealed patterns not previously reported and at times contrary to previous reports. Significant associations were observed between drug use and each of the demographic factors; the likelihood of drug use increased by as much as 80-fold in subgroups defined by interactions among these variables. Native Americans, Hispanics, Black females, and adolescents whose mothers held white-collar jobs were substantially more likely to report drug use compared to other groups; females were generally similar to males in their level of use after adjustment for other factors. These results suggest that multivariate analyses which consider higher-order interactions may more adequately model the distribution of drug use in adolescent populations, compared to those based on univariate or first-order multivariate techniques.
Adolescent↗
Smoking prevention: behavioral prescriptions for the pediatrician.
Pediatricians are important instigators of behavior change for the promotion of nonsmoking. Smoking is harmful to infants, children, and adolescents, and evidence is reviewed that passive smoking can have potent deleterious effects. Interventions with young adolescents based on social-psychologic theory have shown promise in changing smoking behavior and reducing smoking onset rates. Interventions are described, based on epidemiologic and etiologic data, that are appropriate for infants, children, adolescents, and parents. Interventions for parents should encourage cessation and the creation of a smoke-free environment for children. Interventions for children should emphasize the negative health effects of smoking and help them build an armamentarium against factors that promote experimentation with smoking. Interventions for adolescents should encourage them to remain nonsmokers in an environment of social pressure to smoke. The rationale for these strategies and methods of implementation in the pediatrician's office are described.
Adolescent↗
A process evaluation study of peer leaders in health education.
Peer education is an important part of health education programs. In smoking prevention programs, peer leaders are particularly efficacious. Yet, research on peer leaders' perceptions of these programs is minimal. This study assessed the perceptions of elected peer leaders (N = 207) in one seventh grade smoking prevention program and one chemical abuse prevention program in spring 1984. Peer leaders' assessments of the adequacy of their training, the programs' components, the programs' influence on their behavior and attitudes, and the efficacy of the programs were analyzed. Differences between genders and the level of peer leader enthusiasm also were assessed. Further research with peer leaders is suggested as a way to strengthen ongoing health promotion efforts.
Adolescent↗
Community-wide health promotion and drug abuse prevention.
This paper reviews the rationale for a community-wide approach to drug abuse prevention. Four arguments are outlined. The question of how to conceptualize community-wide strategies is then addressed. Three background frameworks, psychosocial theory, the appropriate intervention targets, and the timing or readiness of the community, are reviewed. Examples of each from ongoing research are presented. The usefulness of each framework to the design of specific strategies for drug abuse prevention is provided.
Behavior Therapy↗
The efficacy of peer leaders in drug abuse prevention.
The results from school-based, peer-led psychosocial smoking prevention programs suggest that this approach is effective in reducing smoking onset rates. This paper provides a theoretical rationale for using peer leaders as a major strategy in school-based drug abuse prevention programs and reviews the available literature assessing the impact of peer leadership in such programs. Furthermore, some of the practical issues involved in selecting and training peer leaders and teachers are discussed, and process evaluation data from studies conducted at the University of Minnesota are presented. The authors conclude that peer leadership can be an effective vehicle for drug abuse prevention among adolescents. However, increased research is necessary to clarify the conditions under which the impact of peer leaders is enhanced.
Adolescent↗
Assessing needs for youth health promotion.
Children and adolescents recently have become a group targeted for health promotion efforts. It is argued that early behavioral intervention will alter patterns of behavior that might place young people at increased risk for chronic diseases later in life. The Minnesota Heart Health Program is a longitudinal, community-based research and demonstration project to improve cardiovascular health in three north central communities. Reductions in cigarette smoking, improved eating and exercise patterns, and hypertension management are targeted objectives. To design educational interventions for children and adolescents in these areas as part of this program, a behavioral needs assessment was conducted in the communities prior to program implementation. This needs assessment focused on existing behavior patterns, skills related to the targeted behaviors, and environmental influences. This article describes that needs assessment, the results from two of the communities, differences due to gender and age of student, and the implications of the results for designing intervention activities for children and adolescents.
Adolescent↗
Modifying the eating behavior of young children.
A nutrition education curriculum was developed, based on a social learning model, that emphasized the importance of a low-salt, low-fat, and increased complex carbohydrate diet for cardiovascular health. The curriculum was pilot-tested in eight third and fourth grade classrooms. Students were exposed to cartoon character role models, were reinforced for dietary changes, and practiced relevant behavioral skills. Students in eight other third and fourth grade classrooms served as controls. At posttest, students participating in the nutrition education program reported a significant reduction in consumption of foods high in fat and salt and an increase in consumption of complex carbohydrates. These assessments were confirmed by food selection measures and by 24-hour food recalls. Students in the control classrooms did not report these eating pattern changes.
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The concept of health promotion and the prevention of adolescent drug abuse.
A three-dimensional conceptual model for health promotion interventions to prevent adolescent drug abuse is elaborated. The model is based on an analysis of the concept of health into four domains--physical, psychological, social, and personal; an analysis of intervention approaches to change behavior into two major strategies--introducing/strengthening health-enhancing behavior, and weakening/eliminating health-compromising behavior; and an analysis of the foci of interventions into three levels--environmental, personality, and behavior. Components of a specific health promotion program, the Minnesota Heart Health Program, that are designed to prevent adolescent drug abuse are described. These include health behavior campaigns, educational interventions, and community organization. The theoretical content of the components is shown to be linked logically to the health promotion model.
Adolescent↗
The prevention of adolescent drug abuse: implications of etiological, developmental, behavioral, and environmental models.
Nine models for the etiology of drug abuse have been examined. Problem behavior theory, domain theory, and Flay's developmental model suggest that drug use is a functional behavior for adolescents, and that prevention efforts should address this functionality and provide alternative behaviors for drug use rather than simply trying to suppress the underlying need or reason for use. These positions, together with the stages of drug use and stages of antisocial behavior models, place drug use in a developmental context, suggesting that the factors that influence drug use evolve as the child matures through adolescence, and that the developmental period of the adolescent should be considered in any prevention effort. They also suggest that drug use is common for many adolescents in today's culture. There is general support among the models to consider drug use as a part of a larger constellation of behaviors, whether labeled problem behaviors, antisocial behaviors, or by another name. This suggests that prevention programs must treat drug use in its behavioral context as well as its developmental and functional context. Finally, there is strong support for social-environmental factors such as modelling, availability of drugs, and social supports in the development of drug use. Though the various models often use different terminology, there are remarkable similarities in their implications for prevention efforts.
Acting Out↗