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Biomedical subjects

K Resnicow

Publications and source records attributed to K Resnicow.

At least 19 recordsLinked to original sources
PubMed1998

2-year tracking of children's fruit and vegetable intake.

OBJECTIVE: To evaluate the tracking of children's fruit and vegetable intake over 2 years. DESIGN: Children in the control group from the Gimme 5 nutrition education intervention trial completed three 7-day food diaries once a year in 1994, 1995, and 1996, beginning when they were in third grade. SUBJECTS: Five hundred sixty-one students from public elementary schools. STATISTICAL ANALYSES PERFORMED: Tracking was examined through correlation of fruit and vegetable servings over the 2 years as well as the percent of subjects remaining in the same or adjacent quintiles of fruit and vegetable intake, using the kappa statistic. RESULTS: Tracking of fruit and vegetable intake was fair to moderate over the 2 years. One-year correlations for total fruit and vegetable servings were .37 for boys and .46 for girls; 2-year correlations were .48 for boys and .40 for girls. kappa values for remaining in the same quintile generally exceeded chance rates only for the top and bottom quintiles. No values exceeded .50. APPLICATION/CONCLUSION: The drift in ranking may have been a result of true changes in fruit and vegetable intake or measurement error (i.e., inability to accurately assess actual intake). If this drift reflects true change, it may be difficult for nutrition education programs targeting this age group to demonstrate long-term behavioral effects on fruit and vegetable intake. If the drift is the result of measurement limitations, improved dietary assessment may yield stronger tracking.

Child↗
PubMed1998

Results of the TeachWell worksite wellness program.

OBJECTIVE: This study examined whether providing a school-based teacher wellness program enhances the impact of a health curriculum on student outcomes and improves cognitive, behavioral, and physiological outcomes among participating teachers. METHODS: Thirty-two elementary schools were randomly assigned to experimental or comparison conditions. Comparison group schools received the Gimme-5 program, a curriculum designed to increase fourth and fifty graders' consumption of fruits and vegetables. Experimental schools received Gimme-5 and the teacher wellness program, which included 54 workshops over 2 years, along with several schoolwide health activities. Physiological, behavioral, and cognitive outcomes were assessed in teachers and students. RESULTS: There was no evidence that the intervention favorably modified any student or teacher end points; nor did intervention teachers deliver the Gimme-5 program with greater fidelity than comparison teachers. CONCLUSION: Confidence in the null results is bolstered by the randomized design, baseline sample equivalence, appropriate mixed-model analyses, and lack of selective or differential attrition. Insufficient participation in the wellness program appears a likely explanation for the lack of teacher and student effects. Factors specific to the school setting and intervention may have diminished participation and, thus, intervention effects.

Adult↗
PubMed1998

Knowledge about smoking, reasons for smoking, and reasons for wishing to quit in inner-city African Americans.

OBJECTIVE: To determine knowledge about smoking, reasons for smoking, and reasons for wishing to quit and the association of these variables with abstinence at ten weeks and six months. DESIGN: Descriptive study and longitudinal intervention. SETTING: Inner-city public hospital clinics. PARTICIPANTS: 410 African-American cigarette smokers interested in quitting were surveyed at baseline and subsequently enrolled into a double-blind, placebo-controlled, randomized trial of the transdermal nicotine patch. MAIN OUTCOME MEASURES: Descriptive information about smoking knowledge, reasons for smoking, and reasons for wishing to quit, and association of these variables with abstinence at 10 weeks and 6 months. RESULTS: Among the 410 patients randomized, mean age was 48 years, 61% were female, 41% had less than a high school education, 51% had an annual household income less than $8,000, and the average number of cigarettes smoked a day was twenty. The average number of questions answered correctly was nine out of eleven (84%). The most cited reason for smoking was relaxation/tension reduction and the least cited were stimulation and handling of the cigarette. Ninety-nine percent of patients stated they wished to quit for health reasons. Knowledge, reasons for smoking, and reasons for wishing to quit were not significantly associated with 10-week or 6-month abstinence. CONCLUSIONS: In this group of inner-city African-American smokers, knowledge about cigarette smoking was high. Reasons for smoking were related to relaxation, craving, and pleasure, and reasons for wishing to quit were largely health-related. Knowledge, reasons for smoking, and reasons for wishing to quit were not associated with 10 week or 6 month abstinence. Since knowledge about smoking is already high, future efforts should be directed at promoting cessation through proven behavioral and pharmacological approaches, rather than didactic patient education.

Administration, Cutaneous↗
PubMed1997

Social-cognitive predictors of fruit and vegetable intake in children.

Social-cognitive theory (SCT) was used to explain the fruit and vegetable intake of 1,398 3rd graders. SCT variables assessed included self-efficacy, outcome expectations, preferences, social norms, asking skills, and knowledge. Fruit and vegetable intake was assessed with 7-day records. Bivariate correlations with fruit and vegetable intake ranged from .17 for asking skills to .29 for fruit and vegetable preferences. In analyses controlling for school-level clustering, only preferences and positive outcome expectations remained significantly associated with fruit and vegetable intake, accounting for approximately 10%-11% of the variance. Limitations in the conceptualization, scope, and measurement of the variables assessed may have contributed to the weak associations observed. Models incorporating factors other than individual-level social-cognitive variables may be required to more fully explain children's dietary behavior.

Child↗
PubMed1997

Patterns in children's fruit and vegetable consumption by meal and day of the week.

OBJECTIVE: To assess differences in children's consumption of fruit and vegetables (F&V) by day of the week and meal of the day. DESIGN: Baseline data from two school based nutrition education studies were combined for analysis. SUBJECTS/SETTING: 2984 third grade students from 48 participating elementary schools in three school districts in the metropolitan Atlanta area. MEASURES OF OUTCOME: The frequency of consumption of F&V abstracted by trained registered dietitians from prompted 7-day food records. STATISTICAL-ANALYSES PERFORMED: Mixed model analysis with meals and days as terms, controlling for the within school correlation, gender and ethnic group. RESULTS: F&V were most frequently consumed at weekday lunch, and second most frequently at dinner. Participation in school lunch accounted for a substantial proportion of F&Vs consumed at lunch. Few F&Vs were consumed at breakfast or snack. CONCLUSIONS: School lunch makes an important contribution to elementary school students' F&V consumption. Dietary change programs should target parents to increase F&V consumption at dinner, and target students for the meals over which they assert the most control: breakfast and snacks.

Adolescent↗
PubMed1997

A self-help smoking cessation program for inner-city African Americans: results from the Harlem Health Connection Project.

The authors develop and test a culturally sensitive, low-intensity smoking cessation intervention for low-socioeconomic African Americans. African American adult smokers were randomly assigned to receive either a multicomponent smoking cessation intervention comprising a printed guide, a video, and a telephone booster call or health education materials not directly addressing tobacco use. The results of the study were mixed. Although no significant effects were observed for the entire treatment cohort, the results of post hoc analyses suggest that culturally sensitive self-help smoking cessation materials plus a single phone contact can produce short-term cessation rates similar to those reported for majority populations. This conclusion should be tempered by the low completion rate for the booster call and several design limitations of the study.

Adolescent↗
PubMed1997

Tobacco smoking, cancer and social class.

Consumption of tobacco products, both by smoking and by other means, has long been causally connected with cancers of the lung, larynx, mouth and pharynx, oesophagus, bladder, and many other sites. Tobacco is the main specific contributor to total mortality in many developed countries and has become a major contributor in the developing countries as well. In most industrialized countries, prevalence of cigarette smoking is currently higher in low than in high social classes, although in some industrialized countries smoking was more frequent in high social classes during the first half of this century. The latter pattern of tobacco consumption is more likely to apply to developing countries. To formulate and carry out effective tobacco control activities it is essential to assess the relative incidence of tobacco-related cancers in different social strata and the prevalence of tobacco use across strata. Despite many years of data gathering the information base is far from complete, especially in developing countries where tobacco use is increasing rapidly, and where aggressive marketing by the transnational tobacco industry is occurring. A critical question is the extent to which tobacco usage can 'explain' the observed social class differences in cancer risk. Class differences in lung cancer are likely to be mostly related to the unequal distribution of tobacco smoking between social classes, and in some fairly simple situations this has been satisfactorily demonstrated. Nevertheless, there are many unresolved issues, especially with regard to the role of collateral exposures, such as hazardous occupations, poor diet, and limited access to health care. The question of whether tobacco use 'explains' socioeconomic differences in one or more of the cancers that it causes has rarely been directly addressed in epidemiological studies.

Adolescent↗
PubMed1996

The development, reliability, and validity of a risk factor screening survey for urban minority junior high school students.

PURPOSE: To develop and evaluate a risk factor screening survey as a mechanism to identify inner-city junior high school students who may benefit from medical or mental health services available in school-based clinics. METHODS: A 36-item health risk factor screening survey was developed and administered to 3,787 predominantly Hispanic students from four schools in an economically disadvantaged, medically underserved New York City school district. Students who indicated that they were experiencing one of five major risk factors (suicidality, sexual activity, parental or guardian substance use, personal substance use, or having run away) were scheduled to visit the clinic for services, and to have their survey responses validated by clinic interview. RESULTS: The development of the screening tool resulted in a short, easy to read and understand survey instrument that was feasible to administer within a classroom setting. The reliability of the instrument was excellent, and the results of the validity study indicated that it was successful in identifying students who did not need clinic services. The screening tool produced mixed results in identifying those truly in need through single item identification (e.g., produced a moderate number of "false positives"), although combining items on the screening tool produced much higher positive predictive values. CONCLUSIONS: This screening tool can be used to effectively focus limited clinical resources on those in need. Outreach surveys of this type should be considered as a valuable component of a school-based clinic service delivery strategy.

Adolescent↗
PubMed1996

Conducting a comprehensive school health program.

Since the late 1980s, the eight-component model of the comprehensive school health program (CSHP), has been adopted widely in the United States and internationally. While it is acknowledged that the eight program elements should be delivered in a coordinated, interactive manner, numerous issues regarding how this integration best can be achieved, including who at the school level should have this responsibility and how the eight components relate conceptually and logistically, have not been addressed adequately. In essence, a CSHP transforms several solo performers into an orchestra. This article proposes the school health coordinator as an essential element in the eight-component model of the CSHP--the maestro, without whom there can be no symphony. The coordinator's principal responsibilities include administration, integration of personnel and programs, evaluation, and direct intervention. Three program elements--staff wellness, healthy environment, and community/family involvement--are subsumed within the coordinator's role, effectively reducing the number of program elements from eight to five. Potential benefits in addition to issues regarding feasibility of the SHC, are discussed and studies examining the effectiveness of the SHC model are recommended.

Administrative Personnel↗
PubMed1995

Structure of problem and positive behaviors in African American youths.

The association of 21 problem and positive behaviors was explored in a sample of 283 inner-city, African American youths of ages 8 through 12. Data reduction yielded 4 factors, 3 representing different types or levels of problem behavior, labeled Interpersonal-Minor Deviance, School Problems, and Covert-High Deviance, and 1 representing positive behaviors. The 3 problem behavior factors, although not the positive behavior factor, were significantly correlated with an underlying second-order general deviance factor. The problem behavior clusters identified differed by the settings in which they occur as well as their inherent magnitude of deviance. Discriminant validity analyses confirmed that deviance was not a unitary phenomenon. Limitations as well as other implications of the data are discussed.

Adolescent↗
PubMed1995

Physician- and nurse-assisted smoking cessation in Harlem.

This study was designed to increase smoking cessation rates, quit attempts, and cutting down among low-income African Americans using brief clinician advice in conjunction with socioculturally appropriate self-help smoking cessation/relapse prevention materials. Physicians and nurses were instructed in the National Cancer Institute's smoking intervention at inservice sessions. Smokers interviewed in a Harlem, New York clinic waiting room were recontacted 7 months later by telephone or mail (77% response). Residents receiving the intervention reported a 21% cessation rate at follow-up. An additional 27% decreased cigarette intake by at least 50%. Those reporting follow-up abstinence were significantly more likely to designate a quit date at baseline. They were also more likely to be men, employed, and have a nonsmoking partner. Smokers who decreased their cigarette intake significantly were older, employed, less nicotine-dependent (eg, delayed their wake-up cigarette), and more likely to use project materials. Physician advice had a significant impact both on patients' cutting down at least 50% and patients' watching the project video. Designation of a quit date and using project materials had a significant impact on making serious quit attempts. Results corroborate large sample, randomized, controlled trials with noninner-city physicians. We conclude that clinician smoking advice for every patient is warranted.

Adolescent↗
PubMed1993

Evaluation of a school-site cardiovascular risk factor screening intervention.

BACKGROUND: Though several published reports have demonstrated the feasibility of conducting school-site cardiovascular risk factor screening programs as well as the ability of such programs to detect high-risk children and parents, less is known about their cognitive and behavioral impact. METHODS: Four Michigan elementary schools received a cardiovascular risk factor screening intervention twice between spring 1989 and spring 1990 and four other area schools served as comparison sites. All eight schools received the Michigan Model Comprehensive School Health Education Program. RESULTS: Among participating students (n = 1,166) and their parents (n = 514), significant favorable changes in relevant health knowledge as well as attitudes regarding nutrition and early detection of disease relative to comparison student (n = 480) and parents (n = 158), were observed. There was also a significant decrease in students' self-reported intake of high-fat foods and parents of children who participated were themselves significantly more likely to report having had their cholesterol and blood pressure tested. CONCLUSIONS: This quasi-experimental study suggests that school-based risk factor screening programs can positively influence the knowledge, attitude, and behavior of schoolchildren and their parents and may, therefore, represent a potentially effective adjunct to traditional curricular approaches to disease prevention and health education as well as an alternative means of early detection.

Blood Pressure↗
PubMed1993

Ten unanswered questions regarding comprehensive school health promotion.

The past two decades witnessed dramatic growth in support for comprehensive school health promotion. Yet, many questions about its effectiveness and feasibility remain unanswered. This article poses several research and policy questions, the answers to which may help to shape the future of school health programs in this country.

Adolescent↗
PubMed1993

Body mass index as a predictor of systolic blood pressure in a multiracial sample of US schoolchildren.

We examine the relationship between body mass index (weight divided by height squared) and systolic blood pressure and the implications of using obesity as a criterion for blood pressure screening in a multiracial sample of 11,370 schoolchildren. For the entire sample, the zero-order correlation between body mass index and systolic blood pressure was 0.39. Correlations were strongest among Hispanics (r = .51) and weakest among blacks (r = .29). Among white, black, Asian, and Hispanic boys with body mass index values in the upper decile, the odds of having elevated systolic blood pressure (above the 95th percentile) were significantly higher than among individuals in the bottom decile. Among girls with body mass index values in the top decile, higher odds of hypertension were observed only for whites and Hispanics. For the entire population, the sensitivity of screening only children with body mass index values in the top quartile was 52%. The sensitivity of this cutpoint was higher for Hispanics, although 36% of those with elevated systolic blood pressure would still be missed. These data confirm that overweight children are significantly more likely to have elevated systolic blood pressure and total blood cholesterol levels and that weight reduction may play an important role in the primary prevention of coronary heart disease among children of various ethnic backgrounds. Selective screening of overweight children, however, does not appear warranted.

Blood Pressure↗
PubMed1993

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.

Child↗