High school smoking prevention: the relative efficacy of varied treatments and instructors.
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Adolescent↗
Biomedical subjects
C L Perry
Publications and source records attributed to C L Perry.
Long-term follow-up of a pilot project on smoking prevention with adolescents.
Seventh graders (N = 353) in one junior high school received an experimental smoking prevention program aimed at teaching students to resist the social pressures to smoke cigarettes. Seventh graders (N = 217) in another school served as controls. Teams of high-school students trained in basic behavior change skills led seven classroom sessions of instruction in counter-arguing during the school year. Significant differences were found between groups in reported smoking at a 9-month posttest. Results were maintained at 21- and 33-month follow-ups.
Adolescent↗
Enhancing the transition years: the challenge of adolescent health promotion.
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Adolescent↗
Peer teaching and smoking prevention among junior high students.
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Adolescent↗
Operational design and quality control in the CATCH multicenter Trial.
BACKGROUND: The Child and Adolescent Trial for Cardiovascular Health (CATCH) was the first multicenter school-based research study to employ the fundamentals of clinical trials including the standardized protocol and Manuals of Operation, a steering committee for study governance, a distributed data system, an extensive quality control system, and a Data and Safety Monitoring Board. METHOD: CATCH tested the effectiveness of changes in school lunches, physical education, smoking policy, curricula, and family activities. Ninety-six elementary schools in four states were randomized to intervention or control conditions. The baseline cohort comprised 5, 106 ethnically diverse third graders followed through fifth grade. RESULTS: The percentages of calories from fat and saturated fat were reduced significantly more in the intervention school lunches than among the controls. Significant increases in moderate to vigorous activity levels in existing physical education classes were made as well. Changes in self-reported dietary, physical activity, and psychosocial measures were significant. There were no significant differences in the physiological measures. Measurement error was generally low for all physiologic measures except skinfolds, indicating a high level of reliability. Across all sites, the coefficients of variation for lipids, height, and weight were less than 3%, whereas for skinfolds, they were considerably higher, ranging from 6 to 8%. Intraclass correlations for lipid studies were also uniformly high at 0.99. Interobserver agreement scores for SOFIT were greater than 90% for 9 of the 11 activities observed. Data entry error rates were low with less than five errors per 1,000 fields for all forms. CONCLUSIONS: The CATCH results provided more scientific evidence on the importance of schools in the population approach to health promotion. Many of the strategies used in this complex multicenter trial in the areas of design and analysis, measurement, training, data management, and quality control protocols might be appropriate for adoption in other studies.
Adolescent↗
School physical education: effect of the Child and Adolescent Trial for Cardiovascular Health.
BACKGROUND: Physical inactivity is a risk behavior for cardiovascular and other diseases. Schools can promote public health objectives by increasing physical activity among youth. METHODS: The Child and Adolescent Trial for Cardiovascular Health (CATCH) was a multicenter, randomized trial to test the effectiveness of a cardiovascular health promotion program in 96 public schools in four states. A major component of CATCH was an innovative, health-related physical education (P+) program. For 2.5 years, randomly assigned schools received a standardized PE intervention, including curriculum, staff development, and follow-up. RESULTS: Systematic analysis of 2,096 PE lessons indicated students engaged in more moderate-to-vigorous physical activity (MVPA) in intervention than in control schools (P = 0.002). MVPA during lessons in intervention schools increased from 37.4% at baseline to 51.9%, thereby meeting the established Year 2000 objective of 50%. Intervention children reported 12 more min of daily vigorous physical activity (P = 0.003) and ran 18.6 yards more than control children on a 9-min run test of fitness (P = 0.21). CONCLUSIONS: The implementation of a standardized curriculum and staff development program increased children's MVPA in existing school PE classes in four geographic and ethnically diverse communities. CATCH PE provides a tested model for improving physical education in American schools.
Adolescent↗
The effects of the Child and Adolescent Trial for Cardiovascular Health upon psychosocial determinants of diet and physical activity behavior.
BACKGROUND: The Child and Adolescent Trial for Cardiovascular Health is a multisite study of a school-based intervention to reduce or prevent the development of risk factors for cardiovascular disease. The purpose of this paper is to present the evaluation results of the 3-year intervention, focusing upon the psychosocial variables conceptualized as determinants of dietary and physical activity behaviors. METHODS: A total of 96 schools across four study sites (California, Louisiana, Minnesota, and Texas) were randomized to two treatment conditions: intervention and control. Pre- and postmeasurements on the health behavior questionnaire were collected from over 6,000 students. The data analyses utilized a nested design approach in which schools served as the primary unit of analysis. Repeated-measures multivariate analyses were applied to investigate effect sizes for each determinant and to explore theoretical relationships among the determinants over time. RESULTS: The findings indicated sustained significant effects in improved knowledge, intentions, self-efficacy, usual behavior, and perceived social reinforcement for healthy food choices (P < 0.0001 for these five variables) after 3 years. Intermittent effects were observed for perceived support and self-efficacy for physical activity. No gender by determinant interaction effects were observed, and girls reported significantly greater perceived reinforcement for healthy eating than did boys. CONCLUSION: The CATCH program was effective in changing the psychosocial variables likely to influence a reduction in behavior for cardiovascular disease. The study is significant in that it demonstrates the viability and effectiveness of a sustained multifaceted intervention in a preadolescent population. The results point to a need for greater understanding of adolescent developmental issues and the role of community environment (particularly social support) in creating effective curricula.
Adolescent↗
The effect of adult participation in a school-based family intervention to improve Children's diet and physical activity: the Child and Adolescent Trial for Cardiovascular Health.
UNLABELLED: BACKGROUND. There are strong theoretical reasons for including a family component with a school-based intervention aimed at eating, activity, and smoking behaviors, but the empirical findings to date are limited and show mixed results. The overall CATCH family intervention added only knowledge and attitudinal effects, but no additional behavioral outcomes. This study provides a dose analysis of the family component of the CATCH study by assessing the effect of the level of adult participation. METHOD: This secondary analysis included students who attended a CATCH family intervention school during all 3 years of the study. The extent of the adult-child interaction, the key aspect of the CATCH family intervention, was measured by the number of activity packets that an adult household member completed with the child. Multiple regression analysis was used to assess the association of adult participation with the child's knowledge, attitudes, and behaviors related to diet and physical activity. RESULTS: Statistically significant results suggested that dose effects were found for knowledge and attitudes related to diet and physical activity. These effects were more pronounced for minority and male students. CONCLUSIONS: These results suggest that dose response of a family intervention has been shown in the acquisition of positive knowledge and attitudes toward health habit changes. The methodology of dose response can be applied to other health promotion projects.
Adolescent↗
Changes in nutrient intakes of elementary school children following a school-based intervention: results from the CATCH Study.
BACKGROUND: Twenty-four-hour recalls were used to assess the change in nutrient intake among elementary-age school children exposed to the Child and Adolescent Trial for Cardiovascular Health (CATCH). The purpose of this paper is to compare changes in nutrient intakes between treatment groups, sexes, ethnic groups, and the four CATCH sites. METHODS: Twenty-four-hour recalls were administered to a subsample of the CATCH cohort at baseline in third grade and following the intervention in fifth grade (n = 1,182). Changes in nutrient levels for total energy, dietary cholesterol, and dietary fiber and changes in the proportion of energy from fat, protein, carbohydrate, and fatty acids were studied looking at differences by treatment group, sex, ethnicity, and site. Mixed-model analysis of variance was used to examine the change in nutrient intake, defined as intake at follow-up minus intake at baseline. RESULTS: Students in the intervention schools showed statistically significant differences in the changes in total energy and proportion of energy from total fat, saturated fat, protein, and monounsaturated fat compared with students in the control group. Students in the intervention group decreased their total fat intake from 32.7% of energy to 30.3% of energy and saturated fat from 12.8% of energy to 11.4% of energy. There were no significant differences in intervention effects by ethnic group, sex, or site. Differences in nutrient change between the school-only and the school-plus-family intervention groups were nonsignificant. CONCLUSION: The results show that a school-based intervention can positively influence children's intakes of total fat and saturated fat, suggesting that population-based approaches for reducing cardiovascular risk factors in children are feasible and effective. The results are also important in showing that the intervention was effective in Caucasian, African-American, and Hispanic students, in boys and girls, and across four regions of the United States.
Analysis of Variance↗
Tobacco use measurement, prediction, and intervention in elementary schools in four states: the CATCH Study.
BACKGROUND: The Child and Adolescent Trial for Cardiovascular Health (CATCH) is a multistate field trial examining the effects of school environment, classroom curricula, and family intervention components in promoting the cardiovascular health of elementary school students. The purpose of this paper is to describe the CATCH tobacco use intervention and measurement, including the adoption of tobacco-free school policies. METHODS: In this study, changes in school tobacco use policies and smoking experimentation among students were assessed. Smoking experimentation was measured in all CATCH schools when the students were in their fifth-grade year. A total of 6,527 subjects in 96 schools in California, Louisiana, Minnesota, and Texas answered questions about behaviors and potential correlates of smoking as part of the CATCH health behavior questionnaire in Spring 1994. School tobacco use policy, an important complement to classroom- and home-based prevention efforts, was promoted as part of the CATCH intervention. The degree to which such policy was implemented was measured using surveys of school officials. RESULTS: At the end of fifth grade, only 4.8% of the subjects indicated that they had experimented with tobacco. School intervention condition was not a factor in the prediction of experimentation. Those whose best friend or sibling smoked, or who had ready access to cigarettes in the home, were more likely to have experimented with smoking. In the 3 years of the study, the percentages of tobacco-free schools went up from 49.7 to 76.8%. Though differences in the rate of policy adoption could not be directly attributed to the CATCH intervention, the implementation of the tobacco-free schools' policies did vary substantially from state to state. Minnesota and Texas, with stronger state laws supporting local policy, had nearly completely smoke-free schools. In spite of a statewide tobacco control initiative, California was slower to implement school policies. Louisiana, which allows local decision making regarding smoking policy, had the most difficulty establishing a policy for all districts. CONCLUSION: Future studies should examine the impact of parallel policy interventions that are ongoing at both school and state levels. Tobacco-free policies appear to be a crucial part of school-based interventions and must be tailored to political and regional factors affecting a given school district.
Adolescent↗
The effects of the child and adolescent trial for cardiovascular health intervention on psychosocial determinants of cardiovascular disease risk behavior among third-grade students.
PURPOSE: The Child and Adolescent Trial for Cardiovascular Health is a multi-site study of a school-based intervention designed to reduce or prevent the development of risk factors for cardiovascular disease. The goal was to change (or prevent) related risk behaviors and the psychosocial variables that theoretically influence those behaviors. DESIGN: A nested design was used in which schools served as the primary unit of analysis. Twenty-four schools participated at each of four sites (Austin, San Diego, Minneapolis, and New Orleans). Each site had 10 control and 14 intervention schools. SETTING AND SUBJECT: Ninety-six schools (with more than 6000 students) in the four sites were randomized to three treatment conditions: control, school-based interventions, and school-plus-family interventions. The sample included approximately equal numbers of males and females and was 67.5% white, 13.9% African-American, 13.9% Hispanic, and 4.7% other. MEASURES: The psychosocial determinants included improvements in dietary knowledge, intentions, self-efficacy, usual behavior, perceived social reinforcement for healthy food choices, and perceived reinforcement and self-efficacy for physical activity. RESULTS: The findings indicated significant improvements in all the psychosocial determinants measured (p < .0001). The results revealed a greater impact in the school-plus-family intervention schools for two determinants, usual dietary behavior and intentions to eat heart-healthy foods. CONCLUSIONS: These findings support theory-based interventions for changing selected psychosocial determinants of cardiovascular disease risk behavior among children.
Cardiovascular Diseases↗
Where and how adolescents obtain alcoholic beverages.
Patterns of acquisition of alcoholic beverages by underage youth were studied, using focus group methods with a sample of midwestern youth. Results showed that the alcohol initially used by those in their early teens is obtained from parents' stocks or from older siblings and friends. By the midteens, parties at which alcohol (usually beer) is readily available become the major source. In the mid to late teens, young people purchase alcohol from commercial alcohol outlets, despite the fact that 21 is the legal age for purchasing alcohol. Factors reported to increase the rate of successful alcohol purchases include female buyer, male seller, young seller, and convenience store outlet. Results of focus group interviews revealed the easy accessibility of alcoholic beverages to underage youth. Further investigation into patterns of underage access to alcohol is recommended, with results from the focus group study guiding the design of probability sample studies to assess their generalizability.
Adolescent↗
Smoking among adolescent girls: prevalence and etiology.
The prevalence of regular cigarette smoking among 12th-grade girls is about 28%, with the highest rates among whites and the lowest in African-Americans and Asians. Adolescent girls who do not go on to college are more likely to smoke cigarettes than those with college plans. Girls initiate smoking for diverse reasons; it may be instrumental in attaining a desired self-image that includes feelings of maturity, independence, sexuality, health, and sociability. In addition, tobacco advertisements have exploited white, middle-class women's concerns with staying slim by emphasizing the weight-controlling benefits of smoking. Parents, peers, and friends are influential in creating norms that support or discourage smoking. Reasons for ethnic differences in smoking prevalence among adolescent females are poorly understood, but may be linked to economic and sociocultural factors. Future prevention and treatment programs targeting young women should address their reasons for smoking and identify healthful alternative behaviors that will serve psychosocial functions previously met by cigarette smoking.
Adolescent↗
Qualitative assessment of training programs for alcohol servers and establishment managers.
OBJECTIVE: In an attempt to reduce the societal burden associated with alcohol-related problems such as underage drinking and drunk driving, some local communities and state governments mandate training programs for employees of establishments that serve or sell alcoholic beverages. This study was designed to assess the available training programs for employees and managers and to identify states that either mandate training programs or encourage them by reducing establishments' legal liability. METHODS: Training programs were identified through the Internet, key informants, and the research literature. Three researchers independently rated each of 22 local and national programs across 10 categories. In addition, the authors surveyed alcoholic beverage control agencies and legislative research bureaus in the 50 U.S. states. RESULTS: The results show that training programs are not standardized and vary widely in content, use of behavior change methods, and production quality. Most programs targeted waitstaff and bartenders. Only one program exclusively targeted owners and managers. CONCLUSIONS: National standards must be developed for training programs for servers, managers, and owners.
Adolescent↗