Biomedical subjects

G S Parcel

Publications and source records attributed to G S Parcel.

At least 37 records · Page 2Linked to original sources

PubMed1997

Self-management of cystic fibrosis: short-term outcomes of the Cystic Fibrosis Family Education Program.

This study tested the efficacy of the Cystic Fibrosis Family Education Program, a cystic fibrosis self-management program, on improving participants' knowledge, self-efficacy, self-management behavior, health, and quality of life. A quasi-experimental pretest-posttest nonequivalent comparison group design was employed. Participants made up 104 patient-primary caregiver dyads from the intervention site cystic fibrosis center and 95 from the usual care comparison center. The intervention, a self-paced print curriculum based on social cognitive theory, targeted behavioral capability, self-efficacy, and outcome expectations and was implemented as an integral part of medical care. Parents, early childhood, middle childhood, and adolescents received separate materials on respiratory, nutrition and malabsorption, communication, and coping issues. Significant intervention effects were found on the knowledge scores for caregivers, adolescents, and children; caregiver and adolescent total self-management scores; Child Behavior Checklist total score; one parent coping scale score; the modified NIH score; NIH pulmonary factor 1; and the Brasfield total score. Significant interaction effects were evident in the self-efficacy scores for caregivers and children.

Adolescent↗

PubMed1997

The Child and Adolescent Trial for Cardiovascular Health (CATCH): intervention, implementation, and feasibility for elementary schools in the United States.

The Child and Adolescent Trial for Cardiovascular Health (CATCH) was the largest school-based field trial ever sponsored by the National Institutes of Health. The trial demonstrated positive changes in the school food service and physical education program, as well as in students' cardiovascular health behaviors. Because the CATCH intervention programs were implemented in 56 schools (in four states) that were typical of schools throughout the United States, their reception by schools and degree of implementation provide evidence about their feasibility for schools nationally. Extensive process evaluation data were collected from students, teachers, school food service personnel, and physical education specialists throughout the three school years of the CATCH intervention. Four of the CATCH programs--school food service, physical education, classroom curricula, and home programs--were assessed over the three school years. The process data provide information on participation, dose, fidelity, and compatibility of the CATCH programs in the intervention schools for these programs. High levels of participation, dose, fidelity, and compatibility were observed for the four programs during the 3 school years. CATCH emerges as a model of a feasible multilevel health promotion program to improve eating and exercise behaviors for elementary schools in the United States.

Adolescent↗

PubMed1997

Parent and physician response to children's cholesterol values of 200 mg/dL or greater: the Child and Adolescent Trial for Cardiovascular Health Experiment.

OBJECTIVE: To determine parental actions and concerns and physician responses to parental notification that a child's cholesterol value was 200 mg/dL or greater, a value recommended by the National Cholesterol Education Program to warrant physician follow-up and evaluation. METHODOLOGY: A telephone survey of parents (n = 784) and physicians (n = 117) was carried out after parental notification of a total blood cholesterol value obtained as part of measurement done while participating in the Child and Adolescent Trial for Cardiovascular Health in 96 schools located in California, Louisiana, Minnesota, and Texas. RESULTS: Only 20% of parents contacted physicians. Factors associated with this action included whether the parent was notified once or twice, the level of the cholesterol, previous cholesterol testing in the parent, and medical insurance that covered the visit. Family history of cardiovascular disease, when other factors were considered, did not increase the likelihood that a physician contact would be made. After contact with the physician, 59% of physicians reported evaluating children for cholesterol; about half reported repeating the cholesterol determination. CONCLUSION: Parental knowledge of a child's cholesterol value of 200 mg/dL or greater did not result in substantially further seeking of health care.

Adolescent↗

PubMed1996

Outcomes of a field trial to improve children's dietary patterns and physical activity. The Child and Adolescent Trial for Cardiovascular Health. CATCH collaborative group.

OBJECTIVE: To assess the outcomes of health behavior interventions, focusing on the elementary school environment, classroom curricula, and home programs, for the primary prevention of cardiovascular disease. DESIGN: A randomized, controlled field trial at four sites with 56 intervention and 40 control elementary schools. Outcomes were assessed using prerandomization measures (fall 1991) and follow-up measures (spring 1994). PARTICIPANTS: A total of 5106 initially third-grade students from ethnically diverse backgrounds in public schools located in California, Louisiana, Minnesota, and Texas. INTERVENTION: Twenty-eight schools participated in a third-grade through fifth-grade intervention including school food service modifications, enhanced physical education (PE), and classroom health curricula. Twenty-eight additional schools received these components plus family education. MAIN OUTCOME MEASURES: At the school level, two primary end points were changes in the fat content of food service lunch offerings and the amount of moderate-to-vigorous physical activity in the PE programs. At the level of the individual student, serum cholesterol change was the primary end point and was used for power calculations for the study. Individual level secondary end points included psychological factors, recall measures of eating and physical activity patterns, and other physiologic measures. RESULTS: In intervention school lunches, the percentage of energy intake from fat fell significantly more (from 38.7% to 31.9%) than in control lunches (from 38.9% to 36.2%)(P<.001). The intensity of physical activity in PE classes during the Child and Adolescent Trial for Cardiovascular Health (CATCH) intervention increased significantly in the intervention schools compared with the control schools (P<.02). Self-reported daily energy intake from fat among students in the intervention schools was significantly reduced (from 32.7% to 30.3%) compared with that among students in the control schools (from 32.6% to 32.2%)(P<.001). Intervention students reported significantly more daily vigorous activity than controls (58.6 minutes vs 46.5 minutes; P<.003). Blood pressure, body size, and cholesterol measures did not differ significantly between treatment groups. No evidence of deleterious effects of this intervention on growth or development was observed. CONCLUSION: The CATCH intervention was able to modify the fat content of school lunches, increase moderate-to-vigorous physical activity in PE, and improve eating and physical activity behaviors in children during 3 school years.

Analysis of Variance↗

PubMed1996

Structure of health risk behavior among high school students.

The authors test the contention of R. Jessor's (1977) problem behavior theory that adolescent health risk behaviors comprise a single behavioral syndrome. Multidimensional scaling (MDS) and cluster analysis are used to analyze data from a statewide survey of high school students' (n = 5,537) health risk behaviors. A classical MDS analysis was calculated to test the dimensionality of the behaviors. All indicators supported a multidimensional model. An individual-differences MDS (INDSCAL) analysis revealed that a 4-dimensional solution best fit the data, with gender and racial-ethnic differences emerging in the relative salience of the dimensions. The INDSCAL dimensional coordinates for each health risk behavior were then submitted to a hierarchical cluster analysis technique. Five behavioral clusters were identified, 1 of which included many of the traditional "problem behaviors," such as smoking, unprotected sexual intercourse, and alcohol consumption. These findings support a multidimensional structure underlying adolescent health risk behavior. Implications for theory and prevention of health risk behaviors are discussed.

Adolescent↗

PubMed1996

Planned development and evaluation of AIDS/STD education for secondary school students in The Netherlands: short-term effects.

This study evaluated the effects of an AIDS/STD curriculum for 9th- and 10th-grade students in the Netherlands. Curriculum development was based on (1) theory-based need assessments among students and teachers, (2) pilot testing of data-based and theory-based methods and materials, and (3) cooperation between researchers and students, teachers, and gatekeepers within the school system. Using a quasi-experimental design, program effects on students' attitudes, beliefs, and sexual behavior were compared with those of current AIDS/STD education practice. The results indicated that the experimental curriculum had a stronger favorable impact on students' attitudes and beliefs regarding using condoms consistently. Regarding sexual risk behavior, a differential curriculum effect could be demonstrated. These findings support the contention that current AIDS/STD education can be improved by (1) using empirical data, (2) applying multiple theories from the social sciences, and (3) involving representatives within the school system in the development process.

Acquired Immunodeficiency Syndrome↗

PubMed1995

Cardiovascular risk factors among third grade children in four regions of the United States. The CATCH Study. Child and Adolescent Trial for Cardiovascular Health.

Data on cardiovascular risk factors (body mass index, triceps and subscapular skinfolds, blood pressure, serum total cholesterol, high density lipoprotein (HDL) cholesterol, and apolipoprotein B) were collected as part of the baseline examination (fall 1991) of the Child and Adolescent Trial for Cardiovascular Health, a multicenter school-based intervention study for promoting healthful behaviors. A total of 5,106 third grade children (mean age, 8.76 years) in four states (California, Louisiana, Minnesota, and Texas) were examined. After excluding 194 children of other or unknown origin, the study population consisted of 3,530 Anglo-American children, 674 African-American children, and 708 Latino children. African-American children were the tallest by 1-3 cm (p < 0.0001), while Latino children had the largest body mass index (p < 0.05). Blood pressure levels were similar for boys and girls and among the three races, but systolic levels were 2 mmHg higher in Texas than at the other sites. Serum total cholesterol levels were 5 mg/dl higher in girls than in boys (p < 0.05), while HDL cholesterol levels were 2 mg/dl higher in boys (p < 0.05). HDL cholesterol levels were highest in African-Americans (55.5 mg/dl) compared with Anglo-Americans (50.7 mg/dl) and Latinos (51.3 mg/dl) (p < 0.0001).

Analysis of Variance↗

PubMed1995

The co-morbidity of violence-related behaviors with health-risk behaviors in a population of high school students.

PURPOSE: To describe the frequency of violence-related behaviors and their association with other health behaviors among high school students. METHODS: The Youth Risk Behavior Survey was administered to all ninth and eleventh graders (n = 2075) of a school district in Texas. It provided information regarding violence-related behaviors and other health behaviors. Students were classified into four mutually exclusive, violence-related categories according to whether they were involved in a physical fight and/or carried a weapon. RESULTS: Overall, 20% of the students were involved in a physical fight but had not carried a weapon, 10% carried a weapon but had not been involved in a physical fight, and 17% had been involved in a physical fight and had carried a weapon. Prevalence of weapon-carrying and fighting were higher among males than females, and among ninth graders than eleventh graders. Among males, 48% had carried a weapon the month prior to the survey. Students who both fought and carried a weapon were 19 times more likely to drink alcohol six or more days than students who did not fight nor carried a weapon. Logistic regression analyses showed that drinking alcohol, number of sexual partners, and being in ninth grade were predictors of fighting. These three variables plus having a low self-perception of academic performance and suicidal thoughts were predictors of fighting and carrying a weapon. CONCLUSIONS: The data indicate that violence-related behaviors are frequent among high school students and that they are positively associated with certain health behaviors. Interventions designed to reduce violence should also address coexisting health-risk behaviors and target high-risk groups.

Adolescent↗

PubMed1995

Violence prevention in middle schools: a pilot evaluation.

PURPOSE: To evaluate the effect of a violence prevention curriculum and of trained peer leaders on self-reported aggressive behaviors, knowledge about violence and conflict-resolution skills, self-efficacy, and attitudes among 223 6th graders. METHODS: The effect of two intervention groups (violence prevention curriculum taught by the teacher with or without the assistance of trained peer leaders) and one control group were compared. Ten 6th grade classes (four control and six intervention classes) of four middle schools participated in the study. Students were evaluated before and shortly after the implementation of the curriculum, as well as 3 months later. RESULTS: The intervention reduced self-reported aggressive behaviors among boys, but this reduction was significant only in two of the six intervention classes. Both interventions had an overall significant effect on increasing knowledge about violence and skills to reduce violence. After the intervention, students also developed a more negative attitude toward responding violently when provoked. Attitude change was stronger among students from the teacher plus peer leader group. No intervention effect was observed on self-efficacy nor on attitudes toward skills to reduce violence. Changes were not maintained over time. CONCLUSIONS: Results emphasize the need for continuous and comprehensive interventions, follow-up evaluations, and careful selection of peer leaders. Aggressive behaviors, not knowledge alone, should be used as the main dependent variable.

Adolescent↗

PubMed1995

Zidovudine adherence among individuals with HIV infection.

The objective was to investigate the relationships among health beliefs, attitudes, and zidovudine compliance in individuals with HIV infection. A survey was administered to 52 individuals with HIV infection. The survey items, which reflected concerns expressed about zidovudine, were generated based on barriers to and benefits of zidovudine and the perceived susceptibility to and perceived severity of HIV as described by the health belief model (HBM). These items were expressed as attitudes and beliefs. Items were subjected to factor analysis, and survey results were correlated with laboratory data to predict adherence to their prescribed medication-taking regimen. Data indicated that 42.3% of the subjects were compliant with zidovudine. Factor analysis identified four dimensions: problems taking and scepticism about zidovudine; degree of concern about HIV; perceived severity of HIV; and physical barriers to taking zidovudine. Logistic regression analysis (forward conditional entry) identified those who were having problems taking zidovudine and who were sceptical about its effectiveness, and ethnicity as significant independent predictors of compliance, correctly classifying 75% of cases (p < 0.01). The fact that subjects who have problems taking zidovudine or are sceptical about the value of zidovudine are less compliant, and that this dimension is a significant predictor of compliance, suggests that non-compliance is related to attitudes and beliefs about zidovudine. This is consistent with the HBM, which holds that the balance between barriers and benefits of a health-related behaviour are significant determinants of outcome.

Adult↗

PubMed1995

Diffusion of an effective tobacco prevention program. Part I: Evaluation of the dissemination phase.

As health promotion methods are proven effective, the diffusion and widespread implementation of successful programs can significantly reduce behaviors that pose risks to health within a targeted population. The Smart Choices Diffusion Project developed and evaluated a dissemination intervention program that targeted 128 school districts in east Texas. The project employed a theory-based model to disseminate information about a proven tobacco prevention program to opinion leaders in each district. These opinion leaders were asked to personally communicate the program information within their district using a videotape and printed materials, and advocate for program adoption. In addition to personal communication, a newsletter linked school districts. Opinion leaders in 52% of the districts showed the videotape, which modeled program adoption. A quasi-experimental design was used to evaluate the impact of the dissemination phase on teachers' and administrators' readiness to adopt a tobacco prevention program. Evaluation of the dissemination phase revealed no differences between the intervention and comparison districts in a district's readiness to adopt a tobacco prevention program. However, in intervention districts where school administrators viewed the videotape, the administrators were more likely to perceive the innovative program as having a relative advantage and to perceive their district's organizational and social environment as supportive of adopting the program.

Administrative Personnel↗

PubMed1995

Diffusion of an effective tobacco prevention program. Part II: Evaluation of the adoption phase.

This paper presents the results of theory-based intervention strategies to increase the adoption of a tobacco prevention program. The adoption intervention followed a series of dissemination intervention strategies targeted at 128 school districts in Texas. Informed by Social Cognitive Theory, the intervention provided opportunities for districts to learn about and model themselves after 'successful' school districts that had adopted the program, and to see the potential for social reinforcement through the knowledge that the program had the potential to have an important influence on students' lives. The proportion of districts in the Intervention condition that adopted the program was significantly greater than in the Comparison condition (P < 0.001). Stepwise logistic regression indicated that the variables most closely related to adoption among intervention districts were teacher attitudes toward the innovation and organizational considerations of administrators. Recommendations for the development of effective strategies for the diffusion of innovations are presented.

Administrative Personnel↗

PubMed1995

Measurement of self-efficacy for diet-related behaviors among elementary school children.

Health promotion interventions intended to improve dietary behavior frequently incorporate self-efficacy as a construct to enhance behavior change. This paper presents results from a study to establish psychometric properties of a scale to measure children's self-efficacy for selecting healthful food. As part of a series of pilot studies to develop instrumentation for the Child and Adolescent Trial for Cardiovascular Health (CATCH), data were collected on third and fourth grade students (n = 1,127). Data analyses were conducted to estimate internal consistency, test-retest reliability, factorial validity, and criterion related validity. Results revealed acceptable estimates of internal consistency for the dietary self-efficacy scale (coefficient alpha = .84). Self-efficacy was strong associated with the children's usual food choices, accounting for about 34% of variance (Multiple R = .58). Findings support using such an instrument for evaluating intervention programs addressing nutrition behavior and for studies to determine the association of self-efficacy to dietary behavior or related constructs.

Child↗

PubMed1995

A comprehensive approach to school health program needs assessments.

An assessment of health promotion needs represents a fundamental step for developing comprehensive school health programs. This project developed and tested an approach for school districts to use when conducting a district-wide needs assessment of school health programs. The approach assumes a needs assessment should be multidimensional and comprehensive. Seven priority health-related behaviors were included as well as eight components of a school health program identified by Kolbe. This paper describes each aspect of the needs assessment, discusses the importance of perspectives provided by each component, and provides recommendations for districts interested in conducting an assessment.

Adolescent↗

PubMed1995

Diffusion of AIDS curricula among Dutch secondary school teachers.

This study reports data from a sample of 698 Dutch secondary school teachers intending to provide classroom AIDS education. The study addresses determinants of awareness knowledge about and adoption of four nationally disseminated AIDS curricula. The results indicated that knowledge acquisition was largely dependent on diffusion networks within schools. Transition from awareness knowledge to adoption appeared to be mediated by perceived instrumentality, subjective norms, perceived colleague behavior, and teachers' sexual morality. Preferences for using one curriculum rather than another were related to the same variables, although financial costs became slightly more important. It is concluded that effective dissemination strategies should combine (1) development of validated materials with clear instruction for implementation, (2) focused mass media communication, (3) close collaboration of curriculum designers, linking agents, and teachers, and (4) access to in-person assistance.

Acquired Immunodeficiency Syndrome↗

PubMed1994

Implementation of a physician education intervention. The Childhood Asthma Project.

OBJECTIVES: To increase pediatric residents' knowledge of the Guidelines for the Diagnosis and Management of Asthma (GDMA) developed by the Expert Panel of the National Asthma Education Program and to increase the residents' confidence in their ability to implement these guidelines. Emphasis was placed on the diagnosis and treatment of Hispanic children with asthma, a population at increased risk for morbidity. SETTING: A continuity care clinic located in an urban ambulatory care facility. SUBJECTS: Forty-four pediatric residents: 17 first-year residents, 15 second-year residents, and 12 third-year residents. METHODS: Residents participated in a multicomponent asthma management curriculum that stressed active learning strategies, including the following: focus groups, computer-based testing, lectures, hands-on skill development seminars, role modeling by attending pediatricians, provision of GDMA pocket cards and posters, access to peak flowmeters and spirometry, and an interactive computer-based module. Content focused on pulmonary function testing with spirometry and peak flowmeters, stepwise use of medications, recognition of asthma symptoms and triggers, and cultural considerations that impact asthma management. Pediatric faculty and fellows also participated in a series of asthma seminars to increase the likelihood that faculty would role model the GDMA and provide appropriate feedback to residents. RESULTS: Pediatric residents demonstrated significant increases in knowledge about evaluation of asthma, pulmonary function testing, and clinical management, displayed significantly enhanced levels of confidence, and were enthusiastic about the asthma management curriculum, rating it significantly higher than 15 other content areas in the general pediatric curriculum.

Ambulatory Care Facilities↗

PubMed1994

Self-management of cystic fibrosis: a structural model for educational and behavioral variables.

One hundred and ninety-nine patients and their primary caregivers at two metropolitan cystic fibrosis centers participated in a clinical trial to evaluate the effectiveness of a health education program designed to help improve self-management skills for the care of CF. The baseline data from the study was used to test a structural model that hypothesized the relationship between educational, behavioral, and health status variables. Controlling for the effects of all other variables, including demographic, self-efficacy (confidence in being able to perform a behavior) was the most important educational factor predicting self-management behavior for monitoring and treating respiratory problems. Knowledge about the management of CF was only related to the ability of caretakers to apply coping skills to problems associated with CF. The more caretakers reported performing monitoring behaviors the more likely they were to report performing self-management treatment behaviors. The findings suggest that educational interventions that focus on increased knowledge alone are not likely to be effective in improving self-management behavior for CF. Based on the structural model analyses, it is recommended that educational programs for CF patients and families address increased self-efficacy and improved monitoring skills to influence the improvement of self-management treatment for CF.

Adaptation, Psychological↗

PubMed1994

The effect of two types of teacher training on implementation of Smart Choices: a tobacco prevention curriculum.

This study examined the implementation phase of a four-year research project to test the effectiveness of strategies to increase diffusion of Smart Choices, a school-based tobacco prevention program. The impact on curriculum implementation of two approaches to teacher training are compared. School districts were randomly assigned to a live workshop training or video training condition. The outcome of the evaluation was teachers' implementation of Smart Choices. Results show a lower proportion of video-trained teachers implemented the curriculum, but overall completeness and fidelity of implementation for those teachers who did teach the curriculum were comparable for the two groups. Video-trained teachers, however, were less likely to use brainstorming and student presentations/role plays, two of the methods prescribed by the curriculum. Implications of the results for teacher training are discussed.

Adolescent↗