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Health Promotion in schools, the workplace and the community. Health Psychology. Schools. Walter et al., 1985.
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Health Promotion in schools, the workplace and the community Health Psychology
Walter et al., 1985 • Some school programs have been effective. An experiment in 22 elementary schools introduced a carefully designed curriculum with emphasis on nutrition and physical fitness (Walter et al., 1985). The schools were randomly assigned so that their students either participated in the program or served as a control group.
Walter et al., 1985 • The researchers compared the two groups after a year. Relative to the control subjects, the children who participated in the program showed improvements in their blood pressure and cholesterol levels.
Edwards and Hartwell (2002) • Edwards and Hartwell (2002) investigated whether children, aged 8-11 years could correctly identify commonly available fruit and vegetables; to assess the acceptability of these; and to gain a broad understanding of children's perceptions of 'healthy eating'. Fruit and vegetables used were those readily available in retail outlets in the UK.
Edwards and Hartwell (2002) • Data were collected from 221 children using a questionnaire supported by semistructured interviews and discussions. Overall, fruit was more popular than vegetables and recognition of fruit better; melons being the least well identified.
Edwards and Hartwell (2002) • Recognition of vegetables increased with age; the least well identified being cabbage which was confused with lettuce by 32, 16 and 17% of pupils in their respective age groups. Most children (75%) were familiar with the term healthy eating, citing school (46%) as the most common source of information.
Edwards and Hartwell (2002) • Pupils showed an awareness and understanding of current recommendations for a balanced diet, although the message has become confused. If fresh fruit and vegetables are to form part of a balanced diet, the 'health message' needs to be clear.
Edwards and Hartwell (2002) • Fruit is well liked; vegetables are less acceptable with many being poorly recognized, factors which need to be addressed.
Parcel, Bruhn, & Cerreto, 1986 • Another study found that more children practiced safety behaviour if they were taught about health and safety in a 4-year program than if they were not (Parcel, Bruhn, & Cerreto, 1986).
Kolbe & Iverson, 1984 • But many schools do not provide health education at all, or their programs are under funded, poorly designed, and taught by teachers whose interests and training are in other areas (Kolbe & Iverson, 1984).
Coates et al. (1985) • Coates et al. (1985) examined the effectiveness of a 4-week school-based intervention for decreasing consumption of salty snack foods and increasing consumption of “heart healthy” snacks among African American adolescents.
Coates et al. (1985) • One hundred fifty-four students from one high school received the treatment program, whereas 130 students from another high school served as the no-treatment control group. The program incorporated parental involvement, a school wide media program, and a classroom instruction program.
Coates et al. (1985) • The classroom instruction program included setting written goals for substituting heart-healthy snacks for salty snacks. The treatment program was effective in producing reductions in salty snack foods, however, long-term changes were only significant for students who participated in the classroom instruction program that incorporated written objectives.
Bush et al. (1989) • Relatedly, Bush et al. (1989) examined the effects of a 4-year program for reducing coronary heart disease risk factors among 1,041 African American adolescents. Participants were randomly assigned to either a treatment program or a control program (no treatment).
Bush et al. (1989) • The treatment program involved goal setting, modelling, rehearsal, feedback of screening results, and reinforcement of healthful eating behaviours. Treatment participants showed significant decreases in cholesterol and blood pressure, which were maintained over a 2-year follow-up.
Perry et al. (1989) • In Perry et al’s (1989) study, younger children (ages 8—9 years) participated in either a treatment or control school-based program designed to increase healthy eating habits. The intervention program included modelling through stories and role-playing, self-monitoring of behaviours, behavioural contracting, and material rewards.
Perry et al. (1989) • Treatment participants showed significant reductions in the use of salt. Together, these studies reviewed above provide evidence that incorporating directly observable behavioural objectives—such as setting written goals, modelling behaviours, and providing feedback—can successfully result in long-term dietary change.
Staff support • Another important aspect of school-based interventions has been obtaining support from school staff (e.g., teachers) and school cafeteria providers.
Staff support • Bush et al. (1989) reported that young African American adolescents who were part of a coronary heart disease prevention program and were judged to have the best teachers showed significant decreases in total serum cholesterol at a 2-year follow-up.
Staff support • Resnicow, Cross, and Wynder (1991) also examined the effects of a comprehensive school health education program designed to decrease total cholesterol in young adolescents. They conducted three studies with a combined sample of Whites, African Americans, and Hispanics.
Staff support • The program incorporated a teacher component, a health-screening component, and extracurricular activities. The teacher component advocated decision-making, goal setting, and communication skills. The extracurricular activities included modifying the school cafeteria, developing recipe books, and holding heart-healthy bake sales.
Staff support • The intervention schools reported significantly less consumption of high-fat foods in comparison with no-treatment schools. The intervention participants also showed 4%—7% decreases in total cholesterol level across all ethnic groups.
Staff support • Although Bush et al. and Resnicow et al. did not specifically determine which components of their programs were most effective in creating dietary change, their findings do provide evidence for the importance of obtaining support from school staff and cafeteria providers when designing dietary interventions for adolescents.
Healthier food options • Other investigators have more specifically modified school cafeteria programs to provide healthier food options. Parcel, Simons-Morton, O’Hara, Baranowski, and Wilson (1989) worked with the food service personnel to institute specific goals for dietary change in several school cafeterias in Houston, Texas.
Healthier food options • Their study sample was 62% White, 2I% Mexican, 15% African American, and 2% Asian American and Native American. Participants ranged in age from 5 to 10 years.
Healthier food options • School lunches were modified to decrease the sodium content to less than 600 mg per average school lunch and to decrease the total fat to 30% and saturated fat to 100% or less of the total calories per day. New recipes were tested for taste, texture, appearance, and appeal. The results demonstrated significant decreases in the use of salt.
Healthier food options • Similarly, in a recent review by Stevens and Davis (1988) it was found that effective dietary programs modified the offerings of school cafeterias to include salad bars, fresh fruit, and whole grain breads. Continued research is needed to better understand how programs such as these might affect specific adolescent minority groups.
Pricing • French et al (2001) examined the effects of pricing and promotion strategies on purchases of low-fat snacks from vending machines. Low-fat snacks were added to 55 vending machines in a convenience sample of 12 secondary schools and 12 worksites.
Pricing • Four pricing levels (equal price, 10% reduction, 25% reduction, 50% reduction) and 3 promotional conditions (none, low-fat label, low-fat label plus promotional sign) were crossed in a Latin square design. Sales of low-fat vending snacks were measured continuously for the 12-month intervention.
Pricing • Results show that price reductions of 10%, 25%, and 50% on low-fat snacks were associated with significant increases in low-fat snack sales; percentages of low-fat snack sales increased by 9%, 39%, and 93%, respectively. Promotional signage was independently but weakly associated with increases in low-fat snack sales.
Pricing • Average profits per machine were not affected by the vending interventions. It is concluded that reducing relative prices on low-fat snacks was effective in promoting lower-fat snack purchases from vending machines used by both adult and adolescent populations.
Culturally relevant information • More recently, investigators have integrated culturally relevant information into their school-based dietary interventions. For example, Schinke, Moncher, and Singer (1994) developed a cancer risk-reduction program that included a nutrition focus on reducing fat intake and increasing such nutrients as fibre and carotene.
Culturally relevant information • The study included 368 Native American adolescents whose schools participated in either an intervention or a control program.
Culturally relevant information • The intervention involved using an interactive computer program to present information in the context of a Native American story. The story emphasised the culturally relevant traditional advantages of sound nutrition (e.g., natural and whole foods).
Culturally relevant information • A second aspect of the computer program focused on problem solving and helping adolescents to offset negative pressures within the context of the story. ‘The students received positive feedback on what they had learned through a computerised post-test.
Culturally relevant information • Students in the intervention program showed a greater increase in knowledge regarding positive dietary changes than students from schools who did not receive the intervention. This study did not include behavioural measures to determine if this acquired knowledge would generalise to adolescents’ behaviour.
Culturally relevant information • Nevertheless, this type of program may be especially effective with minority adolescents because it is culturally and developmentally appropriate and has a game like quality.
Aerobic exercise • Ewart, Loftus and Hagberg (1995) evaluated the efficacy of school-based aerobic exercise program for lowering blood pressure in a high-risk urban sample of ninth-grade African American girls. Girls in the intervention group received a one-term aerobics class of fitness instruction and training designed to be enjoyable and engaging for high-risk girls.
Aerobic exercise • Eighteen 50-min class periods involved lecture and discussion and 60 class periods were spent performing aerobic exercise. Girls assigned randomly to the control group just received the regular PE curriculum. After completing the course 81% wished to continue for another term, demonstrating their enjoyment and a developing commitment to regular exercise.
Peer-based programmes • We prefer to take advice from people like ourselves or from people who we respect. It seems reasonable to suggest, then, that health education programmes led by your peers will be more successful than programmes led by adult strangers or by teachers.
Peer-based programmes • Bachman et al. (1988) looked at a health promotion programme where students were asked to talk about drugs to each other, to state their disapproval of drugs and to say that they didn’t take drugs. The idea was to create a social norm that was against drug taking and also give people practice in saying ‘no’.
Peer-based programmes • It was claimed that the programme changed attitudes towards drugs and led to a reduction in cannabis use. A similar programme was reported by Sussman et al. (1995) who compared the effectiveness of teacher-led lessons with lessons that required student participation. The study looked at around 1000 students from schools in the US.
Peer-based programmes • Results suggested that there were significant changes in attitudes to drugs and intentions to use drugs in the active participation lessons, but not in the teacher-led lessons.
Health hazard appraisal • An example of a work-based health programme was introduced at a glass product company in Santa Rosa, California (Rodnick, 1982, cited in Feuerstein, 1986, p. 271). A ‘health hazard appraisal’ counselling session was carried out with nearly 300 employees at the company.
Health hazard appraisal • As part of the programme, full-time staff were offered a comprehensive health examination which included: • • health history • • weight and height measurement • • blood pressure measurement • • range of blood tests including: cholesterol, liver enzyme level, calcium, protein etc. • • TB skin test • • stool test • • physical examination.
Health hazard appraisal • This information was used to provide feedback on the risks of contracting various diseases including specific cancers and cardiovascular disease. About two weeks after the tests, the workers attended a group session where they received feedback about their health-risk profiles. They were also given information about hypertension, heart disease and cancer.
Health hazard appraisal • One year later the workers were tested again and the following improvements in their general health were observed: • • decrease in blood pressure (particularly in individuals with mild hypertension) • • reduction in cholesterol levels in men • • decrease in cigarette smoking • • increase in exercise • • increase in breast self-examination (BSE) • • decrease in alcohol consumption in men • • increase in seat-belt use by men.
Health hazard appraisal • A survey of over 1,300 worksites with 50 or more employees found that nearly two-thirds offered some form of health promotion activity, such as for fitness and weight control (Fielding & Piserchia, 1989). Some programs award prizes for losing weight, or pay employees for stopping smoking, or give bonuses for staying well.
