Alyssa M. Lederer

Implementation and Evaluation of the HEROES Initiative A Tri-State Coordinated School Health Program to Reduce Childhood Obesity

This article describes the design, implementation, and evaluative findings of the HEROES (Healthy, Energetic, Ready, Outstanding, Enthusiastic, Schools) Initiative, a school-based multilevel childhood obesity prevention intervention. Based on the Centers for Disease Control and Prevention’s recommended coordinated school health approach, the HEROES Initiative works to alleviate the burden of childhood obesity in Southern Indiana, Northwestern Kentucky, and Southeastern Illinois in the United States. Process evaluation was conducted with the 17 participating schools in spring 2012 based on interviews with school personnel and observation of the school environment. Findings showed that despite some variability, schools were generally able to implement the intervention with fidelity. School-level outcome evaluation was also based on observation of the school environment, and revealed that schools had implemented a number of new practices to encourage physical activity and healthy eating. Assessment of student-level outcomes was based on professionally collected physiological measurements and self-reported behavioral data collected over an 18-month period of time, last collected in spring 2012. Findings demonstrated that the HEROES Initiative has been successful in reducing the percentage of overweight children in participating schools and healthfully modifying their dietary, physical activity, and sedentary behaviors. Strategies that have facilitated success and challenges related to the intervention are discussed.

Long-term predictors of blood pressure among adolescents during an 18-month school-based obesity prevention intervention.

PURPOSE To evaluate the effectiveness of the HEROES (Healthy, Energetic, Ready, Outstanding, Enthusiastic Schools) initiative, a multicomponent school-based obesity prevention intervention based on the Centers for Disease Control and Preventions coordinated school health approach, on the improvement of blood pressure (BP) and to determine long-term predictors of systolic and diastolic BP changes among high school students who were exposed to the intervention. METHODS Biometric and behavioral data from high school students were analyzed at baseline, 6, 12, and 18 months (N = 847, three schools). The attrition rate at 18 months was 26.1%. Sequential generalized estimating equation models were fit to the data using SAS 9.3, taking into account clustering effects within the same school and correlations within repeated measures. RESULTS A significant downward trend was observed in systolic BP (p = .0006) and diastolic BP (p < .0001) among the students who were exposed to the HEROES initiative. The prevalence of hypertension decreased from 17.1% at baseline to 12.8% at 6 months (p < .0001), 12.0% at 12 months (p < .0001), and 15.0% (p = .0024) at 18 months. Baseline body mass index, increases in body mass index percentiles, and increases of television-viewing hours were associated with BP increases. Increases in frequencies of eating french fries or chips, skipping breakfast, and consuming supersize meals when eating fast food were predictive of systolic BP changes, not of diastolic BP changes. CONCLUSIONS An 18-month multicomponent school-based obesity intervention program may be effectively used to decrease rates of high BP among adolescents.

The Impact of Family Rules on Children's Eating Habits, Sedentary Behaviors, and Weight Status

BACKGROUND Family rules may be influential in helping children to modify their dietary and sedentary behaviors, which are important modifiable risk factors for childhood obesity. However, data examining family rules in relation to childrens health behaviors and weight status are limited. METHODS This cross-sectional study examined differences in family rules by demographic characteristics of students enrolled in the HEROES (Healthy, Energetic, Ready, Outstanding, Enthusiastic Schools) Initiative, a school-based childhood obesity prevention program. It also investigated the relationship between eating and screen time family rules and six eating and screen time behaviors: fast food consumption; soft drink consumption; fruit and vegetable intake; television viewing; computer use; and video game use, in addition to the association between family rules and childrens weight status. Measures included self-reported behavioral data and anthropometric data from students in fourth to eighth grade at 16 schools (N=2819) in a tri-state area of the United States in spring 2012. RESULTS Approximately one-third of students had each of the family rules examined. Whereas the profile of students who had specific rules varied, in general, younger, female, white, and low socioeconomic status students were more likely to have rules than their counterparts. Family rules were associated with healthier outcomes for each of the six behaviors examined (p<0.001), even after controlling for demographics (p<0.001). However, family rules were not associated with childrens weight status. CONCLUSIONS This study demonstrates that family rules are an underutilized strategy to promote healthier eating habits and reduce childrens screen time hours and may serve as an intermediary mechanism to curb childhood obesity.

Determinants of middle-school students asking parents for fruits and vegetables: a theory-based salient belief elicitation

OBJECTIVE Despite the benefits of fruit and vegetable intake, many young Americans do not consume them at adequate levels. The present study sought to determine the beliefs that children have about asking their parents to have fruits and vegetables available at home in order to better understand the role children may play in influencing their own fruit and vegetable consumption. DESIGN An instrument utilizing the Reasoned Action Approach, with closed-ended questions on demographic and behavioural variables and open-ended questions eliciting the belief structure underlying asking parents to make fruits and vegetables available, was distributed. Thematic and frequency analyses were performed for open-ended questions. Statistical analyses were conducted to assess differences between children who had v. had not asked for fruits and vegetables. SETTING Three middle schools in rural Indiana, U.S.A. SUBJECTS A sub-sample of sixty students aged 12–15 years from a larger study of 344 students. RESULTS Qualitative analysis identified benefits (i.e., make me healthier; make parents happy), disadvantages (i.e., will upset my parents) and strategies (i.e., asking when you are at the store) that could be used to improve fruit and vegetable intake. Findings also revealed that students who asked their parents for fruits and vegetables were significantly more likely to perform several healthy eating and physical activity behaviours. CONCLUSIONS Data suggest that young people’s view of parental reactions is critical. While additional research is necessary, the findings support a role for children in shaping their own environment and suggest multilevel interventions that simultaneously address parents and children.

Beliefs about Meditating among University Students, Faculty, and Staff: A Theory-Based Salient Belief Elicitation.

Abstract Objective: Stress impacts college students, faculty, and staff alike. Although meditation has been found to decrease stress, it is an underutilized strategy. This study used the Reasoned Action Approach (RAA) to identify beliefs underlying university constituents’ decision to meditate. Participants: N = 96 students, faculty, and staff at a large midwestern university during spring 2012. Methods: A survey measured the RAA global constructs and elicited the beliefs underlying intention to meditate. Thematic and frequency analyses and multiple regression were performed. Results: Quantitative analyses showed that intention to meditate was significantly predicted (R2 = .632) by attitude, perceived norm, and perceived behavioral control. Qualitative analyses revealed advantages (eg, reduced stress; feeling calmer), disadvantages (eg, takes time; will not work), and facilitating circumstances (eg, having more time; having quiet space) of meditating. Conclusions: Results of this theory-based research suggest how college health professionals can encourage meditation practice through individual, interpersonal, and environmental interventions.