Arthur E. Hernandez

Social marketing-based communications to integrate and support the HEALTHY study intervention

The HEALTHY study was a randomized, controlled, multicenter, middle school-based, multifaceted intervention designed to reduce risk factors for the development of type 2 diabetes. The study randomized 42 middle schools to intervention or control, and followed students from the sixth to the eighth grades. Participants were a racially, ethnically and geographically diverse cohort from across the United States. Here, we describe the conceptual underpinnings and design of the social marketing-based communications component of the HEALTHY study intervention that combined changes in the school nutrition and physical education (PE) environment with behavior change initiatives. The communications intervention component coordinated multiple elements to deliver campaigns that served to integrate and support all aspects of the HEALTHY intervention. The campaigns unfolded across five semesters of middle school, each targeting a specific theme related to the HEALTHY objectives. Communications campaigns comprised (1) core elements such as branding, posters, banners and visual and verbal messaging, (2) student events supporting the nutrition, PE and behavior intervention components through the application of social marketing and communications strategies, including the incorporation of student-generated media and (3) distribution of premiums and theme enhancers to extend the visibility of the study beyond the intervention environment. Formative research conducted with students, parents and school administrators was used to refine the communications strategy. Student peer communicators selected from the student body were involved to influence the normative student environment. Marketing and creative design experts developed a brand, logo, activities and materials. In the latter half of the study, student-generated messages and media were used to reflect local interests and culture and enhance peer influence. The HEALTHY intervention delivery and impact were strengthened by the communications strategies. The HEALTHY experience provides practical considerations for systematically incorporating a social marketing-based communications approach within future school-based health behavior interventions.

Effect of the Bienestar Health Program on Physical Fitness in Low-Income Mexican American Children.

Once considered an adult onset disease, type 2 diabetes is increasingly being diagnosed in low-income Mexican American children. Studies have suggested that most of those so diagnosed were overweight, reported low levels of physical activity, and were generally unaware of their disease. The Bienestar Health Programwas designed to reduce risk factors associated with the onset of type 2 diabetes. A major focus of the curriculum is health and physical education. A comparison of intervention and control group students resulted in a significant difference in physical fitness change scores (p < .003) after an 8-month intervention. This study suggests that it is possible to improve the physical fitness of low-income Mexican American preadolescent children through a comprehensive school-based health program.

Identifying Barriers That Hinder Onsite Parental Involvement in a School-Based Health Promotion Program

We investigated whether barriers to onsite parental involvement in the Bienestar Health Program Parent Component could be identified and whether participation rates could be increased by addressing these barriers. All nonparticipating parents of fourth-grade students of San Antonio Independent School District from 4 schools, which were selected randomly from 20 intervention schools in Bienestar, were invited to take part in this study. A total of 47 of 223 (21%) parents engaged in one of four focus groups offered. Parents identified barriers to their involvement in Bienestar that fit into five descriptive categories: (a) low value, (b) high cost, (c) competing family demands, (d) concerns about the program design, and (e) social role norms. The Bienestar Parent Component was then modified according to the focus group findings, which resulted in a marked increase in parental involvement from 17% to 37% overall. These findings suggest that even when parents are involved in the initial design of parent-friendly and culturally sensitive programs, as was the case for Bienestar, maximizing parental involvement may require additional assessment, identification, and remediation of barriers.

Do Role Models Influence Self Efficacy and Aspirations in Mexican American at-Risk Females?

This study examined changes in levels of self efficacy and aspiration among participants in role model activities of the Hispanic Mother-Daughter Program. The results suggest caution about the use ofself-reportfeedbackfor evaluative purposes, and the manner in which role models are used as means for inspiring confidence in general, or affecting levels of self efficacy or aspirations in particular.

Intergenerational Academic Aspirations of Mexican-American Females: An Examination of Mother, Daughter, and Grandmother Triads:

This exploratory case study is designed to provide information regarding the trigenerational aspirations of Mexican-American women. The study specifically examines each mothers role in relation to her daughters academic aspiration. Nine mother, daughter, and grandmother triads were interviewed and administered questionnaires. Variables examined include: (a) family characteristics, (b) career aspirations, (c) support of academic aspirations, (d) feelings of self-esteem, and (e) educational attainment and aspirations. Results indicate major factors associated with daughters academic levels of aspiration are: mothers encouragement, importance of daughters education to mother, and mothers aspiration of academic levelfor daughter.

Development of new physical activity and sedentary behavior change self-efficacy questionnaires using item response modeling

BackgroundTheoretically, increased levels of physical activity self-efficacy (PASE) should lead to increased physical activity, but few studies have reported this effect among youth. This failure may be at least partially attributable to measurement limitations. In this study, Item Response Modeling (IRM) was used to develop new physical activity and sedentary behavior change self-efficacy scales. The validity of the new scales was compared with accelerometer assessments of physical activity and sedentary behavior.MethodsNew PASE and sedentary behavior change (TV viewing, computer video game use, and telephone use) self-efficacy items were developed. The scales were completed by 714, 6th grade students in seven US cities. A limited number of participants (83) also wore an accelerometer for five days and provided at least 3 full days of complete data. The new scales were analyzed using Classical Test Theory (CTT) and IRM; a reduced set of items was produced with IRM and correlated with accelerometer counts per minute and minutes of sedentary, light and moderate to vigorous activity per day after school.ResultsThe PASE items discriminated between high and low levels of PASE. Full and reduced scales were weakly correlated (r = 0.18) with accelerometer counts per minute after school for boys, with comparable associations for girls. Weaker correlations were observed between PASE and minutes of moderate to vigorous activity (r = 0.09 – 0.11). The uni-dimensionality of the sedentary scales was established by both exploratory factor analysis and the fit of items to the underlying variable and reliability was assessed across the length of the underlying variable with some limitations. The reduced sedentary behavior scales had poor reliability. The full scales were moderately correlated with light intensity physical activity after school (r = 0.17 to 0.33) and sedentary behavior (r = -0.29 to -0.12) among the boys, but not for girls.ConclusionNew physical activity and sedentary behavior change self-efficacy scales have fewer items than classical test theory derived alternatives and have reasonable validity for boys, but more work is needed to develop comparable scales for girls. Fitting the items to a underlying variable could be useful in tailoring interventions to this scale.

Accuracy of self-reported energy intakes in low-income urban 4th grade minority children

We examined the accuracy of self‐reported energy intake (rEI) in low‐income, urban minority school‐aged children at risk for obesity and associated diabetes utilizing a relatively new, simple previously published prediction equation for identifying inaccurate reports of dietary energy intake. Participants included 614 nine‐year‐old boys (51%) and girls (49%). Three 24‐h dietary recalls were collected. Childrens height, weight (used to calculate BMI), and percent body fat (%BF) were measured. Physical fitness, reported family history of diabetes, and ethnicity were also collected. A previously published prediction equation was used to determine the validity of rEIs in these children to identify under‐, plausible‐, and over‐reporters. Additionally, we examined the question of whether there is a difference in reporting by sex, ethnicity, BMI, and %BF. On average, 18% of the children were at risk of being overweight, 43% were already overweight at baseline, yet these children reported consuming fewer calories on average than recommended guidelines. Additionally, reported caloric intake in this cohort was negatively associated with BMI and %BF. Using the previously described methods, 49% of participants were identified as under‐reporters, whereas 39 and 12% were identified as plausible‐ and over‐reporters, respectively. On average, children reported caloric intakes that were almost 100% of predicted energy requirement (pER) when the sedentary category was assigned. Inactivity and excessive energy intake are important contributors to obesity. With the rising rates of obesity and diabetes in children, accurate measures of energy intake are needed for better understanding of the relationship between energy intake and health outcomes.

The Early ON School Readiness Project: A Preliminary Report.

Abstract The Early ON School Readiness Project is an emerging community-based model aimed at promoting the school readiness of 3- to 5-year-old children in a metropolitan area with a predominantly Latino (Mexican-American) population. Using an ecological approach, the multi-component program seeks to enhance school readiness opportunities for children at various levels. Key program components aim to improve community awareness, parent education, professional development for child care teachers, quality of child care environments, and transition to school. The model evolved through a community partnership initiated by the local government, involving nonprofit agencies and a university partnership. Child care environmental quality was measured by administration of the Early Childhood Environment Rating Scale-Revised Edition (ECERS-R; Harms, Clifford, & Cryer, 1998). To measure childrens progress, the Developmental Indicators for the Assessment of Learning-Third Edition (DIAL-3; Mardell-Czudnowski & Goldenberg, 1998) was administered in the fall and spring of two consecutive school years. A sample of children was screened to gain insight regarding the developmental status of children in the project compared to a matched sample of children not involved in the project. Preliminary findings show the progress of children in key developmental areas during the initial and second year of program implementation in selected child care centers. In the baseline year, standard scores of children at the comparison sites were unchanged from fall to spring in all of the developmental areas measured by the DIAL-3; scores at the intervention sites, however, were higher at a statistically significant level for two subtests and the composite score. During the second year, all subtest scores and the composite scores were higher at the intervention sites in the spring as compared to the fall. Although additional research is needed, preliminary results suggest the emerging model shows promise for increasing childrens developmental skills and abilities associated with school readiness.

Physician-assisted suicide attitudes of older Mexican-American and non-Hispanic white adults: does ethnicity make a difference?

Little is known about attitudes toward physician‐assisted suicide (PAS) in various ethnic groups. This study compares attitudes held by older Mexican Americans and non‐Hispanic whites and examines subject characteristics that may influence their responses. A convenience sample of 100 older Mexican Americans and 108 non‐Hispanic whites (n=208) aged 60 to 89 were recruited from four primary care community‐based practice sites in San Antonio, Texas. Interview items measured attitudes toward PAS, cognitive status, functional status, and religiosity.

A Comparison of Kaufman Assessment Battery for Children Reliability for Mexican-Americans and Non-Hispanic Whites:

Reliability estimates were calculated for the Mexican-American and non-Hispanic White standardization samples at eleven age levels on the Kaufman Assessment Battery for Children using computed variance components. These estimates were compared as ratios of error variances and evaluated using F distributions. Ratios for the two groups at all age levels proved to be nonsignificant, indicative of statistically equivalent reliabilities for the two groups. Coefficients were, with two exceptions, similar in magnitude. Although nota proof of nonbias, this demonstration supports the notion that error in this instance is a function that is constant across groups.