Karen L. Senn

A Family Approach to Cardiovascular Risk Reduction: Results from The San Diego Family Health Project:

The effectiveness of a family-based cardiovascular disease risk reduction intervention was evaluated in two ethnic groups. Participants were 206 healthy, volunteer low-to-middle-income Mexican-American and non-Hispanic white (Anglo-American) families (623 individuals), each with a fifth or a sixth-grade child. Families were recruited through elementary schools. Half of the families were randomized to a year-long educational intervention designed to decrease the whole familys intake of high salt, high fat foods, and to increase their regular physical activity. Eighty-nine percent of the enrolled families were measured at the 24-month follow-up. Both Mexican- and Anglo-American families in the experimental groups gained significantly more knowledge of the skills required to change dietary and exercise habits than did those in the control groups. Experimental families in both ethnic groups reported improved eating habits on a food frequency index. Anglo families reported lower total fat and sodium intake. There were no significant group differences in reported physical activity or in tested cardiovascular fitness levels. Significant differences for Anglo-American experimental vs. control adult subjects were found for LDL cholesterol. Significant intervention-control differences ranging from 2.2 to 3.4 mmHg systolic and/or diastolic blood pressure were found in all subgroups. Direct observation of diet and physical activity behaviors in a structured environment suggested generalization of behavior changes. There was evidence that behavior change persisted one year beyond the completion of the intervention program. It is concluded that involvement of families utilizing school based resources is feasible and effective. Future studies should focus on the most cost-effective methods of family involvement, and the potential for additive effects when family strategies are combined with other school health education programs.

Patterns and correlates of smoking and smokeless tobacco use among continuation high school students

Students attending continuation high schools in San Diego, California were surveyed on their smoking and smokeless tobacco (SLT) use. The students are assigned to continuation high schools because of credit deficiencies, usually resulting from absenteeism, poor grades, and delinquency. Results indicated that smoking was higher than national prevalence rates for these adolescents, with the prevalence of weekly and daily smoking at 50.4% and 43.9%, respectively. Among weekly smokers, 43.7% reported smoking at least half a pack of cigarettes per day. Stepwise logistic regression analysis revealed that Anglo ethnicity, having a friend who smokes, weekly use of marijuana and alcohol, and having adults in the home who smoke were significantly associated with weekly smoking. The prevalence of SLT was very low, with only 5.7% reporting monthly use, 2.9% weekly use, and 1.8% daily use. With respect to monthly SLT use, increased risk was found among males, students whose friends used SLT, weekly alcohol users, students who intended on enrolling in college, and those with an adult in the home who used SLT. Comparison to a population of students attending regular public high schools in the same region showed that the prevalence of daily use of cigarettes, alcohol, marijuana and other illicit substances were 3.9, 2.7, 3.7, and 2.2 times higher, respectively, among the continuation high school students than the public school students. Daily use of SLT among the continuation high school students was, however, only 0.4 times as high as the regular public school students.

Attendance at Health Promotion Programs: Baseline Predictors and Program Outcomes

As part of a family cardiovascular health promotion project, 111 Mexican-American and 95 Anglo-American families with fifth- or sixth-grade children were assigned to either a primary prevention program involving 18 sessions or to a control condition. This article evaluates predictors of attendance at the year long sequence of sessions in the intervention group. In addition it considers the relationship between attendance and program outcomes. Low baseline scores on physical activity and cardiovascular fitness measures were associated with higher attendance for both children and adults. High initial health knowledge and self-motivation were also associated with attendance. Multiple regression analysis showed that adult attendance was significantly predicted by a model including completion of a three-day food record, low exercise, higher socioeconomic status, family adaptability, and self-motivation. Attendance was correlated with greater knowledge gains and larger reductions in blood pressure. The results indicate that motivated families who are in greater need of conditioning attended more sessions in a health promotion program.

Relationship between self-monitoring of diet and exercise change and subsequent risk factor changes in children and adults

Self-monitoring is often used in health behaviour change programs; but it is not known to what extent self-monitoring data are valid and useful in predicting changes in cardiovascular disease (CVD) risk. Subjects included 72 Anglo adults, 68 Anglo children, 80 Mexican-American adults and 94 Mexican-American children. Subjects were families with fifth and sixth grade children who participated in an 18-session family-based diet and exercise change program designed to reduce CVD risk. During the intervention, each participant self-monitored diet and aerobic physical activity. Families were measured at baseline, 3, 12, and 24 months. For adults, self-monitored changes in diet correlated with changes in body mass index, systolic blood pressure, total cholesterol and LDL 1 and 2 years later. Correlations between self-monitored diet and diet-related risk factor changes were not observed among children. Correlations between self-monitored exercise and subsequent risk factor changes were not observed among adults. For children, self monitored changes in aerobic physical activity correlated significantly with changes in VO2Max and HDL/LDL ratio 1 and 2 years later. Thus, this study provides some support for the predictive validity of diet self-monitoring in adults and exercise self-monitoring in children.