Lise Renaud

Prevalence and Correlates of Physical Activity Behaviors among Elementary Schoolchildren in Multiethnic, Low Income, Inner-City Neighborhoods in Montreal, Canada

PURPOSE To describe the prevalence and correlates of physical inactivity and of participation in organized sports at and outside school among elementary schoolchildren in multiethnic, low income, urban neighborhoods in Montreal, Canada. METHODS As part of the evaluation of a school-based heart health promotion program, baseline data on physical activity behaviors and potential correlates of these behaviors, were collected from 2285 students aged 9-13 in all 130 grade 4 to 6 classes in 24 inner-city elementary schools from May to June 1993. RESULTS One-fifth of boys (20.5%) and 24.4% of girls were inactive; 40.0% and 33.3% of boys and girls respectively, participated in school sports teams; 82.5% and 74.7% participated in organized sports outside school. Declines in activity levels with age were apparent in both genders. Children who participated in organized sports programs at and outside school, those with higher perceived self-efficacy for physical activity, and those with more parental support for engaging in physical activity were more active. Children of Asian family origin were less active. Socioeconomic status was related to participation in organized sports outside school. CONCLUSIONS To reach children in socio-economically disadvantaged areas and to prevent age-related declines in activity levels, interventions promoting physical activity should focus on increasing availability and access to community-based organized sports programs at and outside school. Also they should include components to increase parental support and to improve perceived self-efficacy for physical activity.

One-year predictors of smoking initiation and of continued smoking among elementary schoolchildren in multiethnic, low-income, inner-city neighbourhoods

OBJECTIVE To identify one-year predictors of smoking initiation among never-smokers, and of continued smoking among ever-smokers. DESIGN Two sequential cohorts of grade 4 and 5 children. Data were collected as part of Coeur en sante St Louis du Parc, a non-randomised controlled trial to evaluate the impact of a school-based heart health promotion programme. SETTING 24 inner-city elementary schools located in multiethnic, low-income neighbourhoods in Montreal. SUBJECT 1824 schoolchildren aged 9–12 years with baseline and one-year follow-up data. MAIN OUTCOME MEASURES Changes in smoking behaviour over a year; the ability of baseline data to predict smoking initiation and continued smoking a year later was investigated in logistic regression analyses. RESULTS The prevalence of ever-smoking was 21.1% at baseline and 30.2% at one-year follow up. One in six never-smokers initiated smoking; one in three ever-smokers continued smoking. Predictors of initiation included age (odds ratio (OR) = 1.6, 95% confidence interval (CI) = 1.3 to 2.0), male gender (OR = 1.5 (95% CI = 1.1 to 2.0)), friends who smoke (OR = 2.3 (95% CI = 1.7 to 3.3)), sibling(s) who smoke (OR = 1.9 (95% CI = 1.2 to 3.1)), father/mother who smokes (OR = 2.2 (95% CI = 1.6 to 3.0)), and frequent high fat/“junk food” consumption (OR = 1.6 (95% CI = 1.1 to 2.1)). Age and friends who smoke were also independent predictors of continued smoking in both genders. In addition, in boys, current smokers at baseline were 2.6 times (95% CI = 1.4 to 5.0) more likely to continue smoking than past smokers. In girls, being overweight was associated with continued smoking (OR = 3.5 (95% CI = 1.6 to 7.6)). CONCLUSIONS Smoking prevention programmes should address parental and sibling influences on smoking, in addition to refusal skills training. Among girls, weight-related issues may also be important.

The impact of a community-based heart disease prevention program in a low-income, inner-city neighborhood.

OBJECTIVES This study evaluated the impact of a 4-year, community-based cardiovascular disease prevention program among adults aged 18 to 65 years living in St-Henri, a low-income, innercity neighborhood in Montreal, Quebec. METHODS Awareness of and participation in the program were monitored in 3 independent sample telephone surveys. Self-reported behaviors were compared in St-Henri and a nearby comparison community before and after program implementation in both a 3-year repeat independent sample survey and a 5-year longitudinal cohort telephone survey. RESULTS Awareness of the program reached 37.4%, but participation was low (2%-3%). There were no secular declines in smoking or high-fat diet; physical inactivity increased in both communities. There were no statistically significant program effects detected in the independent sample surveys, although physical inactivity increased more in the comparison community than in St-Henri. In the longitudinal cohort sample, there was a small, statistically significant increase favoring St-Henri in frequency of cholesterol checkups. CONCLUSIONS Despite careful adaptation of the program to the local social context, there were few community-wide program effects. However, several component interventions showed promise in terms of community penetration and impact.

Prevalence and Correlates of Overweight among Elementary Schoolchildren in Multiethnic, Low Income, Inner-City Neighbourhoods in Montreal, Canada

PURPOSE Increased understanding of the early determinants of obesity is essential because of the increasing prevalence of obesity in many industrialized countries. METHOD As part of the evaluation of a school-based heart health promotion intervention, we measured height, weight, and triceps skinfold thickness at baseline in 2108 students aged 9-12 years (80.5% of eligible students) in 24 inner-city elementary schools located in multiethnic, low income neighbourhoods in Montreal, Canada. Data on students socio-demographic and lifestyle characteristics were collected in classroom-administered questionnaires, and parents completed an at-home self-administered questionnaire. RESULTS Overall, 35.2% of boys and 33.0% of girls were overweight (> or = 85th age and gender-specific percentiles from NHANES 11, for body mass index and triceps skinfold thickness); 15.1% of boys and 13.3% of girls were obese (> or = 95th age and gender-specific percentiles for body mass index and triceps skinfold thickness). Younger age, having lived all ones life in Canada, and being of European or Central American/Caribbean family origin were independent correlates of obesity in boys. Younger age, ever smoked, mother obese and father obese were independent correlates of obesity in girls. Girls of Asian family origin were protected. CONCLUSIONS The very high prevalence of overweight students in this low income, multiethnic population suggests an important need for preventive intervention.

Coeur en santé St-Henri--a heart health promotion programme in a low income, low education neighbourhood in Montreal, Canada: theoretical model and early field experience.

STUDY OBJECTIVE--Coeur en santé St-Henri is a five year, community based, multifactorial, heart health promotion programme in a low income, low education neighbourhood in Montreal, Canada. The objectives of this programme are to improve heart-healthy behaviours among adults of St-Henri. This paper describes the theoretical model underlying programme development as well as our early field experience implementing interventions. DESIGN--The design of the intervention programme is based on a behaviour change model adapted from social learning theory, the reasoned action model, and the precede-proceed model. The Ottawa charter for health promotion provided the framework for the development of specific interventions. Each intervention is submitted to formative, implementation, and impact evaluations using simple and inexpensive methods. PARTICIPANTS--The target population consists of adults living in St-Henri, a neighbourhood of 23,360 residents. Because of costs constraints, the intervention strategy targets women more specifically. The community is one of the poorest in Canada with 46% of the population living below the poverty line and 20% being very poor. The age-sex adjusted ischaemic heart disease mortality in 1985-87 was 317 per 100,000 compared with 126 per 100,000 in an affluent adjacent neighbourhood. RESULTS--Thirty nine distinct interventions have been developed and tested in the community, eight related to tobacco, 10 to diet, seven to physical activity, and 14 which are multifactorial. The interventions include smoking cessation and healthy recipes contests, a menu labelling and healthy food discount programme in restaurants, a point of choice nutrition education campaign, healthy eating and smoking cessation workshops, a walking club, educational material, print and electronic media campaigns, heart health fairs, and community events. CONCLUSION--An integrated heart health promotion programme is feasible in low income urban neighbourhoods but not all interventions are successful. Such a programme requires substantial energy and resources as well as long term commitment from public health departments.

Evaluation of the efficacy of simulation games in traffic safety education of kindergarten children

Using a simulation game designed to teach children to obey certain traffic safety rules, an experimental study was conducted with 136 five-year-old children in four Quebec schools. Within each classroom, subjects were randomly divided into four groups: three intervention groups and one control group. Each of the experimental groups was subjected to a different intervention with outcome measured using three instruments related to attitudes, behavior, and transfer of learning of pedestrian traffic safety. Results suggest that simulation games including role-playing/group dynamics and modeling/training can change attitudes and modify behavior in the area of pedestrian traffic safety in children of this age.

Coeur en santé St-Henri--a heart health promotion programme in Montreal, Canada: design and methods for evaluation.

STUDY OBJECTIVE--This paper describes the objectives, design, and methods of evaluation of the impact of the coeur en santé St-Henri programme, as well as selected results from the evaluation to date. It discusses the possible effects of study design choices made to maintain the impact evaluation within budget. DESIGN--The impact of the programme is evaluated in a community trial which compares the prevalence of cardiovascular disease behavioural risk factors before and after programme implementation in the intervention and a matched comparison community, in both longitudinal cohort and independent sample surveys. In addition, repeated independent sample surveys are conducted in the intervention community to monitor awareness of and participation in the programme. PARTICIPANTS--The baseline sample for both the longitudinal cohort and independent sample surveys included 849 subjects from the intervention community (79.3% of 1071 eligible subjects--8.0% could not be contacted and 12.6% refused) and 825 subjects from the comparison community (77.8% of 1066 eligible subjects--6.6% could not be contacted and 15.6% refused). The two surveys on awareness and participation conducted to date, included 461 (71.0% of 649 eligible subjects) and 387 (67.9% of 570 eligible subjects) subjects respectively from the intervention community. MEASUREMENTS--Baseline data for the longitudinal cohort and independent sample surveys on behavioural risk factor outcomes including use of tobacco, physical activity behaviour, high fat diet, and behaviours related to blood pressure and cholesterol control were collected in 35 minute telephone interviews in both the intervention and comparison communities. Data on awareness of and participation in the programme were collected in 10 minute interviews in the intervention community only in two independent sample surveys conducted seven and 22 months respectively after the baseline survey. RESULTS--With the exception of smoking, the intervention and comparison communities were similar at baseline with regard to the prevalence of behavioural risk factors studied. Awareness of the coeur en santé programme increased from 64.1% in January 1993 to 72.9% 15 months later. Participation in the programme increased from 21.3% to 33.7%. CONCLUSIONS--This paper presents background information on the evaluation of the impact of the coeur en santé programme, as a reference for future publications.

Prevalence and Correlates of Early Smoking among Elementary Schoolchildren in Multiethnic, Low-Income Inner-City Neighborhoods

PURPOSE The prevalence and correlates of early smoking were investigated among schoolchildren in grades 4-6 living in multiethnic, low-income neighborhoods in Montreal. METHODS As part of the evaluation of a school-based heart health promotion program, baseline data on the prevalence of early smoking were collected from 2285 students aged 9-13 years in 24 inner-city elementary schools during May-June 1993. RESULTS Overall, 28.7% of boys and 20.3% of girls had smoked. Girls began trying later than boys, but by age 13 the prevalence of experimental or regular smoking by girls overtook that of boys. Univariately, ever smoking varied considerably by family origin, from 2.1% among Vietnamese girls, to 35.8% among Portuguese boys. In multivariate analysis, age, perceived smoking habits of friends, and smoking by family members, were strong correlates of smoking. Being of Asian family origin was negatively associated with smoking. None of the indicators of social class were significantly associated with ever smoking. CONCLUSIONS Smoking prevention should begin with children even younger than age 9 in multiethnic, low-income, inner-city neighborhoods. With the exception of a lower prevalence of smoking among Asian children, ethnicity and social class were not strong influences on early smoking behavior in this population.

The “Yes, I Quit” Smoking Cessation Course: Does it Help Women in a Low Income Community Quit?

The objectives were to evaluate the impact of “Yes, I Quit” (a smoking cessation course tailored for women in a low income, low education community), and to identify baseline predictors of short and longer-term self-reported cessation. The impact was evaluated in a before-after study design with no comparison group. Baseline data were collected in self-administered questionnaires at the beginning of the first session of the course. Follow-up data were collected in telephone interviews at one, three and six months after the designated Quit Day. Self-reported quit rates among 122 participants were 31.1%, 24.7% and 22.3% at one, three and six months. Non-quitters reduced their consumption by 10.3, 8.3, and 7.1 cigarettes per day at one, three and six months. Multivariate logistic regression analyses showed that being in excellent/good health was significantly associated with cessation at one month (odds ratio (OR) = 2.4). Being married (OR = 13.0) and no other smokers in the household (OR = 3.6) were associated with three-month cessation. Only being married was associated with six-month cessation (OR = 6.8). “Yes, I Quit” produced quit rates among low income, low education participants comparable to those reported for cessation programs directed at the general population of smokers. Good health is associated with early cessation, while support from a spouse is important to maintaining a nonsmoking status among quitters.

The St-Louis du Parc Heart Health Project: a critical analysis of the reverse effects on smoking

Objectives: Although some school based smoking prevention programmes have shown positive impacts, others have had only short term effects, no effects, and in some cases reverse effects. The St-Louis du Parc Heart Health Project was a five year heart health promotion programme targeting children in eight elementary schools aged 9–12 years in disadvantaged multiethnic neighbourhoods in Montreal. In a controlled, longitudinal evaluation, the programme produced reverse effects on smoking—children exposed to the programme were more likely to initiate and to continue smoking than control children. This article explores hypotheses to explain the reverse effects. Design: Following work by an in-house committee, a consensus workshop with international experts was conducted to develop hypotheses to explain the reverse effects. This was complemented by an analysis of the programme’s concordance with the standard guidelines on the school based prevention of tobacco use, and discussions with experts at the Centers for Disease Control and Prevention. Results: The programme respected most standard guidelines for smoking prevention programmes with respect to content and mode of delivery. Hypotheses to explain the reverse effects include: an unfavourable environment characterised by strong pro-smoking models and resistance to environmental interventions; heightened sensitivity to smoking among children most exposed to the programme; defence mechanisms among children stimulated by cognitive dissonance or anxiety; unanticipated effects associated with the health educator who delivered the programme; inadequate attention in programme development to the diverse cultural origins of the population targeted; and intervention content inappropriately targeted to children’s stages of cognitive development. Conclusion: Elementary school based interventions should aim to develop a clear and coherent social norm about the non-use of tobacco, as a precursor to or in close conjunction with having children as their primary target. Programme design should take key student characteristics into consideration and ensure that the modes of communication are adapted to the targeted group’s characteristics. Neighbourhood level interventions should be orchestrated to complement regional, provincial, and national programmes.