Guide to Effective Programs
for Children and Youth

“Know Your Body”: Cigarette Smoking Prevention & Healthy Diet Education

OVERVIEW

The “Know Your Body” curriculum intervention was a program designed to teach healthy behaviors (primarily good nutrition and smoking prevention) to elementary students (grades 4-9) in order to reduce risky adolescent behaviors shown to contribute to the development of chronic illnesses such as cancer. The intervention was taught by trained teachers 2 hours/week for 5 years and addressed the immediate and long-term effects of smoking, the benefits of nutritional diets, and strategies for dealing with some of the social and psychological antecedents of unhealthy behaviors. Fifteen schools were randomly assigned as the intervention (8) or control (7) schools. Researchers measured smoking and dietary behaviors in 4^th graders and then again 6 years later among intervention and non-intervention participants and found significant differences in the prevalence of smoking among 9^th graders at the termination of the study as well as significant differences in dietary behaviors. On average, students in the intervention group smoked less and maintained a diet lower in saturated fat and higher in carbohydrates and fibers than did students in the control condition.

DESCRIPTION OF PROGRAM

Target population: Elementary school students

“Know Your Body” is a special curriculum instituted in school by teachers that is aimed at reducing the risk of developing chronic disease by teaching healthy diet and life-style choices. The nutrition component promoted a reduced-fat diet high in complex carbohydrates and fiber. The cigarette smoking prevention component targeted those health beliefs, psychological influences and social influences which are believed to contribute to adolescent smoking decisions. This curricular component included biofeedback experiments demonstrating the immediate physical effects of smoking, information on the long-term physical effects of smoking, and discussion of the effects of self-image, values, stress and anxiety on smoking-related decisions. Other components include demonstration of alternative stress management techniques, communication and decision-making strategies and assertiveness skills. Cognitive development theory provided the framework for the intervention.

EVALUATION(S) OF PROGRAM

Evaluated population: The program involved 991 elementary students (4^th graders in 1979) in 15 schools in 4 Westchester, NY school districts. Of the participants, 79.3 percent of were white, 13.8 percent Black, 2.2 percent Hispanic and 4.7 percent Other (Asian & Pacific Islander). The median family income was $55,904.

Approach: At study initiation, 8 schools (with 485 4^th graders) were randomly assigned to be intervention schools while 7 schools (with 620 4^th graders) were assigned as control schools. The intervention group received a special curriculum entitled “Know Your Body” beginning in the fourth grade and continuing through the 9^th grade. Classroom teachers (trained by research staff) taught the curriculum in their classes for approximately 2 hours per week.

Cigarette smoking behaviors were measured at baseline and termination by medical tests identifying nicotine byproducts in the blood and/or saliva (this test was changed to use saliva between baseline and termination due to the improved sensitivity of the latter test). Subsamples of each group participated in a 24-hour dietary recall interview which researchers used to gauge food group intake.

Of the original sample (593 students), 65.1 percent had data recorded at both baseline study and termination (6 years later). Further, since the intervention occurred at the school, the school was used as the unit of measurement rather than the individual. Thus the experimental group N was 8 and the control group N was 7.

Results: Researchers found that schools in the intervention group had a significantly smaller mean number of smokers at study termination than schools in the control group. At termination, 3.5 percent of the intervention group classified as current cigarette smokers. The percentage of the control group that classified as cigarette smokers, 13.1, was significantly higher. This effect appeared to be stronger among males than females.

Intervention schools showed a significant net decrease (19.4 percent) in reported saturated fat intake and a significant net increase (9.5 percent) among subjects in reported carbohydrate intake compared to nonintervention schools. When split by gender, males showed a significant net increase in total carbohydrate intake and females showed a significant net decrease in saturated fat intake as well as a significant increase in carbohydrate and crude fiber intake.

Researchers argue that if these results can be replicated among a more ethnically and economically diverse population, a curriculum such as “Know Your Body” could prove to decrease adolescent behaviors linked to the development of chronic illnesses such as cancer.

SOURCES FOR MORE INFORMATION

References

Walter, Vaughn, & Wynder (1989). Primary prevention of cancer among children: Changes in cigarette smoking and diet after six years of intervention. Journal of the National Cancer Institute, 81 (13.) 995-999.

Program categorized in this guide according to the following:

Evaluated participant ages: 8-15 Program age ranges in the Guide: 6-11, 12-14, 15-21

Program components: School-based

Measured outcomes: Physical health

Program information last updated 09/27/04.