Guide to Effective Programs
for Children and Youth

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

OVERVIEW

The “Know Your Body” curriculum intervention is a program designed to teach healthy behaviors (primarily good nutrition and smoking prevention) to students in fourth through ninth grades, in order to reduce behaviors in adolescence shown to contribute to the development of chronic illnesses such as cancer and coronary heart disease. The intervention was delivered by trained teachers, two hours per week for five years, and addressed the immediate and long-term effects of smoking, the benefits of good nutrition, and strategies for dealing with some of the social and psychological precursors of unhealthy behaviors. On average, after six years, students in the intervention group smoked less and maintained a diet lower in saturated fat and higher in carbohydrates and fibers than the one followed by students in the control condition.

DESCRIPTION OF PROGRAM

Target population: Elementary and middle school students

“Know Your Body” is a school-based curriculum aimed at reducing the risk of developing chronic disease by teaching healthy diet and other life-style choices. The nutrition component promotes a reduced-fat diet high in complex carbohydrates and fiber. The cigarette smoking prevention component targets health-related beliefs, and psychological and social influences believed to contribute to adolescent smoking decisions. This curricular component also includes biofeedback demonstrations of the immediate health effects of smoking, information on the long-term health effects of smoking, and discussion of the effects of smoking-related decisions on self-image, values, stress and anxiety. Other components include demonstration of healthy stress-management techniques, communication and decision-making strategies and assertiveness skills. Classroom teachers (trained and monitored by research staff) teach the curriculum in their classes for approximately two hours per week. Cognitive development theory provides the framework for the intervention. The intervention is designed to begin in the fourth grade and lasts, with yearly progress assessments, until ninth grade.

EVALUATION(S) OF PROGRAM

Walter, H. J., Hofman, A., Vaughan, R. D., & Wynder, E. L. (1988). Modification of risk factors for coronary heart disease: Five-year results of a school-based intervention trial. The New England Journal of Medicine, 218, 1093-1100.

Evaluated population: The study involved two demographically dissimilar areas in the New York City area. The first population included 2,283 elementary students (4^th graders in 1980) in all 22 elementary schools in a single school district in the Bronx, a lower-income borough. The second population consisted of 1,105 students (4^th graders in 1979) in all 15 elementary schools in four school districts in Westchester County, a middle- and upper-income suburb.

Approach: Of the 22 schools (2,283 students) in the Bronx who agreed to participate in the study, 14 were randomly assigned to the intervention protocol (1,590 students), and eight to the non-intervention treatment group (693 students). In Westchester, of the 15 schools (1,105 students), eight schools were randomly assigned to the intervention protocol (485 students), and seven schools to the non-intervention treatment group (620 students). It was necessary to assign students to a group based on their school district, because all elementary schools in one district feed into the same high school. Intervention groups only were taught the “Know Your Body” curriculum. Both intervention and nonintervention groups were taught the state-mandated one-semester general health education curriculum.

Biological risk factors and health knowledge were measured in all populations by trained professionals at base line (4^th grade), and at four follow-up points (5^th, 6^th, 7^th, and 9^th grades). All students received by mail examination results with explanatory material and healthy lifestyle recommendations. Students in the intervention group also received their results (with additional classifications of health status) in the classroom. Risk factors were assessed over time, to determine whether or not they were affected by the intervention.

Of the original sample in the Bronx (2,283 students), 66 percent overall (1,036 students) had data recorded at both baseline and termination (six years later). Of the original sample in Westchester County (1,105 students), 81 percent overall (733 students) had data recorded at both baseline study and termination (six years later).

Results: The intervention program appeared to be associated with favorable trends in total cholesterol levels among school children in the two demographically dissimilar populations. The impact appeared to be larger in Westchester than in the Bronx; however, the reasons for this difference are unclear. There was also a significant increase in prevention-related knowledge in both populations. Study time was insufficient to tell if the intervention had any impact on cigarette use. As for body mass, physical fitness or blood pressure, the intervention program appeared to have no main impacts.

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.

Evaluated population: The program involved 991 elementary students (4^th graders in 1979) in 15 schools in four Westchester, New York 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: Schools were randomly assigned to the intervention (eight schools, 485 students) or control (seven schools, 620 students) groups. Researchers measured smoking and dietary behaviors at 4^th grade, and again 6 years later. The intervention group received the “Know Your Body” curriculum beginning in the fourth grade and continuing through the 9^th grade. Classroom teachers (trained by research staff) taught the curriculum for approximately two hours per week.

Cigarette smoking was measured at baseline and termination by testing for nicotine byproducts in the blood and/or saliva (by termination, saliva-based testing only was used due to its superior sensitivity). Subsamples of each group participated in a 24-hour dietary recall interview, which researchers used to examine intake of various food groups.

Of the original sample, 65.1 percent of students (N=395) had data recorded at both baseline study and termination (6 years later).

Results: Students who attended schools in the intervention group had a significantly smaller rate of smoking at study termination than students who attended schools in the control group. At termination, 3.5 percent of the intervention group were classified as current cigarette smokers. The percentage of the control group classified as cigarette smokers, 13.1, was significantly higher. This impact appeared to be stronger among males than females.

Students in the intervention schools showed a significant net decrease (19.4 percent) in reported saturated fat intake and a significant net increase (9.5 percent) in reported carbohydrate intake, compared with students in the nonintervention schools. When the data for the intervention schools were analyzed 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.

SOURCES FOR MORE INFORMATION

Contact information

Lisa M. Zenner

Senior Inside Sales Representative

College Division

Kendall/Hunt Publishing Company

4050 Westmark Drive

P.O. Box 1940

Dubuque, Iowa 52004-1840

800-247-3458 (phone)

563-589-1161 (fax)

lzenner@kendallhunt.com

Curriculum can be purchased at: http://www.kendallhunt.com/Store_Home.aspx

References

KEYWORDS: Nutrition; Other Physical Health; Tobacco; Elementary; Children (3-11); White/Caucasian; Co-ed; Middle-school; School-based; High School; Adolescents (12-17), Manual.

Program information last updated 8/17/2011.