The Stanford Adolescent Heart Health Program
OVERVIEW
The Stanford Adolescent Heart Health Program is a school-based program designed to help high school students develop a heart healthy lifestyle in order to prevent the risk of cardiovascular disease. An experimental evaluation of the program found positive impacts on knowledge of cardiovascular risks, self reported risk behaviors, and physiological risk factors.
The program is a school-based intervention that focuses on multiple factors that may lead to cardiovascular disease. The goals of the program are to encourage adolescents to adopt a heart healthy lifestyle, teach them cognitive and behavioral skills to help them make changes in their behavior and environment, help them develop skills for resisting influences to return to old habits or adopt bad habits, and provide them with opportunities to practice using the skills in order for them to feel confident in their ability to use their newly acquired behaviors.
The program includes 20 classroom sessions led by instructors with academic backgrounds or experience in health-related fields. The sessions take place during physical education class time and each session lasts for 50 minutes. The first session is an introduction to the program. The next 12 are divided into units that focus on topics such as physical activity, nutrition, cigarette smoking, and stress. Special emphasis is placed on the immediate effects on quality of life, but the potential long-term benefits of adopting healthy behaviors are also discussed. Then, students participate in a two-session game in which they are divided into teams and quizzed on information and skills that were introduced to them in the previous 12 sessions. The last five sessions train students in problem-solving and help them develop an action plan for behavior change during which each student chooses a specific long-term goal to change their lifestyle.
Killen, J.D., Robinson. T. N., Telch, M. J., Saylor, K. E., Maron, D. J., Rich, T., & Bryson, S. (1989). The Stanford adolescent heart health program. Health Education Quarterly, 16, 263-286.
Killen, J. D., Telch, M. J., Robinson, T. N., Maccoby, N. M., Taylor, C. B., & Farquhar, J. W. (1988). Cardiovascular disease risk reduction for tenth graders. Journal of the American Medical Association, 260(12), 1728-1733.
Approach: The four participating senior high schools were from two school districts. Within each district, one school was randomly assigned to receive the special intervention and one school served as the comparison school. All tenth graders in each treatment school attended the intervention sessions three days each week for seven weeks, and the intervention was delivered as part of the regular physical education curriculum. Measurements of cardiovascular risk knowledge, physical activity, food preferences, tobacco use, height, weight, body mass index (BMI), skin fold thickness, resting heart rate, and blood pressure were collected at baseline and at a follow-up assessment two months post- intervention.
Results: The program had a significant impact on cardiovascular risk knowledge: students in intervention schools improved their test scores more than students in control schools.
The program had significant impacts on all self-reported behaviors. A higher proportion of students in the intervention group who did not exercise regularly at baseline reported exercising regularly at follow up (intervention group, 30 percent; control group, 20 percent). Students in intervention schools were also more likely to prefer “heart-healthy” snack items than students in the control group. Also, more students in the intervention group who smoked on a monthly basis or less at baseline quit smoking at follow-up (intervention group, 29 percent; control group,18 percent), and fewer of these students became regular smokers (intervention group: 6 percent, control group: 10 percent) when compared to the control group. However, the intervention did not have an impact on smoking frequency for students who had never smoked at baseline or students who were regular smokers at baseline.
The intervention had positive impacts on all physiological variables (resting heart rate, BMI, and skin fold thickness). However, changes in diastolic blood pressure had positive impacts on females in the control group. No impacts were found for systolic blood pressure. Students in intervention schools reduced their resting heart rate significantly more than students in control schools and fared better on measures of BMI and skin fold thickness.
While the results are promising, there are some limitations. First, follow-up assessments took place only two months after the completion of the educational program. Therefore, it is unclear whether the gains observed in the treatment group will be maintained over a longer period of time. Second, only two schools were included in the study. The generalizability of the findings depends, in part, on whether the study population is representative of the general population. Despite the limitations, the results of the study strongly suggest that it is possible to increase adolescents’ understanding of factors that may lead to cardiovascular disease, to modify behaviors that can lead to the disease, and to affect changes in some physiological health risks.
Killen, J.D., Robinson. T.N., Telch, M.J., Saylor, K.E., Maron, D.J., Rich, T., Bryson, S. (1989). The Stanford adolescent heart health program. Health Education Quarterly, 16. 263-286.
Killen, J.D., Telch, M.J., Robinson, T.N., Maccoby, N.M., Taylor, C.B., Farquhar, J.W. (1988). Cardiovascular disease risk reduction for tenth graders. Journal of the American Medical Association, 260(12), 1728-1733.
KEYWORDS: Adolescence (12-17), Youth (16+), School-based, High School, Nutrition, Tobacco Use, Males and Females (co-ed), White/Caucasian, Asian, Health Status/Conditions, Skills Training
Program information last updated 2/24/2012.
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