Program

Feb 11, 2014

OVERVIEW

The Bienestar Health Program is a school-based intervention designed to prevent the development of diabetes in low-income Mexican American children.  In one experimental study in which 27 elementary schools were randomly assigned, students from schools assigned to implement the Bienestar program were compared with students from schools that received no intervention.  Following the intervention, Bienestar students had significantly lower fasting glucose levels than control students.  Bienestar students also had higher physical fitness scores and greater dietary fiber intake.  However, the intervention did not have an impact on saturated fat intake.  In a second experimental study in which 4th-grade classes at 9 elementary schools were randomly assigned to a treatment or control condition, children in the treatment condition had significantly larger gains in physical fitness compared with their peers in the control group.

DESCRIPTION OF PROGRAM

Target population: Mexican American children from low-income households

Bienestar is a school-based intervention developed to encourage healthy lifestyle changes among Mexican American children, who are at increased risk for developing type two diabetes mellitus.

The creation of the Bienestar program was guided by Social Cognitive Theory, which suggests that personal factors, social factors, and behavior are equally important and interact to determine any given outcome.  To address personal factors (students’ knowledge and beliefs) and behavior, the program teaches three main health behavior messages shown to be associated with diabetes mellitus control: decreased dietary saturated fat intake, increased dietary fiber intake, and increased physical activity.  The program also targets social factors by educating and involving adults in children’s lives through components in the classroom, home, school cafeteria, and an after-school care program. All programming is delivered in both English and Spanish and is designed to be culturally appropriate for Mexican Americans.

EVALUATION(S) OF PROGRAM

Trevino, R. P., Yin, Z., Hernandez, A., Hale, D. E., Garcia, O. A., & Mobley, C. (2004). Impact of the Bienestar school-based diabetes mellitus prevention program on fasting capillary glucose levels: A randomized controlled trial. Archives of Pediatric & Adolescent Medicine, 158, 911-917.

Evaluated population: A total of 1,419 4th graders from 27 schools in inner-city San Antonio, Texas served as the study sample for this investigation.  Eighty percent of students were Mexican American, 10 percent were African American, 6 percent were Asian, and the remaining 4 percent were of other ethnicities.  Ninety-four percent of students came from economically disadvantaged households.

Approach: The 27 schools were randomly assigned to the treatment group (N=13 schools) or to the control group (N=14 schools).  Control schools received no intervention.  Treatment schools implemented the Bienestar program over the course of the 2001-2002 school year.  Lessons were taught by school staff as well as Bienestar project staff.  Although the study employed random assignment, there were some demographic differences between the intervention and control groups at baseline.  Intervention schools tended to have higher percentages of Mexican American students and lower fitness scores than those in the control group.

The Bienestar curriculum used in this study consisted of 50 lessons to be taught over the course of seven months.  Parents, teachers, after-school care staff, and school cafeteria workers were asked to support each of these behaviors and to act as role models.  Similarly, children were asked to encourage their peers and caregivers to engage in each of the three behaviors as well.  Students were encouraged to set health goals and to track their progress toward those goals.  Incentives were provided for parents and students who practiced targeted behaviors.

To assess the effectiveness of the program, all students underwent health and fitness evaluations at the beginning and end of their 4th grade year.  Students were also screened for diabetes (via a test of fasting glucose level) and completed 24-hour diet recalls.  Data of interest included fasting capillary glucose concentration, percentage body fat, physical fitness level, dietary fiber intake, and dietary saturated fat intake.

Results:  Over the course of the intervention, fasting glucose levels decreased in intervention schools and increased in control schools, a significant group difference.  The intervention also had a significant impact on intervention students’ physical fitness levels.  Over the course of the school year, intervention students increased their physical fitness while the physical fitness of control students decreased.

Finally, positive changes were observed in intervention students’ intake of dietary fiber.  At follow-up, dietary recall data reflected significantly greater intake of dietary fiber among intervention students compared with control students.

There were no significant differences between intervention students and control students on measures of body fat or saturated fat intake at posttest.

Treviño, R. P., Hernandez, A. E., Yin, Z., Garcia, O. A., & Hernandez, I. (2005). Effect of the Bienestar Health Program on physical fitness in low-income Mexican American children. Hispanic Journal of Behavioral Sciences27(1), 120-132.

Evaluated population: A total of 495 4th grade students from nine elementary schools in urban neighborhoods in the San Antonio Independent School District participated in the study. Out of all the students in the schools involved in the study, ninety-seven percent of the students were Mexican-American and 95 percent were in food assistance programs.  For families of children at participating schools, the mean income was $10,337 in the treatment group schools and $11,691 in the control group schools, the children lived households with an average of 3.5 people.

Approach: Schools were randomly assigned to either a treatment group (N=5) or a control group (N=4). Demographic characteristics were comparable for schools in the treatment group and those in the control group.

Over the program’s 8-month duration, four components were implemented: a parent program, a school curriculum, an after-school club, and a school cafeteria program. The parent program included two plays.  In one, students performed for their parents about how exercise and healthy eating can help prevent diabetes. In the second, parents performed in a Diabetes Demonstration Play illustrating how Diabetes works at the cellular level.  The parent component also included a healthy living-themed Loteria (similar to American bingo) event where winners received prizes, as well as a physical activity event that included a night of dancing at the school. The school curriculum component consisted of 16 lessons about physical activity, nutrition, wellness and diabetes delivered by physical education instructors who received supporting program curriculum materials (i.e., a teacher’s manual, student workbooks, test instruments, etc.). The after-school club component consisted of 32 lesson plans (with an instructor’s manual and student workbooks) that reinforced lessons from the curriculum and emphasized the importance of physical activity through dance, puppet shows, physical activity, song, and dramatic presentations. This component was delivered by San Antonio City Parks and Recreation staff; students’ parents were also encouraged to attend and participate.

Baseline assessments were conducted in August and post-intervention assessments were conducted in May of the same school year.  During these assessments, children took part in a modified Harvard step test (i.e., a child steps on and off a stool for 5 minutes and their heart rate is measured at 0, 1, and 2 minutes afterwards); a physical fitness score (PFS) was calculated for each child by dividing the total time of exercise in seconds by the sum of these three heart rates.

Results: Gains in physical fitness scores were significantly larger for children in the treatment group compared with their peers in the control group (p<.003), even when age and baseline BMI were controlled for. On average, physical fitness scores of children in the treatment group increased by 2.9 points from baseline to post-intervention while scores of their peers in the control group dropped by .2 points.

SOURCES FOR MORE INFORMATION

Curriculum materials available for purchase at: http://www.sahrc.org/products

To order, contact the Social and Health Research Center at (210)533-8886 or info@sahrc.org

References:

Trevino, R. P., Yin, Z., Hernandez, A., Hale, D. E., Garcia, O. A., & Mobley, C. (2004). Impact of the Bienestar school-based diabetes mellitus prevention program on fasting capillary glucose levels: A randomized controlled trial. Archives of Pediatric & Adolescent Medicine, 158, 911-917.

Treviño, R. P., Hernandez, A. E., Yin, Z., Garcia, O. A., & Hernandez, I. (2005). Effect of the Bienestar Health Program on physical fitness in low-income Mexican American children. Hispanic Journal of Behavioral Sciences27(1), 120-132.

KEYWORDS: Children, Elementary, Males and Females (Co-ed), Hispanic/Latino, Urban, School-Based, Cost Information is Available, Manual is Available, Parent or Family Component, After-School Program, Nutrition, Health Status/Conditions

Program information last updated on 2/11/2014