Program

Oct 12, 2007

THE FAMILY HEALTH
PROJECT

OVERVIEW

The Family Health Project was a family-based intervention
designed to improve cardiovascular health among Mexican-American and
Anglo-American parents and children. In a random assignment study,
families at schools assigned to implement the Family Health Project were
compared with families at schools assigned to implement no intervention.
Results over a four-year follow-up period were inconsistent; however, some
evidence does suggest that the Family Health Project led to improved dietary
behavior. For both the Mexican-American and
Anglo-Americans in the treatment group.

DESCRIPTION OF PROGRAM

Target population:Mexican-American and
Anglo-American families

The Family Health Project was a family-based intervention
designed to improve cardiovascular health. The intervention, based on
social learning theory and principles of self-management, was designed to
assist families in making long-term changes to their physical activity and
dietary habits. The intervention sought to reduce participants’ daily
sodium intake to 3 grams, to reduce participants’ fat intake to 30% of total
calories consumed, and to increase participants’ regular physical
activity.

The one-year program included 12 weeks of intensive
intervention, followed by six maintenance sessions distributed over a
nine-month period. During the intensive intervention period, families attended
weekly 90-minute meetings that taught self-monitoring, goal-setting,
problem-solving, self-rewarding goal achievement, and
support-providing.

Meetings always began with an aerobic exercise
activity. Following this activity, parents and children separated in
order to receive new information and skills. Active participation was
stressed, and children frequently learned new information and skills through
game-play. Families then reconvened to set short-term goals for diet,
exercise, and family support. At the end of each session, families ate
heart-healthy snacks together. A different family prepared the snacks
each week.

Maintenance sessions covered topics such as breaking bad
habits, making healthy choices in restaurants, grocery shopping, friend and
peer pressure, and planned and unplanned breaks in exercise and dietary
routines.

The program was designed to be delivered to ethnically
homogeneous groups of families. Groups were structured so as to maximize
cultural, group, and family support for behavioral change and experiential
learning.

EVALUATION(S) OF PROGRAM

Nader, P. R., Sallis,
J. F., Abramson, I. S., et al.
(1992).Family-based cardiovascular risk
reduction education among Mexican- and Anglo-Americans. Family & Community
Health, 15
(1), 57-74.

Evaluated population:206 families served as the
study sample for this investigation. (“Family” was defined as any group
of one or more children and one or more adults who cohabit and share family
functions such as food preparation and socialization of children.)
Families included students from the 5th and 6th grade
classes at 12 elementary schools. At some schools, only Mexican-American
families were selected to participate and, at other schools, only
Anglo-American families were selected to participate.

Approach: Schools were randomly assigned to the
treatment group or the control group. Schools assigned to the treatment
group implemented the Family Health Project intervention. Intervention
sessions were conducted by trained, supervised facilitators. At
intervention schools from which only Mexican-American families had been
recruited, the Family Health Project intervention was conducted in Spanish and
was culturally adapted to better suit a Mexican-American audience.

All families completed baseline assessments before the
intervention period began. Follow-up assessments took place 3, 12, 24,
36, and 48 months after baseline assessments. Assessments included diet
and exercise recalls, as well as measurements of blood pressure levels, serum
lipid levels, body mass index (BMI). Additionally, at the six-month
follow-up, families’ behavior was observed during a day at the zoo.

Results:Results over the four-year follow-up period
were inconsistent; however, the researchers identified changes in blood
pressure and reported dietary behavior as “the most convincing evidence of
consistent intervention effects.” These results were more pronounced for
adults than for children.

Treatment children, with the exception of Mexican-American
boys, had significantly more healthy diets than did control group children at
the three-month follow-up. This impact was no longer significant at the
24-month follow-up. Anglo women and Mexican-American girls from the
treatment group had more healthy diets than did their control group
counterparts at the 48-month follow-up. The only significant blood
pressure differences between treatment and control children were for Anglo boys
at 24 months and for Anglo girls at 48 months.

Differences in nutritional intake were found within some
subgroups at some timepoints. Mexican-American
treatment boys had significantly lower total fat consumption than did
Mexican-American control boys at the 48-month follow-up. Anglo treatment
children had significantly lower dietary fat consumption than did Anglo control
children at the three-month follow-up. This impact remained significant
for girls at the 24- and 48-month follow-ups, but ceased to be significant for
boys. Anglo treatment children also had significantly lower sodium
consumption than did Anglo control children at the three-month follow-up.
This impact was still significant for boys at the 24-month follow-up and was
still significant for girls at the 48-month follow-up.

In general, treatment children did not differ from control
children on energy expenditure and physical activity. At the 48-month
follow-up, however, Anglo treatment boys did report having engaged in
significantly more physical activity than did Anglo control boys. Anglo
treatment girls had greater cardiovascular fitness than did Anglo control girls
at the three-month follow-up. Mexican-American treatment girls had
greater cardiovascular fitness than did Mexican-American control girls at the
24-month and 36-month follow-ups.

At no time point did treatment group members differ from
control group members on measures of body mass index (BMI).

During the observed zoo visit, Mexican-American treatment
families walked significantly further and spent significantly more time being
active, as compared with Mexican-American control families. No
differences in activity level were found between treatment and control Anglo
families. All treatment families were less likely to use escalators (and
more likely to walk up hills) than were control families. Treatment
families also brought healthier snacks and consumed fewer calories than did
control families while at the zoo.

Note: Analyses were designed to adjust for the effect of
clustering within schools.

SOURCES FOR MORE INFORMATION

Contact curriculum developer Philip R. Nader for
curriculum information:

pnader@ucsd.edu

References:

Nader, P. R., Sallis,
J. F., Abramson, I. S., et al.
(1992).Family-based cardiovascular risk
reduction education among Mexican- and Anglo-Americans. Family &
Community Health, 15
(1), 57-74.

Program categorized in this guide according to the
following:

Evaluated participant grades: 5th-6th

Program age ranges in the guide: Middle Childhood,
Adolescence

Program components: Parent/Family Component

Measured outcomes: Physical Health

KEYWORDS:Physical
Health, Cardiovascular Health, Hispanic or Latino, White or Caucasian ,
Nutrition, Family-Based, Life Skills Training, 5th grade, 6th
Grade, Elementary School, Dietary Behavior, Physical Activity, Middle Childhood
(6-11), Adolescence(12-17), Adolescents.

Program information last updated on
10/12/07.