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Dietary fiber (DF) has important health benefits in childhood, especially in promoting normal laxation. Studies also suggest that DF in childhood may be useful in preventing and treating obesity and also in lowering blood cholesterol levels, both of which may help reduce the risk of future cardiovascular disease. In adults, a high-fiber, low-fat diet has been linked to reduced rates of colon and other human cancers, and although it seems highly likely that this benefit would be even greater if this regimen had been started in childhood, epidemiologic and experimental confirmation is currently lacking. Children's typical DF consumption may not be adequate to maintain good health and prevent disease. Therefore, it would be prudent to recommend that children and adolescents increase DF intake by increasing consumption of fruits, vegetables, legumes, cereals, and other grain products. Several guidelines recommend quantitative ranges of DF intake for children. These include recommendations by the National Academy of Sciences, the Food and Drug Administration's (FDA) food label guide, and the "Age+5" guideline. The goal is to achieve a DF intake that is safe even for children and adolescents with marginal intake of vitamins and minerals, provides sufficient DF for normal laxation, and reduces the risk of future chronic diseases, such as coronary artery disease. Current estimates of DF intake are much lower than recommended levels for a large proportion of the US pediatric population. This article reviews these data.

Healthy Start is a three year research project designed to evaluate the effectiveness of a cardiovascular risk reduction program in minority and low-income children and their parents. Baseline 24-hour recall data was collected on 439 three to five year-old children during the Fall of 1995. The methodology used was a combined approach: observation of the children during mealtime to determine quantities of food eaten at school coupled with completion of a food record by the parent/guardian of the child for foods eaten away from school on the same day as the observation. The food record was reviewed by phone with the parent/guardian for accuracy and completeness. In the absence of a completed food record, the parent was asked to recall the child's intake on the day in question. School meal plus home meal intake was merged for each child to create the 24-hour intake. The collection method was done according to specific criteria. The mean caloric intake was 1449 kcal, with 15% of energy from protein, 54% from carbohydrate, 31% from fat and 12% from saturated fat. This combined approach methodology allows 24-hour intakes to be collected on young children in the school setting as well as the home environment.

Healthy Start is a 3–year demonstration and education research project to evaluate the effectiveness of a coronary heart disease risk reduction program in Head Start centers in New York State. The primary goal of the program is to demonstrate that it is possible and safe to reduce young children's intake of fat to desirable levels. The development and initial implementation of the nutrition intervention component of the program are described in this report. Nutrition intervention includes nutrition education for the children's care givers and modifications in the foodservice operation in each of the study's six intervention sites. Recommendations are provided to guide educators in future research and practice.

Primary care physicians play a pivotal role in the successful implementation of the National Cholesterol Educational Program (NCEP) guidelines for both population and high-risk approaches to reduce blood cholesterol levels in children and adults. Increasingly, in this era of health cost containment, the primary care physician is recognized as (1) the main and sometimes the only source of health care for large numbers of individuals; (2) the affordable physician and (3) the gatekeeper for referral to medical specialists. Achievement of NCEP guidelines for cholesterol reduction, American Heart Association (AHA) guidelines for prevention of cardiovascular disease, and Year 2000 National Objectives for Health Promotion and Disease Prevention will all rely heavily on the active cooperation and support of practicing internists, pediatricians, and family/general practitioners in providing patient education, risk factor evaluation and intervention. Although the majority of primary care physicians intuitively support the concept of preventive cardiology and generally have a high level of knowledge of cardiovascular risk factors, a significant gap remains between physician knowledge and attitudes and the actual practice of preventive cardiology in clinical practice. Despite these limitations in implementation of clinical guidelines, significant progress has been made in the past decade in reaching NCEP and Year 2000 goals for population-wide cholesterol reduction.

The care of infants and toddlers in nursery school and day-care centers in increasingly large numbers over the past decade poses special problems with respect to communicable disease control. This age group is particularly susceptible to those infectious agents (bacterial, viral, and parasitic) spread by close personal contact. This study describes an outbreak of Haemophilus influenzae type b meningitis in a large nursery school in Westchester County, New York. Organized efforts to control the outbreak through recommendation of rifampin prophylaxis were undertaken and evaluated. Compliance following the first case of meningitis was unacceptably low (45% of children and 33% of staff). Following the second case, however, compliance rose to 90% among child attendees and 79% among staff. Recommended procedures for implementation of control measures are described.

A controlled study is described for chronic disease risk factor identification and intervention among 3000 (of 4600 eligible) school children, 11 to 14

The goal of health education is to motivate society to adopt health behaviors that will reduce premature morbidity and mortality from known preventable causes, including major chronic disease (heart disease, cancer, and stroke) and accidents. This motivation can be effective only within the framework of an action-oriented school health education program with a high degree of personal involvement. This paper describes the foundations of a new school health education system combining health screening, a “Health Passport,” a behavior-oriented health curriculum, and special interventions for high-risk students. We suggest that effective health education programs such as Know Your Body (KYB) become as important in our schools as reading, writing, and arithmetic, and that these be taught each year on a developmentally progressive scale, much in the same fashion as the three Rs.

The effectiveness of a 10-session social psychological approach to the prevention of cigarette smoking was tested on 8th, 9th, and 10th graders (N = 281) in suburban New York. The program was designed to address both the social and psychological factors promoting the onset of smoking by attempting to: (a) increase students' ability to cope with direct pressures to smoke, (b) decrease their susceptibility to indirect pro-smoking social influences, and (c) improve their ability to cope with anxiety. The program was conducted by allied health professionals and utilized group discussion, modeling, and behavior rehearsal. Results indicate significant differences between the experimental and control groups in terms of the proportion of new “experimental smokers” (P < 0.01). Furthermore, there were significantly greater pretest—post-test changes for the experimental group on several of the knowledge and psychological measures, suggesting that the decrease in the onset of smoking behavior among the experimental subjects did occur for the hypothesized reasons.