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BackgroundObesity interventions targeting Hispanic preschool children are still nascent, and few are culturally appropriate. We evaluated the feasibility of a culturally relevant 9-month intervention program to improve health behaviors in low-income Mexican mothers with 3- to 5-year-old children.MethodsA community engagement approach was used to culturally and linguistically tailor an intervention program that was pilot tested with 33 mother-child dyads enrolled from a large California urban health center. A one-group, pretest-posttest design assessed changes in children's consumption of sugar-sweetened beverages (SSB), mothers' pedometer steps, and BMI. Data were collected at baseline, postintervention and at 6 months postintervention.ResultsAt postintervention, SSB consumption had significantly decreased for soda and other sugary drinks with a modest reduction for 100% juice. Consumption of water had significantly increased, whereas milk had an increased trend. Maternal step counts significantly increased for weekdays by 69% and weekend days by 49%. Overall, maternal BMI decreased while children's BMI% remained stable. At 6 months postintervention, children's soda and juice consumption reverted toward baseline levels, as did maternal step counts, but children's consumption of sugary drinks remained lower, while water and milk remained higher.ConclusionsFindings suggest that a culturally relevant intervention was feasible for improving target health behaviors in a low-income Mexican community. Future work should assess an enhanced intervention including a maintenance phase for long-term adherence to health behavior changes and influence on maternal and child BMI.

Background: Approximately one third of California school-age children are overweight or obese. Legislative approaches to assessing obesity have focused on school-based data collection. During 2010-2011, the Chula Vista Elementary School District conducted districtwide surveillance and state-mandated physical fitness testing (PFT) among fifth grade students. We compared height, weight, and body mass index (BMI) to examine measurement differences between the projects. Methods: We assessed demographic characteristics and BMI category frequencies. We used paired t-tests to test continuous variables. ? statistics were used to assess categorical agreement. Results: Of 3549 children assessed, 69% were Hispanic. Fifty-one percent were boys. Mean heights, weights, and BMIs were significantly different for each project (p?

Eight papers on Australia's school health programs discuss: creating health promoting schools in the United States; intersectoral collaboration for developing a national framework for health promoting schools; school-based health promotion nationwide; auditing health promoting schools policy documentation; the nature of health service/school links; research; the impact of Australia's national health promoting schools initiative; and secondary HIV/AIDS education. (SM)

The study identifies the patterns and causal factors of moderate-to-vigorous physical activity (MVPA) of youth followed from the ages of 9 to 15 years. Findings indicate significant decrease in measured physical activity between the ages of 9 and 15 years.

Objective. To determine from 2 surveys, in 1991 and 2001, 1) the proportion of pediatricians and which pediatricians report doing school health, 2) which school health activities are most commonly engaged in and whether this has changed, 3) whether training/education during residency influences doing school health later in practice, and 4) whether the amount or nature of residency training in school health (as reported by practicing pediatricians) increased over time, as recommended by various task forces. Methods. Surveys were mailed to a 10% randomly selected group of the voting membership of the American Academy of Pediatrics. Results. An estimated 50% to 70% of pediatricians report doing school health, and a consistent 20% report having had training in school health. The nature of school health work varies in urban, suburban, and rural areas, and pediatricians who practice in rural areas are more likely to be involved in school health. When resident education in school health is offered during residency, it is associated with a higher likelihood of pediatricians' doing school health later in practice. Recent trainees report having more residency training in school health, yet fewer recent trainees report doing school health compared with their older colleagues. Conclusions. The gap between those who do school health and have received education in school health during residency has continued over at least a 10-year period. Recommendations include specification of school health and community pediatrics competencies for the effective practice of pediatrics in the future. Pediatrics 2003;111: 730-734; school health, community pediatrics., For >20 years, organized Pediatric Education Task Forces (FOPE I and II) (1,2) have called for more education in residency programs concerning psychosocial, educational, and community pediatrics that would include [...]

Retaining school-aged study participants poses a major challenge in any longitudinal research study. Dropouts produce bias in the remaining sample and this loss may affect study findings and their interpretation. Dominant factors that influence retention in pediatric research studies include family versus individual participation, patient management strategies of study personnel, knowledge about the condition or therapy, age and gender factors, credibility within the community, monetary incentives, and altruism. Eleven years after baseline assessment, Studies of Children's Activity and Nutrition boasts a 53% retention of the original biethnic cohort in San Diego. Retention occurred partly due to a trained measurement team which completed sequential observations primarily in family homes and implemented continuous participant follow-up procedures. Approaches for increasing student retention based on carefully designed studies and adherence indicators can assist researchers seeking maximum retention of school-aged participants. (J Sch Health. 2003;73(2):51-57), Success or failure of longitudinal research often depends on retention of participants after they enter the study. Dropouts produce bias affecting study findings and interpretation, so investigators must be alert [...]

Objective To examine the tracking (ie, the stability over time) of dietary intake in Mexican-American and white children aged 4 to 12 years. Subjects Children 4 years of age (n=351) were assessed at baseline and 65% (n=228) completed the 8-year study. Design Cardiovascular disease-related dietary intake was defined as energy, percent of energy from fat, and sodium (mg/1,000 kcal). From age 4 to 7 years, a modified 24-hour recall with observation of lunch and dinner and interview of the primary food preparer for unobserved foods was used to describe dietary intake. For children aged 11 to 12 years, a standardized 24-hour recall was used. Statistical Analyses A mixed effects model that adjusted for sex, ethnicity, and measurement wave allowed for separation of shorter-term variations in diet from more stable ('between subject') variations. Extent of between-subject variance is an indication of tracking. Results From age 4 to age 7, there were statistically significant between-subject variance components for energy (P Conclusions/Applications It seems that dietary intakes are stable over short periods and at earlier ages compared with longer intervals and later ages. Nutrition interventions are needed in childhood and throughout adolescence. J Am Diet Assoc. 2002;102:683-689., Physiological risk factors track to some extent during youth (1-8). 'Tracking' refers to a collection of related concepts such as 'high correlation between successive measurements of the same individual...the tendency [...]

Background Recent studies in adults suggest that individual dietary fatty acids differ markedly in their effects on serum lipids and lipoprotein levels. However, these associations have rarely been studied in children. Objective To assess, using regression procedures, the associations in children between specific fatty acids and nonfasting serum lipids and cholesterol after controlling for total energy and total fat intake. Subjects The sample consisted of 1,182 children who participated in the Child and Adolescent Trial for Cardiovascular Health. The sample was equally distributed across 4 sites (Louisiana, Texas, Minnesota, California). The sample was 48% boys; 71% white, 15% Hispanic-American, 10% African-American, 2% Asian, and 2% from other or unspecified racial/ethnic heritage. Design In this randomized multicenter trial with 56 intervention and 40 control elementary schools, food record-assisted 24-hour dietary recalls and serum lipid measurements were collected for each child at baseline (3rd grade) and at the 5th grade follow-up. Statistical Analyses Repeated-measures analysis of variance was used to evaluate the association between nutrient composition of the diet and serum lipids. Independent dietary variables included amount and type of fat, individual fatty acids, protein, carbohydrate, and fiber. The dependent variables were the absolute values of serum total cholesterol (TC) and high-density lipoprotein cholesterol (HDL-C) both at baseline (3rd grade) and at follow-up (5th grade). Results Increased total fat (b=0.053; P Conclusions/Applications We conclude that using a modeling approach, the effect of diet on serum lipids in children is similar to that observed in adults. Total fat and saturated fat were positively associated with TC and HDLC levels, saturated fat was positively associated with TC, and carbohydrate was inversely associated with both TC and HDL-C. In the statistical model, substitution of unsaturated fatty acids, monounsaturated fatty acids, or oleic acid for saturated fat, while holding total fat and energy constant, slightly lowered TC. In contrast, substitution of total fat for carbohydrate in the model increased TC and, thus, did not seem to be associated with an apparent health advantage except for HDL-C elevating effects. However, consumption of individual fats tends to be highly correlated, and we were unable to determine if these biological effects were operating independently., The type and amount of dietary fat are associated with serum lipid and lipoprotein concentrations in children as well as in adults (1-7). Dietary alterations in serum lipid levels are [...]

Overconsumption of energy has been linked to many chronic medical conditions, with cardiovascular disease, stroke, and type 2 diabetes meliltus being just a few (1-4). Further, the weight gain associated [...]

Longitudinal changes in physical activity among 129 Mexican-American (mean age 30.8; SD = 5.6) and 97 European-American (mean age 31.2; SD = 5.4) women were studied. Two physical activity recall interviews were administered at baseline and 7 years later. At baseline, European-American women reported more vigorous leisure activity (p < .005) than Mexican-Americans, and Mexican-Americans reported more moderate work activity (p < .02) than European-Americans. Virtually all components of physical activity increased significantly over the 7 years. Pearson tracking correlations for total energy expenditure were about r = 0.30. The finding that both groups increased physical activity over time was unexpected and was unrelated to a reduction in the number of preschool children in the homes over time. KEYWORDS. Women, exercise, ethnicity, prospective

Cardiovascular health interventions based on food service and physical education improvements at elementary schools in addition to family participation appears to decrease the fat intake and increase the vigorous physical activity of children. The Child and Adolescent Trial for Cardiovascular Health (CATCH) was implemented at 56 schools in diverse communities in California, Louisiana, Minnesota and Texas. An additional 40 non-intervention schools were used as controls. A total of 5106 students were followed from third through fifth grade. With intervention, the percentage of energy in school lunches derived from fat decreased and the intensity of physical exercise increased significantly compared to non-intervention. Students' reported fat intake decreased and their reported vigorous physical activity increased significantly with intervention. Serum cholesterol, blood pressure and body size were not found to change significantly with intervention.

Discusses ways physicians can develop family exercise programs for patients, with recommendations for preparing families to exercise and maintain physical activity at all levels. Family exercise lets people spend time together with mutual support that helps them make long-term commitments to fitness. The physician's role is to support that commitment. (SM)

Objective To assess vitamin and mineral intakes of Anglo-American and Mexican-American preschoolers. Design By use of interview and observation methods, acquire food intake data, calculate total nutrient intake, and compare selected nutrients to the Recommended Dietary Allowances (RDAs) for ethnic and gender groups. Subjects Low- to middle-income parents and their preschool children (N=351) recruited from preschools in San Diego, Calif, consented to participate in the Study of Children's Activity and Nutrition conducted by researchers at the University of California, San Diego. Main outcome measures Data regarding 15 nutrients were summarized based on the average of two food intake records for each preschooler. Statistical analyses performed Means and standard deviations were used to describe micronutrient intakes for ethnic and gender groups; analyses of variance and t tests were performed to determine ethnic and gender differences. Results Boys and Anglo-Americans had higher total nutrient intakes than girls and Mexican-Americans, respectively. Mexican-Americans had higher nutrient intakes per energy intake, which indicates a micronutrient-dense diet. When each nutrient was considered by the two thirds of the RDA criterion (66% of the RDA means adequate intake), the nutrients most likely to be inadequate were iron, zinc, vitamin D, vitamin C, and niacin. Mexican-American girls had significantly lower calcium intakes than the other gender and ethnic groups. Application Parents and day care providers must ensure that preschoolers, especially girls and Mexican-Americans, eat nutrient-rich foods in adequate quantities that will achieve the recommended intakes. J Am Diet Assoc. 1995; 95:329-335., The importance of young children consuming foods that contain vitamins and minerals is well known. Yet research has shown that as many as 50% of 2- to 10-year-old children have [...]

Health promotion interventions intended to improve dietary behavior frequently incorporate self-efficacy as a construct to enhance behavior change. This paper presents results from a study to establish psychometric properties of a scale to measure children's self-efficacy for selecting healthful food. As part of a series of pilot studies to develop instrumentation for the Child and Adolescent Trial for Cardiovascular Health (CATCH), data were collected on third and fourth grade students (n = 1,127). Data analyses were conducted to estimate internal consistency, test-retest reliability, factorial validity, and criterion related validity. Results revealed acceptable estimates of internal consistency for the dietary self-efficacy scale (coefficient alpha = .84). Self-efficacy was strong associated with the children's usual food choices, accounting for about 34% of variance (Multiple R =. 58). Findings support using such an instrument for evaluating intervention programs addressing nutrition behavior and for studies to determine the association of self-efficacy to dietary behavior or related constructs. (J Sch Health. 1995;65(1):23-27), Social psychology models that identify environmental, individual, and behavioral characteristics associated with cardiovascular disease (CVD) helped to guide development of chronic disease prevention programs among children and youth.[1-5] Social cognitive [...]

The Project for Attention-Related Disorders (PARD), instituted by the San Diego (Calif.) School District, represents a unique approach to identification, referral, and management of children with Attention-Deficit Hyperactivity Disorder. As a school-based program, PARD coordinates medical, psychosocial, behavioral, and educational interventions for each child, and provides resources for school personnel caring for children with ADHD. Three years after instituting PARD, about 60% to 70% of the children showed improvement after enrollment, evaluation, and treatment. Parental involvement in and acceptance of intervention for their children represented a significant follow-up problem. Both medical and nonmedical interventions such as counseling, special programs, and behavior modification helped improve the educational life of these children. (J Sch Health. 1993;63(7):294-297), Attention-Deficit Hyperactivity Disorder (ADHD) is the most common chronic behavioral disorder in childhood.[1] Prevalence estimates of ADHD in U. S. children range from 1% to 20%.[2] Children with ADHD have [...]

* Objective.--To examine the relationship between parental behaviors and physical activity and fitness in elementary school-aged children. Design.--Cross-sectional survey of students and parents. Setting.--Seven public elementary schools in a suburban southern California city. Participants.--One hundred forty-eight fourth-grade girls and 149 fourth-grade boys and their parents. Eighty-four percent were white. Interventions.--None. Measurements/Main Results.--Children's physical activity was indicated by self-report, data obtained from a monitor (accelerometer), and results of the mile run/walk. Multiple regression analysis, controlling for ethnicity and body mass index, was conducted separately for girls and boys to explain variation in child activity and fitness. Parents' reported physical activity was not associated with child activity or fitness. However, availability of transportation by parents to sport and fitness activities was significant (or nearly so) in two regressions for boys and in one regression for girls. Parents who played with their children had more active boys, based on self-report, but verbal encouragement to be active was not significant in any model. Conclusion.--The parental role as gatekeeper of access to activity and sport facilities deserves further study. (AJDC 1992;146:1383-1388)

National trends in school health practice and training were assessed 10 years after the report of the 1978 American Academy of Pediatrics Task Force on Pediatric Education. A questionnaire was sent to 2,237 randomly selected AAP Fellows and was returned by 1,068 (48%). Seventy-seven percent of practicing pediatricians reported involvement in some type of school-based or school consultant activity. Those having residency training in school health and those practicing in rural areas were most likely to be involved. The most common types of activity were school-based pre-athletic exams (56%), consultant to special education placement (26%), and game/event physician (23%). Pediatricians were paid for 20% of sports-related school consultation and 25% of nonsports school health activities. Didactic or clinical training in school health was offered during residency to 19%. Specific didactic topics in school health included learning and attention deficit disorders (32%), physician role in health education (15%), and sports medicine (12%). Preathletic participation exams were the most commonly performed school health activity during residency (23%), followed by serving as a school consultant (11%), and attending an individual education plan meeting (7%). Most pediatricians engaged in school health activities. However, they did so without preparation during residency and without payment for their services. (J Sch Health. 1991;61(6):245-248), More than a decade has passed since the American Academy of Pediatrics (AAP) Task Force on Pediatric Education labeled the training provided by many residency programs in the biosocial and [...]

To achieve one of the Dietary Guidelines for Americans (1), 'Choose a diet low in fat, saturated fat, and cholesterol,' adults and children over 2 years old should practice fat-lowering [...]

Corporal punishment is the physical infliction of pain as a punishment for improper behavior of a child, for example in school. Such punishment is allowed in the schools of 30 states in the United States. It is estimated that over two million students are punished by this method each year, with males and minority students being the most likely to receive such treatment. There are a number of rationales given for using corporal punishment, such as those based on religion, philosophy, and tradition. Studies show that other methods for dealing with such behavior work better and are more productive. Some research has shown that corporal punishment has the opposite effect of that desired; it also may cause the child psychological and physical harm. Legal efforts to curtail the use of corporal punishment have been successful in a number of states and large cities, but the fact that most control over this area is left to local school boards limits the use of legal action in many settings. The pediatrician can do much to help prevent the use of corporal punishment in the schools. The pediatrician can work to educate him or herself, the public, school officials, and state lawmakers on the detrimental effects of, and alternatives to, corporal punishment. Any cases of excessive use of physical force can be reported. The pediatrician is in a powerful position of influence and can use this influence to help end a system of punishment that does not work. (Consumer Summary produced by Reliance Medical Information, Inc.)

An integrated system for coding direct observations of children's dietary and physical activity behaviors was developed. Associated environmental events were also coded, including physical location, antecedents, and consequences. To assess the instrument's reliability and validity, 42 children, aged 4 to 8 years, were observed for 8 consecutive weeks at home and at school. Results indicated that four 60-min observations at home produced relatively stable estimates for most of the 10 dimensions. Interobserver reliabilities during live and videotaped observations were high, with the exception of 'consequences' categories that occurred in less than 1% of observed intervals. Evidence of validity was provided by findings that antecedents were associated with respective dietary and physical activity behaviors. The five physical activity categories were validated by heart-rate monitoring in a second study. The Behaviors of Eating and Activity for Children's Health Evaluation System is appropriate for studying influences on diet and physical activity in children in a variety of settings.

The Child and Adolescent Trial for Cardiovascular Health (CATCH) is a multisite intervention research study that builds on significant progress made in school health education research in the 1980s. The study has three phases: Phase I deals with study design, intervention, and measurement development, Phase II involves the main trial in 96 schools in four states, and Phase III focuses on analysis. The intervention program targets third-fifth grade students and focuses on multiple cardiovascular health behaviors, including eating habits, physical activity, and cigarette smoking. Classroom curricula, school environmental change, and family involvement programs are developed for each grade level and behavioral focus. This paper describes Phase II of CATCH with a rationale for cardiovascular health promotion with youth. The process of change that appears to be necessary for school-based health promotion and that will be tested in CATCH are presented as a framework to guide these efforts. (J Sch Health. 1990;60(8):406-413), During the past decade, a revolution in school health education occurred, with expanded objectives and demonstrable behavioral outcomes. Before 1980, the goal of school health education was similar to that [...]

The term 'comprehensive' engenders positive feelings, and the term is not new. School health advocates have espoused 'comprehensive school health education K-12' for a number of years. 'Comprehensive care' for [...]