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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. κ 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

Obesity 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.A 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.At 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.Findings 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.

A collaborative approach to identify opportunities for interactions between multiple systems is an important model for childhood obesity prevention. This paper describes a process aligning multiple partners in primary care, public health, university research, schools, and community organizations. Jointly implemented strategies in a Latino underserved community included: (1) building an effective and sustainable collaborative team; (2) disseminating a healthy weight message across sectors; (3) assessing weight status and healthy weight plans in primary care, school, and early childhood settings; and (4) implementing policy changes to support healthy eating and physical activity. The process and lessons learned were analyzed so other communities can utilize a systems approach to develop culturally appropriate interventions tailored to a specific community.

Data on childhood obesity collected by the Centers for Disease Control and Prevention helped reveal the nation's epidemic of overweight and obese children. But more information is needed. Collecting body mass index (BMI)-the widely accepted measurement of childhood weight status-at the state and local levels can be instrumental in identifying and tracking obesity trends, designing interventions to help overweight children, and guiding broader policy solutions. Approximately thirty states have enacted or proposed BMI surveillance laws and regulations. Arkansas stands out as the state with the highest-quality surveillance data. Innovative strategies being pursued in a number of other states should be explored for broader dissemination.

Objective To augment resident training in the delivery of culturally effective care in order to improve clinician capacity to effectively care for patients from diverse backgrounds. Methods Residents from the Naval Medical Center San Diego and the University of California San Diego participated in experiential learning and service activities. Programme evaluation assessed aspects of the delivery of culturally effective care in community settings. A community-based participatory approach to engaging residents in the delivery of culturally effective care and evaluation of the effectiveness of this approach are described. Results A significant pre−post rotation increase was noted in residents' self-perceived ability to identify culture-related issues that may impact on the patient's view of illness (P

Background:Longitudinal patterns in the development of physical activity (PA) and potential causal relationships between parent and child PA are examined.Methods:Autoregressive models were used to examine bidirectional prospective paths between parent and child PA in a longitudinal sample of 351 Anglo and Mexican American families. PA was assessed independently in children and parents over a 13-y period.Results:There was little evidence for a causal path from mother PA to child PA.Conclusions:Modeling does not appear to be the primary mechanism by which parents influence children’s PA behavior. Studies examining relations between parent and child behaviors should not rely on a single respondent for assessing both parent and child PA or on cross-sectional correlational data to make unidirectional causal inferences about determinants of child PA.

Background. Developing and evaluating interventions to influence students' opportunities for healthful choices has been a focus of school-based health promotion research; however, few studies have examined the sustainability of these programs and viability of continued organizational implementation. Methods. The purpose of this study was to determine the maintenance of Child and Adolescent Trial for Cardiovascular Health (CATCH) school-level changes in former intervention (n = 56) and former comparison (n = 20) schools 5 years post-intervention. Twelve schools unexposed to CATCH were measured as controls. Macronutrient content of 5 days of school lunch menus, amount and type of physical education (PE) classes, and health instruction practices in the classroom were assessed. An institutionalization score for schools was developed, using program maintenance variables: % kcal from fat and saturated fat in school lunches, % PE class spent in vigorous and moderate-to-vigorous physical activity, and class time devoted to CATCH topics. Results. Menus from 50% of former intervention cafeterias met the Eat Smart guidelines for fat, compared to 10% of former control cafeterias and 17% of unexposed school cafeterias (P < 0.005). There were no significant differences in implementation of CATCH PE goals between conditions. Although the total time spent teaching CATCH was low in former CATCH schools, the former intervention schools spent significantly more time teaching CATCH and taught more lessons as compared to former comparison schools. Former intervention schools had a higher mean institutionalization score than former comparison schools (P < 0.001). Training had the greatest impact on maintenance of CATCH. Conclusions. Results from this study suggest that changes in the school environment to support healthful behaviors can be maintained over time. Staff training is an important factor in achieving institutionalization of these programs.

We examined associations of demographic/biological, psychological, social, and environmental variables with two different measures (self-reported and accelerometer) of physical activity (PA) in Mexican-American (56 boys; 64 girls) and European-American (49 boys; 45 girls) children (mean age = 12.1 years). Among 32 potential correlates, 4 gender and 16 ethnic differences were found. Percent of variance explained from 3% to 24% for self-reported PA and from 7% to 16% for accelerometer-measured PA. Physical self-perception was the only variable with a significant association across all subgroups and both measures. Less favorable levels of psychosocial variables among Mexican-Americans may explain ethnic differences in PA.

Purpose To determine the long-term effects of a low fat intervention on sugar content in school lunches Methods We calculated contributions of total sugars, 6 specific sugars, and selected nutrients in National School Lunch Program meals served in 56 former intervention, 20 randomly selected control schools that had participated 3 years before in a low fat intervention, and 12 additional schools from neighboring school districts that had never been exposed to the intervention, whose goal was the lowering of total fat to under 30% of calories and saturated fat to under 10% calories. Analysis of variance adjusted for region was used to compare treatment groups. Pearson partial correlations controlling for the effects of region and treatment group were used to assess the strength of sugar and fat relationships. Results Three years after the low fat intervention, former intervention, control and unexposed schools lunches were similar in mean total sugars (25% of calories), and "added" sugars (e.g. sucrose, glucose, galatose, and maltose) at 15% of calories; and differed only in their lactose content. As percent of calories from fat or saturated fat in lunches decreased, that from sugars increased. Lunches that met reduced saturated fat goals were significantly higher than those not meeting goals in percent of calories from sugars both in meals as offered (27.6 ± 0.3% vs. 26.2 ± 0.3 SE p = .004) and as served (26.5 ± 0.4 vs. 23.9 ± 0.4 p = .009). Lunches meeting reduced total fat goals were significantly higher only in percent of calories from sugars as served. Seventy-five percent of total sugar in lunches offered was from chocolate milk, fruit/fruit juices, and white milk. More "added" sugar came from high micronutrient foods, such as fruit, fruit juices, and chocolate milk than from desserts and entrees. Conclusion The existence of a fat-sugar "see-saw" makes it important to emphasize substitutions of fat and saturated fat with starches and fiber in school lunches.

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.

This was a prospective randomized cohort study to assess the effectiveness of an educational immunization intervention with pregnant Latinas on timely initiation of infant immunization. Study participants were recruited from two community clinics in north San Diego County. A total of three hundred and fifty-two Latinas in the third trimester of pregnancy were recruited and randomly assigned to intervention or control groups. Participants received either a culturally and linguistically appropriate session on infant immunization (intervention) or a session on prevention of Sudden Infant Death Syndrome (control). The main outcome measures were pre-post immunization knowledge change and infant immunization status at 92 days. Immunization knowledge increased significantly in the intervention group [p < .0001, 95%CI (1.76, 2.47)]. No difference was found between groups in immunization series initiation: 95 percent of the children in the intervention group were up-to-date by 92 days from birth, and 93 percent of the control group was up-to-date at 92 days. The lack of significant association between receiving immunization education and infant immunization series initiation suggests that parent education may be necessary but not sufficient for timely immunization, particularly in clinics with effective well-child programs. Given the significant increase in immunization knowledge, the broader and perhaps more important implication is that language- and culturally specific infant health education messages in the prenatal period may have a positive long-term impact on the child's health and promote well-child care overall. Future studies should assess the role of prenatal well-child education in the context of clinics with low immunization levels

To describe predictors of lightweight in 11-year-olds and how weight changes between ages 9-11 years affected selected cardiovascular risk factors.Cohort study among an ethnically and geographically diverse group of 5098 nine-year-olds who participated in the Child and Adolescent Trial for Cardiovascular Health (CATCH) and were followed from 1991 to 1994 until age 11 years. Lightweight (body mass index [BMI]15th percentile) was defined from gender- and age-adjusted data on the total population in the National Health and Nutrition Examination Survey I of 1971 to 1973. Weight (BMI) category at follow-up (age 11 years) was the dependent variable in the logistic regression. Gender, race/ethnicity, school site, weight category at baseline, and participation in the CATCH (intervention or control group) were examined for possible predictors.The prevalence of lightweight was much lower than the 15% expected at both ages 9 and 11 years; 4.7% for males (M) and 7.4% for females (F) and at age 11 years; 5.9% for M and 8.3% for F. Lightweight at age 9 years was the best predictor of lightweight at age 11 years (OR = 56.8; CI 41.3, 78.2). Normal-weight children who entered the overweight category exhibited striking adverse percent changes in serum cholesterol and in both serum high-density cholesterol and apolipoprotein B cholesterol levels. Among children in each weight group at age 9 years, the heavier children at age 11 years had higher percent changes in systolic blood pressure, and lower times on the 9-min run. Maintenance of lightweight was associated with the most favorable pattern of cardiovascular risk factors. Differences between groups were not found for percent change in total calorie intake or percentage of calories from fat. Normal-weight children who became overweight exhibited striking percentage increases in levels of serum cholesterol and in serum apolipoprotein B cholesterols.Population-based anticipatory guidance about weight should focus on all children in mid-childhood, not only those at the upper extremes of weight. These who are genetically lean and healthy should be encouraged to remain so. Maintenance or achievement of lightweight was associated with favorable changes in systolic blood pressure in CATCH children during early adolescence. Those below the 5th percentile should be assessed and treated if eating disorders, undernutrition, or chronic illness are present. Optimal weight and optimal health should not be confused.

Identifying correlates of children's television (TV) watching could help identify strategies to reduce children's TV watching and impact children's weight status. Children's TV time and home environment factors were assessed longitudinally among 169 families with children followed from 6 to 12 years of age. TV watching increased with age, as did the number of in-home TVs and the presence of videocassette recorders (VCRs), the frequency of meal eating while watching TV, and the percentage of children with bedroom TVs. Greater meal eating while watching TV was consistently related to overall TV watching and increases in TV watching over time. The number of in-home TVs and the presence of a bedroom TV were less consistent correlates. TV watching was related to weight status when children were younger, and when children were older, more than 2 hours of TV daily was a risk factor for higher weight. Modifying TV access, particularly by reducing the frequency of meals eaten while watching TV, could promote lower children's TV watching and adiposity.

Background. The purpose of the study was to compare immunization-relevant knowledge, certainty about knowledge, self-efficacy, vested interest, and reported practices of providers and clinical staff in the same clinics. Methods. A valid and reliable instrument measuring the aforementioned issues was developed and administered to a sample of 50 providers and 60 members of the clinical staff. Results. Providers were significantly more knowledgeable than staff (P < 0.001); however, they were not more certain about their knowledge (P = 0.52) nor were they more confident in their capability to properly immunize all children in their practice (P = 0.10). Providers reported lower vested interest in immunizations than clinical staff (P < 0.05). Both groups were equally likely to immunize a child with a cold. Providers were less likely to defer needed immunizations for a 15-month-old child, and they were more likely to administer multiple injections to an 18-month-old (both P < 0.05). Providers were more likely than staff to immunize during acute and chronic illness visits (both P < 0.001), and both groups were equally likely to immunize during preventive visits. Conclusions. Discrepancies in reported immunization practices between providers and staff may be a barrier to full immunization.

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.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,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.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.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).Increased total fat (b=0.053; P.03) was associated with increased TC in the model when energy was held constant, whereas increased carbohydrate was associated with decreased TC (b=-0.021, P.02) and HDL-C (b=-0.010, P.005) levels. Increased total protein (b=0.017, P.05) was associated with increased HDL-C when energy was held constant. Saturated fat (b=0.004, P.04), unsaturated fat (b=0.004, P.03), and myristic fatty acid (b=0.021, P.01) all increased TC in the model when total fat and total energy were held constant.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.

Background. The Child and Adolescent Trial for Cardiovascular Health (CATCH), a multisite field trial, tested the effectiveness of multiple interventions for cardiovascular disease risk behaviors in children in third through fifth grades. This paper reports the tracking of physiologic variables through eighth grade. Methods. The cohort began with 5,106 third grade students from diverse ethnic backgrounds: 69% Caucasian, 14% Hispanic, 13% African American, and 4% other. Seventy-two percent of students were remeasured. Measures described are serum lipids, blood pressure, and body anthropometrics. Tracking was examined across three time points (third, fifth, and eighth grades) with a scaled Kendall concordance coefficient and percentage retention within quintiles across time. Results. For the overall sample, tacking was strongest for body mass index (BMI) (Kendall coefficient = 0.86) and weight (0.86), followed by skinfold thicknesses (0.72–0.78), serum lipids (0.67–0.72), and blood pressure (0.45–0.51). For BMI, 96% of students stayed within ±1 quintile from third to fifth grades; 90% stayed within this range from third to eighth grades. Conclusions. There were small but noticeable gender and ethnic differences: tracking was stronger among boys and African American students. These results demonstrate that the children's relative level of cardiovascular risk remained stable over a 6-year period.

The purpose of this study is to look for associations between the following: the frequency of television advertising for certain categories of food products; the number of times they are requested by children; and subsequent purchases by parents. The study design consisted of a cross-analysis of two sets of existing and published databases, one being an independent study of television advertising where data were collected in 1993, and the other being the Study of Children's Activity and Nutrition, with data collected in 1991. The results showed that the correlation coefficient between foods advertised on television during common child viewing hours and foods children requested was 0.91 (p

The Child and Adolescent Trial for Cardiovascular Health (CATCH) is a field study conducted in elementary schools that was designed to assess the outcomes of health behavior interventions for the primary prevention of cardiovascular disease. Beginning in 1991, third grade students (N = 5106) from ethnically diverse backgrounds in 96 public schools in California, Louisiana, Minnesota, and Texas were randomized to intervention or control status. Twenty-eight schools participated in a third through fifth grade intervention that included food service modifications, enhanced physical education, and classroom health curricula. An additional 28 schools received these components plus family education. Outcomes were assessed using pre-randomization measures in early third grade and follow-up at the end of fifth grade. At the school level, the two primary endpoints were changes in the fat content of food service lunch offerings and the amount of moderate to vigorous physical activity in the physical education programs. At the individual student level, endpoints included psychosocial factors, measures of eating and physical activity patterns, and physiologic measures. In the intervention school lunches, the percentage of energy intake from fat fell significantly more (fron 38.7% to 31.9%) than in control lunches (from 38.9% to 36.2%) (P < 0.001 ). The intensity of physical activity in CATCH intervention schools was increased significantly compared with the control schools (P < 0.02). Self-reported energy intake from fat among students in the intervention schools was significantly reduced (from 32.7% to 30.3%) compared with the controls (from 32.6% to 32.2%) (P < 0.001 ). Intervention students reported significantly more daily vigorous physical activity than controls (58.6 vs. 46.5 minutes) (P < 0.003). Blood pressure, body size, and cholesterol measures did not differ significantly between treatment groups. No evidence of deleterious effects of the intervention on growth or development was observed. The CATCH intervention was able to modify the fat content of school lunches. increase daily school physical activity, and improve individual eating patterns and physical activity in children during three school years. Follow-up of this cohort continues.

Previous studies have not used both self-report and objective measures to assess sex and ethnic differences in children’s physical activity. In the present study, 187 Mexican American and Anglo American children, aged 11 to 12 years, were assessed by two 7-day physical activity recall interviews and up to 8 days of accelerometer (Caltrac) monitoring over a 6-month period. Compared to Anglo American boys, accelerometer data showed Mexican American boys, Anglo American girls, and Mexican American girls to be 95,81, and 75% as active, respectively. Activity recall data showed that, compared to Anglo American boys, Mexican American boys, Anglo American girls, and Mexican American girls were 95,95, and 90% as active, respectively. The extent of sex and ethnic differences in children’s physical activity depend on the measure used.

Managed care organizations (MCOs) are being recruited to support school health services delivered in school clinics. Schools without clinics already provide numerous health services and could provide more if they had support from managed care organizations. This article describes the first two years of a San Diego-based collaborative consisting of MCOs, school districts, and other health care agencies. By establishing trust, developing overriding principles, and creating an interagency communication infrastructure, this collaborative has encouraged shared management of many student health issues. Because the agreements apply to all schools, programs can reduce high rates of absenteeism district-wide and avoid unnecessary doctor appointments for common health problems. These collaborative agreements are designed to be financially self-sustaining. However, data collection, the logistics of obtaining parental consent, and getting health professionals to communicate with each other in new ways remain to be significant challenges.

The Child and Adolescent Trial for Cardiovascular Health (CATCH) was the largest school-based field trial ever sponsored by the National Institutes of Health. The trial demonstrated positive changes in the school food service and physical education program, as well as in students' cardiovascular health behaviors. Because the CATCH intervention programs were implemented in 56 schools (in four states) that were typical of schools throughout the United States, their reception by schools and degree of implementation provide evidence about their feasibility for schools nationally. Extensive process evaluation data were collected from students, teachers, school food service personnel, and physical education specialists throughout the three school years of the CATCH intervention. Four of the CATCH programs—school food service, physical education, classroom curricula, and home programs—were assessed over the three school years. The process data provide information on participation, dose, fidelity, and compatibility of the CATCH programs in the intervention schools for these programs. High levels of participation, dose, fidelity, and compatibility were observed for the four programs during the 3 school years. CATCH emerges as a model of a feasible multilevel health promotion program to improve eating and exercise behaviors for elementary schools in the United States.

A community-based immunization registry is an essential tool for the attainment and maintenance of optimal immunization rates among preschool children. While local community-level effort is necessary to create such registries, the challenge to do so rapidly becomes regional and even national in scope. This reflects the notion that, in the long run, immunization registries must, at some level, be compatible with one another. This article briefly outlines the process that one local immunization registry undertook to collaborate with others on the development of core data elements. What began as a local effort in San Diego rapidly grew to one involving the sharing of plans and information in many western states. Lessons learned include the value of registry developers to agree on norms for data elements, the need to allow for unique local functionality in registry development, and the need to continuously collaborate with others at the state and regional levels to assure ultimately compatible systems.

For the first time ever in the U.S., a centralized registry will make it possible to identify which preschool children are in need of immunizations. Presently, records of immunizations are dispersed in patients’ charts among multiple providers, thus making tracking the immunization status of children difficult. Automating current immunization records and patient tickler systems likely will increase efficiency and productivity of office staff and contribute to increasing preschool immunization rates. We examine the process used in San Diego, California, to create the support and infrastructure for a countywide immunization system. Steps include establishing physician, community, and technical advisory groups, and parental focus groups; a comprehensive assessment of existing computer systems and required design elements; and marketing the system to providers and health care institutions.

Background.Cardiovascular risk factors and related behaviors begin during youth.Methods.As part of the Child and Adolescent Trial for Cardiovascular Health, 4,019 children from four states and representing multiple ethnic groups were measured for selected risk factors both at baseline and after 2 1 2 years of intervention. Common protocols were used for both examinations at the four sites.Results.Overall, changes in obesity, blood pressure, and serum lipids in the intervention group, compared with the control group, were not statistically significant. Total cholesterol, the primary physiologic outcome measure, decreased by 1.3 mg/dl over time in the intervention group and by 0.9 mg/dl (P> 0.05) in the control group. Different risk factor patterns for boys and girls and among three ethnic groups were noted.Conclusions.Although the school-based program effected significant institutional changes in food service and physical education class and although the children made significant changes in eating and physical activity behaviors, these did not translate to significant changes in risk factors at these ages. These behavioral changes, however, if sustained into adulthood, have the potential to influence cardiovascular risk reduction.[ep[rsKey words:risk factors; youth; school health promotion; ethnic groups; lipids; blood pressure; obesity.

Background. There are strong theoretical reasons for including a family component with a school-based intervention aimed at eating, activity, and smoking behaviors, but the empirical findings to date are limited and show mixed results. The overall CATCH family intervention added only knowledge and attitudinal effects, but no additional behavioral outcomes. This study provides a dose analysis of the family component of the CATCH study by assessing the effect of the level of adult participation. Method. This secondary analysis included students who attended a CATCH family intervention school during all 3 years of the study. The extent of the adult–child interaction, the key aspect of the CATCH family intervention, was measured by the number of activity packets that an adult household member completed with the child. Multiple regression analysis was used to assess the association of adult participation with the child's knowledge, attitudes, and behaviors related to diet and physical activity. Results. Statistically significant results suggested that dose effects were found for knowledge and attitudes related to diet and physical activity. These effects were more pronounced for minority and male students. Conclusions. These results suggest that dose response of a family intervention has been shown in the acquisition of positive knowledge and attitudes toward health habit changes. The methodology of dose response can be applied to other health promotion projects.

Gender and ethnic trends were examined in 351 Mexican American and Anglo American children between the ages of four and seven. Four physiologic variables, seven observed and reported variables related to diet, and eight observed and reported variables related to physical activity were periodically assessed. Children were observed at home at meal times and at school (or a day care center) at lunch and recess. A linear regression model was used. Of the four physiologic variables, two variables (height and total skinfolds) showed significant ethnic differences, with Mexican American children showing greater skinfolds over time and the tendency to be shorter than Anglo American children. Of the variables related to diet, five of the seven variables showed gender or ethnic differences; percent of calories from fat and food preparation behaviors tended to place Mexican American children at greater risk. When examining physical activity, four of the eight variables showed gender and/or ethnic difference...

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 .

Data on cardiovascular risk factors (body mass index, triceps and subscapular skinfolds, blood pressure, serum total cholesterol, high density lipoprotein (HDL) cholesterol, and apolipoprotein B) were collected as part of the baseline examination (fall 1991) of the Child and Adolescent Trial for Cardiovascular Health, a multicenter school-based intervention study for promoting healthful behaviors. A total of 5,106 third grade children (mean age, 8.76 years) in four states (California, Louisiana, Minnesota, and Texas) were examined. After excluding 194 children of other or unknown origin, the study population consisted of 3,530 Anglo-American children, 674 African-American children, and 708 Latino children. African-American children were the tallest by 1-3 cm (p < 0.0001), while Latino children had the largest body mass index (p < 0.05). Blood pressure levels were similar for boys and girls and among the three races, but systolic levels were 2 mmHg higher in Texas than at the other sites. Serum total cholesterol levels were 5 mg/dl higher in girls than in boys (p < 0.05), while HDL cholesterol levels were 2 mg/dl higher in boys (p < 0.05). HDL cholesterol levels were highest in African-Americans (55.5 mg/dl) compared with Anglo-Americans (50.7 mg/dl) and Latinos (51.3 mg/dl) (p < 0.0001).

The School Nutrition Dietary Assessment Study provides current data on the nutritional quality and adequacy of the National School Lunch Program (NSLP) and the School Breakfast Program (SBP) as well as on the dietary intakes of students participating in these programs. The study demonstrates that the NSLP and SBP meals and children's total diets do not conform to the recommendations of the US Department of Agriculture and the National Research Council and confirms the need to improve the nutritional quality of the nation's school meal program and student's overall dietary intakes. In this regard, the Child and Adolescent Trial for Cardiovascular Health (CATCH) is the first collaborative, school-based field trial that tests the effectiveness of a multi-level intervention designed to reduce the fat, saturated fat, and sodium content of school meals and student's diets. This commentary highlights the findings and questions raised by the School Nutrition Dietary Assessment Study and presents an overview of CATCH, including the implications and significant questions that can be addressed by this intervention study.

There is an urgent need for effective, sustainable child obesity prevention strategies. Progress toward this goal requires strengthening current approaches to add a component that addresses pregnancy onward. Altering early-life systems that promote intergenerational transmission of obesity holds promise for interrupting the continuing cycle of the obesity epidemic. A 2011 Institute of Medicine (IOM) report emphasizes the need for interventions early in life to prevent obesity. A 2010 IOM report called for addressing gaps in existing obesity research evidence by using a systems perspective, simultaneously addressing interacting obesity promoting factors in multiple sectors and at multiple societal levels. A review of evidence from basic science, prevention, and systems research supports an approach that (1) begins at the earliest stages of development, and (2) uses a systems framework to simultaneously implement health behavior and environmental changes in communities.

The Child and Adolescent Trial for Cardiovascular Health (CATCH) is an elementary school cardiovascular health education field trial in progress in San Diego, California, New Orleans, Louisiana, Minneapolis, Minnesota, and Austin, Texas. Because a significant part of a child's health behaviors are shaped within the home, CATCH is evaluating whether the effects of the school-based program are enhanced by the inclusion of a home-based program. A 7 x 7 x 10 randomized design with 7 school-only and 7 school-plus-family intervention schools, along with 10 control schools is implemented at each site. The CATCH family intervention is implemented during Grades 3 through 5 and consists of home-based curricula and Family Fun Nights focusing on healthier eating and increased physical activity during Grades 3 and 4, along with a smoking prevention curriculum in Grade 5. CATCH is examining the effectiveness of family (household) involvement through changes in students' dietary intake of fat and sodium. This paper describes the process evaluation methods used to document the extent of participation in the family program. Data reported for the third-grade Family Fun Nights held in the 28 family schools across all sites reflected an average student participation rate of 67%. The average family member to student ratio was approximately 2:1. Participation by all third-grade teachers and the majority of physical education specialists was observed.

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.

We evaluated a Preventive Cardiology Academic Award (PCAA) program designed to integrate preventive cardiology concepts into the medical school curriculum. Diet, preventive cardiology knowledge, preventive cardiology attitudes, exercise behavior, and body mass index were compared at entrance to medical school and during the graduation year. Complete data were available on 94 students (65 men and 29 women). Similar data from students who graduated in 1987, prior to the introduction of the PCAA curriculum, served as a control. Women showed a significant enhancement in attitude towards cardiovascular disease (CVD) prevention, while both men and women significantly increased their knowledge about CVD prevention. The frequency of planned physical activity decreased significantly in both sexes and men showed a significant increase in body mass index. Men significantly reduced total calories, percent of calories from fat and saturated fat and dietary cholesterol and increased fiber intake. In women, the only significant reduction was in total calories. In comparison to the control class that did not have the program, men receiving the PCAA curriculum reduced dietary cholesterol, dietary fat, saturated fat and monounsaturated fat. Changes in these dietary parameters were nonsignificant for women in comparison to the control class women. Additional analyses showed no systematic secular trends in dietary or other variables in classes entering from 1986 to 1990. We conclude that the PCAA curriculum changes have favorably affected the preventive cardiology knowledge, attitudes and diet of medical students.

For three consecutive years, beginning in 1986, we evaluated cardiovascular disease (CVD) risk factors of medical students as part of the teaching program in a Preventive Cardiology Academic Award. Entering students in three consecutive classes were screened on the first day of orientation to medical school. The first year, we evaluated 108 students (71 men and 37 women), the second year, 99 students (75 men, 24 women), and the third year 108 students (67 men and 41 women). During the single four-hour period, we obtained data on personal and family history of CVD risk factors, type A behavior, knowledge of CVD, attitudes toward CVD prevention, measures of depression and anger, blood pressure, blood pressure reactivity, physical activity, and diet. Blood was drawn for lipid analysis. Height and weight were measured, and a physical fitness step test was administered. Pulmonary function was measured during the third year. We used a four-tiered approach to preventive cardiology education. During the assessment session, abnormalities, such as elevated blood pressure or abnormal pulse, were discussed with the student. In the second tier, the data were analyzed and returned to all students during teaching sessions, enabling them to compare their levels with the class and the national averages. For the third tier, students with high-risk values, defined as low-density lipoprotein cholesterol level > or = 150 mg/dL, a total cholesterol or triglyceride level > or = 200 mg/dL, or blood pressure > or = 140/90 mmHg, were seen by faculty physicians who suggested remedial interventions in separate sessions.(ABSTRACT TRUNCATED AT 250 WORDS)

This article presents results of a process evaluation study of the third and fourth grade home-based family programs of the Child and Adolescent Trial for Cardiovascular Health (CATCH). A 50 percent stratified random sample of third and fourth grade parents at each site (California, Louisiana, Minnesota, and Texas) were interviewed by telephone prior to, and again after, completion of the home-based interventions. Of the 424 parents providing two interviews, 75 percent reported participating in the home activities. Demographic correlates of participation included age, education, occupation, and ethnicity. Neither self-report food intake, exercise patterns, confidence for behavior change, nor parental support and role modeling were significant correlates of participation. There were significant site differences in food consumption and exercise patterns. For the majority of the eating and exercise behaviors examined, changes toward more healthful habits over time were reported. Results of Ms study ...

This paper describes SOFIT (System for Observing Fitness Instruction Time), an observation instrument designed to assess variables associated with students’ activity levels and opportunities to become physically fit in physical education. SOFIT involves the direct observation of classes while simultaneously recording student physical activity levels, curriculum context variables, and teacher behavior. The paper reports the reliability, validity, and feasibility of using the instrument, as well as data from using SOFIT to assess 88 third- and fourth-grade classes.

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 heartrate 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.

As part of a family cardiovascular health promotion project, 111 Mexican-American and 95 Anglo-American families with fifth- or sixth-grade children were assigned to either a primary prevention program involving 18 sessions or to a control condition. This article evaluates predictors of attendance at the year long sequence of sessions in the intervention group. In addition it considers the relationship between attendance and program outcomes. Low baseline scores on physical activity and cardiovascular fitness measures were associated with higher attendance for both children and adults. High initial health knowledge and self-motivation were also associated with attendance. Multiple regression analysis showed that adult attendance was significantly predicted by a model including completion of a three-day food record, low exercise, higher socioeconomic status, family adaptability, and self-motivation. Attendance was correlated with greater knowledge gains and larger reductions in blood pressure. The results indicate that motivated families who are in greater need of conditioning attended more sessions in a health promotion program.

'The family that plays together stays together' is not just a cliché. Family exercise is a good way to spend time together, and the resulting mutual support helps people make a long-term commitment to fitness.

Purpose. To examine associations of neighborhood walkability and recreation environment variables with physical activity in adolescents. Methods. The cross-sectional study was conducted with 98 white or Mexican-American adolescents (mean age = 16.2 years). Physical activity was measured with 7 days of accelerometer monitoring. Height and weight were measured to compute body mass index (BMI). Environmental measures were created using geographic information systems. A neighborhood walkability index was based on land use mix, retail density, street connectivity, and residential density. Proximity to public and private recreation facilities was assessed. Results. In a linear regression, the walkability index within 0.5 mile of homes was related to minutes of moderate to vigorous physical activity, explaining approximately 4% of variance. Recreation variables were not related to physical activity, and BMI was not explained by environmental variables. Conclusion. Neighborhood walkability was related to adolescents' physical activity, similar to findings for adults.

OBJECTIVES. Our aim with this study was to assist clinicians by estimating the predictive value of earlier levels of BMI status on later risk of overweight and obesity during the middle childhood and early adolescent years.METHODS. We present growth data from the National Institute of Child Health and Human Development Study of Early Child Care and Youth Development, a longitudinal sample of 1042 healthy US children in 10 locations. Born in 1991, their growth reflects the secular trend of increasing overweight/obesity in the population. Height and weight of participating children in the study were measured at 7 time points. We examined odds ratios for overweight and obesity at age 12 years comparing the frequency with which children did versus did not reach specific BMI percentiles in the preschool- and elementary-age periods. To explore the question of whether and when earlier BMI was predictive of weight status at age 12 years, we used logistic regression to obtain the predicted probabilities of being overweight or obese (BMI ≥85%) at 12 years old on the basis of earlier BMI.RESULTS. Persistence of obesity is apparent for both the preschool and elementary school period. Children who were ever overweight (>85th percentile), that is, ≥1 time at ages 24, 36, or 54 months during the preschool period were >5 times as likely to be overweight at age 12 years than those who were below the 85th percentile for BMI at all 3 of the preschool ages. During the elementary school period, ages 7, 9, and 11 years, the more times a child was overweight, the greater the odds of being overweight at age 12 years relative to a child who was never overweight. Sixty percent of children who were overweight at any time during the preschool period and 80% of children who were overweight at any time during the elementary period were overweight at age 12 years. Follow-up calculations showed that 2 in 5 children whose BMIs were ≥50th percentile by age 3 years were overweight at age 12 years. No children who were 6 times more likely to be overweight at age 12 years than those CONCLUSIONS. The data from this study indicate that children with BMIs >85th percentile, as well as with BMIs in the high reference range are more likely than children whose BMI is

Acculturation is typically defined in terms of individual responses to a dominant culture. In the present study, we examined the effects of different levels of acculturation among family members. Specifically, we looked at the health and risk behavior in Mexican-American children as related to a variety of psychosocial predictors, especially the differences in orientation toward Mexican- and Anglo-American cultures between them and their parents. Mother and child pairs (n = 106) noted their orientation toward both Anglo and Mexican cultures. Children’s dietary and sedentary behaviors, tobacco and alcohol use (and susceptibility to use), and depressive symptoms were also measured. Males were more likely to be sedentary and consume higher levels of total fat and saturated fat, whereas girls reported higher levels of depression. Anglo-oriented youth consumed lower levels of calories from fat but also more alcohol than did their Mexican-oriented counterparts. The latter was particularly the case among those children who were relatively more Anglo oriented than were their parents. Parent–child acculturation differential in terms of the differences in Mexican orientation, in comparison, predicted susceptibility to tobacco use. However, the sum of the absolute values of these two differences predicted only lifetime alcohol use, and in a counter-intuitive direction. This familial measure of acculturation shows some promise, but additional formative research is needed to operationalize this construct.

The current report is a follow-up evaluation of a cohort of Mexican-American and non-Hispanic white children 5.5 years after the previous study (1) to determine whether the increased features of insulin resistance observed in these Mexican Americans at age 11 years were still present at age 17 years. Furthermore, we determined which of these measures in childhood would best predict the risk for the insulin resistance syndrome (IRS) at age 17 years. As inflammation has recently been recognized as potentially playing important roles in the pathogenesis of insulin resistance, diabetes, and cardiovascular disease (2–4), measures of C-reactive protein (CRP) were also assessed in the follow-up study. The study cohort was the San Diego Study of Children’s Activity and Nutrition, an ongoing observational study that began when the subjects were 4 years of age (with follow-up assessments at intervals of ∼5–7 years) and consisted of non-Hispanic white and Mexican-American children recruited through state-funded daycare programs. Detailed methods and health behavior results have been previously reported (1,5–11). The current study sample includes 83 adolescents: 29 non-Hispanic white (17 males and 12 females) and 54 Mexican-American (25 males and 29 females) subjects who had completed study visits at age 11 and again at age 17 years. Based on demographic and laboratory data, there was no evidence of a bias in the drop out of subjects between study visits. All blood samples were obtained in the fasting state. ### Anthropometric and blood pressure measures Height, weight, waist circumference, …