Original articleChanging the tide: an Internet/video exercise and low-fat diet intervention with middle-school students☆
Introduction
Poor diet, obesity, and inactivity result in more than 300,000 preventable deaths per year and chronic disease accounts for 60% of medical care expenditures in the United States (National Center for Disease Prevention and Health Promotion, 2001). When compared with early adolescents in other countries, those in the United States exercise less frequently and have less healthy diets (World Health Organization, 2000). Patterns established during middle-school years are important in the development of adult health-related habits (Leger & Nutbeam, 2000).
Nearly half of American youths aged 12–21 years lack vigorous activity on a regular basis. Inactivity is more common among young women (14%) than young men (7%) and among Black women (21%) than White women (12%). Participation in all types of physical activity declines strikingly as age or grade in school increases (National Center for Disease Prevention and Health Promotion, 2001).
Extensive reviews (Contento et al., 1995, Kennedy, 1998) of research on the effectiveness of nutrition education revealed many studies in which nutrition knowledge and attitudes of children were improved. School-based interventions were more effective than interventions conducted outside the school setting (Contento et al., 1995). Harrell, McMurray, Gansky, Bangdiwala, and Bradley (1999) demonstrated population-based approaches in schools are as effective as intervening with those at most risk for cardiovascular disease. Dietz and Gortmaker (2001) identified the great impact of school-based approaches, which is important, given the increasing prevalence of problems that can be prevented with improved nutrition and exercise and does not further stigmatize those who are obese.
Prior studies have demonstrated the usefulness of health promotion/transtheoretical model (HP/TM) constructs in predicting dietary fat intake among low-income, culturally diverse, middle-school students (Frenn & Malin, 2003, Frenn et al., 2003). The HP/TM constructs guiding intervention development (shown in Fig. 1) included (a) increasing benefits/decreasing barriers to change, (b) fostering access to healthy foods and opportunities for physical activity, (c) stage-tailored feedback, emphasizing consciousness-raising (e.g., reading food labels) and self-reevaluation (analyzing fat grams in previous daily intake), and (d) building self-efficacy by modeling refusal of junk food and substituting activity for sedentary behavior with friends. A four-session classroom-based intervention using the HP/TM resulted in significant decreases in dietary fat intake and increases in physical activity as did a four-session Internet/video delivery of the intervention (Frenn et al., 2003, Frenn et al., 2003). Although reduced significantly compared with the control groups in these studies with similar low-income, culturally diverse, middle-school students, dietary fat intake was not reduced to Healthy People 2010-recommended levels of 30% of total calories. Subjects' dietary fat was reduced with each additional module in which they participated, suggesting that additional modules might help them achieve that goal.
The purpose of this study was to examine the effectiveness of an eight-session HP/TM model Internet/video-delivered intervention to increase physical activity and reduce dietary fat among low-income, culturally diverse, seventh-grade students.
We hypothesized that subjects participating in more than half the intervention sessions would have (1) significantly (p < .05) higher physical activity and (2) significantly (p < .05) lower dietary fat intake as compared with those in the control group.
Section snippets
Methods
Following approval for protection of human subjects, the project was described and a consent form (in English and Spanish) sent home with students. A $1 school bookstore coupon was given for returned signed consent regardless of answer and a $2 coupon was awarded for completion of pre- and posttest data. A quasi-experimental design was used with subjects assigned to the intervention or control group based on classroom assignment to prevent diffusion of the intervention to the control group. The
Hypothesis 1: Physical activity
No significant differences (p < .05) were found in demographic, stage of change, or outcome variables on pretest. Of the initial 137 subjects, 60 were included in the control condition and 43 in the intervention condition with complete data on pre- and posttest for physical activity. Intervention classroom students (n = 12) who did not complete at least half the exercise sessions were not included in the subsequent analyses, although their change in activity was not significantly different from
Discussion
The findings of this study further add to the body of literature suggesting that computer-tailored interventions are effective in improving health behaviors in middle-school students.
Computer-tailored interventions for dietary fat have been deemed more effective than general nutrition information (Brug, Oenema, & Campbell, 2003). Computer-tailored intervention studies have been reported with high-school students and adults for dietary fat and physical activity (Bull et al., 1999, Kreuter &
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This study was funded in part by the Milwaukee Area Health Education Center and the state of Wisconsin.