While researching I found out a lot of information about Newark that I never knew before. First is the serious lead poisoning problem in the city. When I first used that as one of my health risks I did not think that I would make it my major concern, but it quickly jumped to the top after doing some research on government websites. I learned that Newark alone makes up for 18% of the lead poisoning cases in children under the age of 6 in the entire state, and when you compare them to other large cities (such as Paterson, Trenton, Jersey City) they are more than double the next closest city. A large part of this is due to the housing. Nearly half the housing units in Essex County were built before 1950, and back then the paint used on the houses had an extremely high lead percentage level. A large portion of the housing units were also built before 1978 which was the year the Nation put a ban on all lead based paints. When these old houses are lived in there is obviously a direct hazard with the eating of paint chips, inhalation of dust, playing in contaminated soil, and drinking water out of lead pipes as well. Even when these houses are demolished the dust contaminates the air and soil, which makes it a hazard even when a newer home is built in the same plot of land. Although there have been significant improvements in the amount of lead poisoning cases in Newark it is still a health issue that needs to be looked at.
When I did some observations at a local park in Newark I looked to see how many children were putting their hands, toys, or snacks in their mouth after playing on the grass or in the dirt. I only analyzed 5 different children, but all together those children had 17 mouthing habits. If the area in which these children were playing was contaminated they would all be at a high risk level of getting lead poisoning.
I also did an observation period at local fast food restaurant to get a good idea of how many children eat fast food for dinner. Over the course of 1 hour, during dinner hours, 29 different children ate at either McDonalds or White Castle. The food they ordered was typically chicken nuggets, cheeseburgers, fries, and regular cola. The nutritional value of these items is very unhealthy. This is something that parents should take into consideration with their children. African-Americans and Hispanics are at the higher levels of obesity and are at the highest risk of contracting a cardiovascular disease than any other ethnicity. If you allow young children to eat unhealthy foods you are putting htem at risk for obesity, a disease which has been rapidly increasing throughout the US each year.
The last set of information that I have is that the school which I observed has no recess, and the students usually have P.E. class twice a week. With obesity and heart disease being such a threat to the majority of the students going to this school I find it shocking that they are not given the opportunity to exercise, or even be physically active, more than twice a week. Exercise has a positve relationship with academic performance, and by not allowing the students to be physically active the schools are hurting their physical and educational development.
Monday, May 11, 2009
Introduction
The inhabitants of the city of Newark face many problems every day. The portrayal from the media leads the public to believe that issues such as violence, drugs, and murder are the main issues that Newark has to deal with day in and day out; when in reality there are issues that face every member of Newark’s community. Issues such as lead poisoning, asthma, and obesity are dangerous problems that can affect any member of the community, starting with newborn infants all the way up to senior citizens. These are issues that can damage both an individual’s physical and mental development. In the North Ward children who attend the public school which I observed have to face these issues on a daily basis.
One issue that residents of Newark have to worry about more than any other city in New Jersey is lead poisoning. The ingestion of lead is something that many children face every day, and without proper awareness and prevention any child can accidentally ingest lead. Even low lead exposure affects children’s intellectual development. What many people do not realize is how many ways lead can be ingested into the body. Lead poisoning can come from paint, dust, soil, food, dietary supplements, glass, vinyl lunchboxes, toys, synthetic turf and air. It was also found in a 2008 study that lead contamination is typically greater in urban areas, and that “children with elevated blood lead levels (EBL’s) are more common in communities with many households below the federal poverty level” (Levin, Brown, Kashtock, Jacobs, Whelan, Rodman, Schock, Padilla, & Sinks, p.1289).
Obesity is another major problem in Newark. Within the past thirty years obesity has doubled for adolescents and children ages 6-17. Also in a 2008 study it was found that obesity is more prevalent in African-American and Hispanic children. The results of this study should add warning to the city of Newark. With the majority of its population being African American and Hispanic its citizens are at a greater risk than Caucasian communities. In addition to their prevalence of obesity African Americans and Hispanics are also have the greatest chances of contracting type 2 diabetes, hypertension, and cardiovascular diseases, a chance that only increases with obesity (Davis, Young, Davis, & Moll, p.61). Obesity not only effects the physical development of a child, but can affect their educational development as well.
The last issue that will be looked at in this study is asthma. Asthma is a chronic health condition that can vary with its severity. The majority of asthma cases are only mild, but children with severe asthma have a very limited level of physical activity. Asthma is an issue that is faced all over the world, but is particularly worse in urban areas. In a recent study it was found that asthma “has a disproportionate effect on low-income minority children who reside in large urban areas” (Nelson, Awad, Alexander, & Clark, 2009, p.210). Children in the North Ward are surrounded by polluted air and inhale second hand smoke on a daily basis which directly affects their health.
One issue that residents of Newark have to worry about more than any other city in New Jersey is lead poisoning. The ingestion of lead is something that many children face every day, and without proper awareness and prevention any child can accidentally ingest lead. Even low lead exposure affects children’s intellectual development. What many people do not realize is how many ways lead can be ingested into the body. Lead poisoning can come from paint, dust, soil, food, dietary supplements, glass, vinyl lunchboxes, toys, synthetic turf and air. It was also found in a 2008 study that lead contamination is typically greater in urban areas, and that “children with elevated blood lead levels (EBL’s) are more common in communities with many households below the federal poverty level” (Levin, Brown, Kashtock, Jacobs, Whelan, Rodman, Schock, Padilla, & Sinks, p.1289).
Obesity is another major problem in Newark. Within the past thirty years obesity has doubled for adolescents and children ages 6-17. Also in a 2008 study it was found that obesity is more prevalent in African-American and Hispanic children. The results of this study should add warning to the city of Newark. With the majority of its population being African American and Hispanic its citizens are at a greater risk than Caucasian communities. In addition to their prevalence of obesity African Americans and Hispanics are also have the greatest chances of contracting type 2 diabetes, hypertension, and cardiovascular diseases, a chance that only increases with obesity (Davis, Young, Davis, & Moll, p.61). Obesity not only effects the physical development of a child, but can affect their educational development as well.
The last issue that will be looked at in this study is asthma. Asthma is a chronic health condition that can vary with its severity. The majority of asthma cases are only mild, but children with severe asthma have a very limited level of physical activity. Asthma is an issue that is faced all over the world, but is particularly worse in urban areas. In a recent study it was found that asthma “has a disproportionate effect on low-income minority children who reside in large urban areas” (Nelson, Awad, Alexander, & Clark, 2009, p.210). Children in the North Ward are surrounded by polluted air and inhale second hand smoke on a daily basis which directly affects their health.
Saturday, May 9, 2009
Abstract
The purpose of this study was to take a closer look at the issues of lead poisoning, obesity, and asthma in a North Ward school community. Data were collected through the methods of observation, research, and personal interviews. Over the past few weeks it was discovered that Newark has the highest rate of child lead poisoning in New Jersey, making up for nearly twenty percent of the state’s total cases. The second major issue in the community, childhood obesity, is a concern which is rapidly growing within the school. Families are not provided with proper nutritional, recreational, and school facilities within the neighborhood to help the prevention of this disease. The issue of asthma is one that is prominent in many school age children due to a direct connection with second hand smoke within the home. This information is important because each issue threatens the overall quality of life for children living in this Newark community.
Monday, April 20, 2009
Turn to the NJRCL report and pay specific attention to the information provided about Essex County, and the concerns, challenges, and recommendations in the report. Review the six families in Unequal Childhoods, and make connections between the NJRCL report and the realities these families might face if they lived in Essex County, NJ.
After looking at the Self-Sufficiency Standard for living in Essex County I realized that each of the families in this book would have a very different living situation here. The annual cost of living in Essex for only a single adult is just over $20,000 which does not prove well for many of the families. A family such as the Tallinger's would survive just fine in Essex. With two adults, two school age children and one preschooler their cost of living would be $57,983, and since both parents work full time they would have no problem paying that kind of money. On the other hand the Taylor and Brindle families would not be able to survive in Essex County. Miss Taylor earns $20,000 annualy which is enough for her to get by on her own, but with two school age children to look after she would not be able to live in Essex. The Brindle family would never be able to get by in NJ. They live on public assistance, food stamps, and medical assistance as it is, and having them live in an expensive state such as New Jersey would not be ideal for them.
Look at the two reports from the LSNJ on living in poverty. What further information can you glean from the reports regarding the struggles the poor families in Unequal Childhoods might face if they lived in NJ?
Some of the information that I saw in "A Desperate and Widening Divide" was pretty surprising. Although most of the information in this report was taken from 1989-1999 it still shows how much of a problem poverty is in the state of New Jersey. During that decade NJ saw a gain of 125,000 people living in poverty, and 49% of the states poverty are living in sever poverty. I would have never guessed that percentage to be so high. In regards to the book we see a couple of single mothers raising families, and the numbers for those situations were interesting as well. Here are some of the statistics for single female-headed households: they make up for 53% of all poor families, and 60% of NJ children living in poverty reside in these types of households. For mothers such as Miss Taylor, Miss Brindle, and Miss McAllister this helps to show how difficult it would be for their families to live in Essex County.
Finally, turn inward and think about who you are as a budding urban educator. In what ways is this information useful (or not) for you? In terms of better understanding a community? What do you need to learn, or what skills and dispositions (frames of mind) do you need to develop related to demographics and economics to be a successful urban educator?
The information really opened up my eyes to the cost of living in New Jersey. Growing up in Bergen County I never thought of how difficult it can be for some of the families trying to make a living in NJ, especially those which are composed of single working parents with multiple children. New Jersey is a really expensive state to live in, and after reading through information I understand why many families move out of the state once their children are through the educational system. This information is really important to know because one of the most important parts of teaching is understanding where your students come from. It is easy to sit back and put the blame on the children, parents, neighborhood, etc..., but the great teachers are the ones who put forth the effort to get involved with the community so that they have a better understanding of their students and the community in which they live. This is something that would be of major importance for myself teaching in an urban community since I have little experience in working in this type of environment.
After looking at the Self-Sufficiency Standard for living in Essex County I realized that each of the families in this book would have a very different living situation here. The annual cost of living in Essex for only a single adult is just over $20,000 which does not prove well for many of the families. A family such as the Tallinger's would survive just fine in Essex. With two adults, two school age children and one preschooler their cost of living would be $57,983, and since both parents work full time they would have no problem paying that kind of money. On the other hand the Taylor and Brindle families would not be able to survive in Essex County. Miss Taylor earns $20,000 annualy which is enough for her to get by on her own, but with two school age children to look after she would not be able to live in Essex. The Brindle family would never be able to get by in NJ. They live on public assistance, food stamps, and medical assistance as it is, and having them live in an expensive state such as New Jersey would not be ideal for them.
Look at the two reports from the LSNJ on living in poverty. What further information can you glean from the reports regarding the struggles the poor families in Unequal Childhoods might face if they lived in NJ?
Some of the information that I saw in "A Desperate and Widening Divide" was pretty surprising. Although most of the information in this report was taken from 1989-1999 it still shows how much of a problem poverty is in the state of New Jersey. During that decade NJ saw a gain of 125,000 people living in poverty, and 49% of the states poverty are living in sever poverty. I would have never guessed that percentage to be so high. In regards to the book we see a couple of single mothers raising families, and the numbers for those situations were interesting as well. Here are some of the statistics for single female-headed households: they make up for 53% of all poor families, and 60% of NJ children living in poverty reside in these types of households. For mothers such as Miss Taylor, Miss Brindle, and Miss McAllister this helps to show how difficult it would be for their families to live in Essex County.
Finally, turn inward and think about who you are as a budding urban educator. In what ways is this information useful (or not) for you? In terms of better understanding a community? What do you need to learn, or what skills and dispositions (frames of mind) do you need to develop related to demographics and economics to be a successful urban educator?
The information really opened up my eyes to the cost of living in New Jersey. Growing up in Bergen County I never thought of how difficult it can be for some of the families trying to make a living in NJ, especially those which are composed of single working parents with multiple children. New Jersey is a really expensive state to live in, and after reading through information I understand why many families move out of the state once their children are through the educational system. This information is really important to know because one of the most important parts of teaching is understanding where your students come from. It is easy to sit back and put the blame on the children, parents, neighborhood, etc..., but the great teachers are the ones who put forth the effort to get involved with the community so that they have a better understanding of their students and the community in which they live. This is something that would be of major importance for myself teaching in an urban community since I have little experience in working in this type of environment.
Tuesday, April 7, 2009
Inquiry Project
When people think of the risks of living in an urban environment they typically think of issues such as gang related fights, shootings, drug overdoses, or other risks that are related to the negative stereotypes connected to urban areas. What people don’t realize is that there are numerous health risks that urban students face, and these are not connected to any stereotypes. Health issues such as obesity, lead poisoning, and asthma are very popular in urban areas, and it is my goal to see how these issues are affecting the Newark School system.
I feel that gathering information on the health of urban students would best be done by asking them. I intend on creating a questionnaire with general questions about the students’ lifestyle (I will disclose the topics of these questions below). This will give me direct answers to some of my questions and can either support or rebut some of the information that I have gathered from research studies online. Another source that I will look to for answers will be the school nurse; I know I will not be able to get private information about students, but I am hoping that general information such as number of students with asthma or any other diseases may be revealed to me. These will be my two main sources of information on the student’s health risks. I may look for other sources in the community but these will be the first two that I seek out.
The first risk that I will look to gather information on is asthma. With heavily polluted air and cigarette smoke the risk of developing asthma has increased in urban populations, and I intend to put some questions about the in home lifestyle of these students in the questionnaire. By asking if the students have parents, siblings, care takers, or even they smoke inside the home will let me know if the exposure to cigarette smoke is daily for these students. This is important to know because second hand smoke contains the same amount of deadly chemicals as direct inhalation, and exposure in a contained environment is not what children need.
The second risk that I will look at will be lead poisoning. Lead poisoning, although not popular, is also a health risk that urban students face. What many people don’t realize is that children can get lead poisoning from many objects, including soil. Many children do not wash their hands after playing in the park and if there is direct hand to mouth contact without washing off contaminated soil than children can obtain lead poisoning. I may not be able to find out whether the soil itself or other easily reachable items in the city are contaminated, but I will ask the children if they routinely wash their hands after playing outside. This will give me a good idea whether their chances are higher or lower.
The final risk that I will be looking at is obesity. African Americans have the highest percentage of contracting a heart disease at some point throughout their lives. With the majority of the urban population being African Americans I felt this was an issue that I may take a look into. One major contributor to heart disease is obesity, and since the percentage of people who are labeled obese is increasing in the Unites States I felt this would be a good studying point. I intend to ask students questions about their diet (eating of fast food, fruits/vegetables, whole grains), physical activity inside and outside of the school, and family history (if known) to gather some basic information. These questions will help to see if basic changes can be done in their daily lifestyle that will decrease their risk of obesity, which in turn can have a direct positive effect on the issue of heart disease.
Most of the information I intend to gather is direct from the students or the school itself, and I will look to make possible graphs to display this information. I hope to learn more about the risks that urban students face, and I hope that even by answering simple questions that these students may seem more interested in their health habits.
I feel that gathering information on the health of urban students would best be done by asking them. I intend on creating a questionnaire with general questions about the students’ lifestyle (I will disclose the topics of these questions below). This will give me direct answers to some of my questions and can either support or rebut some of the information that I have gathered from research studies online. Another source that I will look to for answers will be the school nurse; I know I will not be able to get private information about students, but I am hoping that general information such as number of students with asthma or any other diseases may be revealed to me. These will be my two main sources of information on the student’s health risks. I may look for other sources in the community but these will be the first two that I seek out.
The first risk that I will look to gather information on is asthma. With heavily polluted air and cigarette smoke the risk of developing asthma has increased in urban populations, and I intend to put some questions about the in home lifestyle of these students in the questionnaire. By asking if the students have parents, siblings, care takers, or even they smoke inside the home will let me know if the exposure to cigarette smoke is daily for these students. This is important to know because second hand smoke contains the same amount of deadly chemicals as direct inhalation, and exposure in a contained environment is not what children need.
The second risk that I will look at will be lead poisoning. Lead poisoning, although not popular, is also a health risk that urban students face. What many people don’t realize is that children can get lead poisoning from many objects, including soil. Many children do not wash their hands after playing in the park and if there is direct hand to mouth contact without washing off contaminated soil than children can obtain lead poisoning. I may not be able to find out whether the soil itself or other easily reachable items in the city are contaminated, but I will ask the children if they routinely wash their hands after playing outside. This will give me a good idea whether their chances are higher or lower.
The final risk that I will be looking at is obesity. African Americans have the highest percentage of contracting a heart disease at some point throughout their lives. With the majority of the urban population being African Americans I felt this was an issue that I may take a look into. One major contributor to heart disease is obesity, and since the percentage of people who are labeled obese is increasing in the Unites States I felt this would be a good studying point. I intend to ask students questions about their diet (eating of fast food, fruits/vegetables, whole grains), physical activity inside and outside of the school, and family history (if known) to gather some basic information. These questions will help to see if basic changes can be done in their daily lifestyle that will decrease their risk of obesity, which in turn can have a direct positive effect on the issue of heart disease.
Most of the information I intend to gather is direct from the students or the school itself, and I will look to make possible graphs to display this information. I hope to learn more about the risks that urban students face, and I hope that even by answering simple questions that these students may seem more interested in their health habits.
Monday, March 23, 2009
Annotated Resource
Family Involvement in School-Based Health Promotion:
Bringing Nutrition Information Home
Jessica Blom-Hoffman, Kaila R. Wilcox, and Liam Dunn
Northeastern University
Stephen S. Leff and Thomas J. Power
The Children’s Hospital of Philadelphia and University of Pennsylvania School
of Medicine
Abstract. Family–school collaboration related to children’s physical development
has become increasingly important as childhood obesity rates continue to rise.
The present study described the development and implementation of a literacybased,
family component of a school-based health education program and investigated
its viability, acceptability, and effectiveness. Interactive children’s books
were the mechanism by which students, parents, and teachers received consistent
messages at home and school regarding nutrition information. The home–school
intervention served to bridge home and school cultures in an urban population.
Preliminary process evaluation results indicated that the interactive children’s
books were feasible to implement in the school context. Parents, children, and
teachers had positive perceptions of the books. Parents who received the books
demonstrated increased knowledge of “5 a Day,” which highlights the importance
of eating fruits and vegetables. Although not statistically significant, after the first
and second years of intervention, parents in the experimental group reported that
their children were eating 0.54 and 0.36 additional servings of fruit and vegetables
per day compared with children in the control group. The program did not seem
to influence the availability and accessibility of fruits and vegetables at home.
This project was supported by Grant Number K23HD047480 from the National Institute of Child Health and Human
Development. The content of this article is solely the responsibility of the authors and does not necessarily represent
the official views of the National Institute of Child Health and Human Development and the National Institutes of
Health. The authors are deeply appreciative of the children, parents, school staff, and public health professionals, who
participated in the development, dissemination, and evaluation of the interactive children’s books. Finally, the authors
are indebted to the support of the Center for Study of Sport in Society at Northeastern University.
Correspondence regarding this article should be addressed to Jessica Blom-Hoffman, Department of Counseling
and Applied Educational Psychology, 203 Lake Hall, Northeastern University, Boston, MA 02115; E-mail:
j.blom-hoffman@neu.edu
Copyright 2008 by the National Association of School Psychologists (ISSN 0279–6015), which has nonexclusive
ownership in compliance with Division G, Title II, Section 218 of PL 110–161 and NIH Public Access
Policy (NIHMSID# 67401).
School Psychology Review,
2008, Volume 37, No. 4, pp. 567–577
567
To date, much of the focus of family–
school collaboration in the educational literature
is related to promoting children’s academic
and social development (e.g., Christenson,
2004). Home–school collaboration
focused on promoting children’s physical
health has received less attention, yet may be
just as important. The present study addresses
this gap by focusing on home–school collaboration
related to the promotion of healthy
eating, an important topic for families and
schools given that proper nutrition is important
for cognitive and physical development
(Nutrition-Cognition National Advisory Committee,
1998). This topic is relevant for school
psychologists (Harrison, Cummings, Dawson,
Short, Gorin, & Palomares, 2004; Ysseldyke
et al., 2006), who can play important roles in
the design, implementation, and evaluation of
school-based health promotion programs
(Power, DuPaul, Shapiro, & Kazak, 2003).
Given the current obesity epidemic
(U.S. Department of Health and Human Services,
2001), it is now more important than
ever for families and schools to collaborate in
obesity prevention. Both home and school settings
influence children’s eating and physical
activity, so consistent messages across these
settings are important. This is particularly relevant
for young children who rely on their
caregivers and school to procure and prepare
their food.
Because of the importance of children’s
healthy eating and the suitability of the school
environment for nutrition education, many
school-based nutrition education programs
have been developed and evaluated. Schoolbased
programs frequently include family
components. The authors conducted a systematic
review of 58 school-based, nutrition education
programs implemented in preschools
and elementary schools.1 Thirty-eight programs
(65.5%) mentioned the inclusion of a
family component. Of the 38 programs that
mentioned a family component, 8 (21.1%) included
activities that were based at school or
in the community only (e.g., family activity
nights), 20 (52.6%) described activities that
were based at home only (e.g., newsletters;
homework), 8 (21.1%) described family activities
that were based both at school and at
home, and 2 (5.2%) were unclear. That many
school-based nutrition programs send information
home is important because parents frequently
find it difficult to attend school events.
Engaging, time-efficient, enjoyable activities
that can be completed at home can meet the
needs of large numbers of families. Two published
studies incorporated home-based activities
assigned for homework at the elementary
school level. Gordon and Haynes (1982) developed
a series of parent pamphlets that outlined
information students learned in school
over a 3-week period. Luepker, Perry, Murray,
and Mullis (1988) designed family games and
a 5-week correspondence course that was sent
home in packets. Luepker et al. reported an
86% participation rate by families. These
types of approaches are desirable to reach the
maximum number of families. Although both
approaches were evaluated in controlled studies,
neither study reported the degree to which
activities were implemented in the homes or
parent- and child-reported acceptability. Information
regarding the degree to which homebased
activities are completed and found to be
acceptable is important when considering issues
of program feasibility and sustainability.
This article describes the development,
implementation, and process evaluation of the
family component of a school-based nutrition
program that also used an interactive, homebased
approach to family–school involvement.
The family component involved a literacybased
approach with shared book reading. It
was intended that parents would read the
books to their children. Books were designed
to provide multiple opportunities for children
to respond through active engagement (Greenwood,
Delquadri, & Hall, 1984). They reinforced
messages that students learned at
school in an engaging, interactive format and
communicated consistent, informative messages
to parents. Book activities provided a
context for children and parents to have a
conversation about the health information. Assigning
the books as homework may have
increased the likelihood they would be read.
Another advantage of this approach was that it
was an efficient way to promote shared book
School Psychology Review, 2008, Volume 37, No. 4
568
reading within the comfort of the families’
own home. This study is innovative in that it
represents the first time interactive, shared
book reading, assigned as homework and used
to communicate school-based nutrition information
with families, has been evaluated. The
main purpose of this article was to describe the
development, implementation, and preliminary
evaluation of this approach. The following
research questions were addressed:
1. Did the children complete the activities
in the books with the assistance of family
members? In this study, the completed
activities served as permanent
products documenting that children
read the books with an adult.
2. Was this type of home–school transmission
of health information acceptable to
parents, children, and teachers?
3. Did parents learn the “5 a Day” message
(i.e., the importance of eating at
least five servings of fruits and vegetables
[F&V] per day), and report
changes in their children’s F&V consumption
and the availability/accessibility
of F&V at home?
Method
Participants and Setting
The study took place in four elementary
schools in a large, urban, public school district.
The schools represented a sample of convenience
as the first author’s university already
had a relationship with them. Two
schools were randomly assigned to receive the
Fruit and Vegetable Promotion Program
(F&VPP), a school-based, multiyear, multicomponent
program designed to increase children’s
F&V consumption (Blom-Hoffman,
2008), and two were randomly assigned to
serve as comparison schools. All schools were
already participating in a physical activity promotion
program called Athletes in Service.
Schools in the experimental group received
the F&VPP plus Athletes in Service. Schools
in the control group received Athletes in Service
only. A total of 297 parents provided
written consent for their kindergarten or firstgrade
child to participate in the evaluation
(56% participation rate). Demographic information
is displayed in Table 1. Participating
school staff included kindergarten, first, and
second grade, computer and art teachers (n
24). Most teachers had been teaching for 10 or
more years (80%), and almost all were women
(95%).
Materials
Interactive children’s books. Five interactive
children’s books were developed
over a 2-year period with a partnership between
the first author, public health professionals,
and parents. The books were designed
to communicate a simple health message that
the students already learned at school, contained
a variety of activities designed for children
to complete with adult assistance, and
were written on a third- through seventh-grade
reading level. A brief questionnaire was included
at the end of each book for parents and
children. The books were available in English,
Spanish, and Vietnamese, the primary languages
spoken by the families. See Table 2 for
titles and descriptions.
Teacher acceptability. Teachers completed
a modified version of the Intervention
Rating Profile (Martens & Witt, 1982) to report
acceptability of the F&VPP in the spring
of 2006 and 2007. The questionnaire was
modified so items were directly related to the
F&VPP. For this study, the primary item of
interest was: “The children’s health books are
an acceptable way to encourage students to eat
more fruits and vegetables during school
lunch.” Teachers used a 6-point Likert-type
scale to rate this item.
Parent questionnaire. Parents were
interviewed by phone in their native language
by a native speaker, who used a structured
questionnaire in the summer 2005 (pretreatment),
summer 2006 (post-Year 1) after the
first three books were distributed, and summer
2007 (post-Year 2) after all books were distributed.
Parents provided demographic information,
knowledge of the 5 a Day message,
information regarding F&V availability (i.e.,
Family Involvement
569
the degree to which foods are present) and
accessibility (i.e., the extent to which foods
are prepared, presented, or maintained in a
way that makes them easy to eat) in the home
(F&V Availability/Accessibility Scale; Hearn
et al., 1998), and the number of F&V servings
their child eats per day.
Procedure
The books were developed over a 2-year
period in an iterative process with feedback
from parents and public health professionals.
A parent focus group was held to review the
first three books. Feedback included shortening
the books’ length, adding more game-like
activities, and making the books narrative in
structure. The final book was co-developed by
a community coalition of public health professionals,
and was illustrated by children because
culturally relevant clip art was unavailable.
All books followed the same format.
Each included a short letter to parents, activities
requiring adult assistance, a simple health
message, and a brief questionnaire at the end
of the book for parents and children. Books
were translated into Spanish and Vietnamese
by native speakers working at a professional
translation company. Participant recruitment
procedures are described in detail elsewhere
(Blom-Hoffman, Leff, Franko, Weinstein,
Table 1
Participant Demographic Characteristics
Variable
Group
Experimental
(N 149)
Control
(N 148)
Gender (% male; N 297) 51% 50.7%
Age (in years) at baseline (N 297) 6.22 6.21
Student weight status at baseline (N 293)a
Overweight 17.6% 19.3%
Obese 22.3% 26.2%
Percentage of students receiving free or reduced price lunch (N 192)b 93.9% 88.3%
Parent-reported child race and ethnicity (N 190)b
African American 29.3% 36.3%
Asian 24.2% 0%
Hispanic 41.4% 50.5%
White 3% 4.4%
Other 2% 8.8%
English only spoken at home (N 196)b 29.7% 51.6%
Maternal education (N 191)b
High school degree or less 60.8% 72.3%
More than high school 39.2% 27.7%
Paternal education (N 175)b
High school degree or less 79.8% 82.6%
More than high school 20.2% 17.4%
aChildren removed their shoes and sweaters before being measured. Weight was measured to 0.1 kg (Seca digital
electronic scale, Creative Health Products, Plymouth, Michigan). Standing height was measured to 0.1 cm with a
portable stadiometer (Shorr Productions, Olney, Maryland). Weight status of children determined using gender-specific
Centers for Disease Control and Prevention growth reference charts (Ogden et al., 2002). Overweight 85th percentile
and 95th percentile; obese 95th percentile.
bParents provided demographic information as part of a structured phone interview conducted in Summer 2005. Almost
all phone interviews were conducted in the parents’ native language by a native speaker. A total of 196 parents (66%)
were able to be reached for the first phone interview.
School Psychology Review, 2008, Volume 37, No. 4
570
Table 2
Titles and Descriptions of the Interactive Children’s Books
Title
———’s 5 a Day Book
Smart Shopping &
Great Goals Color Your Plate
———’s Physical
Activity Book Delicious Drinks
Key Message(s) 5 a Day goal; different
ways to reach the
goal.
5 a Day; self-monitoring
F&V eating
behaviors.
Eating a variety of F&V
in different colors.
Being physically active
every day;
minimizing
sedentary activity.
Promoting non-sugar
sweetened
beverages.
Flesch-Kincaid grade levela 5.2 4.6 7.8 5.4 3.9
Illustrations Clip art Clip art Clip art Clip art Children’s artwork
Activities Drawing Drawing Drawing Drawing Drawing
Coloring Coloring Coloring Circling Circling
Self-monitoring Self-monitoring Coloring Coloring
Shopping List
Note. F&V fruit and vegetables.
aThe Flesch-Kincaid grade level was calculated using Microsoft’s Word Readability Statistics (http://unf.edu/ccavanau/readabilitystats.pdf).
Family Involvement
571
Beakley, & Power, in press). The study was
approved by the Institutional Review Board at
Northeastern University and the school district’s
research office. Although signed consent
was required for study participation, all
students in the target grades received the
books. Students received the books over a
16-month period (Winter 2006 to Spring
2007). Teachers sent them home as homework
in an envelope, and asked parents to return
them within a week. When families spoke
either Vietnamese or Spanish at home, teachers
provided the book in both English and the
native language. Research assistants collected
the books from teachers to review the completed
activities and the parent and child questionnaire
responses. Because participation in
the F&VPP was voluntary, no negative consequences
were imposed if students did not
return the books. Only those students whose
parents provided written permission to participate
in the study were included in the data
analyses. All books were returned to students.
Results
The first research question was to understand
the extent to which the books would be
returned and completed. As shown in Table 3,
77% of students returned the first book; subsequent
books were returned at a lower rate
(range 43%–59%). Table 3 shows that the
majority of activities were completed (range
51%–85%), indicating that children read
the books with an adult.
The second question asked if parents,
children, and teachers would find the books
acceptable. Table 3 shows their perceptions.
When asked how much they enjoyed reading
the book together with their child, parents
responses across the books on the 3-point
scale ranged from 2.84 to 2.91 (1 not at all
acceptable, 2 a little acceptable, and 3 a
lot/very acceptable). When asked how much
they enjoyed reading each book, children’s
responses across the books ranged from 2.86
to 2.90. When asked how much they learned
from each book, parents’ responses across the
books ranged from 2.82 to 2.91, and children’s
responses across the books ranged from 2.89
to 2.91. The final two books also asked parents
to report behavioral intentions to make
changes suggested in the book. As shown in
Table 3, parents’ responses indicted they were
considering or were very likely to make
changes after reading the book. Teachers also
believed the books were an acceptable way to
encourage students to develop the target behaviors
(Year 1 M 5.36; SD 0.93; Year 2
M 5.29; SD 0.91; on a 6-point scale
anchored by 1 strongly disagree and 6
strongly agree).
The final question asked if parents
would learn the 5 a Day message and report
changes in children’s consumption and home
availability/accessibility of F&V. Eighty parents
(27% of the sample) participated in all
three phone interviews: Summer 2005 (pretreatment),
Summer 2006 (post-Year 1), and
Summer 2007 (post-Year 2). As shown in
Table 4, parents in the experimental group
were more likely to know about the 5 a Day
message at the second and third time points
compared with pretreatment (Time 1–2:
2
Yates [1, n 37] 3.91, p .05; Time 1–3:
2
Yates [1, n 37] 13.88, p .001) and
compared with parents of children who did not
receive the books (Time 2: 2
Yates [n 80]
3.98, p .05; Time 3: 2
Yates [1, n 80]
12.81, p 0.001). As shown in Table 4, there
were no significant differences with regard to
parent-reported child F&V consumption (F[2,
77] 2.02, p ns), parent-reported F&V
availability at home (F[2, 77] 0.86, p ns),
and parent-reported F&V accessibility in the
home (F[2, 77] 0.68, p ns).
Discussion
The interactive children’s books were
feasible to implement in the school context.
Many books were returned, and of those books
the majority of activities were completed. Parent
and child questionnaires indicated the
books were perceived as beneficial and enjoyable.
Teachers also reported that the books
were acceptable; however, teacher acceptability
of the books was limited in that it was
assessed from a single item that was part of a
broad acceptability questionnaire reported
School Psychology Review, 2008, Volume 37, No. 4
572
Table 3
Titles, Descriptions, and Parent and Child Perceptions of the Children’s Books
Title
———’s 5 a Day Book
Smart Shopping &
Great Goals Color Your Plate
———’s Physical
Activity Book Delicious Drinks
Percentage Returneda 77% 59% 47% 53% 43%
Percentage Activities completedb 79%–85% 71%–83% 74% 51%–71% 67%–83%
Parent acceptabilityc
Book was enjoyable 2.89 (0.35) 2.89 (0.36) 2.91 (0.29) 2.86 (0.35) 2.84 (0.42)
Book was informative 2.84 (0.40) 2.82 (0.47) 2.87 (0.34) 2.84 (0.42) 2.91 (0.29)
Likely to make behavioral changesd,e NA NA NA 2.73 (0.45) 2.35 (1.23)
Child acceptabilityc
Book was enjoyable 2.89 (0.35) 2.88 (0.32) 2.87 (0.40) 2.90 (0.31) 2.86 (0.35)
Book was informative 2.89 (0.32) NA 2.91 (0.29) 2.86 (0.35) 2.91 (0.29)
aAlthough all children in the classrooms received and were asked to return the books, this percentage refers only to children whose parents provided written permission for their children
to participate in the outcome evaluation.
bBecause each book contained several activities, the ranges refer to the percent of activities completed within each book.
cMean (SD) parent- and child-rated acceptability. The following 3-point scale was used: 1 not at all; 2 a little; 3 a lot.
dThese items were only asked at the end of ———’s Physical Activity Book and Delicious Drinks. The items asked parents how likely they were to help their child (a) be more physically
active after reading the book and (b) make healthy drink choices after reading the book. Response items included: 1 not likely at all; 2 may be; 3 very likely; or my child is
already physically active for at least 1 hour/day or we already make healthy drink choices.
eNA not asked.
Family Involvement
573
Table 4
Parental Awareness of the 5 a Day Message, Report of Children’s F&V Eating Behaviors, and Availability/Accessibility
of Fruits and Vegetables at Home by Group
Variable
Pretreatment Post-Year 1 Post-Year 2 Group
Time
Experimental Control Experimental Control Experimental Control Interaction
Parent 5 a Day Knowledge
(percentage correct) 10.8% 7.0% 32.4%* 11.6%* 54.1%** 14.0%**
F&V servings children eat each
day; M (SD) 2.46 (.99) 2.44 (1.10) 2.89 (.97) 2.35 (1.20) 2.76 (.90) 2.40 (1.10) ns
F&V home availabilitya M (SD) 17.51 (3.85) 17.76 (5.22) 18.78 (4.04) 19.67 (5.33) 19.00 (3.84) 18.90 (5.26) ns
F&V home accessibilityb M (SD) 2.65 (.58) 2.58 (.63) 2.81 (.46) 2.60 (.48) 2.76 (.56) 2.54 (.53) ns
Note. F&V fruit and vegetables; ns not significant. n 80 (Experimental n 37; Control n 43).
aParents were asked if they had 48 different types of fruits or vegetables in the home in the past 7 days. The foods could have been in fresh, frozen, or canned forms. This questionnaire
was based on the Fruit and Vegetable Availability/Accessibility Scale (Hearn et al., 1998). It was modified to include additional fruits and vegetables common in Central and South
American, and Vietnamese diets.
bParents used the following scale to respond to seven F&V accessibility items on a modified version of the Fruit and Vegetable Availability/Accessibility Scale: 1 Never; 2 Once
in a While; 3 Most of the Time; 4 All of the Time.
*Experimental Control, p .05
**Experimental Control, p .001
School Psychology Review, 2008, Volume 37, No. 4
574
elsewhere (Blom-Hoffman, 2008). Parents in
the experimental group were significantly
more likely to demonstrate awareness of the 5
a Day message relative to pretreatment and
relative to parents in the comparison group.
Parents estimated the number of F&V
servings their children ate per day. Although
the group by time interaction did not reach
statistical significance, an examination of the
mean changes in child consumption showed
the changes were in the expected direction.
Whereas control group children’s F&V consumption
remained stable across all three time
periods, F&V consumption of children in the
experimental group increased. Parents in the
experimental group reported a 0.43 serving
per day increase between pretreatment and
post-Year 1 and a 0.30 serving per day increase
between pretreatment and post-Year 2.
Also, after Years 1 and 2 of program implementation,
parents in the experimental group
reported that their children were eating 0.54
and 0.36 more servings of F&V per day compared
with children in the control group. Although
not statistically significant, the magnitude
of these changes is consistent with those
reported in the school-based F&V promotion
literature (Howerton, Bell, Dodd, Berrigan,
Stozenberg-Solomon, & Nebeling, 2007;
Knai, Pomerleau, Lock, & McKee, 2006). A
power analysis (using an alpha level of .05 and
an effect size of .5 based on data from this
study) indicated that we only had 54% power
for the group by time interaction; to have 80%
power to test the group by time interaction
with a repeated-measures analysis of variance,
we would have needed 70 participants per
group. In addition, it is important to interpret
our preliminary findings regarding child F&V
consumption with caution because of the parent
report methodology used, which did not
include training on portion size estimation.
However, parent reports of small changes in
children’s F&V consumption are consistent
with our research team’s own direct assessment
of children’s eating behaviors in the
school cafeteria (Blom-Hoffman, Franko,
Power, Stallings, Dai, & Thompson, 2007).
The books were read by a large group of
parents and were disseminated in an efficient
manner. Costs associated with the books included
time spent writing and formatting the
book, translating, and printing. Once completed,
very few resources were spent disseminating
the books. Each book cost approximately
$3.38, including translation and printing
expenses. Relative to other modes of
family involvement in school-based initiatives,
the books enabled large numbers of families
to participate and served to provide consistent
health messages between home and
school environments. In contrast, other forms
of family involvement in school-based nutrition
education initiatives have considerable
limitations. In-school events often require sufficient
resources to organize and host, and
sometimes are met with extremely poor parent
attendance. Newsletters cost little to develop
and disseminate, but it is unclear how many
parents actually read and discuss them with
their children. The interactive books assigned
as homework address these limitations by engaging
families around health information.
This study suggests that the use of interactive
books has promise as a mechanism of
conveying knowledge. The program did not
change home F&V availability/accessibility.
This finding is consistent with other health
education research (e.g., Blom-Hoffman &
DuPaul, 2003) indicating the provision of
knowledge is not sufficient for behavior
change. To improve F&V availability and accessibility,
particularly in under-resourced
communities, major environmental changes
are likely required (e.g., supermarket availability;
food pricing).
There were a number of limitations in
this preliminary study that should be addressed
in future research. First, this study
compared a group of parents who received a
multilevel program that included the family
component described in this study to a control
group. Therefore, it is unclear if the parent
knowledge change resulted from the books
alone or the books in combination with knowledge
that the children brought home from
school. Future research efforts can explore the
individual and combined effects of the
F&VPP components. Second, book return
rates declined across time. Classwide ap-
Family Involvement
575
proaches (e.g., interdependent group contingencies)
can be established to increase the
number of books returned. Third, because of
practical reasons, schools as opposed to participants
were assigned to study condition;
therefore, children and parents were nested
within schools. Fourth, three books in this
study promoted the 5 a Day message. In 2007,
5 a Day was replaced by Fruits and Veggies—
More Matters (Produce for Better Health
Foundation, 2007), a campaign promoting individualized
recommendations based on gender,
age, and physical activity level, and communicated
in cups instead of servings (http://
www.fruitsandveggiesmatter.gov/). As such,
these books should be revised to reflect the
new message. Fifth, children’s F&V consumption
was assessed via parent report. Future
research should use more rigorous dietary assessment
methods (e.g., 24-hour recalls; Lytle
et al., 1993). Finally, the selection of anchor
points for the parent and child acceptability
measures may have had an influence on ratings.
Respondents may have been reluctant to
use the lowest anchor point (i.e., “never”; S.
McConaughy, personal communication, January
22, 2008). Nevertheless, the majority of
parents and children reported liking the books
“a lot,” and learning “a lot” from them, suggesting
that the level of acceptability was at
least moderately high. Finding ways to create
effective, acceptable, feasible mechanisms to
promote home–school collaboration related to
healthy eating is important. This pilot study
illustrates one such effort.
Bringing Nutrition Information Home
Jessica Blom-Hoffman, Kaila R. Wilcox, and Liam Dunn
Northeastern University
Stephen S. Leff and Thomas J. Power
The Children’s Hospital of Philadelphia and University of Pennsylvania School
of Medicine
Abstract. Family–school collaboration related to children’s physical development
has become increasingly important as childhood obesity rates continue to rise.
The present study described the development and implementation of a literacybased,
family component of a school-based health education program and investigated
its viability, acceptability, and effectiveness. Interactive children’s books
were the mechanism by which students, parents, and teachers received consistent
messages at home and school regarding nutrition information. The home–school
intervention served to bridge home and school cultures in an urban population.
Preliminary process evaluation results indicated that the interactive children’s
books were feasible to implement in the school context. Parents, children, and
teachers had positive perceptions of the books. Parents who received the books
demonstrated increased knowledge of “5 a Day,” which highlights the importance
of eating fruits and vegetables. Although not statistically significant, after the first
and second years of intervention, parents in the experimental group reported that
their children were eating 0.54 and 0.36 additional servings of fruit and vegetables
per day compared with children in the control group. The program did not seem
to influence the availability and accessibility of fruits and vegetables at home.
This project was supported by Grant Number K23HD047480 from the National Institute of Child Health and Human
Development. The content of this article is solely the responsibility of the authors and does not necessarily represent
the official views of the National Institute of Child Health and Human Development and the National Institutes of
Health. The authors are deeply appreciative of the children, parents, school staff, and public health professionals, who
participated in the development, dissemination, and evaluation of the interactive children’s books. Finally, the authors
are indebted to the support of the Center for Study of Sport in Society at Northeastern University.
Correspondence regarding this article should be addressed to Jessica Blom-Hoffman, Department of Counseling
and Applied Educational Psychology, 203 Lake Hall, Northeastern University, Boston, MA 02115; E-mail:
j.blom-hoffman@neu.edu
Copyright 2008 by the National Association of School Psychologists (ISSN 0279–6015), which has nonexclusive
ownership in compliance with Division G, Title II, Section 218 of PL 110–161 and NIH Public Access
Policy (NIHMSID# 67401).
School Psychology Review,
2008, Volume 37, No. 4, pp. 567–577
567
To date, much of the focus of family–
school collaboration in the educational literature
is related to promoting children’s academic
and social development (e.g., Christenson,
2004). Home–school collaboration
focused on promoting children’s physical
health has received less attention, yet may be
just as important. The present study addresses
this gap by focusing on home–school collaboration
related to the promotion of healthy
eating, an important topic for families and
schools given that proper nutrition is important
for cognitive and physical development
(Nutrition-Cognition National Advisory Committee,
1998). This topic is relevant for school
psychologists (Harrison, Cummings, Dawson,
Short, Gorin, & Palomares, 2004; Ysseldyke
et al., 2006), who can play important roles in
the design, implementation, and evaluation of
school-based health promotion programs
(Power, DuPaul, Shapiro, & Kazak, 2003).
Given the current obesity epidemic
(U.S. Department of Health and Human Services,
2001), it is now more important than
ever for families and schools to collaborate in
obesity prevention. Both home and school settings
influence children’s eating and physical
activity, so consistent messages across these
settings are important. This is particularly relevant
for young children who rely on their
caregivers and school to procure and prepare
their food.
Because of the importance of children’s
healthy eating and the suitability of the school
environment for nutrition education, many
school-based nutrition education programs
have been developed and evaluated. Schoolbased
programs frequently include family
components. The authors conducted a systematic
review of 58 school-based, nutrition education
programs implemented in preschools
and elementary schools.1 Thirty-eight programs
(65.5%) mentioned the inclusion of a
family component. Of the 38 programs that
mentioned a family component, 8 (21.1%) included
activities that were based at school or
in the community only (e.g., family activity
nights), 20 (52.6%) described activities that
were based at home only (e.g., newsletters;
homework), 8 (21.1%) described family activities
that were based both at school and at
home, and 2 (5.2%) were unclear. That many
school-based nutrition programs send information
home is important because parents frequently
find it difficult to attend school events.
Engaging, time-efficient, enjoyable activities
that can be completed at home can meet the
needs of large numbers of families. Two published
studies incorporated home-based activities
assigned for homework at the elementary
school level. Gordon and Haynes (1982) developed
a series of parent pamphlets that outlined
information students learned in school
over a 3-week period. Luepker, Perry, Murray,
and Mullis (1988) designed family games and
a 5-week correspondence course that was sent
home in packets. Luepker et al. reported an
86% participation rate by families. These
types of approaches are desirable to reach the
maximum number of families. Although both
approaches were evaluated in controlled studies,
neither study reported the degree to which
activities were implemented in the homes or
parent- and child-reported acceptability. Information
regarding the degree to which homebased
activities are completed and found to be
acceptable is important when considering issues
of program feasibility and sustainability.
This article describes the development,
implementation, and process evaluation of the
family component of a school-based nutrition
program that also used an interactive, homebased
approach to family–school involvement.
The family component involved a literacybased
approach with shared book reading. It
was intended that parents would read the
books to their children. Books were designed
to provide multiple opportunities for children
to respond through active engagement (Greenwood,
Delquadri, & Hall, 1984). They reinforced
messages that students learned at
school in an engaging, interactive format and
communicated consistent, informative messages
to parents. Book activities provided a
context for children and parents to have a
conversation about the health information. Assigning
the books as homework may have
increased the likelihood they would be read.
Another advantage of this approach was that it
was an efficient way to promote shared book
School Psychology Review, 2008, Volume 37, No. 4
568
reading within the comfort of the families’
own home. This study is innovative in that it
represents the first time interactive, shared
book reading, assigned as homework and used
to communicate school-based nutrition information
with families, has been evaluated. The
main purpose of this article was to describe the
development, implementation, and preliminary
evaluation of this approach. The following
research questions were addressed:
1. Did the children complete the activities
in the books with the assistance of family
members? In this study, the completed
activities served as permanent
products documenting that children
read the books with an adult.
2. Was this type of home–school transmission
of health information acceptable to
parents, children, and teachers?
3. Did parents learn the “5 a Day” message
(i.e., the importance of eating at
least five servings of fruits and vegetables
[F&V] per day), and report
changes in their children’s F&V consumption
and the availability/accessibility
of F&V at home?
Method
Participants and Setting
The study took place in four elementary
schools in a large, urban, public school district.
The schools represented a sample of convenience
as the first author’s university already
had a relationship with them. Two
schools were randomly assigned to receive the
Fruit and Vegetable Promotion Program
(F&VPP), a school-based, multiyear, multicomponent
program designed to increase children’s
F&V consumption (Blom-Hoffman,
2008), and two were randomly assigned to
serve as comparison schools. All schools were
already participating in a physical activity promotion
program called Athletes in Service.
Schools in the experimental group received
the F&VPP plus Athletes in Service. Schools
in the control group received Athletes in Service
only. A total of 297 parents provided
written consent for their kindergarten or firstgrade
child to participate in the evaluation
(56% participation rate). Demographic information
is displayed in Table 1. Participating
school staff included kindergarten, first, and
second grade, computer and art teachers (n
24). Most teachers had been teaching for 10 or
more years (80%), and almost all were women
(95%).
Materials
Interactive children’s books. Five interactive
children’s books were developed
over a 2-year period with a partnership between
the first author, public health professionals,
and parents. The books were designed
to communicate a simple health message that
the students already learned at school, contained
a variety of activities designed for children
to complete with adult assistance, and
were written on a third- through seventh-grade
reading level. A brief questionnaire was included
at the end of each book for parents and
children. The books were available in English,
Spanish, and Vietnamese, the primary languages
spoken by the families. See Table 2 for
titles and descriptions.
Teacher acceptability. Teachers completed
a modified version of the Intervention
Rating Profile (Martens & Witt, 1982) to report
acceptability of the F&VPP in the spring
of 2006 and 2007. The questionnaire was
modified so items were directly related to the
F&VPP. For this study, the primary item of
interest was: “The children’s health books are
an acceptable way to encourage students to eat
more fruits and vegetables during school
lunch.” Teachers used a 6-point Likert-type
scale to rate this item.
Parent questionnaire. Parents were
interviewed by phone in their native language
by a native speaker, who used a structured
questionnaire in the summer 2005 (pretreatment),
summer 2006 (post-Year 1) after the
first three books were distributed, and summer
2007 (post-Year 2) after all books were distributed.
Parents provided demographic information,
knowledge of the 5 a Day message,
information regarding F&V availability (i.e.,
Family Involvement
569
the degree to which foods are present) and
accessibility (i.e., the extent to which foods
are prepared, presented, or maintained in a
way that makes them easy to eat) in the home
(F&V Availability/Accessibility Scale; Hearn
et al., 1998), and the number of F&V servings
their child eats per day.
Procedure
The books were developed over a 2-year
period in an iterative process with feedback
from parents and public health professionals.
A parent focus group was held to review the
first three books. Feedback included shortening
the books’ length, adding more game-like
activities, and making the books narrative in
structure. The final book was co-developed by
a community coalition of public health professionals,
and was illustrated by children because
culturally relevant clip art was unavailable.
All books followed the same format.
Each included a short letter to parents, activities
requiring adult assistance, a simple health
message, and a brief questionnaire at the end
of the book for parents and children. Books
were translated into Spanish and Vietnamese
by native speakers working at a professional
translation company. Participant recruitment
procedures are described in detail elsewhere
(Blom-Hoffman, Leff, Franko, Weinstein,
Table 1
Participant Demographic Characteristics
Variable
Group
Experimental
(N 149)
Control
(N 148)
Gender (% male; N 297) 51% 50.7%
Age (in years) at baseline (N 297) 6.22 6.21
Student weight status at baseline (N 293)a
Overweight 17.6% 19.3%
Obese 22.3% 26.2%
Percentage of students receiving free or reduced price lunch (N 192)b 93.9% 88.3%
Parent-reported child race and ethnicity (N 190)b
African American 29.3% 36.3%
Asian 24.2% 0%
Hispanic 41.4% 50.5%
White 3% 4.4%
Other 2% 8.8%
English only spoken at home (N 196)b 29.7% 51.6%
Maternal education (N 191)b
High school degree or less 60.8% 72.3%
More than high school 39.2% 27.7%
Paternal education (N 175)b
High school degree or less 79.8% 82.6%
More than high school 20.2% 17.4%
aChildren removed their shoes and sweaters before being measured. Weight was measured to 0.1 kg (Seca digital
electronic scale, Creative Health Products, Plymouth, Michigan). Standing height was measured to 0.1 cm with a
portable stadiometer (Shorr Productions, Olney, Maryland). Weight status of children determined using gender-specific
Centers for Disease Control and Prevention growth reference charts (Ogden et al., 2002). Overweight 85th percentile
and 95th percentile; obese 95th percentile.
bParents provided demographic information as part of a structured phone interview conducted in Summer 2005. Almost
all phone interviews were conducted in the parents’ native language by a native speaker. A total of 196 parents (66%)
were able to be reached for the first phone interview.
School Psychology Review, 2008, Volume 37, No. 4
570
Table 2
Titles and Descriptions of the Interactive Children’s Books
Title
———’s 5 a Day Book
Smart Shopping &
Great Goals Color Your Plate
———’s Physical
Activity Book Delicious Drinks
Key Message(s) 5 a Day goal; different
ways to reach the
goal.
5 a Day; self-monitoring
F&V eating
behaviors.
Eating a variety of F&V
in different colors.
Being physically active
every day;
minimizing
sedentary activity.
Promoting non-sugar
sweetened
beverages.
Flesch-Kincaid grade levela 5.2 4.6 7.8 5.4 3.9
Illustrations Clip art Clip art Clip art Clip art Children’s artwork
Activities Drawing Drawing Drawing Drawing Drawing
Coloring Coloring Coloring Circling Circling
Self-monitoring Self-monitoring Coloring Coloring
Shopping List
Note. F&V fruit and vegetables.
aThe Flesch-Kincaid grade level was calculated using Microsoft’s Word Readability Statistics (http://unf.edu/ccavanau/readabilitystats.pdf).
Family Involvement
571
Beakley, & Power, in press). The study was
approved by the Institutional Review Board at
Northeastern University and the school district’s
research office. Although signed consent
was required for study participation, all
students in the target grades received the
books. Students received the books over a
16-month period (Winter 2006 to Spring
2007). Teachers sent them home as homework
in an envelope, and asked parents to return
them within a week. When families spoke
either Vietnamese or Spanish at home, teachers
provided the book in both English and the
native language. Research assistants collected
the books from teachers to review the completed
activities and the parent and child questionnaire
responses. Because participation in
the F&VPP was voluntary, no negative consequences
were imposed if students did not
return the books. Only those students whose
parents provided written permission to participate
in the study were included in the data
analyses. All books were returned to students.
Results
The first research question was to understand
the extent to which the books would be
returned and completed. As shown in Table 3,
77% of students returned the first book; subsequent
books were returned at a lower rate
(range 43%–59%). Table 3 shows that the
majority of activities were completed (range
51%–85%), indicating that children read
the books with an adult.
The second question asked if parents,
children, and teachers would find the books
acceptable. Table 3 shows their perceptions.
When asked how much they enjoyed reading
the book together with their child, parents
responses across the books on the 3-point
scale ranged from 2.84 to 2.91 (1 not at all
acceptable, 2 a little acceptable, and 3 a
lot/very acceptable). When asked how much
they enjoyed reading each book, children’s
responses across the books ranged from 2.86
to 2.90. When asked how much they learned
from each book, parents’ responses across the
books ranged from 2.82 to 2.91, and children’s
responses across the books ranged from 2.89
to 2.91. The final two books also asked parents
to report behavioral intentions to make
changes suggested in the book. As shown in
Table 3, parents’ responses indicted they were
considering or were very likely to make
changes after reading the book. Teachers also
believed the books were an acceptable way to
encourage students to develop the target behaviors
(Year 1 M 5.36; SD 0.93; Year 2
M 5.29; SD 0.91; on a 6-point scale
anchored by 1 strongly disagree and 6
strongly agree).
The final question asked if parents
would learn the 5 a Day message and report
changes in children’s consumption and home
availability/accessibility of F&V. Eighty parents
(27% of the sample) participated in all
three phone interviews: Summer 2005 (pretreatment),
Summer 2006 (post-Year 1), and
Summer 2007 (post-Year 2). As shown in
Table 4, parents in the experimental group
were more likely to know about the 5 a Day
message at the second and third time points
compared with pretreatment (Time 1–2:
2
Yates [1, n 37] 3.91, p .05; Time 1–3:
2
Yates [1, n 37] 13.88, p .001) and
compared with parents of children who did not
receive the books (Time 2: 2
Yates [n 80]
3.98, p .05; Time 3: 2
Yates [1, n 80]
12.81, p 0.001). As shown in Table 4, there
were no significant differences with regard to
parent-reported child F&V consumption (F[2,
77] 2.02, p ns), parent-reported F&V
availability at home (F[2, 77] 0.86, p ns),
and parent-reported F&V accessibility in the
home (F[2, 77] 0.68, p ns).
Discussion
The interactive children’s books were
feasible to implement in the school context.
Many books were returned, and of those books
the majority of activities were completed. Parent
and child questionnaires indicated the
books were perceived as beneficial and enjoyable.
Teachers also reported that the books
were acceptable; however, teacher acceptability
of the books was limited in that it was
assessed from a single item that was part of a
broad acceptability questionnaire reported
School Psychology Review, 2008, Volume 37, No. 4
572
Table 3
Titles, Descriptions, and Parent and Child Perceptions of the Children’s Books
Title
———’s 5 a Day Book
Smart Shopping &
Great Goals Color Your Plate
———’s Physical
Activity Book Delicious Drinks
Percentage Returneda 77% 59% 47% 53% 43%
Percentage Activities completedb 79%–85% 71%–83% 74% 51%–71% 67%–83%
Parent acceptabilityc
Book was enjoyable 2.89 (0.35) 2.89 (0.36) 2.91 (0.29) 2.86 (0.35) 2.84 (0.42)
Book was informative 2.84 (0.40) 2.82 (0.47) 2.87 (0.34) 2.84 (0.42) 2.91 (0.29)
Likely to make behavioral changesd,e NA NA NA 2.73 (0.45) 2.35 (1.23)
Child acceptabilityc
Book was enjoyable 2.89 (0.35) 2.88 (0.32) 2.87 (0.40) 2.90 (0.31) 2.86 (0.35)
Book was informative 2.89 (0.32) NA 2.91 (0.29) 2.86 (0.35) 2.91 (0.29)
aAlthough all children in the classrooms received and were asked to return the books, this percentage refers only to children whose parents provided written permission for their children
to participate in the outcome evaluation.
bBecause each book contained several activities, the ranges refer to the percent of activities completed within each book.
cMean (SD) parent- and child-rated acceptability. The following 3-point scale was used: 1 not at all; 2 a little; 3 a lot.
dThese items were only asked at the end of ———’s Physical Activity Book and Delicious Drinks. The items asked parents how likely they were to help their child (a) be more physically
active after reading the book and (b) make healthy drink choices after reading the book. Response items included: 1 not likely at all; 2 may be; 3 very likely; or my child is
already physically active for at least 1 hour/day or we already make healthy drink choices.
eNA not asked.
Family Involvement
573
Table 4
Parental Awareness of the 5 a Day Message, Report of Children’s F&V Eating Behaviors, and Availability/Accessibility
of Fruits and Vegetables at Home by Group
Variable
Pretreatment Post-Year 1 Post-Year 2 Group
Time
Experimental Control Experimental Control Experimental Control Interaction
Parent 5 a Day Knowledge
(percentage correct) 10.8% 7.0% 32.4%* 11.6%* 54.1%** 14.0%**
F&V servings children eat each
day; M (SD) 2.46 (.99) 2.44 (1.10) 2.89 (.97) 2.35 (1.20) 2.76 (.90) 2.40 (1.10) ns
F&V home availabilitya M (SD) 17.51 (3.85) 17.76 (5.22) 18.78 (4.04) 19.67 (5.33) 19.00 (3.84) 18.90 (5.26) ns
F&V home accessibilityb M (SD) 2.65 (.58) 2.58 (.63) 2.81 (.46) 2.60 (.48) 2.76 (.56) 2.54 (.53) ns
Note. F&V fruit and vegetables; ns not significant. n 80 (Experimental n 37; Control n 43).
aParents were asked if they had 48 different types of fruits or vegetables in the home in the past 7 days. The foods could have been in fresh, frozen, or canned forms. This questionnaire
was based on the Fruit and Vegetable Availability/Accessibility Scale (Hearn et al., 1998). It was modified to include additional fruits and vegetables common in Central and South
American, and Vietnamese diets.
bParents used the following scale to respond to seven F&V accessibility items on a modified version of the Fruit and Vegetable Availability/Accessibility Scale: 1 Never; 2 Once
in a While; 3 Most of the Time; 4 All of the Time.
*Experimental Control, p .05
**Experimental Control, p .001
School Psychology Review, 2008, Volume 37, No. 4
574
elsewhere (Blom-Hoffman, 2008). Parents in
the experimental group were significantly
more likely to demonstrate awareness of the 5
a Day message relative to pretreatment and
relative to parents in the comparison group.
Parents estimated the number of F&V
servings their children ate per day. Although
the group by time interaction did not reach
statistical significance, an examination of the
mean changes in child consumption showed
the changes were in the expected direction.
Whereas control group children’s F&V consumption
remained stable across all three time
periods, F&V consumption of children in the
experimental group increased. Parents in the
experimental group reported a 0.43 serving
per day increase between pretreatment and
post-Year 1 and a 0.30 serving per day increase
between pretreatment and post-Year 2.
Also, after Years 1 and 2 of program implementation,
parents in the experimental group
reported that their children were eating 0.54
and 0.36 more servings of F&V per day compared
with children in the control group. Although
not statistically significant, the magnitude
of these changes is consistent with those
reported in the school-based F&V promotion
literature (Howerton, Bell, Dodd, Berrigan,
Stozenberg-Solomon, & Nebeling, 2007;
Knai, Pomerleau, Lock, & McKee, 2006). A
power analysis (using an alpha level of .05 and
an effect size of .5 based on data from this
study) indicated that we only had 54% power
for the group by time interaction; to have 80%
power to test the group by time interaction
with a repeated-measures analysis of variance,
we would have needed 70 participants per
group. In addition, it is important to interpret
our preliminary findings regarding child F&V
consumption with caution because of the parent
report methodology used, which did not
include training on portion size estimation.
However, parent reports of small changes in
children’s F&V consumption are consistent
with our research team’s own direct assessment
of children’s eating behaviors in the
school cafeteria (Blom-Hoffman, Franko,
Power, Stallings, Dai, & Thompson, 2007).
The books were read by a large group of
parents and were disseminated in an efficient
manner. Costs associated with the books included
time spent writing and formatting the
book, translating, and printing. Once completed,
very few resources were spent disseminating
the books. Each book cost approximately
$3.38, including translation and printing
expenses. Relative to other modes of
family involvement in school-based initiatives,
the books enabled large numbers of families
to participate and served to provide consistent
health messages between home and
school environments. In contrast, other forms
of family involvement in school-based nutrition
education initiatives have considerable
limitations. In-school events often require sufficient
resources to organize and host, and
sometimes are met with extremely poor parent
attendance. Newsletters cost little to develop
and disseminate, but it is unclear how many
parents actually read and discuss them with
their children. The interactive books assigned
as homework address these limitations by engaging
families around health information.
This study suggests that the use of interactive
books has promise as a mechanism of
conveying knowledge. The program did not
change home F&V availability/accessibility.
This finding is consistent with other health
education research (e.g., Blom-Hoffman &
DuPaul, 2003) indicating the provision of
knowledge is not sufficient for behavior
change. To improve F&V availability and accessibility,
particularly in under-resourced
communities, major environmental changes
are likely required (e.g., supermarket availability;
food pricing).
There were a number of limitations in
this preliminary study that should be addressed
in future research. First, this study
compared a group of parents who received a
multilevel program that included the family
component described in this study to a control
group. Therefore, it is unclear if the parent
knowledge change resulted from the books
alone or the books in combination with knowledge
that the children brought home from
school. Future research efforts can explore the
individual and combined effects of the
F&VPP components. Second, book return
rates declined across time. Classwide ap-
Family Involvement
575
proaches (e.g., interdependent group contingencies)
can be established to increase the
number of books returned. Third, because of
practical reasons, schools as opposed to participants
were assigned to study condition;
therefore, children and parents were nested
within schools. Fourth, three books in this
study promoted the 5 a Day message. In 2007,
5 a Day was replaced by Fruits and Veggies—
More Matters (Produce for Better Health
Foundation, 2007), a campaign promoting individualized
recommendations based on gender,
age, and physical activity level, and communicated
in cups instead of servings (http://
www.fruitsandveggiesmatter.gov/). As such,
these books should be revised to reflect the
new message. Fifth, children’s F&V consumption
was assessed via parent report. Future
research should use more rigorous dietary assessment
methods (e.g., 24-hour recalls; Lytle
et al., 1993). Finally, the selection of anchor
points for the parent and child acceptability
measures may have had an influence on ratings.
Respondents may have been reluctant to
use the lowest anchor point (i.e., “never”; S.
McConaughy, personal communication, January
22, 2008). Nevertheless, the majority of
parents and children reported liking the books
“a lot,” and learning “a lot” from them, suggesting
that the level of acceptability was at
least moderately high. Finding ways to create
effective, acceptable, feasible mechanisms to
promote home–school collaboration related to
healthy eating is important. This pilot study
illustrates one such effort.
Tuesday, March 3, 2009
Being a Health and Physical Education teacher I can not help but be interested in the health and well being of individuals. With urban students growing up in environments with less parks/fields, smaller yards (if any), fewer workout facilities, etc... I am worried that they will get less of a physical workout throughout their lives. Growing up in a suburban town provided me with plenty of chances to go for a run, walk to a field and play a game of soccer/football with my friends, or go over to a friends house and run around in their backyard. On top of all of this I have to note that studies throughout American have shown that African Americans and Hispanics are at the highest risk of developing heart disease, and since urban areas have high African American and Hispanic populations I feel that these topics are directly related. With this in mind some topics that I would like to explore for my final project are as follows:
1. What are some of the health risks urban students face?
2. What are some ways urban students can change their daily habits to promote healthier lifestyles?
3. How does the opportunity to exercise differ in an urban environment than it does in a rural or suburban environment?
1. What are some of the health risks urban students face?
2. What are some ways urban students can change their daily habits to promote healthier lifestyles?
3. How does the opportunity to exercise differ in an urban environment than it does in a rural or suburban environment?
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