Impact of the American Heart Association's Heart Health

in the Young Curriculum on Cardiovascular Knowledge Scores

and Behavior Changes in Smoking, Exercise, and Nutrition

in Eighth Grade Students

A Thesis Presented

to

The Graduate Faculty

University of Wisconsin-Lacrosse

In Partial Fulfillment

of the Requirements for the

Master of Science Degree

by

Fred Hebert

May, 1987

ABSTRACT

This was a pre-test post-test experimental study. The experimental group received 15 (45 minute) lessons from the AHA curriculum. Pre-test and post-test scores were recorded. The control group attended regular health education classes between the pre-test and the post-test. The Know Your Body Health Questionnaire for grades 6-8 was used as a base instrument to assess knowledge change. The Know Your Body Health Habits Survey instrument was used to assess behavior change in the areas of smoking and exercise. The DINE system, created by Darwin Dennison, was used to measure nutrition change. The data was analyzed using between group T-tests and Pearson product moment correlations. The alpha level was established at the .05 level of significance. Results indicated significant differences in knowledge change scores in the experimental group versus the control group. None of the 46 subjects in the study reported smoking behavior, makinq it impossible to test for smoking change. Statistical significance was not demonstrated in exercise behavior change in either group. There was not a statistically significant correlation demonstrated in either the experimental or the control group between knowledge change scores and change scores in exercise behavior. Interestingly, statistical significance was demonstrated in diet behavior in a negative direction. Both groups decreased their heart healthy nutritional behavior from pre-test to post-test. The experimental qroup also demonstrated a statistically significant correlation between knowledge change and diet change, illustrating decreased heart healthy diet with increased knowledge. This was not true in the control group. The study indicates the need for comprehensive long-term health education programs to bring about necessary changes in health habits and skills.

UNIVERSITY OF WISCONSIN-LACROSSE College of Health, Physical Education and Recreation

Lacrosse, Wisconsin 54601

Candidate: Fred F. Hebert

We recommend acceptance of this thesis in partial fulfill-

ment of this candidate's requirements for the degree:

Master of Science - School Health Education The candidate has completed his/her oral report.

I7 i' TLL'? , A"b Thesis committe 1 Date

s s Commitpe Member Date

?/2d#* Thesis Committee Memwer Ddte '

This thesis is approved for the College of Health, Physical Education and Recreation.

.?/YX 7 d Recreation

Dean of Graduate Stddies A p f . I IF, fiq Date

ACKNOWLEDGEMENT

I am very grateful to and would like to thank the

following faculty members: Dr. Leslie Oganowski and Dr.

Russell Phillips for serving on my.committee; Dr. R. Daniel

Duquette for chairing my committee and going repeatedly

above and beyond his duties and responsibilities in that

position. I would also like to thank Dr. Carol Huettig and

Dr. John Munson, of the University of Wisconsin-Stevens

Point, for the many hours of assistance and encouragement

rendered in the completion of this project.

I am also grateful to my wife Carol and my children,

Katie and Abby, for their constant support and

encouragement, as well as the sacrifices they made, to make

this project a reality. Lastly, I would like to thank my

parents for their support and assistance throughout my life.

TABLE OF CONTENTS

APPROVAL PAGE .......................................... ii

ACKNOWLEDGEMENTS ....................................... iii

. . . . LIST OF TABLES ................. . . . . . . . . . . . . . . . . . . . . . . . . . v

Chapter Page

I . INTRODUCTION ..................................... 1 Purpose of the Study ............................. 2 Statement of the Problem ......................... 2 Hypotheses ....................................... 3 Assumptions ...................................... 4 Delimitations .................................... 5 ...................................... Limitations 5 Operational Definitions .......................... 6

I1 . REVIEW OF LITERATURE ............................. 7 Severity of the Problem .......................... 7 Modifiable Risk Factors .......................... 10 Impact of Other Studies on Heart Health .......... 21 ........ Impact of Other Curricula on Heart Health 29

I11 . METHODOLOGY ...................................... 36 ......................................... Subjects 36 Instruments ...................................... 36 Procedures ....................................... 38 .................................... Data Analysis 40

IV . RESULTS AND DISCUSSION ........................... 42 Results .......................................... 42 Discussion and Implications ...................... 53

...................................... V . CONCLUSIONS 55 Summary ......................................... 55 ...................................... Conclusions 57 .................................. Recommendations 57

............................................. REFERENCES 59

APPENDIX .... A . Knowledge Test and Behavior Change Instrument 64

...................... B . AHA Heart Health Curriculum 76

LIST OF TABLES

Table Paqe

......................... 1 . Knowledge Pre-test Scores 43

........................ 2 . Knowledge Post-test Scores 44

........................... 3 . Knowledge Change Scores 45

4 . DINE Scores Pre-test .............................. 46

5 . DINE Scores Post-test ............................. 46

6 . DINE Change Scores ................................ 47

.......................... 7 . Exercise Levels Pre-test 48

8 . Exercise Levels Post-test ......................... 49

9 . Exercise Change Scores ............................ 49

10 . Correlation Knowledge/Diet Experimental Group ..... 50

11 . Correlation Knowledge/Diet Control Group .......... 51

12 . Correlation ~nowledge/Exercise Experimental Group ...................................... 52

...... 13 . Correlation Knowledge/Exercise Control Group 53

CHAPTER I

INTRODUCTION

Background

Medicine and disease control of the past depended to a

large extent on what a physician did to or for a patient.

Whenever people became ill or disabled, they turned to the

doctor as their automatic savior or restorer of good health.

Today, however, more people are realizing that they

need to work at taking charge of their own self care with

the help of knowledge, choices, and consultation with a

physician. In the past decade medicine has become far more

c0ncerne.d with attempting to prevent diseases by recognizing

some of the causative factors that lead to being at risk.

To minimize risk of heart disease an intelligent patient-

doctor relationship is necessary.

Over one and a half million people will suffer heart

attacks this year and approximately 550,000 people will die

from heart and blood vessel diseases (AHA, 1985). Coronary

atherosclerosis appears to result from the interaction of

multiple factors of civilization with an insidious and

silent beginning in early childhood. Certain risk factors

have been identified, which are associated with the

advancement of coronary atherosclerosis. These include:

age, sex, race, genetics, diet, hypertension, smoking and a

sedentary lifestyle (AHA, 1985). While nothing can be done

about age, sex, race or genetic endowment, hypertension can

be modified with medication. The remainder are under the

control of t h e individual and their modification is

dependent on knowledge and motivation. This study will

measure the impact of knowledge upon behavior provided by a

health curriculum.

Purpose

Can education have an impact on behavior? This study

will determine the effectiveness of the American Heart

'~ssociation Heart Health curriculum on students' knowledge

of cardiovascular diseases and risk factors and subsequent

changes in behavior. Health educators need to determine if

we have available a curriculum that is indeed effective in

developing knowledge that will encourage adoption of

lifestyle change to maintain/improve cardiovascular health.

Young people need to realize their roles in maintaining a

healthy lifestyle in order to begin their own preventive

measures toward the healthiest lifestyle possible to them.

Statement of the Problem

The vast majority of behaviors are learned in childhood

and are difficult to change in adult life (Kolbe and Newman,

1983). Researchers of cardiovascular diseases have

determined that marginal decreases in several cardiovascular

risk factors add up to a substantial reduction in total risk

of cardiovascular disease (Kolbe and Newman, 1983). With

these findings in mind, the following problem statement

generates a good deal of interest: :{hat is the impact of

implementing the AHA Heart Health Curriculum on the

cardiovascular knowledge scores and behavior changes in the

areas of smoking, exercise, and nutrition of eighth grade

students at St. Stevens parochial school?

Hypotheses

1. The students exposed to the American Heart Association

Iieart Health in the Young curriculum will not

demonstrate a significant increase in cardiovascular

knowledge scores when compared to students exposed to

the traditional curriculum.

2. The students exposed to t h ~ AHA Heart Health in the

Young curriculum will not demonstrate a significant

reduction in smoking behavior in the area of cigarette

smoking when compared to students exposed to the

traditional curriculum.

3 . The students exposed to the AHA Heart Health in the

Young curriculum will not demonstrate a significant

increase in Heart Healthy Diet behavior when compared

to the students exposed to the traditional curriculum.

4. The students exposed to the AHA Heart Health in the

Young curriculum will not demonstrate a significant

change in exercise behavior when compared to the

students exposed to the traditional curriculum.

There is no s i g n i f i c a n t r e l a t i o n s h i p between knowledge

change s c o r e s and smoking b e h a v i o r change i n t h e

e x p e r i m e n t a l group.

There i s no s i g n i f i c a n t r e l a t i o n s h i p between knowledge

change s c o r e s and smoking b e h a v i o r change i n t h e

c o n t r o l group.

There i s no s i g n i f i c a n t r e l a t i o n s h i p between knowledge

change s c o r e s and d i e t b e h a v i o r change i n t h e

e x p e r i m e n t a l group.

There is no s i g n i f i c a n t r e l a t i o n s h i p between knowledge

change s c o r e s and d i e t b e h a v i o r change i n t h e c o n t r o l

group.

There i s no s i g n i f i c a n t r e l a t i o n s h i p between knowledge

change s c o r e s and e x e r c i s e b e h a v i o r change i n t h e

e x p e r i m e n t a l group.

There i s no s i g n i f i c a n t r e l a t i o n s h i p between knowledge

change s c o r e s and e x e r c i s e b e h a v i o r change i n t h e

c o n t r o l group.

Assumptions

The two g r o u p s o f s t u d e n t s e n t e r i n g t h e s t u d y have t h e

same d e g r e e of m o t i v a t i o n t o improve h e a l t h knowledge

and i n t e n t i o n .

The r e a d i n g l e v e l s o f t h e s t u d e n t s invo lved i n t h e

s t u d y w i l l b e t h e same.

The s t u d e n t s w i l l f i l l o u t a l l a ssessment forms

h o n e s t l y and c o m p l e t e l y .

Delimitations

1. The students involved in the study are eighth grade

I boys and girls from St. Stanislaus and St. Stevens

parochial schools in Stevens Point, Wisconsin.

Limitations

1. This study is set in a midwcstern college community of

approximately 25,000 people. Stevens Point as a

community and a university has been very active in

wellness activities for many years and the results

should be extrapolated with this in mind.

2. The curriculum focuses on only the following five

areas: nutrition, smoking, exercise, heart physiology,

and cardiovascular diseases.

3. The size of the population is quite small (N=46) and

any results taken from this study should keep that in

mind.

4. The subjects of this study are all members of the

Catholic faith.

5. The subjects of this study could be described as

members of the middle to upper middle socioeconomic

class and results should be extrapolated with this as a

consideration.

6. The subjects of this study are in the eighth grade.

The results may not be similar in different age groups.

Operational Definitions

Smoking Behavior - determined by response to the following question: How many times a week do you generally

smoke cigarettes?

Diet Behavior - determined by recording food intake for

a 24 hour time span and then coding this information to

arrive at a DINE score, which is based on a 0 to 10 scale,

with 0 being very poor and 10 being excellent.

Exercise Behavior - determined by response to the following question: How many times per week do you do

strenuous exercise? (heart beats rapidly) LIKE - running, jogging, swimming, baseball, football, basketball, soccer,

volleyball, singles tennis, active gymnastics, bicycling up

hills or long distances.

CHAPTER I1

REVIEW OF RELATED LITERATURE

T h e r e have been numerous s t u d i e s t o d e t e r m i n e t h e

i m p a c t o f v a r i o u s c u r r i c u l a on a t t i t u d e s and b e h a v i o r a l

c h a n g e i n a young p o p u l a t i o n . The AHA H e a r t H e a l t h i n t h e

Young c u r r i c u l u m h a s n o t been ana lyzed t o t h i s d e g r e e a t

t h i s p o i n t i n t i m e . T h e c u r r i c u l u m was d e s i ~ n e d u s i n g a

modular fo rmat r a t h e r t h a n a s c o p e and s e q u e n t i a l p a t t e r n

f a v o r e d by most c u r r i c u l a . The major t h r u s t o f t h e

c u r r i c u l u m l i es i n t h e f o l l o w i n g f i v e a r e a s : h e a r t

p h y s i o l o g y , h e a r t d i s e a s e s , smoking, n u t r i t i o n , and

e x e r c i s e .

T h i s s e c t i o n p r e s e n t s a rev iew of p e r t i n e n t s t u d i e s

t h a t a f f o r d background i n f o r m a t i o n and a r a t i o n a l b a s i s f o r

t h e d e s i g n of t h e s t u d y .

T o p i c a l a r e a s reviewed i n c l u d e : (1) s e v e r i t y o f t h e

problem, ( 2 ) m o d i f i a b l e r i s k f a c t o r s , ( 3 ) impac t o f o t h e r

s t u d i e s on h e a r t h e a l t h ; and ( 4 ) impact o f o t h e r c u r r i c u l a

on h e a r t h e a l t h i n a young p o p u l a t i o n .

S e v e r i t y o f t h e Problem

The t e c h n o l o g i c r e v o l u t i o n h a s l a r g e l y r e p l a c e d muscle

power w i t h machines and compute rs and h a s p r o v i d e d a s u r f e i t

o f r i c h food a t a low energy cost. I t h a s promised

i n d o l e n c e , s e d e n t a r y l i v i n g h a b i t s , and o b e s i t y . I t h a s

7

been estimated that over 43,500,000 ~mericans have one or

more forms of heart or blood-vessel disease (AHA, 1985). In

the United States approximately 1.5 million people will

suffer a heart attack this year, while an estimated 550,000

of these will result in death. High blood pressure afflicts

an estimated 37,990,000 people in the United States, with

stroke incidence affecting some 1,900,000 people each year

(AHA, 1985). If 1986 is like 1985, almost 1 million people

will die from a problem of the cardiovascular system. This

rneans that nearly half of the people who die in the United

States each year are dying from cardiovascular diseases such

as hypertension, stroke, and coronary heart disease. All of

this is at an estimated yearly cost of 72.1 billion dollars

(AHA, 1985).

The above statistics are both frightening and

depressing. However, much has been done to identify risk

fac!:ors that increase one's chances of being afflicted with

some type of cardiovascular disease. Identified living

habits and conditions which increase a person's chance of

getting heart disease are called risk factors. Seventeen

possible risk factors have been identified by researchers,

with age, sex, hypertension, cigarette smoking, and a high

serum cholesterol level, when grouped together, having been

shown to double an individual's risk of cardiovascular

disease (Kolbe and Newman, 1983). Weaker contributing risk

factors are heredity, exercise, obesity, and diabetes. Salt

intake, use sf oral contraceptives, personality type, and

environmental stress are of uncertain importance as

cardiovascular disease risk factors (Kolbe and Newman,

1983 ) . Risk factors such as age, sex, and heredity cannot be

modified. Although the other risk factors mentioned can be

controlled to some extent by health behaviors and lifestyle

choices, in some cases, we are still dealing with the

unknown when confronted with cardiovascular disease. Kannel

and Dawber, in 1972, found thht only 25% of heart attack

victims had previous symptoms. Watkins (1984) found that

~lthough one or more risk factors are usually present in patients with coronary heart disease (CHD), certain individuals with clinical manifestations of CHD have no identifiable risk factors; this suggests the existence of yet unidentifiable etiologic factors (p . 13).

An individual's susceptibility to risk factors is contingent

on inherited traits (Wallis, 1984). We cannot control the

inherited traits, but need to be able to recognize them to

become aware of factors that may make an individual more at

risk than others.

Modifiable Risk Factors

Cholesterol

The research literature indicates a strong link between

cardiovascular disease and diet (Weidman, Kwiterovich,

Jesse, and Nugent, 1983; American Academy of Pediatrics

Committee on ~utrition, 1983; AHA, 1985). The people of

Finland have the highest incidence rate of heart attack and

also the highest daily intake of fat and cholesterol.

Conversely, the Japanese take in low levels of fat and

cholesterol and suffer from a very low incidence of heart

attacks (Wallis, 1984).

The United States ranks right behind Finland in the

amount of fat and cholesterol in our diet and also in

cardiovascular disease incidence rates (Wallis, 1984).

Wallis states, "by the time the average American puts down

his fork for the day, he has consumed the equivalent of a

full stick of butter in fat and cholesterol' (p. 56).

Approximately 40% of daily calories are taken in in the form

of fat. This is 30% more than 60 years ago and 3 times the

Japanese intake (Wallis, 1984).

Cholesterol is not all bad. In fact, our body needs it

to survive. Cholesterol is produced in the liver and is

used in the body as a building block of the outer cell

membrane, a principal ingredient in the digestive juice

bile, nerve insulation, and is a component in the sex

hormones, estrogen and androgen (Wallis, 1984). Cholesterol

is transported in plasma in combination with specific

aggregates of lipids and proteins-lipoproteins (Harrison and

Winston, 1982). Plasma cholesterol is carried either in low

density lipoproteins (LDL) or high density lipoproteins

(HDL). It seems that the higher the level of HDL the less

an individual would be susceptible to cardiovascular disease

(Harrison and Winston, 1982). The amount of HDL and LDL

within an individual is controlled by genetics and diet

(Harrison and Winston). We cannot control our genetics, but

we can control our diet. Wallis (1984) stated,

"approximately 20-30% of the cholesterol found in our body

comes from the food we eat" (p . 56).

The AHA recommends the daily calorie intake of

saturated fats to make up 10% of the daily intake of

calories (AHA, 1985). Presently the average American is

ingesting 15-178 saturated fats in daily caloric intake

(Harrison and Winston, 1982). Sources of saturated fats are

red meats, dairy products, bakery goods, and some vegetable

oils. The AHA recommends replacing saturated fats with

unsaturated fats, polyunsaturated fats, or carbohydrates

(Harrison and Winston, 1982).

The reasons behind the cholesterol concern center

mainly around the development of atherosclerosis. This

disorder, which is indicated by a build up of cholesterol on

the walls of the blood vessels, causing them to lose their

elasticity, starts very young and if unchecked can and does

lead to an increased incidence of stroke or heart attack.

As many as 1/3 of all children over age 12 have

elevated cholesterol levels (Carey, Hager and Harrison,

1985). The average American child whose cholesterol level

reaches 165 mg/100 ml by age 3, is equal to a middle aged

man in Japan (Williams and Wynder, 1976). When American

children are compared with Mexican school children, the

American children's cholesterol levels are so much higher

that the distribution curves of the two populations barely

overlap (Williams and Wynder, 1976). Enos, Holmes and Beyer

(1953) found in autopsies of 300 American casualties of the

Korean War, with a mean age of 22, evidence of coronary

atherosclerosis in 77% of these men. A similar study

conducted on 105 American soldiers, with a mean age of 22.1,

killed in the Vietnam War, confirmed that 45% had some

evidence of atherosclerosis (McNamera, Molot, Stremple, and

Cutting, 1971).

We can reduce our level of LDL by increasing our intake

of polyunsaturated fats, increasing the amount of fiber in

our diets, and exercising aerobically 3-4 times/week. Dr.

Charles Glueck, director of Cincinnati Lipid Research

Center, states, "for every 1% reduction in total cholesterol

level, there is a 2% reduction in heart disease riskn

(Wallis, 1984, p. 60).

It has been demonstrated that dietary habits in

childhood carry over into adult life (Weidman, Kwiterovich,

Jesse, and Nugent, 1983). However, it has not been

demonstrated directly by controlled studies whether dietary

modification in children will alter CHD incidence in later

life (Weidman et al., 1983).

The American Academy of Pediatrics Committee on

Nutrition (AAPCN) stated in a 1983 publication,

The s a f e t y o f d i e t s d e s i g n e d t o d e c r e a s e c a l o z i c i n t a k e , i n c r e a s e consumption o f complex c a r b o h y d r a t e s , d e c r e a s e i n t a k e o f r e f i n e d s u g a r s , d e c r e a s e consumption of f a t and c h o l e s t e r o l , and l i m i t sodium i n t a k e h a s n o t been e s t a b l i s h e d i n growing c h i l d r e n Ip. 7 9 ) .

T h i s commit tee i n t h e same p u b l i c a t i o n i n 1983 s t a t e d ,

L i m i t i n g f a t and c h o l e s t e r o l i n t a k e has been q u e s t i o n e d b e c a u s e d u r i n g t h e f i r s t y e a r o f l i f e , b r e a s t mi lk ( a c h o l e s t e r o l c o n t a i n i n g f o o d ) is c o n s i d e r e d t h e i d e a l food f o r i n f a n t s . I n t e e n a g e r s serum c h o l e s t e r o l c o n s i s t e n t l y d e c r e a s e s f rom p r e - t e e n l e v e l s . I n a d d i t i o n , f o r m a t i o n o f b i l e a c i d s , hormones, and s p e c i a l t i s s u e s may i n d i c a t e a c o n t i n u i n g need f o r c h o l e s t e r o l d u r i n g t h e e n t i r e growth p e r i o d ( p . 7 8 ) .

Weidman e t a l . (1983) p o i n t o u t t h a t i n p o p u l a t i o n s

where CHD is low, t h e mean l e v e l s o f plasma c h o l e s t e r o l i n

c h i l d r e n r a n g e from 100-150 mg/dl, and i n p o p u l a t i o n s where

CHD is h i g h t h e mean l e v e l s o f plasma c h o l e s t e r o l i n

c h i l d r e n r a n g e from 150-200 mg/dl. Wil l iams and Wynder

(1978) found t h a t a l m o s t a l l c h i l d r e n demons t ra te f a t t y

s t r e a k s i n t h e i r a o r t a s by 3 y e a r s o f age. Wil l iams and

Wynder (1978) g o on t o s t a t e ,

V a r i o u s s t u d i e s s u g g e s t t h a t a t h e r o s c l e r o s i s is probab ly r e v e r s i b l e i n man u n t i l t h e end of t h e second decade of l i f e , s o t h a t any hope o f c o m p l e t e l y p r e v e n t i n g t h i s d i s e a s e p r o c e s s must b e g i n i n ch i ldhood ( p . 212) .

Weidman e t a l . (1983) s t a t e s ,

There i s a g e n e r a l agreement a t h e r o s c l e r o s i s may b e g i n i n y o u t h and undergo p r o g r e s s i o n th rough young a d u l t h o o d , even though c l i n i c a l m a n i f e s t a t i o n s u s u a l l y d o n o t a p p e a r u n t i l midd le a g e o r l a t e r ( p . 1411A).

Webber, C r e s a n t a , Voors, and Berenson (1983) s u p p o r t t h a t

t h e o r y by s t a t i n g , " c a r d i o v a s c u l a r e v e n t s g e n e r a l l y d o n o t

o c c u r u n t i l t h e f o u r t h d e c a d e o f l i f e n (p . 649) .

W e l l c o n t r o l l e d s t u d i e s d e m o n s t r a t e plasma l i p i d l e v e l s

c a n b e changed by changing amounts o f s a t u r a t e d and

p o l y u m ~ s a t u r a t e d f a t and c h o l e s t e r o l i n t h e d i e t , b u t

r e s p o n s e i s v a r i a b l e d e m o n s t r a t i n g c l e a r l y t h a t b o t h

e x t e r n a l ( o f t e n n u t r i t i o n a l ) and i n t e r n a l ( i n h e r i t a b l e )

f a c t o r s a r e i n v o l v e d (Weidman e t a l . , 1983) . A d i e t h i g h i n

s a t u r a t e d f a t s and c h o l e s t e r o l w i l l t e n d t o r a i s e t h e l e v e l

o f c h o l e s t e r o l i n t h e b lood , whereas a d i e t lower i n

s a t u r a t e d f a t s and c h o l e s t e r o l w i l l t e n d t o lower t h e l e v e l

o f c h o l e s t e r o l i n t h e b lood (AHA, 1 9 8 5 ) .

Hyper tens ion

Blood p r e s s u r e i s t h e f o r c e o f t h e b lood a g a i n s t t h e

w a l l s o f t h e a r t e r i e s o f t h e body. I t c a n b e measured by

u s i n g a machine known a s a sphygmomanometer. When measuring

b lood p r e s s u r e t h e maximum p r e s s u r e produced by t h e h e a r t is

c a l l e d t h e s y s t o l i c p r e s s u r e , and s h o u l d measure 120 o r

less. The l e a s t amount o f p r e s s u r e i n t h e a r t e r y i s shown

i n t h e d i a s t o l i c p r e s s u r e , and s h o u l d measure a t 80 o r less.

A normal r e a d i n g f o r b lood p r e s s u r e would t h e n be 120/80.

Blood p r e s s u r e becomes a problem when t h e s y s t o l i c p r e s s u r e

e x c e e d s 140 and t h e d i a s t o l i c p r e s s u r e e x c e e d s 90 (AHA,

1 9 8 5 ) . Blood p r e s s u r e i s p r i m a r i l y de te rmined by g e n e t i c

and l i f e s t y l e f a c t o r s , a l t h o u g h a g e , s e x , r a c e , body b u i l d ,

and food i n t a k e may have a n i n f l u e n c e ( F r a s e r , P h i l l i p s , and

H a r r i s , 1983) . High b lood p r e s s u r e may a f f e c t a s many a s

1 /3 o f t h e a d u l t p o p u l a t i o n i n t h e Uni ted S t a t e s ( F r a s e r e t

al., 1983). It adds to the work load causing the heart to

enlarge and become weaker over time (AHA, 1985).

Hypertension is related directly to level of blood

pressure and to presence and magnitude of coexistent risk

factors (Harrison and Winston, 1982). A relationship to

salt intake and overweight has been shown in susceptible

people. A reduction of both, salt and weiqht, usually leads

to a reduced systolic and diastolic blood pr2ssure (Harrison

and Winston).

Accumulating data indicate clearly that primary

hypertension has its origin in childhood (Berenson et al.,

1982). A retrospective study (Connolly, Elveback, and

Oxman, 1983) found that the presence of hypertension is

associated with an increased risk of the development of

coronary artery disease. It has been shown that the

treatmcnt of hypertension, including mild hypertension,

reduces mortality in patients with hypertension (Connolly et

al., 1983). Kannel, McGee, and Gordon (19761, in assessing

the results of the retrospective Framingham study, found the

most useful single factor for detecting persons at high risk

of CHD to be blood pressure.

Exercise

Exercise has much in common with both hypertension and

cholesterol levels because of the impact that regular

exercise has on both. Siscovick, Weiss, Hallstrom, Invi,

and Peterson (1982) report that findings suggest that

individuals who engage in high intensity leisure time

activities have a reduced risk of primary cardiac arrest.

Fraser et al. (1983) found that for all sex adolescent

groupings, for both diastolic and systolic pressures, the

more physically fit group had lower blood pressure. The

level of physical fitness predicts systolic blood pressure

independently of body build measures and age (Fraser et al.,

1983). Milhorn (1984) reported that systolic blood pressure

in normal persons is unchanged by exercise; however,

significant changes in hypertensive persons were observed.

Milhorn found the diastolic pressure to remain unchanged in

both normal and hypertensive persons with exercise.

In 1984 Milhorn reported that the serum triclyceride

level is readily reduced by exercising, but returns to

previous levels in three to four days. A triclyceride is

formed when three fatty acids combine with glycerol. Serum

triclycerides are transported within the blood. Milhorn

also found that exercising aerobically three times or more

per week reduces triclycerides on a chronic basis as long as

the training continues. Aerobic exercise has three main

components to it: it must be vigorous, continuous, and

regular. Aerobic simply means that the body is using oxygen

as its source of energy. Hartung, Foreyt, Mitchell, Ulasek,

and Gotto (1980) found in a study of HDL levels in marathon

runners, joggers, and inactive men that differences within

the three groups were primarily the result of distance run,

not dietary factors. Milhorn (1984) found that cholesterol

decreases with exercise only if weight loss also occurs.

Although total cholesterol levels may remain unchanged,

reduction of LDL and an increase in HDL have been shown to

occur.

Greenburg (1984) in a 10 year study of 16,936 Harvard

graduates showed exercise to be the single most important

indicator of heart disease, showing those who exercised

regularly to be at low risk and those with sedentary

lifestyles to be at high risk. In a somewhat similar study,

Stone (19831, using 21 corporate executives with a mean age

of 44.7, measured changes in cardiovascular risk factors

after implementing an on-the-job exercise program.

Reduction of cardiovascular risk factors ranged from 17-38%

on the instruments after six months of exercise program

involvement. No modifications in lifestyle were attempted

other than exercise.

Benefits can be derived from exercise periods as short

at 10 minutes. Ideally sessions should generally be 20-30

minutes long (Milhorn, 1984).

Smoking

Cigarette smoking had become a way of life for many

Americans until it was determined to be hazardous to health

by the Surgeon General in 1964. Harrison and Winston (1982)

found that a person's risk of CHD associated with cigarette

smoking increases with the number of cigarettes smoked. It

was also determined that the younger an individual was when

s/he began smoking, the greater the risk of CHD. The

smoking of cigarettes affects platelet adhesiveness,

arterial endothelium, susceptibility to ventricular

dysrhythmias, oxygen transport and utilization, heart rate,

and blood pressure (Harrison and Winston, 1982). Harrison

and Winston also found that cigarette smoking appears to

depress HDL levels. A cigarette smoker has twice the risk

of a heart attack and five times the risk of a stroke than a

nonsmoker (AHA, 1985).

Tobacco is one of the most commonly used substances

among American adolescents, with 2/3 having tried smoking

and 20-25% doing so regularly (Lauer, Ackers, Massey, and

Clarke, 1982). Some children begin smoking regularly as

early as third grade (Berenson et al., 1982). Baugh,

MacDonald-Hunter, Webber, and Berenson (1982) found that

half of those starting to smoke do so before the age of 12,

and have established the habit by age 14. Baugh et al. also

found 60% of children were given their first cigarette and

were likely to have smoked it with family members or

friends. Children are more likely to begin smoking if they

had parents providing a smoking model, had low self esteem,

disliked school, and feared failure (Ahlgren, Norem,

Hochhauser, and Garvin (1982). Hunter, Baugh, Webber,

Sklov, and Berenson (1982) found a positive smoking

relationship between brothers' and sisters' smoking

behaviors, and a very strong positive correlation to smoking

and peer smoking. In a study by Lauer et al. (19821, 80% of

respondents whose parents and friends were nonsmokers

indicated they were a nonsmoker, whereas 11% of respondents

whose parents and friends were smokers indicated being a

nonsmoker. Hunter et al. (1982) found, "the more smokers in

a child's environment the more likely s/he will imitate the

behavior" (p. 36). Hunter et al. further states,

Smoking behavior depends not only on the mere presence of users as in trial, but also on the beliefs concerning the social reinforcement consequences associated with continued usage (p. 37).

Adult cigarette smoking has been decreasing since the

Surgeon General's report in 1964 (Evans et al., 1981).

Cigarette smoking is remaining constant or decreasing in

every group except teenage white girls where it is

increasing (Evens et al., 1981; Hunter et al., 1982).

Teenage girls are now smoking more than teenage boys

(Berenson et al., 1982).

There are approximately 33 million Americans who have

quit smoking (AHA, 1985). Freidman, Petitti, Banol, and

Siegelaub (1981) found that the act of quitting smoking

appears to result in a substantial reduction in coronary and

total mortality that cannot be explained by the

characteristics of quitters before they quit. The AHA

(1985) claims that a smoker who quits smoking for 10 years

has the same risk of a heart attack as a person who has

never smoked.

Obesity

In 1983, Hubert, Manning, McNamera, and Castelli found

obesity to be associated with high blood pressure, increased

blood lipids, and increased blood glucose. Drawing on the

Framingham study, Hubert et al. (1983) point out that

obesity is clearly a long-term predictor of CHD incidence

particularly in younger members of the cohort, with younger

being undc - 50 years of age. Hubert et al. also found

weight to be a very potent risk factor for women, with only

age and blood pressure being pore powerful predictors. The

United States population, particularly men, have been

getting heavier over the past few decades (Hubert et al.,

1983 ) . The AAPCN in 1981 found most obese infants do not

become obese adults. The AAPCN (1981) stated,

The correlations between obesity in late childhood, adolescence, and adulthood are considerably stronger than those of infancy. As many as 75% of obese adolescents are obese adults (p. 881).

We need to communicate what we know to our children.

Kolbe and Newman (1983) estimated that 36-60% of children by

age 12 exhibit at least one of the following risk factors:

cigarettes smoked, cholesterol level of 180 mg/dl, blood

pressure reading in top 5% for sex and age or greater than

140/90, were 120% of ideal weight for height, sex and age,

o r s c o r e d "poor" on t h e Harvard s t e p test. Our c h i l d r e n a r e

c r e a t u r e s o f h a b i t , and we need t o beg in t o g i v e them good

sound h e a l t h y h a b i t s .

Impact o f Other S t u d i e s on Hear t Hea l th

Framingham

The Framingham Study h a s fo l lowed 5,209 men and women

r e s i d i n g i n Framingham, M a s s a c h u s e t t s s i n c e 1948, w i t h t h e

f i r s t c l i n i c a l examina t ion conduc ted i n January o f 1950.

These s u b j e c t s ranged i n a g e from 30-59, and i n o r d e r t o be

c o n s i d e r e d a s u b j e c t , a p e r s o n must have been f r e e of CHD a t

t h e b e g i n n i n g of t h e s t u d y . The s u b j e c t s o f t h e s t u d y have

u n d e r t a k e n numerous m e d i c a l tests t o de te rmine p e r s o n a l and

e n v i r o n m e n t a l r i s k f a c t o r s t o h e a r t h e a l t h . The p e r s o n a l

r i s k f a c t o r s a s s e s s e d w e r e a g e , s e x , blood l i p i d s , b lood

p r e s s u r e , impa i red c a r b o h y d r a t e t o l e r a n c e , and ECG

a b n o r m a l i t i e s . The e n v i r o n m e n t a l r i s k f a c t o r s measured were

d i e t , l e v e l of p h y s i c a l a c t i v i t y , o b e s i t y , and c i g a r e t t e

smoking (Kannel and Dawber, 1 9 7 2 ) .

Kannel and Dawber (1972) found ,

The development of CHD is n o t a chance o c c u r r e n c e or mere ly a consequence o f t h e a g i n g p r o c e s s . I t was a p p a r e n t k h a t c e r t a i n i n d i v i d u a l s a r e h i g h l y v u l n e r a b l e and t h a t t h e d e g r e e of s u s c e p t i b i l i t y c o u l d be a s s e s s e d i n asymptomatic p e r s o n s (p. 7 9 8 ) .

Soms o f t h e s e i d e n t i f i e d r i s k f a c t o r s have been mentioned

e l s e w h e r e w i t h i n t h i s r e v i e w i n r e g a r d t o t h e Framingham

Study, but need t o b e f u l l y t i e d t o t h i s s t u d y a t t h i s p o i n t

When examining the personal risk factors measured

within the Framingham Study the following information was

discovered. Men are distinctly more prone to CHD than

women, although this relative immunity wanes with advancing

age (Kannel and Dawber, 1972). Blood lipid content is one

of the most potent ingredients of the potential CHD

candidate. High blood cholesterol values were the most

powerful precursor of CHD. The average value of cholesterol

in those who developed coronary attacks was 245 mg per cent

(Kannel and Dawber, 1972). Kannel and Dawber (1972) found,

The risk of CHD was proportional to the antecedent blood pressure level, systolic or diastolic, casual or basal, at any age in either sex. Even modest elevations of pressure, particularly when associated with lipid abnormalities, were associated with a substantial increase in risk (p. 800).

Risk of coronary events was increased in persons with a

tendency to diabetes. These blood lipid abnormalities that

accompany diabetes were found present a decade before the

appearance of the overt diabetes (Kannel and Dawber, 1972).

Examination of the environmental influences on CHD as

measured within the Pramingham Study by Kannel and Dawber

(1972) leads to the following conclusions. The most

sedentary subjects appear to be subjected to substantially

higher mortality from CHD. An increased incidence of

coronary attacks was observed in the least active persons

compared to those who were active. The smoking habits of

those in the study were carefully recorded, and inhaled

cigarette smoke was found to be an important contributor to

coronary attacks. Risk tended to increase with the number

of cigarettes smoked each day. The interpretation of the

dietary investigation from this study must be made

guardedly. The variation in serum cholesterol level from

person to person within. the population could not be

accounted for by differences in nutrient intake. However,

we know that there are many other factors that account for

cholesterol levels, and within this population the

cholesterol intake was rather high when compared to other

populations. Increased weight was associated with an

elevation of blood pressure and an increased tendency

towards diabetes. Hubert et al. (19831, in a 26 year follow

up of the Framingham Study subjects, found obesity,

particularly among women, to be a significant independent

predictor of CHD. Weight gain after the young adult years

conveyed an increased risk of CHD in both sexes that could

not be attributed either to the initial weight or the levels

of the risk factors that may have resulted from the weight

gain (Hubert et al., 1983 1.

Kannel, McGee, and Gordon (1976) found that in the

Framingham Study the chances of developing cardiovascular

disease by age 65 are 37% for a man and 18% for a woman.

With this in mind, Kannel et al. (1976) developed the risk

function to group risk factors together to indicate those

risk factors which are tied closely to a particular

cardiovascular disease. Kannel et al. (1976) states,

A single risk factor is neither a logical nor an effective means of detecting persons at high risk of cardiovascular disease. Screening efficiency can be considerably improved if other risk factors are taken into consideration (p. 47).

Kannel et al. (1976) concluded that persons at a high risk

of cardiovascular disease could effectively be identified

from a measurement of their serum cholesterol and blood

pressure, smoking history, an electrocardiogram, and a

determination of glucose intolerance.

North Karelia

The population of North Karelia, a county in Finland,

has a high rate of coronary heart disease. It also has a

high prevalence of hypercholesterolemia, but whether this

reflects a diet rich in animal fats or is a result of

genetic factors in unclear. A number of studies have been

done within this county, which will be talked about briefly

as they relate to heart health.

Ehnholm et al. (19821, with 52 middle-aged volunteers,

significantly reduced total serum cholesterol with a low fat

diet and a high ratio of polyunsaturated to saturated fatty

acids. These changes reversed when the volunteers returned

to their regular diet. This suggests that hyper-

cholesterolemia in this population is due at least in part

to dietary factors.

Puska et al. (1982) used the Know Your Body Program

(Williams, Carter, and Eng, 1980) in a 2-year study

involving 871 13-15 year olds at 3 matched schools, aimed at

preventing smoking and influencing dietary habits to reduce

serum cholesterol and blood pressure levels. The level of

smoking increased in all groups, although not as much in the

experimental school as the control schools. The serum

cholesterol level dropped in girls, but not boys.

McAlister, Puska, Salonen, Tuomilehto, and Koskela

(1982) enacted a health promotion program county wide with

the following program objectives: (1) improved preventive

services, (2) information to educate people about their

health and how to maintain it, (3) persuasion to motivate

people to take healthy action, (4) training to increase

skills of self-control, environmental management, and social

action, ( 5 ) community organization for social support and

power for social action, and (6) environmental change to

create opportunity for health actions and improve various

unfavorable conditions. The results of the study were not

conclusive, but they were encouraging. The study did bring

McAlister et al. (1982) to arriving at the following

conclusion :

No matter how effectively a person has been educated, persuaded, and trained to make changes in behavior, it is unlikely that the change will be maintained unless it is reinforced by the social environment (p. 4 6 ) .

Bogalusa Study

The Bogalusa Study was a major investigation of

cardiovascular risk factors in children and adolescents

conducted during 1976-1977, involving 3,014 children, ages

8-17 years.

Berenson et al. (1982) found a positive correlation

between saturated fat intake and high LDL and very low level

lipo-proteins (VLDL) levels, and also that complex

carbohydrate intake has an inverse relationship with these

levels. In this study Berenson et al. also found obesity of

parents and foster parents to be a determinant of childhood

obesity.

Hunter, Frerichs, Webber, and Berenson (1979) found

that children with a higher socio-economic status had fewer

risk factors than their peers. However, the numbers were

small and the available methodology for assessing these

factors needs to be more precise.

University of Minnesota

Gillum, Taylor, Brozek, Anderson, and Blackburn (1982)

reported their findings after following 162 male volunteers

for 32 years taking repeated measures of serum cholesterol

levels and other variables. The first measurements of the

162 men, with a mean age of 20.5, were taken in 1947. In

1968 it was possible to reexamine 118 subjects and 112

subjects were measured in 1979. The findings of the

retrospective study demonstrated that the baseline total

serum cholesterol level was a strong correlate of serum

cholesterol levels found 32 years later. This suggests that

high cholesterol in middle age may be determined or set

early in life (Gillum et al., 1982).

Seventh-Day Adventist Adolescents

Cooper et al. (1984) conducted a study on the lifestyle

of adolescents attending a Seventh-Day Adventist boarding

school and evaluated it as it related to cardiovascular risk

factors. The study site was the Broadview Academy, which is

located 40 miles west of Chicago. About 200 students

.boarded at the school full time. The school cafeteria was

the only on-site source of food for the students and served

a lacto-ovo-vegetarian cuisine in keeping with the Seventh-

Day Adventist precepts. Students returned home for a four-

day holiday on every fourth weekend and occasionally went

out to dinner in local restaurants when their parents came

for-a visit. There are no vending machines on campus and no

commercial centers within walking distance where students

could buy food. They were allowed to have pizza and other

take-out food delivered about once a month. Virtually all

the students were practicing Seventh-Day Adventists and

about half maintained a lacto-ovo-vegetarian diet when not

at the school. Smoking, alcohol usage, and oral

contraceptive use is prohibited by Seventh-Day Adventist

Church.

The s t u d y involved 43 male/female vo lun tee r s from t h e

s c h o o l w i t h a mean age of 16.3. The t o t a l serum c h o l e s t e r o l

levels were 138 mg/dl, w h i l e t h e average ~ m e r i c a n youth

serum c h o l e s t e r o l l e v e l is 170 mg/dl. The blood p r e s s u r e

r e a d i n g s showed an average s y s t o l i c reading of 104.1 and an

ave rage d i a s t o l i c r e a d i n g o f 65.7 (Cooper et a l . , 1984).

Cooper e t a l . concluded t h e fo l lowing based upon t h e s tudy

r e s u l t s :

Based on c u r r e n t knowledge, t h e s e young people en joy an ex t remely f a v o r a b l e c a r d i o v a s c u l a r r i s k s t a t u s and, i f t h i s l i f e s t y l e p e r s i s t s th roughout adul thood, t h e y can e x p e c t a reduced r a t e of coronary h e a r t d i s e a s e r e l a t i v e t o t h e g e n e r a l United S t a t e s popula t ion (p . 476) .

Impact of Other C u r r i c u l a on Heart Heal th i n a Young Popula t ion

Heal th Educat ion Curriculum

A s s t a t e d by Stone and Rubinson (1979) ,

Heal th educa t ion is pe rce ived a s a p roces s t h a t i n c r e a s e s t h e a b i l i t i e s of people t o make informed d e c i s i o n s concern ing t h e i r pe r sona l , fami ly , and community w e l l b e ing (p. 45) .

Stone and Rubinson (1979) a l s o s t a t e d ,

The assumption cannot be made t h a t t h e r e i s a d i r e c t c a s u a l r e l a t i o n s h i p between knowledge and behavior . However, it can be assumed t h a t i d e a l l y , knowledge i s a p recu r so r t o a p p r o p r i a t e behavior , but c o r r e c t a c t i o n is n o t always based on knowledge (p. 4 8 ) .

Williams, Carter, and Eng (1980) concluded,

While behavior change may not be demonstrated within 1-2 years, if cognitive and attitudinal changes occur, behavioral change may occur in the future with or without continued education (p. 375).

People, and in particular young children, sometimes

fail to distinguish between behaviors and occurrences that

may be the outcomes of those behaviors (Ajzen and Fishbein,

1980). Many different behaviors may be responsible for an

outcome. McAlister et al. (1982) stated, "it is well known

that behavior cannot always be changed simply by providing

informationn (p. 45). McAlister et al. (1982) went on to

list four steps necessary to facilitate the learning of new

habits and skills: (1) needs to be modeling of new

responses and action patterns, (2) needs to be guided and

increasingly independent practice in those thoughts and

behaviors, (3) needs to be feedback concerning the

appropriateness of responses, and (4) needs to be

reinforcement in the form of support. Stone and Rubinsan

(1979) found that the likelihood of behavioral change is a

function of beliefs along Pour subjective dimensions: (1)

personal susceptibility, (2) degree of severity of the

consequences, ( 3 ) estimation of the benefits of the

recommended action, and (4) views of psychological and other

cost barriers.

The teaching methodologies incorporated in imparting

knowledge to the learner are important far any subject

matter being taught. However, health education because of

the material being presented and the potential impact upon

the person's life and lifestyle, needs to have learner

involvement and participation perhaps moreso than any other

discipline. Didactic teaching alone has been unsuccessful

because children cannot relate information about diseases in

adult life to themselves (Williams and Wynder, 1978).

Williams and Wynder (1978) stated, "motivating children to

reduce risk for future disease can only be effective within

a framework of personal involvement and peer interaction1'

(p. 212). In regard to heart health education, Williams and

Wynder (1978) found the following necessary for motivation:

(1) children must be medically screened to become aware of

their own risk status; (2) children must receive their own

results; (3) children must receive post screening

educational materials on risk factor significance; and (4)

children must be channeled into active intervention programs

within a peer setting so healthy behavior becomes the norm

rather than the exception. Williams and Wynder (1978) felt

that screening for risk factors provides the "reality

factor" which makes health education personal and pertinent.

Children are more present oriented than future oriented.

When teaching heart health one should stress the immediate

effects rather than the long term (Evans et al, 1981).

School H e a l t h Cur r icu lum P r o j e c t

T h i s was deve loped i n 1969 and was des igned n o t o n l y t o

a f f e c t t h e c h i l d , b u t a l s o c l a s s m a t e s , t e a c h e r s , f a m i l y , and

t h e community. The f o c u s o f t h e c u r r i c u l u m was t o a i d t h e

c h i l d i n r e a l i z i n g t h a t o n e ' s body is h i s / h e r g r e a t e s t

r e s o u r c e and a s s e t . S t u d i e s i n d i c a t e t h a t s t u d e n t s e n r o l l e d

i n t h e p r o j e c t showed g r e a t e r h e a l t h knowledge and

p r e v e n t i v e h e a l t h b e h a v i o r two t o f i v e y e a r s a f t e r b e i n g

exposed t o t h e c u r r i c u l u m t h a n t h o s e n o t exposed ( S t o n e and

Rubinson, 1979 ) . School H e a l t h Educa t ion S tudy

T h i s s t u d y , which began i n 1961, was concerned w i t h t h e

s t a t u s and e f f e c t i v e n e s s o f h e a l t h e d u c a t i o n programs i n t h e

n a t i o n ' s s c h o o l s . The s t u d y i n v o l v e d t h e development o f a

c o n c e p t u a l framework f o r a K-12 c u r r i c u l u m , w i t h 10 major

c o n c e p t s t o serve a s major o r g a n i z i n g e l e m e n t s r e f l e c t i n g

s c o p e and sequence of h e a l t h e d u c a t i o n . There were t h r e e

key c o n c e p t s i n t e r w e a v i n g e v e r y t h i n g : growing and

d e v e l o p i n g , i n t e r a c t i n g , and d e c i s i o n making. R e s u l t s o f

f i e l d t e s t i n g i n d i c a t e d t h a t t h e c o n c e p t approach used i n

d e v e l o p i n g t h e new c u r r i c u l u m d i d r e v e a l r e l a t i o n s h i p s

between i d e a s which e n a b l e d t h e s t u d e n t t o make

g e n e r a l i z a t i o n s and b r o a d e r a p p l i c a t i o n s o f t h e i r knowledge.

I n g e n e r a l t h e e x p e r i m e n t a l c l a s s e s performed b e t t e r w i t h

r e s p e c t t o h e a l t h knowledge t h a n d i d t h e c o n t r o l c l a s s e s

( S t o n e and Rubinson, 1979) .

Health Activities Project

This project began in 1975 and has developed several

learning modules relating to the concept of fitness.

Student-centered modules have been developed for use with

fifth through eighth grade students. The program is geared

toward making children more aware of the control and

responsibility that they have concerning their own health

and safety. Children develop an awareness that they possess

a considerable degree of control over their bodies and can

change their health habits in the present and the future.

The students involved in the project evaluation indicated a

preference for activities relating to certain aspects of

health that they could control in some manner. Other

findings emphasized the importance of the teacher's role in

how s/he relates to the project activities in the classroom

and the significance of the role of the home as a source of

health information (Stone and Rubinson, 1979).

Body Power

This was developed by the Chicago Heart Association in

1975. The educational strategies of the program stressed

that the students are active participants in the learning

process, and that teaching learning activities should

include value clarification techniques, value grids, role

playing, games and experiments. This program appears to

develop positive attitudes in children concerning their

self-concept and the promotion of preventive health behavior

at an early age. Also, the use of humanistic education

tends to provide students with strategies useful in

decision-making skills and value clarification (Stone and

Rubinson, 1979).

Know Your Body

The Know Your Body curriculum is designed around a

health decision-making framework in which health concepts

are taught in relation to lifestyle behavioral patterns

(Williams et al., 1980). The Know Your Body program began

in 1975 in New York area city schools. It was initially

designed to identify major chronic risk factors among a

cohort of 11-14 year old children and to intervene to reduce

risk (Killiams, Carter, Wynder, and Blumenfeld, 1979). It

is an action-oriented school health education program with a

high degree of personal involvement (Williams et al., 1980).

The major intervention goals are directed toward reducing

cigarette smoking and dietary modification (reduced intake

of saturated fats and cholesterol) (Williams and Wynder,

1976). When it was discovered that many children had

already began smoking or had a weight problem at this age,

the curriculum was developed for grades K-12. The program

provides specific strategies on modifying lifestyles that

are designed to reduce risk factors (Stone and Rubinson,

1979 1.

AHA H e a r t H e a l t h i n t h e Young Cur r icu lum

The AHA began c o n s t r u c t i n g t h e modular c u r r i c u l u m

f o r m a t i n t h e summer o f 1977 w i t h t h e h i r i n g o f D r . B e t t y

T e v i s . A commit tee was e s t a b l i s h e d i n t h e summer o f 1978 t o

i n c l u d e e d u c a t o r s and t o u p d a t e m a t e r i a l s and f i l m s . The

modules were t h e n s e n t o u t t o t h e AHA a f f i l i a t e s and t e a c h e r

t r a i n i n g c e n t e r s . The modules were deve loped w i t h t h e l o c a l

community i n mind f o r development o f a l o c a l c u r r i c u l u m .

The t h e o r y behind t h e modules was t h a t t h e y c o u l d be u s e d a s

d e s i r e d by t h e e d u c a t i o n f a c i l i t a t o r ( B e t t y T e v i s , p e r s o n a l

communicat ion, January 29, 1 9 8 6 ) . The modules were

deve loped f o r K-2, 3-5, and 6-8. The modules were deve loped

a round r i s k f a c t o r a r e a s and were d e s i g n e d f o r i n t e g r a t i o n

i n t o e x i s t i n g s c h o o l h e a l t h programs (AHA, 1 9 8 2 ) .

The rev iew of r e l a t e d l i t e r a t u r e c l e a r l y i l l u s t r a t e s

t h e impor tance o f h e a r t h e a l t h i n s t r u c t i o n f o r young people .

Making c h i l d r e n aware of t h e i r b o d i e s and how t h e y c a n

c o n t r o l and m a i n t a i n a s t a t e o f w e l l n e s s w i t h i n themse lves

is a n i m p o r t a n t concep t t o p r e s e n t and a d i f f i c u l t one f o r

most young p e o p l e t o g r a s p . W e a r e c r e a t u r e s o f h a b i t . I t

is i m p o r t a n t t o beg in good h e a l t h y h a b i t s a t a n e a r l y age .

The freedom o f f e r e d w i t h i n t h e AHA c u r r i c u l u m a l l o w s f o r

e a c h i n d i v i d u a l i n s t r u c t o r t o a d a p t t o h i s / h e r p a r t i c u l a r

g r o u p o f s t u d e n t s . S i n c e t h e c u r r i c u l u m h a s n e v e r t r u l y

been t e s t e d i n a n e x p e r i m e n t a l manner, t h i s s t u d y i s

c e r t a i n l y s i g n i f i c a n t i n many ways.

CHAPTER I11

METHODOLOGY

S u b j e c t ?

The s u b j e c t s o f t h e s t u d y were male and female members

o f t h e e i g h t h g r a d e c l a s s e s a t S t . S t a n i s l a u s and S t .

S t e v e n s p a r o c h i a l g r a d e s c h o o l s i n S t e v e n s P o i n t , Wisconsin.

S t e v e n s P o i n t i s a community o f 25 ,000 p e o p l e l o c a t e d i n

P o r t a g e County i n c e n t r a l Wisconsin.

The e i g h t h g r a d e c l a s s a t S t . S t e v e n s was made u p o f 14

g i r l s and 11 boys, w i t h a median a g e o f 14.1. T h i s g r o u p o f

s t u d e n t s r e c e i v e d t h e AHA H e a r t H e a l t h i n t h e Young

c u r r i c u l u m and w i l l be r e f e r r e d t o a s t h e e x p e r i m e n t a l

g roup . The e i g h t h g r a d e a t S t . S t a n i s l a u s was made u p o f 9

g i r l s and 14 boys, w i t h a median a g e o f 13.9. T h i s g r o u p o f

s t u d e n t s r e c e i v e d t h e i r r e g u l a r h e a l t h e d u c a t i o n c u r r i c u l u m

and w i l l be r e f e r r e d t o a s t h e c o n t r o l group. A l l o f t h e

s t u d e n t s w i t h i n t h e s t u d y were a t t e n d i n g p a r o c h i a l s c h o o l s ,

meaning t h e i r p a r e n t s pay t u i t i o n and a r e o f t h e C a t h o l i c

f a i t h .

I n s t r u m e n t s

The Know Your Body H e a l t h Knowledge Q u e s t i o n n a i r e f o r

g r a d e s 6-8 was used t o assess knowledge change s c o r e s . The

q u e s t i o n n a i r e was made u p o f 52 t r u e and f a l s e q u e s t i o n s .

T h e r e was a b u i l t - i n n o r e s p o n s e column

for those not knowing the answer to avoid guessing. The

test-retest reliability of the instrument is 0.80 for a

one-week interval (Williams et al., 1980).

The instrument used to measure a Heart Healthy Diet

was the Dennison Inventory of Nutritional Experiences,

DINE, created by Darwin Dennison in 1979. The DINE

system, now in its sixth edition, is a micro-computer

nutritional program with over 3,500 foods coded. Foods

eaten over a 24-hour time span were coded and placed into

the DINE system. The DINE system rates dietary intake on

a scale of 0 to 10, with 0 being the lowest possible

score and 10 being the best possible score. The DINE

system was compared to two mainframe computers taking the

nutrient content of six major dietary components and

comparing them by using an analysis of variance (Frank

and Pelican, 1986). The DINE system reported a

consistently lower level than the Nutrition Coding Center

(p=.103) (Frank and Pelican, 1986). Frank and Pelican

felt that this modest test of validity revealed close

agreement among the three systems for the six dietary

components examj ned . The instrument used to measure smoking and exercise

behavior was taken from the Know Your Body Health Habits

Survey (Williams et al., 1978). The test re-test

reliability of this instrument w a s determined by the

r e s e a r c h e r t o b e 0.86 f o r a three-week i n t e r v a l , which

was t h e t i m e s p a n a120 u s e d i n t h i s s tudy . T h i s was

d e t e r m i n e d by a d m i n i s t e r i n g t h e s u r v e y t o 3 1 e i g h t h g r a d e

s t u d e n t s a t Ben Frank l i r i J u n i o r High School i n S tevens

P o i n t , Wisconsin.

P r o c e d u r e s

T h i s is a p r e - t e s t p o s t - t e s t e x p e r i m e n t a l s t u d y .

The e i g h t h g r a d e s t u d e n t s ' knowledge and behav ior change

s c o r e s serve a s t h e dependent v a ~ i a b l e s and t h e p r e s e n c e

o r a b s e n c e o f t h e AHA H e a r t H e a l t h i n t h e Young

c u r r i c u l u m a c t e d a s t h e i n d e p e n d e n t v a r i a b l e . The

s t u d e n t s a t b o t h of t h e s c h o o l s i n t h e s t u d y were

a t t e n d i n g t h a t s c h o o l p r i m a r i l y because o f r e l i g i o n and

l o c a t i o n w i t h i n t h e community o f S tevens P o i n t . S i n c e

t h e s t u d e n t s were n o t a s s i g n e d t o t h e s c h o o l th rough any

l e v e l i n g o r t r a c k i n g sys tem, it was r e a s o n a b l e t o assume

t h a t a n y academic d i f f e r e n c e s between t h e two groups was

randomly d i s t r i b u t e d .

The e x p e r i m e n t a l and c o n t r o l g roups took t h e

knowledge test and t h e b e h a v i o r change i n s t r u m e n t

(Appendix A ) on F r i d a y , February 28, 1986. Beginning on

Monday, March 3, t h e AHA H e a r t H e a l t h i n t h e Young

c u r r i c u l u m (Appendix B) was implemented f o r t h e n e x t 15

s c h o o l d a y s a t S t . S t e v e n s , w h i l e t h e s t u d e n t s a t S t .

S t a n i s l a u s a t t e n d e d r e g u l a r h e a l t h e d u c a t i o n c l a s s e s . On

Monday, March 24, 1986 both the control and experimental

groups were again administered the instruments.

In any experimental design there are possible

confounding variables that pose a threat to the validity

of the study. This study was no exception, and the

researcher would like to point those out at this time.

The Hawthorne effect concerning a test-retest

situation may have brought about change in both groups

due to the attention the subjects received. This could

be more noticeable in the areas of behavior change than

in knowledge change. The random distribution of the

subjects should have eradicated this situation.

Statistical regression as a result of testing the

groups two times could also be viewed as a confounding

variable. Since the subjects of the study attend

separate schools within the city of Stevens Point,

intersubject interaction was very low. The researcher

guarded against the experimenter effect of allowing

personal characteristics arid behaviors bias the study.

The study was delayed until March in order to avoid any

historical inference that possibly may have been brought

about by February being National Heart Month.

The data was collected by the researcher at the end

of each testing period, with the results being recorded.

The researcher was the only person to handle the results

of the testing.

Data Analysis

The collected data is presented with descriptive

statistics for the following: knowledge change scores of

the control group and knowledge change scores of the

experimental group, behavioral change scores for both

smoking and nutrition of the control group, and

behavioral change scores for smoking and nutrition of the

experimental group. The change scores for both of the

groups were obtained by subtracting the pre-test score

from the post-test score.

The inferential parametric statistical analysis of a

between groups T-test was used at a significance level of

0.05 to determine the significance of research hypotheses

1-4. This was determined by having the presence or

absence of the AHA Heart Health in the Young curriculum,

a dichotomous nominal variable, as the independent

variable in each one, with knowledge scores and behavior

change scores being interval ratio dependent variables.

The statistical test employed for hypotheses 5-10 was the

Pearson correlation at a significance level of 0.05. The

knowledge change scores, an interval ratio variable, act

as the independent variable and the behavior change

score, also an interval ratio variable, as the dependent

variable.

CHAPTER IV

RESULTS

The subjects of this study were male and female members

of the eighth grade classes at St. Stanislaus and St.

Stevens parochial grade schools in Stevens Point, Wisconsin.

The eighth grade class at St. Stevens was made up of 13

girls and 12 boys, with a mean age of 14.1 years. This

group of students received the AHA Heart Health in the Young

curriculum and will be referred to as the experimental

group. The number of subjects dropped from 25 to 23 because

one of the girls went on a two-week vacation to Hawaii with

her family and one of the boys was pulled from the unit by

his parents.

The eighth grade at St. Stanislaus was made up of 9

girls and 14 boys, with a mean age of 13.9 years. This group

received regular health education olasses and will be

referred to as the control group.

This study was designed to determine the impact of the

AHA Heart Health in the Young curriculum on knowledge and

behavior in the areas of smoking, exercise and nutrition.

The collected data along with the stated hypotheses are

displayed in the remainder of this chapter.

The first hypothesis was stated as follows: The

students exposed to the AHA Heart Health in the Young

c u r r i c u l u m w i l l n o t d e m o n s t r a t e a s i g n i f i c a n t i n c r e a s e i n

c a r d i o v a s c u l a r knowledge s c o r e s when compared t o s t u d e n t s

exposed t o t h e t r a d i t i o n a l c u r r i c u l u m . The s t u d e n t s o f b o t h

g r o u p s were a d m i n i s t e r e d a 52 q u e s t i o n t r u e and f a l s e

e x a m i n a t i o n a s a p r e - t e s t , w i t h t h e e x p e r i m e n t a l q r o u p

r e c e i v i n g t h e three-week AHA H e a r t H e a l t h Curr iculum, and

t h e n b o t h g r o u p s were g i v e n t h e same examina t ion as a p o s t -

test . The s u b j e c t s were prov ided w i t h t h e o p p o r t u n i t y t o

respond t o a q u e s t i o n w i t h a n a l t e r n a t i v e "I d o n ' t know"

r e s p o n s e t o r e d u c e t h e g u e s s i n g . T a b l e 1 i l l u s t r a t e s t h e

d a t a on p r e - t e s t knowledge s c o r e s and T a b l e 2 t h e p o s t - t e s t

know l e d g e s c o r e s .

T a b l e 1 - Knowledge P r e - t e s t S c o r e s

I t e m Exper imenta l Group C o n t r o l Group

N 2 3 2 3

Mean

S.D.

High Score 35 4 0

LOW s c o r e 16 12

Low Score 3 6 13

The knowledge change scores were then calculated and the

statistical significance was determined by conducting a

between groups T-test at a significance level of . 0 5 . The

results of this test are demonstrated in Table 3.

The data illustrated a clear rejection of the stated

null hypothesis. One would expect an increase in knowledge

when exposed to a three-week curriculum.

The second hypothesis was stated as follows: The

students exposed to the AHA Heart Health in the Young

curriculum will not demonstrate a significant reduction in

smoking behavior in the area of cigarette smoking when

compared to the students exposed to the traditional

curriculum. This hypothesis was not stable because none of

Table 3 - Knowledge Change Scores

Item Experimental Group Control Group

Mean Difference 18.30

S . D . 4 . 5 5

One Tailed 0.0001

Probability

the respondents to the questionnaire in either the control

or experimental groups reported to be a cigarette smoker. A

total of 19 subjects, 8 in the control group and 11 in the

experimental group, reported to have tried cigarettes, but

no one indicated to be a current user of cigarettes. This

was encouraging from a health standpoint, but made the

hypothesis untestable.

The third hypothesis reads as follows: The students

exposed to the AHA Heart Health in the Young curriculum will

not demonstrate a significant increase in Heart Healthy Diet

behavior when compared to the students exposed to the

traditional curriculum. Table 4 displays the pre-test

information for both groups, with Table 5 illustrating the

post-test data.

Table 4 - DINE Scores Pre-test

1tem Experimental Group Control Group

N 2 3 2 3

Mean 3.217 3.239

S. D. 1.251 1.437

High Score 5.5 5.5

Low Score 0.5 0.0

Table 5 - DINE Score Post-test

Item Experimental Group Control Group

N

Mean

S.D. 1.488

High Score 6.5 4.5

LOW Score 1.0 0.0

A between groups T-test was implemented to determine the

statistical significance at a level of -05 of the DINE

change scores from pre-test to post-test. The results of

that test are demonstrated in Table 6.

Table 6 - DINE Change Scores

Item Experimental Group Control Group

Mean Difference -0.239 -1.239

One Tailed 0.0168

Probability

The results of this hypothesis indicate statistical

significance, but in the opposite direction stated in the

hypothesis. Both the experimental and control groups

demonstrated a decrease in heart healthy dietary behavior.

These results lead to a failure to reject the null

hypothesis.

The fourth hypothesis was stated as follows: The

students exposed to the AHA Heart Health in the Young

curriculum will not demonstrate a significant change in

exercise behavior when compared to the students exposed to

the traditional curriculum. The type of exercise that was

being surveyed was strenuous aerobic type exercise, with the

subjects being asked how many times per week they engaged in

this type of exercise. The top answer in the questionnaire

was 4 times per week, with 0 times per week being the lowest

possible score. Table 7 illustrates the pre-test exercise

levels of both groups, with Table 8 demonstrating the post-

test exercise levels for both .groups.

Table 7 - Exercise Levels Pre-test

Item Experimental Group Control Group

N

Mean

S.D.

High Score

Low Score

A between groups T-test was implemented to determine the

statistical significance of the exercise change scores at a

level of . 0 5 . Table 9 indicates the results of that test.

Table 8 - Exercise Levels Post-test

- -

Item Experimental Group Control Group

N 2 3 2 3

Mean

S. D.

High Score 4 4

Low Score 0 1

Table 9 - Exercise Change Scores

Item Experimental Group Control Group

N 23 2 3

Mean Difference -0.09

S.D. 1.20

One Tailed 0.2210 Probability

This failed to demonstrate any significance. As seen in

Table 9 the exercise level decreased in the experimental

group and increased in the control group. These results led

to a failure to reject the null hypothesis.

The fifth and sixth hypotheses were not testable due to

the fact that there were no reported cigarette smokers in

either the experimental or control groups.

The seventh hypothesis was stated as follows: There is

no significant relationship between knowledge change scores

and diet behavior change in the experimental group. A

Pearson correlation of .4135 indicates a fairly strong

relationship between knowledge and diet behavior. Table 10

demonstrates the data.

Table 10 - Correlation Knowledge-Diet Experimental Group

Item Knowledge Change DINE Change

N 23 23

Mean 18.30 -0.239

S.D. 4.62 1.802

Correlation 0.4135

Significance 0.0237

A significance level of 0.0237 indicates a decision to

reject the null hypothesis. As in hypothesis three the

significance indicated is in the opposite direction that was

a n t i c i p a t e d . A s knowledge i n c r e a s e d , h e a r t hea l thy d i e t

decreased i n t h e exper imenta l group.

Hypothesis number e i g h t was s t a t e d a s fo l l ows : There

i s no s i g n i f i c a n t r e l a t i o n s h i p between knowledge change

s c o r e s and d i e t behavior change i n t h e c o n t r o l group. A

Pearson c o r r e l a t i o n of -0.0362 i n d i c a t e s l i t t l e r e l a t i o n s h i p

between knowledge and d i e t behavior . Table 11 demonstrates

t h e d a t a .

Table 11 - C o r r e l a t i o n Knowledge-Diet Cont ro l Group

I t e m Knowledge Change DINE Change

N 23

Mean 1.91

S.D. 6.32

C o r r e l a t i o n -0.0362

S ign i f i cance 0.4319

A s i g n i f i c a n c e l e v e l of .4319 i n d i c a t e s a d e c i s i o n t o f a i l

t o reject t h e n u l l hypothes is .

The n i n t h hypothes is s t a t e s : There is no s i g n i f i c a n t

r e l a t i o n s h i p between knowledge change s c o r e s and e x e r c i s e

behavior change i n t h e expe r imen ta l group. A Pearson

c o r r e l a t i o n of .2620 i n d i c a t e s a weak r e l a t i o n s h i p between

*

knowledge and exercise behavior. The data is displayed in

Table 12.

Table 12 - Correlation Knowledge - Exercise Experimental Group

Item Knowledge Change DINE Change

N 2 3 2 3

Mean 18.30 -0.09

S. D. 4.72

Correlation 0.2620

Significance 0.1127

A significance level of -1127 indicates a decision to fail

to reject the null hypothesis.

The tenth and last hypothesis was stated as follows:

There is no significant relationship between knowledge

change scores and exercise behavior change in the control

group. A Pearson correlation of .I216 iadicates little

relationship between knowledge and exercise behavior. The

data and results are posted in Table 13.

A significance level of .2933 indicates a decision to fail

to reject the null hypothesis.

Table 13 - Correlation Knowledge- Exercise Control Group

1tem Knowledge .Change DINE Change

N 2 3 23

Mean

S. D.

correlation 0.1216

Significance 0.2933

Discussion/Implications

The most exciting finding of the study has to be the

significance of the knowledge change scores in the

experimental group. However, it is well known, and has been

reported earlier within this document, that knowledge alone

is insufficient to motivate change. A three-week period of

time is not long enough to notice a chanqe in behavior.

Diet and exercise patterns are not easily changed and

certainly not readily within such a short time frame. The

findings of McAlister (1982) demonstrate the need for

effective modeling, feedback, and reinforcement of the

appropriate choices, as well as the opportunity to make

these decisions on an increasingly independent basis.

Consideration has to be made in regard to students'

control of choices. How much control does s/he have over

the meals being served at home and in school? How much

control does s/he have over the type of snack foods afforded

him/her at home? How much access does s/he have to exercise

facilities and equipment? Most eighth grade students are

under the control of their parents and what their parents'

choices are in the above areas.

As McAlister stated in 1982,

No matter how effectively a person has been educated, persuaded, and trained to make changes in behavior, it is unlikely that the change will be maintained unless it is reinforced by the social environment (p. 46).

A daily class period of 40 minutes for 15 consecutive

class days is probably not going to be enough social

reinforcement for most students. Parental involvement and

total family education is perhaps the most effective method

of bringing about behavior change.

This investigation provides information in regard to

the AHA curriculum being capable of bringing about knowledge

change, but not behavior change over a short term. The

implications for further study are many.

CHAPTER V

CONCLUSIONS

Summary

The p u r p o s e o f t h i s s t u d y was t o de te rmine i f t h e AHA

H e a r t H e a l t h i n t h e Young c u r r i c u l u m c o u l d s i g n i f i c a n t l y

change c a r d i o v a s c u l a r knowledge s c o r e s and b e h a v i o r s i n t h e

a r e a s o f smoking, d i e t and e x e r c i s e i n an e i g h t h g r a d e

p o p u l a t i o n .

The AHA c u r r i c u l u m was implemented f o r 15 c o n s e c u t i v e

s c h o o l d a y s w i t h a p r e - t e s t and p o s t - t e s t a d m i n i s t e r e d to

measure change i n knowledge and behav ior . The e x p e r i m e n t a l

s u b j e c t s a t t e n d e d S t . S t e v e n s p a r o c h i a l s c h o o l , w i t h t h e

c o n t r o l g r o u p a t t e n d i n g S t . S t a n i s l a u s p a r o c h i a l s c h o o l .

Both o f t h e s c h o o l s a r e l o c a t e d i n S tevens P o i n t , Wisconsin.

The d a t a was a n a l y z e d w i t h i n t h e framework of a series

of between g r o u p s T - t e s t s and t h e Pearson produc t moment

c o r r e l a t i o n s . The a l p h a l e v e l was e s t a b l i s h e d a t t h e .05

l e v e l o f s i g n i f i c a n c e .

The f i r s t h y p o t h e s i s d e a l t w i t h t h e knowledge change

s c o r e s w i t h i n t h e two groups and how t h i s knowledge change

c o r r e l a t e d w i t h b e h a v i o r a l change w i t h i n each group.

On t h e b a s i s o f t h e r e s u l t s o f t h i s i n v e s t i g a t i o n , and

w i t h i n t h e l i m i t a t i o n s o f t h e p o p u l a t i o n s t u d i e d , t h e

f o l l o w i n g c o n c l u s i o n s were reached :

1. Statistical significance was demonstrated in knowledge

change scores in the experimental group vs. the control

group.

2. Of the 46 subjects involved in either the experimental

or control groups no one reported to be a smoker of

cigarettes, making it impossible to test the hypotheses

in regard to smoking behavior.

3. There was statistfcal significance demonstrated in diet

behavior change for both the experimental and control

groups. Both groups experienced a reduction in their

DINE scores.

4. There was not a statistical significance demonstrated

in exercise behavior changes in either the experimental

or the control group.

5. There was not a statistically significant correlation

demonstrated in the experimental group between

knowledge change scores and change scores in exercise.

6. There was a statistically significant correlation

demonstrated in the experimental group between the

knowledge change scores and heart healthy diet

behavior. This relationship was negative. As

knowledge increased, diet behavior decreased.

7. There was not a statistically significant correlation

demonstrated in the control group between knowledge

change scores and change scores in either diet or

exercise.

Conclusions

In conclusion, the results of this study indicated:

1. The AHA curriculum impacted in a statistically

significant manner on knowledge.

2. The AHA curriculum did not impact in a statistically

significant manner on behavior change scores in the

areas of exercise or diet.

3. There was not any statistically significant correlation

demonstrated between knowledge change scores and

behavior change scores in exercise.

4. Statistical significance was demonstrated in a negative

direction in diet behavior.

5. Statistical significance was demonstrated in a

correlation between knowledge change and diet change

illustrating decreased heart healthy diet with

increased knowledge.

Recommendations

As a result of this investigation, the following

suggestions for further study have been made:

1. A replication of this study should be conducted, but

focus on intent to behave rather than actual behavioral

change.

2. A replication of the study should be conducted with the

post-test being conducted 6-8 weeks after the unit to

determine if knowledge gained is retained and to see if

behavioral change would occur with a longer time span.

3 . A replication of the study should be conducted to

determine the impact of curriculum on cigarette smoking

by choosing a different group of subjects.

4 . A replication of the study should be done in a

different socio-economic group to determine the impact

on a different population.

5 . A replication of the study should be done with an

attempt made to also include the parents, so the

participants would have the necessary social support.

6. A replication of the study should be done focusing upon

different age groups.

7 . A replication of the study should be done focusing upon

gender to determine if there is any difference between

the sexes.

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American Academy of Pediatrics Committee on Nutrition. (1983). Toward a prudent diet for children. Pediatrics, 71(1), 78-80. -

American Heart Association. (1982). We've put our heart into the curriculum: AHA subcommittee on health education of the young. Health Education, z(1), 20.

American Heart Association. (1985). Heart Facts 1985. National Center, Dallas, Texas.

Baugh, J.G., MacDonald-Hunter, S., Webber, L.S., and Berenson, G.S. (1982). Developmental trends of first cigarette smoking experience of-children: The Bogalusa Heart Study. The American Journal of Public Health, 72(10), 1161-1164. -

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Carey, J., Hager, M., and Harrison, J. (1985, April). Failing in fitness. Newsweek, pp. 84-86.

Cooper, R., Allen, A., Goldberg, R., Trevisan, M., VanHorn, L., Liu, K., Steinhauer, M., Rubenstein, A., and Stamler, J. (1984). Seventh-dav adventist adolescents - life- style patterns and card~ovascular risk factors. Western Journal of Medicine, 1 4 0 ( 3 ) , 471-477.

Ehnholm, C., Huttunen, J.K., Pietinen, P., Leino, U., Mutanen, M., Xustiainen, E., Pikkarainen, J., Dougherty, R., Iacono, J., and Puska, P. (1982). Effect oi diet on serum li~ovroteins in a ~ o p u l a ~ on with a high risk of coronary- heart disease. ' he New England ~ouinal of Medicine, m(141, 850-854.

Enos, W . , Holmes, F., and Beyer, J. (1953) . Coronary d i s e a s e among U.S . s o l d i e r s k i l l e d i n Korea. J o u r n a l of t h e American Medical A s s o c i a t i o n , 152, 1090-1092.

Evans, R. I. , R o z e l l e , R. M. , Maxwell, S. E. , Raines , B. E. , D i l l , C.A., G u t h e r i e , T.J. , Henderson, A.H., and H i l l , P.C. (1981) . S o c i a l modeling f i l m s t o d e t e r r i n g smoking i n a d o l e s c e n t s : R e s u l t s o f a 3 y e a r f i e l d i n v e s t i g a t i o n . J o u r n a l o f Appl ied psycho log^, 66, 399-412.

F r a n k , G.C., and P e l i c a n , S. (1986) . G u i d e l i n e s f o r s e l e c t i n g a d i e t a r y a n a l y s i s system. J o u r n a l o f t h e American Dietetic A s s o c i a t i o n , 86(1), 72-75.

F r a s e r , G.E., P h i l l i p s , R.L., and H a r r i s , R. ( 1 9 8 3 ) . P h y s i c a l f i t n e s s and blood p r e s s u r e i n s c h o o l c h i l d r e n . C i r c u l a t i o n , 6 7 ( 2 ) , 405-412.

Freidman, G.D. , P e t t i t t i , D.B., Bawol, R.D., and S i e g e l a u b , A.B. (1981) . M o r t a l i t y i n c i g a r e t t e smokers and q u i t t e r s . The New England J o u r n a l o f Medicine, = ( 2 3 ) , 1407-1410.

Gi l lum, R.F., T a y l o r , H.L., Brozek, J., Anderson, J., and Blackburn , H. (1982) . Blood l i p i d s i n young men f o l l o w e d 32 y e a r s . J o u r n a l o f Chron ic D i s e a s e s , 35, 635- 641.

Greenburg, J. (1984, September) . E x e r c i s e : A m a t t e r o f l i f e o r d e a t h ? S c i e n c e News, pp. 138-141.

H a r r i s o n , D.C., and Winston, M. (1982, J a n u a r y / F e b r u a r y ) . C a r d i o v a s c u l a r r i s k r e d u c t i o n : The problems f a c i n g o u r s o c i e t y . H e a l t h Educa t ion , pp. 9-12.'

Har tung , H.G., F o r e y t , J .P . , M i t c h e l l , R.E., Ulasek, I . , and g o t t o , A.M. Jr. (1980) . R e l a t i o n o f d i e t t o h igh- d e n s i t y l i ~ o - v r o t e i n c h o l e s t e r o l i n middle-aged marathon - - r u n n e r s , j o g g e r s , and i n c c t i v e men. New ~ n g i a n d J o u r n a l o f Medicine, 3 0 2 ( 7 ) , 357-361.

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Kannel, W.B. and Dawber, T.R. (1972). Contributors to coronary risk implications for prevention and public health: The Framingham study. Heart and Lung, 1(6), 797-809.

Kannel, W.B., McGee, D., and Gordon, T. (1976). A general cardiovascular risk profile: The Framingham study. The American Journal of Cardiology, 38, 46-51.

Khoury, P.R., Morrison, J.A., Laskarzewski, P., Kelly, K., 1 Mellis, M.J., King, P., Larson, R., and Glueck, C.J. (1981). Relationships of education and occupation to coronary heart disease risk factors in school children and adults: The Princeton school district study. American Journal of Epidemiology, 113(4), 378-395.

Kolbe, L.J., and Newman, I.M. (1983, September). The role of school health education in preventing heart, lung, and blood diseases. Proceedinqs of the National Conference on School Health Education Research in Heart, Lung, and Blood Areas (pp. 15-26 ) . Bethesda, Maryland.

Lauer, R.M., Ackers, R.L., Massey, J., and Clarke, W.M. (1982). Evaluation of cigarette smoking among adolescents: The Muscatine study. Preventive Medicine, 11, 417-428. -

McAlister, A., Puska, P., Salonen, J.T., Tuomilehto, J., and Koskela, K. (1982). Theory and action for health promotion: ILlustrations from the North Karelia project. American Journal of Public Health, 72, 43-50.

McNamera, J.J., Molot, M.A., Stremple, J.F., and Cutting, R.T. (1971). Coronary artery disease in combat casualties in Vietnam.- The 3ournal of the American Medical Association-, = ( T I , 1185-1187.

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Nader, P.R., Baranowski, T., Vanderpool, N.A., Dunn, K., worki in, R., and Ray, L. (1983). The family health project: Cardiovascular risk reduction education for children and parents. Journal of Developmental and Behavioral Pediatrics, 4(l), 3-10.

Puska, P., Vartianen, E., Pallonen, V., Salonen, J.T., Poyhia, P., Koskela, K., and McAlister, A. (1982). The North karelia youth project: Evaluation of two years of intervention on health behaviors and CVD risk factors among 13-15 year old children. Preventive Medicine, 11(5), 550-570. -

Siscovick, D.S., Weiss, N.S., Hallstrom, A.P., Invi, T.S., and Peterson, D.R. (1982). Physical activity and primary cardiac arrest. The Journal of the American Medical Association, E(231, 3113-3117.

Stone, D.B., and Rubinson, L.G. (1979). The issue of school health education - theory and practice. Public Health Reviews, g( 11, 45-78.

Stone, W.J. (1983). Exercise and long-term CVD risk reduction in corporate executives. Health Education, 1494 ) , 26-27. -

Wallis, C. (1984, March, 26). Hold the eggs and butter. Time, pp. 56-63.

Watkins, L.O. (1984). The child: When to begin preventive cardiology. Current Problems in Pediatrics, 14(6), 1-71.

Webber, L.S., Cresanta, J.L., Voors, A.W., and Berenson, G.S. (1983). Tracking of cardiovascular disease risk factor variables in school aged children. Journal of Chronic Disease, 2, 647-660.

Weidman, W., Kwiterovich, P. Jr., Jesse, M.J., and Nugent, E. (1983). Diet in the healthy child.

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Williams, C.L., Carter, B.J., and Eng, A. (1980). The ''know your body" program: A developmental approach to health education and disease prevention. Preventive Medicine, 2(3),*371-383.

Williams, C.L., Eng, A., Botvin, G.J., Hill, P., and Wynder, E.L. (1979). Validation of students' self-reported cigarette smoking status with plasma cotinine levels. American Journal of Public Health, 69(12), 1272-1274.

W i l l i a m s , C.L., and Wynder, E.L. (1978 1 . Motivat ing a d o l e s c e n t s to reduce r i s k f o r c h r o n i c d i s e a s e . Pos tgraduate Medical Journa l , 3, 212-214.

Appendix A

Knowledge, Smokinq, and Exercise Inventory

Students fill in the letter "a" for TRUE statements and the

letter "b" for FALSE statements. If you DON'T KNOW the

answer please fill in the letter "c".

All smokers gain weight when they quit smoking.

Cholesterol is a fatty substance found in everyone's

blood.

High blood cholesterol levels are found in only adults.

Air pollution causes more cases of lung cancer than

cigarettes.

Smokers who cough and spit alot probably have

bronchitis.

Cholesterol buildup in the arteries may interfere with

the blood flow in the body.

A risk factor is a health condition or habit which

increases the chance of developing certain chronic

diseases.

People with high blood pressure usually feel sick.

The first few cigarette puffs contain the most tar and

nicotine.

The main danger in having clogged arteries is that they

lead to heart attacks.

High blood pressure may cause damage to the kidneys.

When t a r and n i c o t i n e a r e removed from c i g a r e t t e s ,

t h e r e a r e no o t h e r c h e m i c a l s i n t o b a c c o t h a t c a u s e

d i s e a s e .

Symptoms o f l u n g c a n c e r u s u a l l y d o n o t appear u n t i l it

is t o o l a t e t o c u r e t h e d i s e a s e .

P e o p l e s h o u l d e a t f i s h and p o u l t r y i n s t e a d of meats t o

lower t h e i r c h o l e s t e r o l l e v e l s .

Dr ink ing whole mi lk t e n d s t o lower t h e blood

c h o l e s t e r o l l e v e l s .

People w i t h h i g h b lood p r e s s u r e s h o u l d a v o i d a l l k i n d s

o f e x e r c i s e .

Unsa tura ted f a t s a r e m o s t l y o i l s from p l a n t and

v e g e t a b l e s o u r c e s , i n c l u d i n g c o t t o n s e e d , soybean, and

corn .

C h o l e s t e r o l i s n o t n e c e s s a r y t o m a i n t a i n h e a l t h .

Regular p h y s i c a l e x e r c i s e may h e l p d e l a y o r p r e v e n t a

h e a r t a t t a c k .

To r e d u c e blood c h o l e s t e r o l , p e o p l e should e a t

u n s a t u r a t e d f a t s .

I f a pe rson has low b lood p r e s s u r e , less s t r a i n is

p l a c e d on t h e h e a r t .

When p e o p l e who have been heavy smokers f o r many y e a r s

q u i t smoking, it d o e s n o t make any d i f f e r e n c e on t h e i r

h e a l t h .

23. A person who is underweight is more l i k e l y t o have

d i a b e t e s t han an overweight person.

24. Ea t ing "luncheon meats" such a s ho t dogs, sausage and

sa l ami w i l l raise blood c h o l e s t e r o l l e v e l s .

25. Foods l i k e chicken, saf f lower o i l and skim milk c o n t a i n

less c h o l e s t e r o l than l i v e r , beef s t e a k , and b u t t e r .

26. F r i e d foods con ta in less f a t t han foods t h a t a r e

r o a s t e d o r b ro i l ed .

27. A good blood c h o l e s t e r o l l e v e l f o r persons 10 t o 1 4

y e a r s o l d is 140.

28. Genera l ly , low blood p re s su re is a s s e r i o u s a c o n d i t i o n

a s high blood pressure .

A doc to r measures c h o l e s t e r o l by t e s t i n g t h e blood.

Lung cancer i s d i f f i c u l t t o d e t e c t e a r l y .

Hardening o f t h e a r t e r i e s i s caused by t h e hni ldup of

suga r i n t h e w a l l s of t h e a r t e r i e s .

People who a r e overweight should go on c r a s h d i e t s t o

l o s e weight a s quickly a s poss ib l e .

Smoking f i l t e r t i p c i g a r e t t e s p reven t s a l l t h e t a r s

from reaching t h e lungs.

Anothex name f o r high blood p r e s s u r e is hyper tens ion .

Eat ing s a t u r a t e d f a t s t ends t o r a i s e c h o l e s t e r o l l e v e l s

i n t h e blood.

Most persons w i t h high blood p r e s s u r e need t o l o s e

weight .

37. I t i s harmfu l f o r a non-smoker t o b r e a t h e i n smoke from

a b u r n i n g c i g a r e t t e .

38. Most h i g h b lood p r e s s u r e i s d i f f i c u l t f o r d o c t o r s t o

treat.

39. Hardening of t h e a r t e r i e s can b e g i n i n ch i ldhood .

40. Blood p r e s s u r e is t h e f o r c e o f t h e blood a g a i n s t t h e

w a l l s o f t h e a r t e r i e s .

P e r s o n s who smoke p i p e s and c i g a r s a r e a s l i k e l y t o

d e v e l o p lung c a n c e r a s c i g a r e t t e smokers.

Smoking j u s t one c i g a r e t t e w i l l i n c r e a s e a p e r s o n ' s

h e a r t rate.

Organ m e a t s such a s l i v e r a r e v e r y h i g h i n c h o l e s t e r o l .

P e o p l e w i t h h i g h blood p r e s s u r e may need t o t a k e

medic ine f o r t h e c o n d i t i o n even though t h e y f e e l w e l l .

C i g a r e t t e smoking g e n e r a l l y d o e s n o t a f f e c t t h e t i n y

h a i r - l i k e c i l i a t h a t keep t h e l u n g s c l e a n .

I n most c a s e s , t h e c a u s e s o f h i g h b lood p r e s s u r e a r e

unknown.

S a t u r a t e d f a t s a r e p r i m a r i l y a n i m a l f a t s such a s f a t i n

meat, e g g s , and b u t t e r .

Excess f o o d , whe ther f a t , p r o t e i n , o r c a r b o h y d r a t e s , i s

changed i n t o f a t by t h e body.

Emphysema is a l u n g d i s e a s e p r o b a b l y caused by

c i g a r e t t e smoking.

V e g e t a b l e s and f r u i t s do n o t c o n t a i n c h o l e s t e r o l .

51. High blood pressure is a condition affecting only

nervous people.

52. People with high blood pressure need to reduce their

salt intake.

HOW MANY TIMES PER WEEK DO YOU DO THE FOLLOWING KINDS OF

EXERCISE?

53. STRENUOUS EXERCISE: (heart beats rapidly). Like - running, jogging, swimming, baseball, football,

basketball, soccer, volleyball, singles tennis, active

gymnastics, bicycling up hills or long distances.

a. 0 times

b. 1 time

c. 2 times

d. 3 times

e. 4 times or more

54. MODERATE EXERCISE: (not exhausting). Like - brisk walking, dancing, doubles tennis, easy bicycling, easy

swimming, housework, bowling, golf.

a. 0 times

b. 1 time

c. 2 times

d. 3 times

e. 4 times or more

55. MILD EXERCISE: (minimal e f f o r t ) . Like - average

walk ing , q u i e t p l ay , slow dancing.

a. 0 t i m e s

b. 1 t i m e

c. 2 t i m e s

d. 3 t i m e s

e . 4 t i m e s o r more

56. Whom do you g e n e r a l l y e x e r c i s e w i th?

a. a l o n e

b. w i t h f r i e n d s

c . w i t h a b r o t h e r o r sister

d. w i t h f a t h e r o r mother

HOW MANY OF YOUR BEST FRIENDS CURRENTLY:

57. Smoke c i g a r e t t e s

a . 0

b. 1

c. 2

d. 3

e. 4 o r more

58. Smoke mar i juana

a. 0

3. 4 o r more

HAVE YOU EVER T R I E D :

59. Cigarettes

a. yes

b. no

60. Marijuana

a. yes

HOW MANY TIMES A WEEK DO YOU GENERALLY:

61. Smoke cigarettes

a. 0

b. 1-3

c. 4-6

d. 7-9

e. 10 or more times

62. Smoke marijuana

a. 0

b. 1-3

c. 4-6

d. 7-9

e. 10 or more times

63. How does your mother feel about whether or not you

smoke cigarettes?

a. Approves

b. Disapproves

C. Doesn't care

d. Doesn't know that I smoke

64. How does your father feel about whether or not you

smoke cigarettes?

a. Approves

b. Disapproves

C. Doesn't care

d. Doesn't know that I smoke

ANSWER QUESTIONS 65 TO 68 ONLY IF YOU HAVE SMOKED ANY

CIGARETTES IN THE PAST MONTH.

65. With whom are you usually with when you smoke

cigarettes?

a. family

b. friends

c. alone

66. Do you inhale when you smoke cigarettes?

a. all the time - - -- - . . - - . --

b. sometimes

C. never

67. Do you have a brand of c i g a r e t t e s t h a t you smoke most

o f t h e t ime?

a. y e s

b. no

I F YES, WRITE BRAND HERE

68. How many c i g a r e t t e s have you smoked i n t h e p a s t 7 days?

a . 1-5

b. 6-10

c. 11-15

d. 16-20

e. 21 or more

WHICH OF YOUR RELATIVES HAS HAD OR PRESENTLY HAS WHAT

CONDITIONS?

69. D i a b e t e s ( suga r i n t h e blood

a . mother

b. f a t h e r

c. g r a n d p a r e n t s

d. no o n e i n t h e fami ly

e. don* t know

70. High b lood p r e s s u r e

a . mother

b. f a t h e r

c. g r a n d p a r e n t s

d. no o n e i n t h e fami ly

e. d o n ' t know

High cholesterol

a. mother

b. father

c. grandparents

d. no one in the family

e. don't know

Heart attack before age 50 years

a. mother

b. father

c. grandparents

d. no one in the family

e. don't know

Heart attack when age 50-64 years

a. mother

b. father

c. grandparents

d. no one in the family

e. don't know

Heart attack after age 64 years

a. mother

b. father

c. grandparents

d. no one in the family

e. don't know

75. Cancer (write in what kind 1

a. mother

b. father

c. grandparents

d- no one in the family

e. don't know

a. mother

t, father

c , grandparents

1.3, no one in the family

e. don't know

-- i - G5stity

o, mother

h, father

c, grandparents

C. no one in the family

e- don't know

-C3 SsWILY MEMBERS CURRENTLY SMOKE CIGARETTES OR SMOKED IN

53 PC-ST?

-. .iB, -Id's mother

e. currently smokes cigarettes

k, smoked, but quit

c, never smoked

7 9 . C h i l d ' s f a t h e r

a . c u r r e n t l y smokes c i g a r e t t e s

b. smoked, but q u i t

c. never smoked

80 . C h i l d ' s brother

a . c u r r e n t l y smokes c i g a r e t t e s

b. smoked, but q u i t

c . never smoked

81. C h i l d ' s sister

a . c u r r e n t l y smokes c i g a r e t t e s

b. smoked, but q u i t

c . never smoked

Appendix B

AHA Heart Health in the Young Curriculum

Circulation of the Blood

Classroom materials - Film - Circulation of the Blood - order number P-667-A

Student materials - Circulatory System Chart - pp. 9-10 HS Your Heart and How it Works - pp. 13-14 HS

About Your Heart and Bloodstream - pp. 17-20 HS

Work Sheet and Word Find - pp. 21-22 HS

Cardiovascular System Diseases

Classroom materials - Film - What Goes Up - Blood Pressure Sphygmomanometer

Stethoscope

Student materials - About Your Heart and Blood Pressure - pp. 91-92 HS Blood Pressure Crossword Puzzle - pp. 97-98 HS

Smoking

Classroom materials - Films - Let's Talk About Smoking Smoking Lung - Courtesy of the American Cancer Society Cigarettes

Student Materials

Reasons We Give For Smoking - p. 41 JHS

Pressures to Smoke - p. 49 JHS

Why Smoke? - pp. 51-52 JHS

Why Be a Nonsmoker? p. 53 JHS

Smoking and Me - pp. 59-62 JHS

Advertisements Big Sell - pp. 55-57 JHS

Exercise

Classroom materials - Films - The Exercise Film

Student materials - Exercise and Weight Control - pp. 49-50 ZS

Exercise and Weight - p. 52 HS

Exercise Is - p. 52 HS

Voting on Exercise - p. 54 HS

Exercise and You - p. 59 HS

About Your Heart and Exercise - pp. 85-6E a-5

Benefits of Exercise - p. 55 HS

Five Myths of Exercise - pp. 60-61 HS

How Do I Begin an Exercise Program - pp. 51-63 HS

How Hard Should I Exercise - p. 64 HS

Nutrition

Classroom materials - Film - Body Fuel

Student m a t e r i a l s - Hear t Heal thy Word Find - pp. 89-50 JHS

Foods I Ea t Most Of ten - pp. 101-102 JHS

Food Diary

Hear t Heal th Snacks

Day-to-day implementat ion of t h e AHA Heart Heal th i n

t h e Young curr iculum.

Uni t Ob jec t ive

The s t u d e n t s w i l l be a b l e t o i d e n t i f y t h e i r own

p e r s o n a l c a r d i o v a s c u l a r r i s k f a c t o r s and list ways of

a l t e r i n g t h e i r l i f e s t y l e s t o reduce chances of

c a r d i o v a s c u l a r problems.

Each and every day t o do ou r h e a r t s a f avo r , e i t h e r

b e f o r e c l a s s o r a t t h e end f o r 3-5 minutes , we d i d an

a c t i v i t y t o music a s a group. A t t h e end w e measured our

pu l se r a t e s and compared them t o ou r t a r g e t h e a r t r a t e s when

we a r r i v e d a t t h a t p o i n t i n t h e curr iculum.

Day 1

Objec t ives

The s t u d e n t w i l l be a b l e t o :

1. d e s c r i b e how blood t r a v e l s through t h e body

2. d i f f e r e n t i a t e between a v e i n and an a r t e r y

3. c o n c e p t u a l i z e t h e s imp le workings of t h e h e a r t .

Heart F a c t s - 1985 - 5-10 minutes

Film - C i r c u l a t i o n of t h e Blood - 10 minutes

D i scuss ion and q u e s t i o n s a t t h e end of t h e f i l m - 10-15

minutes

Teacher w i l l u s e l a r g e c h a r t o f t h e c i r c u l a t o r y system t o

i l l u s t r a t e and e x p l a i n YOUR HEART AND HOW I T WORKS. The

s t u d e n t s w i l l r e c e i v e handouts , w h i l e t eache r w i l l u s e t h e

l a r g e c h a r t t o e x p l a i n .

Assign - Crossword Puzz l e on Hear t

Day 2

O b j e c t i v e s

The s t u d e n t w i l l be a b l e t o :

1. l o c a t e and c a l c u l a t e p u l s e r a t e

2. t r a c e movement of blood through t h e h e a r t

3. d e f i n e t h e fo l lowing vocabulary : a r t e r y , c a p i l l a r y ,

a r t e r i o l e , pulmonary c i r c u l a t i o n , ve in , venule, a o r t a ,

sy s t emic c i r c u l a t i o n , oxygen, a t r i um, d i l a t i o n ,

i n f e r i o r vena cava , c i r c u l a t o r y system, carbon d iox ide ,

v e n t r i c l e , c o n t r a c t i o n , s u p e r i o r vena cava.

Answer crossword puzz l e on overhead p r o j e c t o r - 5 minutes

Trace blood movements. th rough t h e h e a r t and understand t h e

vocabulary concern ing t h e h e a r t - 15-20 minutes

Locate p u l s e and c a l c u l a t e h e a r t r a t e when s i t t i n g ,

s t a n d i n g , and l y i n g down and e x p l a i n why t h e r e i s a

d i f f e r e n c e i n p u l s e r a t e s f o r each body pos i t i on . L i s t

o t h e r p o s s i b l e c a u s e s of p u l s e rate changes - 15 minutes

Assign - Read About Your Heart and Bloodstream. Complete

the following handouts: Circulatory System, About Your

Heart and Bloodstream, and Word Find - 5 minutes

Day 3

Objectives

The student will be able to:

1. explain what blood pressure is and how it is measured

using a sphygmomanometer

2. differentiate between diastolic and systolic blood

pressure readings

3. explain what hypertension is.

Correct and review circulatory system and About Your Heart

and Bloodstream - 10 minutes Film - What Goes Up - 10 minutes Discuss film and ask questions - 10 minutes

What is blood pressure? Diastolic and systolic - 5 minutes Assign - Blood Pressure Crossword Puzzle

Day 4

Objectives

The students will be able to:

1. demonstrate the proper procedure for taking blood

pressure using a sphygmomanometer and a stethoscope

2. write down their own blood pressure

3. list three causes of primary hypertension

4. list three causes of secondary hypertension

5. identify the effects of uncontrolled hypertension.

Review Crossword Puzzle - 5 minutes

Take the blood pressure of the class members using a

stethoscope and a sphygmomanometer with the assistance of 4-

5 college students - 15-20 minutes Primary and secondary causes of hypertension - 5-10 minutes Effects of uncontrolled hypertension - 5 minutes What can be done to control hypertension? - 5 minutes

Day 5

Objectives

The students will be able to:

1. explain what atherosclerosis is

2. list factors that can possibly cause atherosclerosis to

occur and progress

3. list at least five foods high in cholesterol

4. explain what a heart attack is

5. identify the warning signals of a heart attack.

Wtat is atherosclerosis? - 5 minutes What is cholesterol and where does it come from? - 5 minutes What foods add cholesterol to the blood? - 5 minutes Effects of uncontrolled atherosclerosis - 5 minutes Warning signals of a heart attack - 5-10 minutes How to reduce the chances of having a heart attack - 5-10 minutes

Day 6

Objectives

The student will be able to:

1. explain what a stroke is and identify the warning

signals of a stroke

2. identify the warning signals of a stroke

3. identify what the risk factors are for cardiovascular

disease

4. define the following vocabulary: diastolic,

atherosclerosis, stroke, collateral circulation, angina

pectoris, aneurysm, systolic, hypertension, heart

attack, cholesterol, varicose veins, embolism.

What is a stroke? - 5 minutes Warning signals of a stroke - 5-10 minutes

Other problems of the cardiovascular system - rheumatic fever, congenital heart defects - 10 minutes Identify risk factors to heart and blood vessel disease and

discuss those that are modifiable and those that are not - 15 minutes

Day 7

Objectives

The student will be able to:

1. keep a three-day record of exercise activity beginning

today

2. d i s c u s s w i t h peer h i s /he r f e e l i n g s and pe rcep t ion about

e x e r c i s e .

The E x e r c i s e Film - 10 minutes

D i scuss ion and ques t ions - 5-10 minutes

E x e r c i s e is... a l o n e - sma l l groups - 10 minutes

S t a r t r e c o r d i n g d a i l y e x e r c i s e a c t i v i t i e s

Handout f o r s t u d e n t reading - About Your Heart and Exe rc i se

Assign - Scramble Words - B e n e f i t s of Exerc ise

Day 8

O b j e c t i v e s

The s t u d e n t w i l l be a b l e t o :

1. c a l c u l a t e c a l o r i e s used du r ing e x e r c i s e

2. keep a three-day r eco rd of t h e i r e x e r c i s e a c t i v i t y

3 . d e c i d e how t o begin an e x e r c i s e program

4 . l ist t h e b e n e f i t s of r e g u l a r e x e r c i s e

5. de te rmine and c a l c u l a t e maximal and t a r g e t h e a r t r a t e s

6. e x p l a i n t h e e f f e c t exces s weight has upon t h e h e a r t

7. i d e n t i f y e x e r c i s e i n t e n s i t y , f requency and d u r a t i o n

8. keep a d a i l y l o g of food i n t a k e .

B e n e f i t s of e x e r c i s e - sma l l groups 5-10 minutes

Determine and c a l c u l a t e maximal and t a r g e t h e a r t r a t e s - 10-

15 minutes

How Hard Should I Exerc ise - 5 minutes

E x e r c i s e and Pu l se Rates - 5 minutes

E x e r c i s e and Weight - 5-10 miriutes

8 4

Assign - Fitness Likes Start to Chart Food Intake

Day 9

Objectives

The student will be able to:

1. set up a personal exercise program

2 . list some common myths of exercise

3. share with peers personal exercise patterns

4. define the following vocabulary: fitness, static

exercise, stroke volume, frequency, intensity, aerobic

exercise, cool down, cardiovascular fitness, dynamic

exercise, maximal heart rate, target heart rate,

duration, aerobic exercise, warm up.

Do through fitness likes and relate them to setting up an

exercise program - small groups - 15 minutes Look at exercise records of the previous two days and

discuss - small groups - 10 minutes Discussion topic - 5 Common Myths About Exercise - 10 minutes

Nutrition Handout - Lifestyle

Day 10

Objectives

The student will be able to:

1. explain the exercise programs available to the

employees at Sentry Insurance

2. explain the ideas behind corporate fitness programs.

Field trip to Sentry Insurance - Dealt with exercise programs, exercise prescription, physical examinations given

before exercise begins, i.e. stress test, etc.

Day 11

Objectives

The student will be able to:

1. identify foods that are high in calories and fats

2. explain how to cut down on intake of saturated fats

3. identify foods high in sugar and calories

4. identify foods high in sodium

5 . list foods considered to be sensible snacks.

Film - Body Fuel - 10 minutes Film discussion - 10 minutes Discussion - About Your Heart and Diet - 15-20 minutes Assign - Heart Health Foods Word Find, Foods I Eat Most Often, In groups of 4-5 bring in a heart healthy snack

tomorrow.

Day 12

Objectives

The students will be able to:

1. analyze own diet for heart healthy foods

2. differentiate heart healthy snacks from non-heart

healthy snacks.

Review and discuss Word Find and Foods I Eat Most Often - 10 minutes

Review food chart and analyze for heart healthy foods

Heart Healthy Snacks - Make and allow students to sample some heart healthy snacks - 30 minutes

Day 13

Objectives

The students will be able to:

1. identify the effects of nicotine and carbon monoxide on

the heart and circulatory system

2. analyze the reasons people give for smoking

3. recognize the benefits of being a non-smoker

4. define the following vocabulary: nicotine, carbon

monoxide.

Reasons We Give For Smoking - small group discussion - 5-10 minutes

Films - Let's Talk About Smoking - 10 minutes Pressures to smoke - 15 minutes Conduct a smoking experiment using an artificial lung

courtesy of the American Cancer Society to demonstrate the

effect of cigarette properties on the lungs of the smoker. -.

Why Be a Non-Smoker? - 10-15 minutes Assign - The Big Sell, Smoking and Me, Warning Label

Day 14

Objectives

The students will be able to:

1. analyze the effects of cigarette advertising and deduce

its impact upon the consumer

2. re-write the warning label on cigarettes in their own

words.

Advertisements Big Sell - 20 minutes Warning Label - 10 minutes Smoking and Me - 10 minutes

Day 15

Objectives

The student will be able to:

1. list the risk factors associated with CHD

2. participate in Heart Health Squ;~res as a review

activity.

Discuss in small groups ways to reduce risk of heart

problems

Play Heart Health Squares