Teens Listen to ‘Cosmetic’ Health Tips
For years teachers and parents have been trying with little effect to convince teen-agers that junk food, cigarette smoking and lack of exercise could come back to haunt them with heart and other health problems in middle age.
But now a fast-paced experimental high school program has provided evidence that good health habits seem to stick with teens if teachers put the emphasis on immediate cosmetic benefits rather than on dire warnings of long-term consequences.
The program, designed to reduce the risk of cardiovascular disease and described today in a medical journal, produced significant changes in blood pressure, body fat, smoking and other behavior among several hundred students at two Silicon Valley high school districts who took the course in 10th grade and who were then monitored by their schools through graduation.
It has convinced researchers that a radical change in school health instruction, starting in kindergarten, may be necessary.
The experimental curriculum focuses, for instance, not on how smoking can result in lung cancer or emphysema in later years but instead on how it can lead to yellow teeth and fingers and even smelly hair now. Instead of being told they run the risk of becoming couch potatoes as adults, the students were taught that intensive aerobic exercise can give them trimmer, attractive, more athletic bodies.
To the surprise of some school officials, normally skeptical teens appeared to stick to behavior they learned in the course until they graduated: They ate healthier snacks, avoided tobacco and even agitated for more exercise.
The report on the test’s initial findings is being published today in the Journal of the American Medical Assn. At the same time, a team of University of Iowa researchers has published new data that underscores the potential significance of early health training.
In the journal Pediatrics, researchers at a prominent long-term heart study based in Muscatine, Iowa, found a direct correlation between elevated blood cholesterol in children 8 to 18 and subsequent premature heart disease risk in adults 25 to 30.
The link has long been suspected, but the report is among the first confirmations based on hard research data in subjects tracked for more than a decade.
The Stanford pilot curriculum was tested three years ago in the Santa Clara and Fremont high school districts. Tenth-graders were selected because they were thought to be like adults in terms of being set in their health habits.
A total of 1,447 teen-agers at Lynbrook High School in San Jose and Santa Clara High School in Santa Clara were taught by Stanford-trained instructors in their 20s. The course consisted of 20 hourlong sessions three times a week for seven weeks. Results from health-factor awareness tests and fitness-oriented physical examinations were compared with control classes.
Carbon Monoxide Tests
Both student groups were asked whether they smoked and were given carbon monoxide tests to verify their answers. They were also tested on their knowledge of a variety of health factors and their interest in eating “heart-healthy” snack foods. And their blood pressure, body fat and muscle tone were monitored. Monitoring of cholesterol levels was not done, however, because the researchers felt that the drawing of blood for such testing would make both the students and their parents wary.
The results, said Dr. Joel Killen, the Stanford researcher who headed the project, clearly indicated that the program altered smoking behavior and lowered blood pressure.
“We started with the assumption that if we just went in and talked about the dangers of heart disease and the virtues of engaging in certain kinds of behavior, we would be shot out of the water,” Killen said. “Our (preparatory) work suggested that most 15-year-olds aren’t interested. Heart disease isn’t a salient issue to them.”
What seemed to matter in building motivation, he said, was immediate impact, particularly on looks. “Cosmetic factors are pretty important to teen-agers,” he noted.
The districts have continued the program by using high school physical education teachers. Killen said that may bring a shift in the focus of physical education programs, which traditionally have emphasized sports.
Because a surprisingly high percentage of 10th-grade girls taking the curriculum showed indications of obsessive weight-control behavior, including binging and purging, Killen and other Santa Clara district officials said a new program is being developed for seventh-grade girls in an attempt to head off eating disorders.
The blood pressure decreases were consistent in both boys and girls, Killen said, but the effect was more pronounced in the girls--indicating that they may have altered their life styles more than boys.
Pulse rates in both sexes dropped in the teens who took the courses but rose slightly in those who did not. Within established ranges, a lower pulse rate is associated with better cardiovascular and physical fitness and was seen as confirming that the teens had adopted better exercise habits.
In students given the instruction, only about 6% of those who had tried smoking continued it, while more than 10% of teens in the control group reported that they had graduated to habitual tobacco use. Of the teens taking the course, 28.5% stopped smoking entirely, compared with 17.6% in the control group.
“In the larger scheme of things,” said Killen, “what we’re ultimately looking to do here is develop an integrated life-style promotion program that could be implemented (from kindergarten to 12th grade). We’re very encouraged by the results to date.”
Killen conceded that more testing is necessary to establish the overall success of the program and noted that it involved a student population that was mostly white and upper middle class.
Gene Unger, the Santa Clara district’s administrator for instruction and guidance, said the nature of the Stanford course--especially its focus on a short blitz of intensive sessions instead of semester- or yearlong instruction--may have important implications for curriculum planning in areas other than health education.
Unger said that, while the new Stanford study included follow-up data after just two months, the district had informally monitored students involved until they graduated. “What was so significant,” he said, “was that the kids seemed to hold the same general values they developed as a result of the curriculum.”
John Mix, an assistant principal at Santa Clara High School, said that the program produced significant and recognizable behavior change.
“We just noticed that these kids were paying more attention to their diets,” Mix said. Some teens even demanded an explanation of why only two 20-minute periods of intensive aerobic exercise were offered when the course had taught them three was optimal.
The Santa Clara district is exploring modifications in cafeteria menus, Unger said, and dietary workers have already started offering a salad bar at lunch.
The Iowa study was headed by Dr. Ronald Lauer, a pediatric heart specialist at the University of Iowa Hospitals and Clinics.
In it, 2,446 young people ages 8 to 18 were followed through young adulthood and re-examined at ages 20 to 25 or 26 to 30.
Lauer and the research team confirmed a direct relationship between high cholesterol in children and teens and levels recorded when they had become adults.
The research, begun in 1971, included periodic blood pressure, cholesterol, height, weight and skin-fold thickness measurements. As much as 25% to 50% of adult level cholesterol danger is predictable from childhood levels, the researchers concluded.