Evaluation of a health and nutrition education program in primary school children of Crete over a three-year period.

BACKGROUND No national policy for health education in schools exists to date in Greece. The first attempt to apply a school-based health education intervention program was launched in 1992 on all 4,171 pupils registered in the first grade in two counties of Crete. The 1,510 pupils registered in a third county served as controls. METHODS The school-based intervention and the seminars organized for parents were primarily aimed at improving children's diet, fitness, and physical activity. Pupils in the first grade in a representative sample of 40 schools were examined prior to the intervention program on a variety of health knowledge, dietary, physical activity, fitness, anthropometric, and biochemical indices. The same measurements were taken after 3 years of the program on 288 intervention group and 183 control group pupils. RESULTS Positive serum lipid level changes occurred to a greater extent in the intervention group than the control group. BMI increased less in the intervention group than for controls. The increase in health knowledge and physical activity and fitness levels occurred to a higher extent in the intervention group compared to controls. CONCLUSIONS The short-term changes observed in the present study are markedly encouraging and indicate great potential for progressive improvement. Continuation and expansion of such a program may prove to be beneficial in initiating long-term changes.

[1]  A. Kafatos,et al.  Trans fatty acids in foods in Europe : the TRANSFAIR study , 1998 .

[2]  Y. Manios,et al.  Physical Activity of 6-Year-Old Children: Validation of Two Proxy Reports , 1998 .

[3]  J. Harrell,et al.  Effects of a school-based intervention to reduce cardiovascular disease risk factors in elementary-school children: the Cardiovascular Health in Children (CHIC) study. , 1996, The Journal of pediatrics.

[4]  A. Kafatos,et al.  Prevalence of obesity in Greece. , 1996, International journal of obesity and related metabolic disorders : journal of the International Association for the Study of Obesity.

[5]  J O Hill,et al.  Nutrition and physical activity program to attenuate obesity and promote physical and metabolic fitness in elementary school children. , 1996, Obesity research.

[6]  S. Kelder,et al.  Outcomes of a field trial to improve children's dietary patterns and physical activity. The Child and Adolescent Trial for Cardiovascular Health. CATCH collaborative group. , 1996, JAMA.

[7]  A. Dontas,et al.  Changing Prevalence of Coronary Heart Disease Risk Factors and Cardiovascular Diseases in Men of a Rural Area of Crete from 1960 to 1991 , 1996, Angiology.

[8]  S. Kelder,et al.  Community-wide youth nutrition education: long-term outcomes of the Minnesota Heart Health Program. , 1995, Health education research.

[9]  J. Cutler,et al.  Review of Behavioral Research for Cardiopulmonary Health: Emphasis on Youth, Gender, and Ethnicity , 1995 .

[10]  S. Kelder,et al.  Longitudinal tracking of adolescent smoking, physical activity, and food choice behaviors. , 1994, American journal of public health.

[11]  D. Erkelens,et al.  Additional Physical Education and Plasma Lipids and Apoproteins: A 3-Year Intervention Study , 1994 .

[12]  A. Kafatos,et al.  Changing patterns of fat intake in Crete. , 1993, European journal of clinical nutrition.

[13]  D. Sprecher,et al.  Primary hyperlipidemia in a pediatric population: classification and effect of dietary treatment. , 1993, Pediatrics.

[14]  D. Cross,et al.  A Three-Year Evaluation of the Know Your Body Program in Inner-City Schoolchildren , 1992, Health education quarterly.

[15]  I. Contento,et al.  Research perspective on school-based nutrition education , 1992 .

[16]  T. Nozue,et al.  Beneficial effects of dietary intervention on serum lipid and apolipoprotein levels in obese children. , 1992, American journal of diseases of children.

[17]  C Lionis,et al.  The effects of a health education intervention program among Cretan adolescents. , 1991, Preventive medicine.

[18]  I. Vlachonikolis,et al.  Coronary-heart-disease risk-factor status of the Cretan urban population in the 1980s. , 1991, The American journal of clinical nutrition.

[19]  R. Forthofer,et al.  Promoting physical activity and a healthful diet among children: results of a school-based intervention study. , 1991, American journal of public health.

[20]  C. J. Cohen,et al.  Long-term effects of a lifestyle modification exercise program on the fitness of sedentary, obese children. , 1991, The Journal of sports medicine and physical fitness.

[21]  Ernst L. Wynder,et al.  Hyperlipidemia in Childhood and the Development of Atherosclerosis , 1991 .

[22]  E. Vartiainen,et al.  The North Karelia Youth Programs , 1991, Annals of the New York Academy of Sciences.

[23]  T. Reybrouck,et al.  Exercise Therapy and Hypocaloric Diet in the Treatment of Obese Children and Adolescents , 1990, Acta paediatrica Scandinavica.

[24]  K. Sidney,et al.  Enhancing children's participation in physical activity. , 1989, The Journal of school health.

[25]  E. Wynder,et al.  Primary prevention of cancer among children: changes in cigarette smoking and diet after six years of intervention. , 1989, Journal of the National Cancer Institute.

[26]  P. Bush,et al.  Cardiovascular Risk Factor Prevention in Black School Children: The "Know Your Body" Evaluation Project , 1989, Health education quarterly.

[27]  C. Perry,et al.  Synthesis of Cardiovascular Behavioral Research for Youth Health Promotion , 1989, Health education quarterly.

[28]  L. Epstein,et al.  The effect of weight control on lipid changes in obese children. , 1989, American journal of diseases of children.

[29]  P J Bush,et al.  Cardiovascular risk factor prevention in black schoolchildren: two-year results of the "Know Your Body" program. , 1989, American journal of epidemiology.

[30]  C. Perry,et al.  Nutrition intervention strategies preferred by parents: Results of a marketing survey , 1989 .

[31]  E. Wynder,et al.  Implementation of a pilot school-site cholesterol reduction intervention. , 1989, The Journal of school health.

[32]  R. Lauer,et al.  Factors affecting the relationship between childhood and adult cholesterol levels: the Muscatine Study. , 1988, Pediatrics.

[33]  C. Perry,et al.  Parent involvement with children's health promotion: the Minnesota Home Team. , 1988, American journal of public health.

[34]  Alexander N. Chen,et al.  A three-year school-based nutrition education study , 1988 .

[35]  V L Katch,et al.  Coronary risk incidence of obese adolescents: reduction by exercise plus diet intervention. , 1988, Pediatrics.

[36]  G. Berenson,et al.  Cardiovascular Risk Factors in Childhood: Epidemiology and Prevention , 1987 .

[37]  K. Berg,et al.  Exercise training effects on serum lipids of prepubescent boys and adult men. , 1986, Medicine and science in sports and exercise.

[38]  A. Hofman,et al.  Primary prevention of chronic disease in childhood: changes in risk factors after one year of intervention. , 1985, American journal of epidemiology.

[39]  Z. Tran,et al.  Differential effects of exercise on serum lipid and lipoprotein levels seen with changes in body weight. A meta-analysis. , 1985, JAMA.

[40]  G. Berenson,et al.  Conference on Blood Lipids in Children: Optimal Levels for Early Prevention of Coronary Artery Disease: Workshop report: Epidemiological section April 18 and 19, 1983, American Health Foundation , 1983 .

[41]  H. Mcgill,et al.  Conference on Blood Lipids in Children: optimal levels for early prevention of coronary artery disease. Workshop report: Experimental Section. American Health Foundation, April 18 and 19, 1983. , 1983, Preventive medicine.

[42]  L. Sims,et al.  Nutrition knowledge and attitudes of elementary school students after receiving nutrition education. , 1982, Journal of the American Dietetic Association.

[43]  L. Prencipe,et al.  Serum triglycerides determined colorimetrically with an enzyme that produces hydrogen peroxide. , 1982, Clinical chemistry.

[44]  B. Shannon,et al.  Food behavior of elementary school students after receiving nutrition education. , 1982, Journal of the American Dietetic Association.

[45]  E. Vartiainen,et al.  The North Karelia youth project: evaluation of two years of intervention on health behavior and CVD risk factors among 13- to 15-year old children. , 1982, Preventive medicine.

[46]  F. Oberklaid,et al.  The longitudinal study of findings in childhood. Analysis of an interdisciplinary process. , 1982, American journal of diseases of children.

[47]  J. Morris,et al.  Epidemiology and prevention. , 1982, The Milbank Memorial Fund quarterly. Health and society.

[48]  M. Levenstein,et al.  Screening for risk factors for chronic disease in children from fifteen countries. , 1981, Preventive medicine.

[49]  E. Wynder,et al.  Cardiovascular Risk Factor Status of Greek Adolescents in Athens , 1980, Pediatric Research.

[50]  A. Eng,et al.  The "Know Your Body" program: a developmental approach to health education and disease prevention. , 1980, Preventive medicine.

[51]  R. Schifman,et al.  Cholesterol in high-density lipoprotein: use of Mg2+/dextran sulfate in its enzymic measurement. , 1978, Clinical chemistry.

[52]  E. Wynder,et al.  Primary prevention of chronic disease beginning in childhood. The "know your body" program: design of study. , 1977, Preventive medicine.

[53]  P. Fu,et al.  Enzymatic determination of total serum cholesterol. , 1974, Clinical chemistry.

[54]  R. Levy,et al.  Estimation of the concentration of low-density lipoprotein cholesterol in plasma, without use of the preparative ultracentrifuge. , 1972, Clinical chemistry.

[55]  A. Keys.  CORONARY HEART DISEASE IN SEVEN COUNTRIES , 1971, The Medical journal of Australia.

[56]  S. Bondurant.  Symposium on Research on Acute Myocardial Infarction , 1970 .

[57]  F. Kafatos,et al.  CRETE: A STUDY IN THE METABOLIC EPIDEMIOLOGY OF CORONARY HEART DISEASE. , 1965, The American journal of cardiology.

[58]  R. Vandongen,et al.  A controlled evaluation of a fitness and nutrition intervention program on cardiovascular health in 10- to 12-year-old children. , 1995, Preventive medicine.

[59]  M. Sánchez-Bayle,et al.  Diet therapy for hypercholesterolemia in children and adolescents. A follow-up. , 1994, Archives of pediatrics & adolescent medicine.

[60]  A. Kafatos,et al.  Policies and programs in nutrition and physical fitness in Greece. , 1993, World review of nutrition and dietetics.

[61]  A. Simopoulos.  Nutrition and fitness in health and disease , 1993 .

[62]  A. Alexandrov,et al.  Primary prevention of cardiovascular disease: 3-year intervention results in boys of 12 years of age. , 1992, Preventive medicine.

[63]  G. Berenson,et al.  The Heart Smart cardiovascular school health promotion: behavior correlates of risk factor change. , 1992, Preventive medicine.

[64]  S. Halfon,et al.  Primary prevention of cardiovascular diseases in childhood: changes in serum total cholesterol, high density lipoprotein, and body mass index after 2 years of intervention in Jerusalem schoolchildren age 7-9 years. , 1990, Preventive medicine.

[65]  E. Wynder,et al.  The development, implementation, evaluation, and future directions of a chronic disease prevention program for children: the "Know Your Body" studies. , 1989, Preventive medicine.

[66]  A. Kafatos,et al.  Serum lipids, apoproteins and nutrient intake in rural Cretan boys consuming high-olive-oil diets. , 1988, Journal of clinical epidemiology.

[67]  T. Lohman,et al.  Anthropometric Standardization Reference Manual , 1988 .

[68]  J. Sasaki,et al.  A long-term aerobic exercise program decreases the obesity index and increases the high density lipoprotein cholesterol concentration in obese children. , 1987, International journal of obesity.

[69]  C. W. Linder,et al.  The effect of physical conditioning on serum lipids and lipoproteins in white male adolescents. , 1983, Medicine and science in sports and exercise.

[70]  M. Jeffries.  Know your body , 1976 .