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Evaluation of a short-term health educational program Vogel, Anne MacLeod 1980

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EVALUATION OF A SHORT-TERM HEALTH EDUCATIONAL PROGRAM BY ANNE MACLEOD VOGEL M.D.C.M. DALHOUSIE UNIVERSITY 1958 A THESIS SUBMITTED IN PARTIAL FULFILLMENT OF THE REQUIREMENTS FOR THE DEGREE OF MASTER OF SCIENCE IN THE FACULTY OF GRADUATE STUDIES UNIVERSITY OF BRITISH COLUMBIA (Department of Health Care and Epidemiology) WE ACCEPT THIS THESIS AS CONFORMING TO THE REQUIRED STANDARD: THE UNIVERSITY OF BRITISH COLUMBIA DECEMBER 19 79 (c) Anne MacLeod Vogel, 1980. In presenting th i s thesis in pa r t i a l fu l f i lment of the requirements for an advanced degree at the Un ivers i ty of B r i t i s h Columbia, I agree that the L ibrary sha l l make it f ree ly ava i lab le for reference and study. I fur ther agree that permission for extensive copying of th i s thesis for scho lar ly purposes may be granted by the Head of my Department or by his representat ives. It is understood that copying or pub l i ca t ion o f th is thes is fo r f i nanc ia l gain sha l l not be allowed without my writ ten permission. Department of I^JXi C c L ^ t flW (^/^JjL^ cj The Univers i ty of B r i t i s h Columbia 2075 Wesbrook Place Vancouver, Canada V6T 1W5 i . A B S T R A C T An i n t e r v e n t i o n study was conducted i n a Vancouver, B r i t i s h Columbia High School i n the S p r i n g of 1977. The o b j e c t i v e of the study was to measure changes i n knowledge, a t t i t u d e and behaviour i n regard to the 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 , smoking, p h y s i c a l i n a c t i v i t y and h i g h - f a t d i e t , f o l l o w i n g a s h o r t - t e r m e d u c a t i o n a l program. The p r i n c i p a l hypotheses were t h a t students exposed to ah e d u c a t i o n a l program d i r e c t e d towards r e d u c i n g c a r d i o v a s c u l a r r i s k - b e h a v i o u r s w i l l : CI) have more knowledge about c a r d i o v a s c u l a r r i s k -behaviours than students who are not exposed to the program. (2) have a more p o s i t i v e a t t i t u d e towards r e d u c i n g c a r d i o v a s c u l a r r i s k - b e h a v i o u r s than students who are not exposed to the program. C3) w i l l change t h e i r behaviour i n such a way as to p r a c t i c e fewer r i s k - b e h a v i o u r s than students who are not exposed to the program. The m a j o r i t y of the students i n the study s c h o o l were from m i d d l e - c l a s s backgrounds and were i n the u n i v e r s i t y entrance program. The study p o p u l a t i o n c o n s i s t e d of a l l of the students i n grade 9 and one-half of the students i n grade 10 and 11 f o r a t o t a l of 510 s t u d e n t s . The students were randomly assig n e d to two groups. One group was' exposed to a h e a l t h e d u c a t i o n a l program d i r e c t e d towards r e d u c i n g r i s k of c a r d i o v a s c u l a r d i s e a s e . The program c o n s i s t e d of a p r e s e n t a t i o n by a h e a l t h educator, a f i l m and w r i t t e n m a t e r i a l s p r o v i d e d by the B r i t i s h Columbia Heart Foundation. The c o n t r o l group took p a r t i n the r e g u l a r s c h o o l guidance c l a s s e s . A p r e t e s t , p o s t t e s t r e s e a r c h d e s i g n was used. The measuring instrument used was a w r i t t e n q u e s t i o n n a i r e developed from the content o f the e d u c a t i o n a l program. The students completed the same q u e s t i o n n a i r e b e f o r e and a f t e r t h e i r exposure to the e d u c a t i o n a l program. The students a l s o took p a r t i n p r e t e s t , p o s t t e s t f i t n e s s t e s t i n g u s i n g the Canada Home F i t n e s s T e s t . The 287 students exposed to the e d u c a t i o n a l program were compared w i t h 187 from the same grade and s c h o o l who were not exposed to the e d u c a t i o n a l program. In reg a r d to the hypotheses s t a t e d above, s i g n i f i c a n t l y more students i n the i n t e r v e n t i o n group answered 11 of the 34 of the knowledge qu e s t i o n s c o r r e c t l y . There were no d i f f e r e n c e s between the i n t e r v e n t i o n and non-i n t e r v e n t i o n groups i n d i c a t e d by r e p l i e s to the que s t i o n s about a t t i t u d e towards red u c i n g c a r d i o v a s c u l a r r i s k . There were no d i f f e r e n c e s between the i n t e r v e n t i o n and non-i n t e r v e n t i o n group i n s e l f - r e p o r t e d , c a r d i o v a s c u l a r r i s k -behaviour. F i t n e s s l e v e l s as measured by the Canada Home F i t n e s s Test showed a p u z z l i n g i n c r e a s e i n f i t n e s s among the non-i n t e r v e n t i o n group. In summary, the study i n d i c a t e d t h a t students exposed to a h e a l t h e d u c a t i o n a l program i n s c h o o l had a s i g n i f i c a n t i n c r e a s e i n h e a l t h knowledge but not i n health, a t t i t u d e nor behaviour. The evidence i n t h i s study t h a t students made s i g n i f i c a n t knowledge gains f o l l o w i n g an e d u c a t i o n a l program, together w i t h the theory t h a t knowledge of f a c t u a l i n f o r m a t i o n i s o f t e n the f i r s t s tep i n the d e c i s i o n making process CBloom, 1956) , j u s t i f i e s continued h e a l t h e d u c a t i o n a l programs i n s c h o o l s . Although, t h i s study d i d not pr o v i d e evidence of a t t i t u d e or behaviour change i n the short-term, f u r t h e r long-term e v a l u a t i v e s t u d i e s o f h e a l t h e d u c a t i o n a l programs i n the schools are i n d i c a t e d . i v TABLE OF CONTENTS PAGE ABSTRACT i TABLE OF CONTENTS . i v LIST OF TABLES v i ACKNOWLEDGEMENTS v i i INTRODUCTION 1 CHAPTER I BACKGROUND OF STUDY . . . . 4 R i s k - F a c t o r s . 4 Risk-Behaviours . . . . . 5 Knowledge of Risk F a c t o r s 6 Risk A t t i t u d e s 7 Other Stud i e s of E d u c a t i o n a l H e a l t h Programs . . . . . . . 10 CHAPTER II THEORY, RATIONALE AND OBJECTIVES 13 OF STUDY Theory and R a t i o n a l e 13 Conceptual Scheme 16 Hypotheses 17 E d u c a t i o n a l Program 17 P h y s i c a l and Socio-demographic S e t t i n g of the Study 17 Research O b j e c t i v e s . 18 S i g n i f i c a n c e 19 CHAPTER I I I METHODS 20 Independant V a r i a b l e 20 The Dependant V a r i a b l e s 21 Research Design 23 Measuring Instruments 24 Sampling Methods 26 Implementation of Study 27 Procedure 28 CHAPTER IV RESULTS 3 0 Hypothesis I 30 Hypothesis II . . . ... . 62 Hypothesis I I I 6 4 Canada Home F i t n e s s T e s t 66 V PAGE CHAPTER V DISCUSSION AND CONCLUSION . . . . . . . 7 2 D i s c u s s i o n . . . . . . 72 C o n c l u s i o n 7 4 BIBLIOGRAPHY . 75 APPENDIX A Q u e s t i o n n a i r e 82 v i LIST OF TABLES PAGE TABLE I - XI Number and Percentage D i s t r i b u t i o n o f Responses to Knowledge Questions About C a r d i o v a s c u l a r Risk I 40 II 42 I I I 44 IV 46 V . . . . 48 VI 50 VII . 52 VI I I . . . 54 IX 56 X 59 XI 61 XII Number and Percentage D i s t r i b u t i o n of Ten Second Pulse Recorded During the Canada Home F i t n e s s T e s t 68 XIIT Number and Percentage D i s t r i b u t i o n of D i f f e r e n c e s Between Pre- and P o s t t e s t s of Ten Second Pulse Rates i n Students Recorded d u r i n g the Canada Home F i t n e s s T e s t 70 v i i ACKNOWLEDGEMENTS I would l i k e t o acknowledge the co o p e r a t i o n , h e l p and a s s i s t a n c e of many people i n the p r e p a r a t i o n of t h i s paper; the Vancouver School Board f o r g i v i n g t h e i r a p p r o v a l ; the a d m i n i s t r a t i v e , t e a c h i n g and c l e r i c a l s t a f f o f E r i c Hamber School f o r a d m i n i s t e r i n g t e s t s and c o l l e c t i n g data, p l a n n i n g t i m e t a b l e s , t y p i n g and copying; the B r i t i s h Columbia Heart Foundation f o r p r e s e n t i n g the e d u c a t i o n a l program, s u p p l y i n g the f i l m and the w r i t t e n m a t e r i a l s and a l s o s u p p l y i n g a gra n t t o the Y.M.C.A. to pay t h e i r s t a f f to conduct the Canada Home F i t n e s s T e s t ; the Y.M.C.A. f o r a d m i n i s t e r i n g the Canada Home F i t n e s s Test; the Vancouver He a l t h Department f o r hel p i n many ar e a s . I would l i k e to p a r t i c u l a r l y acknowledge the h e l p o f Dr. M. V e r n i e r o f U.B.C., Dr. F. Bass and Mr. Guy Constanzo of the Vancouver He a l t h Department f o r t h e i r h e l p i n p r e p a r i n g the paper and Mrs. Judy C h a r l t o n f o r her devoted t y p i n g . -1-INTRODUCTION Coronary h e a r t d i s e a s e and the c a r d i o v a s c u l a r c o m p l i c a t i o n s of h y p e r t e n s i o n are major h e a l t h problems i n North America. The f i r s t major, long term e p i d e m i o l o g i c a l s t u d i e s i n Framingham (Dawber, 1951) and Minnesota (Keys, 1963) began about 30 years ago. The r i s k - f a c t o r concept has become f i r m l y e s t a b l i s h e d and the i n f l u e n c e of the environment, comprising h a b i t s o-f l i v i n g , has been shown to have a d e c i s i v e impact on the o r i g i n and course of the d i s e a s e . E l e v a t e d l e v e l s of serum c h o l e s t e r o l , blood p r e s s u r e and smoking are by f a r the three most f i r m l y e s t a b l i s h e d coronary h e a r t d i s e a s e r i s k - f a c t o r s . (The P o o l i n g P r o j e c t Research Group, 1963.) To the e x t e n t t h a t h e a l t h p r a c t i c e s can be m o d i f i e d , the prevalence o f coronary h e a r t d i s e a s e can be reduced. CBelloc, 1972; Turner, 1963.) Thus a major task f o r p r e v e n t i v e medicine i n western s o c i e t y has become changing the p a t t e r n s of behaviour t h a t i n c r e a s e the r i s k of c h r o n i c d i s e a s e i n the p o p u l a t i o n . (Turner, 197 3; Pomerleau, 19 75.) The d e s i r a b i l i t y of changing behaviour to improve h e a l t h has been d i s c u s s e d a t l e n g t h i n a Canadian Government Working Document e n t i t l e d "A New P e r s p e c t i v e on the H e a l t h of Canadians" (Lalonde, 1974) and there i s no q u e s t i o n t h a t the promotion of s e n s i b l e l i v i n g h a b i t s i s a p r i o r i t y task f o r community medicine. - 2 -The e s t a b l i s h m e n t of the r i s k - f a c t o r concept i n r e l a t i o n to c a r d i o v a s c u l a r d i s e a s e l e d to the development of s t r a t e g i e s d i r e c t e d towards encouraging the formation of p o s i t i v e a t t i t u d e s and behaviours and m o d i f y i n g e x i s t i n g n e g a t i v e a t t i t u d e s and b e h a v i o u r s . These s t r a t e g i e s i n c l u d e d the i n t r o d u c t i o n of h e a l t h e d u c a t i o n a l programs i n t o schools with the e x p e c t a t i o n t h a t an i n c r e a s e i n knowledge about the i m p l i c a t i o n s of c e r t a i n r i s k - b e h a v i o u r s f o r f u t u r e health, would a f f e c t the students' a t t i t u d e and behaviour. I m p l i c i t i n the programs, d i r e c t e d towards improving c a r d i o v a s c u l a r h e a l t h , i s the message t h a t a v o i d i n g smoking, r e d u c i n g f a t i n t a k e and e x e r c i s i n g r e g u l a r l y are p o s i t i v e h e a l t h behaviours. Experts i n h e a l t h e d u c a t i o n are agreed t h a t a t t i t u d e s p l a y an important r o l e i n h e a l t h behaviour. ( S p i t z n a g e l , 1969.) A t t i t u d e s c o n s i s t of one's knowledge and b e l i e f about an e n t i t y i n the world, one's p o s i t i v e or negative f e e l i n g s toward i t and one's b e h a v i o u r a l tendencies r e g a r d i n g i t . (Baron, 1977.) Attempts a t changing a t t i t u d e s must i n v o l v e the a l t e r a t i o n of one or more of the three b a s i c elements of which they are composed. Since a t t i t u d e s are o f t e n a c q u i r e d very e a r l y i n l i f e and strengthened through r e i n f o r c e m e n t over a p e r i o d of years they are r e s i s t a n t to change. Although a program may be s u c c e s s f u l i n m o d i f y i n g the a t t i t u d e o f the r e c i p i e n t t h i s does not n e c e s s a r i l y assure a change i n behaviour. E x i s t i n g evidence suggests t h a t the r e l a t i o n s h i p between a t t i t u d e and behaviour i s complex. A - 3 -n u m b e r o f s t u d i e s ( W i c k e r , 1 9 7 1 ; W r i g h t m a n , 1 9 6 9 ) h a v e i n d i c a t e d t h a t a t t i t u d e a n d . b e h a v i o u r a r e n o t c l o s e l y r e l a t e d . O t h e r e v i d e n c e ( F i s h b e r n , 1 9 7 5 ; R o k e a c h . , 1 9 7 2 ) s u g g e s t s t h a t a t t i t u d e s c a n o f t e n s e r v e a s e f f e c t i v e p r e d i c t o r s o f b e h a v i o u r . D e s p i t e t h e d i f f i c u l t i e s i n v o l v e d i n m o d i f y i n g e s t a b l i s h e d b e l i e f s , p r o g r a m s d i r e c t e d t o w a r d s : p e r s u a d i n g s t u d e n t s t o b e h a v e i n s u c h a m a n n e r a s t o r e d u c e t h e i r r i s k o f d e v e l o p i n g c a r d i o -v a s c u l a r d i s e a s e , h a v e p r o l i f e r a t e d . T h e e v a l u a t i v e l i t e r a t u r e w i t h r e g a r d t o s c h o o l h e a l t h p r o g r a m s i s s p a r s e a n d i s l i m i t e d t o a f e w s u b j e c t a r e a s , p r i m a r i l y d r u g u s e a n d n u t r i t i o n . N o s t u d i e s o f t h e l o n g - t e r m , e f f e c t s o f h e a l t h e d u c a t i o n i n t h e s c h o o l s h a v e b e e n r e p o r t e d t o d a t e . S h o r t - t e r m s t u d i e s o f t h e 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 a l p r o g r a m s i n t h e a r e a s o f d r u g u s e a n d n u t r i t i o n i n d i c a t e a n i n c r e a s e i n t h e l e v e l o f k n o w l e d g e o f t h e s t u d e n t s i n v o l v e d i n t h e p r o g r a m s , b u t e v i d e n c e o f a t t i t u d e a n d b e h a v i o u r c h a n g e i s m o r e d i f f i c u l t t o i l l u s t r a t e . C S p i t z n a g e l , 1 9 6 9 ; A m e n d o l a r a , 1 9 7 3 ; S w i s h e r , 1 9 7 2 ; P o d e l l , 1 9 7 8 ; M c A l i s t e r , 1 9 7 9 ) . I t i s e x p e c t e d t h a t t h i s s t u d y w i l l i n d i c a t e w h e t h e r s t u d e n t s e x p o s e d t o a n e d u c a t i o n a l p r o g r a m d e v e l o p e d b y t h e B . C . H e a r t F o u n d a t i o n t o a l e r t s t u d e n t s t o t h e r i s k s o f s m o k i n g , h i g h - f a t d i e t a n d p h y s i c a l i n a c t i v i t y w i l l s h o w e v i d e n c e o f m o r e k n o w l e d g e o f t h e s e r i s k s , w i l l i n d i c a t e a m o r e p o s i t i v e a t t i t u d e t o w a r d s t h e i m p o r t a n c e o f r e d u c i n g t h e s e r i s k s a n d w i l l r e p o r t f e w e r r i s k -b e h a v i o u r s t h a n s t u d e n t s w h o a r e n o t e x p o s e d t o t h e p r o g r a m . -4-CHAPTER I BACKGROUND OF THE STUDY R i s k - F a c t o r s Smoking i s the s i n g l e most pr e v e n t a b l e cause of c a r d i o -v a s c u l a r d i s e a s e , c h r o n i c o b s t r u c t i v e pulmonary d i s e a s e and cancer. (American Heart A s s o c i a t i o n Report, 1977.) The r i s k o f c a r d i o v a s c u l a r d i s e a s e i n c r e a s e s i n p r o p o r t i o n to the number o f c i g a r e t t e s smoked and the d u r a t i o n of exposure to the h a b i t . I t i s estimated t h a t c i g a r e t t e smoking i s r e s p o n s i b l e f o r 325,000 premature deaths each year. T o t a l m o r t a l i t y i s 1.6 times h i g h e r i n c i g a r e t t e smokers than among non-smokers. ( F e r n l e i b , 1975.) The e f f e c t of c i g a r e t t e smoking on c a r d i o v a s c u l a r d i s e a s e r i s k i s independent of other major r i s k f a c t o r s and t h i s r i s k i s g r e a t l y aggravated when such f a c t o r s as hig h b l o o d pressure or dia b e t e s m e l l i t u s are p r e s e n t . (DHEW, 1975.) E l e v a t e d serum c h o l e s t e r o l has the h i g h e s t s i n g l e c o r r e l a -t i o n w i t h the r i s k of major coronary h e a r t d i s e a s e . (American Heart A s s o c i a t i o n , 19 78.) Average val u e s i n a North American p o p u l a t i o n tend to be much h i g h e r than i n p o p u l a t i o n s where there i s a low i n c i d e n c e of a t h e r o s c l e r o s i s . Students of U.S. school-age c h i l d r e n from 6 to 16 years have shown t h a t 10 to 20 p e r c e n t have e l e v a t e d serum c h o l e s t e r o l . (Glueck, 19 74.) Modest s h i f t s i n d i e t a r y p a t t e r n s w i t h a r e d u c t i o n i n meat, eggs and d a i r y products have been shown to reduce a t h e r o s c l e r o s i s . (.Wissler, 197 3.) -5-The p r e c i s e r o l e of p h y s i c a l a c t i v i t y as a p r o p h y l a c t i c a g a i n s t the development of c a r d i o v a s c u l a r h e a r t d i s e a s e has not y e t been determined. Various e p i d e m i o l o g i c a l s t u d i e s have i s o l a t e d the l a c k o f p h y s i c a l a c t i v i t y as a coronary r i s k f a c t o r , and reviews by Fox and Skinner (1964), Fox, Naughton and H a s k e l l (.1971) and F r o e l i c h e r and Oberman (.1972) have g e n e r a l l y shown decreased m o r t a l i t y from c a r d i o v a s c u l a r h e a r t d i s e a s e i n p h y s i c a l l y a c t i v e p o p u l a t i o n s . Recent s t u d i e s by Pa f f e n b e r g e r (.1975) and Cooper (1976) have p l a c e d s t r o n g evidence i n favour of the r o l e e x e r c i s e p l a y s i n p r e v e n t i v e medicine. Risk-Behaviours A review o f the l i t e r a t u r e r e g a r d i n g a d o l e s c e n t h e a l t h behaviours i n d i c a t e s t h a t the U.S. Department of H e a l t h , E d u c a t i o n and Welfare (U.S. P u b l i c H e a l t h S e r v i c e , 1976) r e p o r t s t h a t 15.3 p e r c e n t o f males and 15.8 p e r c e n t of females between the ages of 12 and 18 c o n s i d e r themselves r e g u l a r smokers. A Canadian study CHanley, 1976) r e p o r t e d 10 per c e n t of the 13 year age group, 20 p e r c e n t of the 14 year age group and 30 per c e n t of the 15 year age group s t a t e d t h a t they smoked d a i l y . H ealth and Welfare Canada (1976) r e p o r t e d a decrease i n non-smokers i n the 15 to 19 year age group from 6 8.9 p e r c e n t to 6 4.3 p e r c e n t . T h i s change was due p r i m a r i l y to a d e c l i n e i n the non-smoking behaviour of teenage g i r l s . A r e p o r t on the food consumption p a t t e r n s of Canadians (Department of N a t i o n a l Heath and Welfare, 1976) i n d i c a t e d t h a t the average d a i l y i n t a k e of f a t i n the 12 to 19 age group was -6-40 p e r c e n t of the t o t a l c a l o r i e i n t a k e . I t was r e p o r t e d t h a t many a u t h o r i t i e s c o n s i d e r e d t h i s h i g h - f a t i n t a k e d e l e t e r i o u s to h e a l t h and t h a t a lower percentage of c a l o r i e s consumed from f a t be recommended. Meat, p o u l t r y , f i s h and eggs were r e p o r t e d as the main source o f f a t i n the d i e t . The average a d o l e s c e n t consumed 2 - 2 3/4 cups of m i l k d a i l y . Knowledge of R i s k - F a c t o r s A review of the l i t e r a t u r e i n d i c a t e s a low l e v e l of knowledge of c a r d i o v a s c u l a r r i s k s i n the community. The H a r r i s study (1973) r e v e a l e d t h a t the ge n e r a l p u b l i c has l i t t l e knowledge of the r i s k - f a c t o r s of c a r d i o v a s c u l a r d i s e a s e . Among a l l e d u c a t i o n a l groups on l y 40 p e r c e n t knew t h a t people c o u l d have high, blood pressure without obvious symptoms. Only 13 pe r c e n t r e l a t e d h i g h b l o o d p r e s s u r e to h e a r t t r o u b l e and 24 to 36 p e r c e n t mentioned smoking as a r i s k - f a c t o r . A community survey i n Ca l g a r y , A l b e r t a (Mackie, 19 73) found t h a t 53 p e r c e n t mentioned overweight as a c a r d i o v a s c u l a r r i s k -f a c t o r , 42 p e r c e n t mentioned smoking, 12 per c e n t mentioned c h o l e s t e r o l and 25 pe r c e n t mentioned i n s u f f i c i e n t e x e r c i s e . A study from the U n i v e r s i t y of Iowa looked a t the s t a t u s of c a r d i o v a s c u l a r h e a l t h knowledge among s i x t h , seventh and eighth, grade s t u d e n t s . (White, 1977.) The students completed a knowledge q u e s t i o n n a i r e . N i n e t y p e r c e n t was c o n s i d e r e d an adequate s c o r e . They found the average s i x t h , seventh and e i g h t h grade students c o u l d answer c o r r e c t l y only 38, 41 and -7-44 p e r c e n t of t e s t items, r e s p e c t i v e l y . F o l l o w i n g an e d u c a t i o n a l program there were s i g n i f i c a n t but s m a l l g a i n s . The School H e a l t h E d u c a t i o n Study (1964) i n v e s t i g a t e d h e a l t h e d u c a t i o n a l programs on a n a t i o n a l b a s i s . T h i s study found t h a t n u t r i t i o n was one of the most f r e q u e n t l y taught s u b j e c t s a t a l l grade l e v e l s , but was one of the s u b j e c t s i n which h i g h s c h o o l students were l e a s t able to answer q u e s t i o n s c o r r e c t l y . A study i n s e l e c t e d schools i n the State of South C a r o l i n a , which has mandated h e a l t h e d u c a t i o n , i n d i c a t e d t h a t students h e a l t h knowledge was weak. (Conley, 1978.) Risk A t t i t u d e s There has been a v a s t amount of r e s e a r c h i n r e c e n t years on the e f f e c t s of p e r s u a s i o n communications and the impact of v e r b a l communication on knowledge, a t t i t u d e and p r a c t i c e . McGuire (1969) d e s c r i b e s the independent v a r i a b l e s i n most a t t i t u d e change s t u d i e s as the source of the message, the message i t s e l f and the r e c i p i e n t of the message. The source person i s d e s c r i b e d as having p e r s u a s i v e impact to the e x t e n t t h a t he i s c o n s i d e r e d to be communicating the t r u t h . (McGuire, 19 6 9.) The p e r s u a s i v e impact i s d e s c r i b e d as i n c r e a s i n g l i n e a r l y as a f u n c t i o n o f the p e r c e i v e d s i m i l a r i t y between the source and the r e c i p i e n t . (Byrne, 1971.) The e x p e r t source i s o f t e n very d i s s i m i l a r to the r e c i p i e n t ; f o r example, the cancer e x p e r t and the 12-year o l d . A study shows t h a t the most e f f e c t i v e source i s an i n t e r m e d i a t e l e v e l between these two extremes. (Latane and Wheeler, 1966.) I t i s suggested t h a t - 8 -t h e p e r c e i v e d p o w e r o f t h e s o u r c e a l s o e n c i l a n c e s t h e p e r s u a s i v e i m p a c t . ( M c G u i r e , 1 9 6 9 .). T h e s e c o n d c o m p o n e n t o f t h e c o m m u n i c a t i o n s i t u a t i o n i s t h e m e s s a g e i t s e l f . R e s e a r c h , f i n d i n g s c l e a r l y i n d i c a t e t h a t p e r s u a s i v e i m p a c t i s g r e a t e s t w h e n t h e m e s s a g e n o t o n l y i n c l u d e s a l l t h e a r g u m e n t s b u t a l s o e x p l i c i t l y d r a w s t h e c o n c l u s i o n f o r t h e l i s t e n e r . C M c G u i r e , 1 9 6 9 ; H b v l a n d a n d M a n d e l l , 1 9 5 2 . ) M o s t s t u d i e s a l s o t e n d t o i n d i c a t e . t h a t t h e a m o u n t o f o p i n i o n c h a n g e g e n e r a l l y i n c r e a s e s w i t h d i s c r e p a n c y , t h e l a r g e r t h e c h a n g e a d v o c a t e d t h e m o r e l i k e l y i t w i l l o c c u r . ( B e r g i n , 1 9 6 2 ; H o v l a n d a n d P r i t z k e r , 1 9 5 7 . ) M a n y s t u d i e s h a v e l o o k e d a t " f e a r a r o u s a l " m e s s a g e s . T h e a s s u m p t i o n i s t h a t t h r e a t m e d i a t e s f e a r , a n d t h a t f e a r i s a b a s i c d r i v e t h a t e n g e n d e r s r e s p o n d i n g . T h e h o p e i s t h a t t h e r e s p o n s e s e n g e n d e r e d w i l l b e t h o s e a d v o c a t e d i n t h e m e s s a g e . S t u d i e s h a v e s h o w n t h a t c e r t a i n f e a r - a r o u s i n g m e s s a g e s l e a d t o m o r e c h a n g e a l t h o u g h g e n e r a t i o n o f a h i g h l e v e l o f f e a r m a y p r e v e n t c h a n g e . ( L e v e n t h a l , 1 9 7 0 ; L e v e n t h a l , W a t t s a n d P a g a n o , 1 9 6 7 . ) T h e t h i r d c o m p o n e n t i n t h e p e r s u a s i o n m o d e l i s t h e r e c e i v e r . W h a t d o e s t h e r e c e i v e r b r i n g t o t h e m e s s a g e ? S t u d i e s h a v e s h o w n t h e r e m a y b e a n e g a t i v e r e l a t i o n s h i p b e t w e e n s e l f - e s t e e m a n d i n f l u e n c e a b i l i t y . H o w e v e r , i t h a s b e e n s h o w n t h a t o p t i m a l p e r s u a s i o n o c c u r s w h e n t h e a u d i e n c e i s h i g h e n o u g h i n s e l f - e s t e e m t o e n s u r e a h i g h l e v e l o f r e c e p t i o n - c o m p r e h e n s i o n , b u t n o t s o h i g h a s . t o e n s u r e ' t h e k i n d o f s e l f - c o n f i d e n c e t h a t m a k e s r e j e c t i o n o f t h e m e s s a g e a l i k e l y o u t c o m e . C M c G u i r e , 1 9 6 9 . ) -9-There i s l i t t l e c o n s i s t e n c y i n the data on i n t e l l i g e n c e and i n f . l u e n c e a b i l i t y . McGuire (1969) i n d i c a t e s th.at i n t e l l i g e n c e leads to b e t t e r r e c e p t i o n and comprehension but i m p l i e s a lower p r o b a b i l i t y of y i e l d i n g . When a message i s presented i n a s i t u a t i o n which ensures a t t e n t i o n , i . e . , the classroom i n a form which i s not d i f f i c u l t to. l e a r n , comprehension i s most l i k e l y . (Hovland, 1953.) When a p e r s u a s i v e message i s presented to an a d o l e s c e n t p o p u l a t i o n s e v e r a l s p e c i f i c f a c t o r s should be taken i n t o con-s i d e r a t i o n . Adolescence i s a time when some r e b e l l i o n a g a i n s t the a d u l t world takes p l a c e and peer i n f l u e n c e i s most important and i t i s u n l i k e l y t h a t h e a l t h - r e l a t e d behaviour can be a f f e c t e d i n t h i s age group un l e s s the peer group phenomena i s taken i n t o account. I t i s a l s o a time when, r i s k - t a k i n g emerges and i s d e l i b e r a t e l y entered i n t o as a form of c h a l l e n g e . (Rosenberg, 1965.) The i n f l u e n c e of p s y c h o s o c i a l f a c t o r s i n s c h o o l c h i l d r e n s ' smoking has been the s u b j e c t o f a number of s t u d i e s . Some of these have p a i d p a r t i c u l a r a t t e n t i o n to p a r e n t a l smoking (Bewley, 1974), peer group smoking (Bynner, 1969), and type of s c h o o l (Holland, 1969) . Many h a b i t s o f l i f e s t y l e are a c q u i r e d by c h i l d r e n d u r i n g t h e i r years a t s c h o o l and the. development of these i s i n f l u e n c e d by v a r i o u s f a c t o r s a c t i n g both i n s i d e and o u t s i d e s c h o o l : the a c t i o n s of teachers are a major i n f l u e n c e a t t h i s time. (Egsmose, 1973.) Morrison and Maclntyre (1971) suggest t h a t c h i l d r e n i m i t a t e what they p e r c e i v e as c o r r e c t -10-grownup behaviour and t h i s probably i n c l u d e s smoking behaviour. One review c i t e s over 60 s c h o l a r l y i n v e s t i g a t i o n s p e r t i n e n t to a d o l e s c e n t smoking behaviour. (Williams, 1972.) Other Stud i e s of E d u c a t i o n a l H e a l t h Programs Because of the recency of h e a r t h e a l t h e d u c a t i o n few s t u d i e s have been r e p o r t e d . There are a number of r e p o r t s of e d u c a t i o n a l programs d i r e c t e d towards s p e c i f i c h e a l t h - r i s k b e h a v i o u r s . A C a l i f o r n i a S t a t e Department of E d u c a t i o n (1969 and 1970) b e f o r e -a n d - a f t e r study of knowledge, a t t i t u d e and use of drugs a s s o c i a -ted w i t h a t r a d i t i o n a l drug e d u c a t i o n a l program i n the schools showed p o s i t i v e r e s u l t s i n the knowledge and a t t i t u d e areas but showed no decrease i n drug use. However, most students f e l t t h e i r s c h o o l program had some p o s i t i v e i n f l u e n c e on t h e i r d e c i s i o n not to misuse drugs. A b e f o r e - a n d - a f t e r e v a l u a t i o n of a s h o r t - t e r m drug e d u c a t i o n a l program (Swisher, 1971) showed a knowledge i n c r e a s e but l i t t l e a t t i t u d e or b e h a v i o u r a l change. A very w e l l designed study by Swisher i n 197 2 comparing three d i f f e r e n t e d u c a t i o n a l drug programs wi t h a c o n t r o l group showed t h a t n o t h i n g seemed to i n f l u e n c e a t t i t u d e s or r e p o r t e d behaviour. F u r t h e r s t u d i e s by Swisher (19 7 3) and Tennant (197 3) came to the same c o n c l u s i o n . S p i t z h a g e l (1978) showed an a p p r e c i a b l e i n c r e a s e i n know-ledge f o l l o w i n g a program of s t a n d a r d i z e d i n s t r u c t i o n i n f a c t o r s r e l a t i n g to smoking. He a l s o showed a p o s i t i v e change i n a t t i t u d e of non-smokers but a r e l a t i v e l y unchanged a t t i t u d e i n smokers. -11-A study i n th.e New York m e t r o p o l i t a n area i n d i c a t e d t h a t a b e h a v i o u r a l l y - o r i e n t e d cancer and c a r d i o v a s c u l a r d i s e a s e e d u c a t i o n a l program i n c r e a s e d th.e knowledge of the p a r t i c i p a n t s . CEng, 1979.) The B e r k l e y P r o j e c t p r o v i d e d a m u l t i p l i c i t y o f l e a r n i n g experiences t h a t emphasized health, problems a f f e c t i n g the d i g e s t i v e t r a c t , lungs, h e a r t and b r a i n . Research on the e f f e c t s of the p r o j e c t i n d i c a t e t h a t students 1 c a r d i o v a s c u l a r h e a l t h knowledge improved. (Hert, 1977.) A study of the e f f e c t s of a Heart Health. I n s t r u c t i o n a l Model upon the h e a r t health, behaviour o f asymptomatic u n i v e r s i t y students was conducted a t two S.U.N.Y. campuses i n western New York. Experimental groups at both campuses r e c e i v e d i n s t r u c t i o n r e l a t e d t o n u t r i t i o n , e x e r c i s e , smoking and r e l a x a t i o n w h i l e c o n t r o l groups a t both campuses r e c e i v e d i n s t r u c t i o n i n non-h e a r t h e a l t h areas. Although data c o l l e c t e d on e x e r c i s e , smoking and s t r e s s changed i n the expected d i r e c t i o n , only the n u t r i -t i o n a l h y p o thesis was supported. ( A f f l e c k , 197 8.) The e f f e c t s of a c a r d i o v a s c u l a r n u t r i t i o n a l e d u c a t i o n a l program upon h i g h s c h o o l b i o l o g y students' n u t r i t i o n a l behaviour were e v a l u a t e d by an a n a l y s i s of b e f o r e - a n d - a f t e r program data. Improvements were observed i n n u t r i t i o n a l knowledge, n u t r i t i o n a l a t t i t u d e s and r e p o r t e d e a t i n g behaviour. ( P o d e l l , 1978.) A study by M c A l i s t e r C19 78) r e p o r t e d r e s u l t s of a smoking i n t e r v e n t i o n program based on p s y c h o l o g i c a l i n o c u l a t i o n theory. The i d e a is: t h a t we can expect adolescents to be exposed to p r e s s u r e s to s t a r t smoking. I f the a d o l e s c e n t has been exposed to p o s s i b l e p r e s s u r e s i t u a t i o n s , and taught s k i l l s to d e a l with, these s i t u a t i o n s , the i n i t i a t i o n of smoking behaviour may be avoided. The study by M c A l i s t e r (1979) r e p o r t e d th.at c l a s s e s exposed to a program u t i l i z i n g i n o c u l a t i o n theory d i d i n f a c t have fewer students who adopted smoking behaviour. -13-CHAPTER I I THEORY, RATIONALE AND OBJECTIVES OF STUDY Theory and R a t i o n a l e The theory behind measuring the e f f e c t s o f an e d u c a t i o n a l program on the knowledge, a t t i t u d e and p r a c t i c e of r i s k -behaviours of a group of hig h s c h o o l students stems from l e a r n i n g and b e h a v i o u r a l theory. The authors of "Taxonomy of Edu c a t i o n O b j e c t i v e s " (Bloom, 1956) r e f e r t o the concepts of knowledge, a t t i t u d e and p r a c t i c e as the c o g n i t i v e , a f f e c t i v e and a c t i o n domains. The c o g n i t i v e domain r e l a t e s to the i n d i v i d u a l ' s a b i l i t y to d e a l w i t h knowledge and f a c t u a l i n f o r -mation from an i n t e l l e c t u a l p e r s p e c t i v e . I t i s arranged i n t o s i x major c l a s s e s which move from a knowledge of f a c t s to the comprehension, a p p l i c a t i o n , a n a l y s i s and s y n t h e s i s of the f a c t s . In the f i n a l step the i n d i v i d u a l makes a d e c i s i o n based on the q u a l i t a t i v e o r q u a n t i t a t i v e judgments of the accuracy, e f f e c -t i v e n e s s or value of an i d e a or s o l u t i o n . The a f f e c t i v e domain i n c l u d e s a t t i t u d e s and v a l u e s . Rokeach (.1966) d e f i n e d a t t i t u d e as a r e l a t i v e l y enduring organ-i z a t i o n of b e l i e f s about an o b j e c t or s i t u a t i o n . McGuire (1973) d e s c r i b e d s i x b e h a v i o u r a l steps i n the process of a t t i t u d i n a l development; being presented w i t h the s t i m u l u s , a t t e n d i n g to i t , comprehending, y i e l d i n g , r e t a i n i n g the new p o s i t i o n and behaving on the b a s i s o f i t . The p o s s e s s i o n of c o r r e c t i n f o r m a t i o n w i l l not always l e a d to a person choosing h e a l t h f u l behaviour. Humans are moved to -14-a c t i o n f o r a v a r i e t y of reasons. The f a c t o r s t h a t i n f l u e n c e health, behaviour can be c a t e g o r i z e d i n t o e x t e r n a l f a c t o r s such as environment, f a m i l y , p e e r s , mass media and i n t e r n a l f a c t o r s such, as p e r s o n a l i t y , i n t e l l i g e n c e , emotion. Knowledge may or may not motivate an i n d i v i d u a l to a more h e a l t h f u l s t a t e . Many fa c t o r s : i n f l u e n c e the r e c e p t i o n of the i n f o r m a t i o n i n c l u d i n g q u a l i t i e s a t t r i b u t e d t o the source, the content o f the message and i n h e r e n t f a c t o r s o f the r e c i p i e n t . There are v a r i o u s stages between knowing a f a c t and e x e c u t i n g a behaviour. Throughout t h e i r l i v e s i n d i v i d u a l s are bombarded by an i n f i n i t e number of s t i m u l i . They p e r c e i v e o n l y those t h a t are important to them at the time because of t h e i r i n i t i a l mental s e t . Once the s t i m u l i i s p e r c e i v e d , i t i s analysed i n terms, of p e r s o n a l experience and, i f i t has p e r s o n a l meaning, the i n d i v i d u a l w i l l proceed to the f i n a l s t e p of a c t i o n . The l i k e l i h o o d of a c t i o n depends on the balance between the rewards and p a y - o f f s f o r change and the c o s t , inconvenience, p a i n or s o c i a l obstacles, a s s o c i a t e d w i t h the change. I t a l s o depends on the complexity and the magnitude of the change expected. The f o l l o w i n g c o n c e p t u a l scheme (see F i g u r e One) attempts to e x p l a i n h e a l t h behaviour change b y ; d e s c r i b i n g some of the many f a c t o r s i n v o l v e d i n t h i s change. The i n d i v i d u a l w i t h c e r t a i n health, knowledge a t t i t u d e s and behaviours, because of p r i o r i n f l u e n c e and e x p e r i e n c e s , i s exposed to a new i n f l u e n c e , such as -15-an e d u c a t i o n a l program. The e f f e c t of t h i s s t i m u l u s i s d e s c r i b e d i n terms of the source and content of the stimulus and the age, sex, p e r s o n a l i t y , s o c i a l c l a s s , i n t e l l i g e n c e , peers, f a m i l y , of the i n d i v i d u a l exposed to the s t i m u l u s . The g e n e t i c back-ground, p r i o r c o n t a c t w i t h d i s e a s e , and experience of i l l h e a l t h of the i n d i v i d u a l are a l s o considered.. The d e c i s i o n reached by the i n d i v i d u a l a f t e r comprehending, a n a l y s i n g , s y n t h e s i z i n g and e v a l u a t i n g the stimulus may e f f e c t behaviour, change depending on the p o s i t i v e or n e g a t i v e support of f a m i l y , peers and environment. SOCIAL INFLUENCES Demographic V a r i a b l e s Age, Sex, Race, Ed u c a t i o n Sbcio-psychol6 g i c a1 V a r i a b l e s P e r s o n a l i t y T r a i t s , S o c i a l C l a s s , Peers, I n t e l l i g e n c e , Family COMMUNICATION STIMULI Source of Communication School H e a l t h Education, Mass Media C h a r a c t e r i s t i c s o f  Source of Communication C r e d i b l e , S i m i l a r to R e c i p i e n t Content of Communication Fear, L o g i c INDIVIDUAL BEFORE INTERVENTION DECISION INDIVIDUAL AFTER INTERVENTION I n d i v i d u a l 1 s Knowledge, A t t i t u d e , P r a c t i c e o f Relevant Risk Components of D e c i s i o n Comprehension, A n a l y s i s , S y n t h e s i s , E v a l u a t i o n I n d i v i d u a l 1 s Knowledge, A t t i t u d e , P r a c t i c e o f Relevant Risk SOCIAL SUPPORTS FIGURE 1 - CONCEPTUAL SCHEME D e s c r i b i n g H e a l t h Behaviour Change S o c i a l Support For or  A g a i n s t R i s k - F a c t o r Change Family, Peers, Environment -17-Hypotheses The hypotheses to be t e s t e d i n t h i s study are t h a t students exposed to. an e d u c a t i o n a l program d i r e c t e d towards r e d u c i n g c a r d i o v a s c u l a r r i s k - b e h a v i o u r s w i l l : CI) have more knowledge about c a r d i o v a s c u l a r r i s k -behaviours than students who are not exposed to the program; (2) have a more' p o s i t i v e a t t i t u d e towards r e d u c i n g c a r d i o v a s c u l a r r i s k - b e h a v i o u r s than students who are not exposed to the program; (3) w i l l change t h e i r behaviour i n such a way as to p r a c t i c e fewer r i s k - b e h a v i o u r s than students who are not exposed to the program. E d u c a t i o n a l Program The e d u c a t i o n a l program p r o v i d e d by the B r i t i s h Columbia Heart Foundation was s e l e c t e d as the program to be used i n t e s t i n g the hypotheses. I t was chosen because the h e a l t h o b j e c t i v e s of those who developed the program were s i m i l a r to the hypotheses to be t e s t e d and because i t was the o n l y e d u c a t i o n a l program a v a i l a b l e i n Vancouver a t the time o f t h i s study d i r e c t e d towards the t o p i c o f 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 used i n the h i g h s c h o o l s e t t i n g . P h y s i c a l and Socio-demographic S e t t i n g of the Study E r i c Hamber School was chosen as the s e t t i n g f o r the study because i t i s s i t u a t e d i n the s e r v i c e area o f the author -18-and because the a d m i n i s t r a t i o n and s t a f f of the s c h o o l were i n t e r e s t e d and c o o p e r a t i v e . I t i s a s c h o o l s i t u a t e d i n the west area o f the C i t y o f Vancouver. The 1976 census g i v e s the p o p u l a t i o n o f Vancouver as 396,563 wit h an average income of $10,519.00. E r i c Hamber i s a p u b l i c high s c h o o l under the j u r i s d i c t i o n of the Vancouver School Board. The student p o p u l a t i o n of the s c h o o l i s 1,832 with an approximate student teacher r a t i o of 30:1. Th.e r a t i o of males to females i s approximately e q u a l . The s c h o o l i n c l u d e s grades 8 to 12 i n c l u s i v e . The m a j o r i t y of the students come from a m i d d l e - c l a s s bakcground. The m a j o r i t y o f the students i n the s c h o o l are p r e p a r i n g f o r u n i v e r s i t y entrance. The s c h o o l i s o r g a n i z e d on a two-semester program each year; the f i r s t semester runs from September to the end of January, the second semester runs from February to the end o f June. Research O b j e c t i v e s The o b j e c t i v e s of the p r e s e n t study are to measure: (1) the change i n knowledge of a group o f h i g h s c h o o l students about the 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 ; smoking, p h y s i c a l i n a c t i v i t y , h i g h - f a t d i e t ; (2) the change i n a t t i t u d e of a group o f high s c h o o l students towards the 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 ; smoking, p h y s i c a l i n a c t i v i t y and h i g h - f a t d i e t ; (3) the change i n p r a c t i c e of these r i s k - f a c t o r s by the students; -19-f o l l o w i n g exposure to a s h o r t - t e r m e d u c a t i o n a l program d i r e c t e d towards r e d u c i n g c a r d i o v a s c u l a r r i s k . S i g n i f i c a n c e There i s an e v e r - i n c r e a s i n g demand by h e a l t h educators f o r a l a r g e r share of time and money resou r c e s of the s c h o o l system. Many community o r g a n i z a t i o n s , i n c l u d i n g the A l c o h o l and Drug Foundation, Planned Parenthood, the B.C. Heart Foundation, to name a few, ask the c i t i z e n and the government f o r funds to f i n a n c e e d u c a t i o n a l programs i n the s c h o o l s . School a d m i n i s t r a t o r s are a s k i n g f o r evidence t h a t there i s value i n a l l o c a t i n g time to these programs. With, the present-day i n t e r e s t i n methods of m o d i f y i n g c a r d i o -v a s c u l a r r i s k - b e h a v i o u r s , there has been l i t t l e work done i n the area of e v a l u a t i n g e d u c a t i o n a l programs d i r e c t e d towards m o d i f y i n g these behaviours. T h i s study i s expected to p r o v i d e some evidence of the e f f i c a c y of a s h o r t - t e r m h e a l t h e d u c a t i o n a l program and h e l p s c h o o l a d m i n i s t r a t o r s to p l a n f u t u r e programs. CHAPTER I I I METHODS A sample of h i g h s c h o o l students who were exposed to an e d u c a t i o n a l program were examined i n an attempt to i d e n t i f y d i f f e r e n c e s i n knowledge, a t t i t u d e and p r a c t i c e of d e s i g n a t e d 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 when compared wi t h a group t h a t d i d not r e c e i v e the e d u c a t i o n a l program. Thaepende n t Variab1e The independent v a r i a b l e i s the st i m u l u s v a r i a b l e or i n p u t . In t h i s study the independent v a r i a b l e i s the e d u c a t i o n a l program t h a t i s p r e s e n t e d t o one group and w i t h h e l d from the o t h e r . The e d u c a t i o n a l program o f f e r e d by the B.C. Heart Foundation to each c l a s s was a one-hour p r e s e n t a t i o n by the h e a l t h educator o f the B.C. Heart Foundation who was a middle-aged female who admitted to the students t h a t she smoked. The program was presented i n a r e g u l a r classroom s i t u a t i o n . The educator presented the same f i l m i n the same way to each c l a s s . The h e a l t h educator i n t r o d u c e d h e r s e l f , said: who she re p r e s e n t e d and why she was i n the s c h o o l . She then showed a f i l m "I Am Joe's Heart" produced by the American Heart A s s o c i a t i o n . Henry Morgan i s the p e r s o n a l i t y v o i c e i n t h i s animated and l i v e l y f i l m . Joe, an average American, does not e x e r c i s e , smokes h e a v i l y , i s overweight, and g i v e s l i t t l e thought to proper d i e t . The drama and f e a r o f Joe having a h e a r t a t t a c k i s p o r t r a y e d . Joe reco v e r s and changes h i s l i f e s t y l e . The message i s a p l e a f o r - 2 1 -understanding the h e a r t and r i s k - f a c t o r s i n order t o reduce the r i s k o f h e a r t a t t a c k . The w r i t t e n m a t e r i a l d i s c u s s e d b r i e f l y w i t h the students and g i v e n t o them t o keep i n c l u d e d pamphlets: (:1) "Food and Your Heart" - Discu s s e d how the food eaten a f f e c t s the h e a r t , what should be eaten to reduce the r i s k o f h e a r t d i s e a s e , l i m i t i n g th.e amount of f a t i n the d i e t , what i s c h o l e s t e r o l . C 2 ) " P h y s i c a l A c t i v i t y and Your Heart" - Di s c u s s e d the known e f f e c t s o f e x e r c i s e on the f u n c t i o n i n g o f the h e a r t , types o f a c t i v i t i e s and frequency necessary to reduce the r i s k o f h e a r t a t t a c k s . C3) "What Everyone Should. Know About Smoking and Heart Disease" - Discu s s e d the e f f e c t s of smoking on the h e a r t f u n c t i o n and the r i s k s of smoking i n r e l a t i o n t o h e a r t d i s e a s e . (4) "About Your Heart and Your Bloodstream", "Your Heart and How I t Works" - Di s c u s s e d the anatomy and p h y s i o l o g y of the h e a r t . The package a l s o i n c l u d e d drawings o f the h e a r t and c i r c u l a t i o n and anti-smoking p o s t e r s . The Dependent V a r i a b l e s The dependent v a r i a b l e s are the response or output v a r i a b l e s . The dependent v a r i a b l e s are those f a c t o r s which are observed and measured to determine the e f f e c t o f the independent v a r i a b l e . - 2 2 -Th.e dependent v a r i a b l e s i n t h i s study are the l e v e l s o f knowledge, a t t i t u d e and behaviour of 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 . The 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 are d e f i n e d as smoking, p h y s i c a l i n a c t i v i t y and h i g h - f a t d i e t . The l e v e l of knowledge of 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 i s d e f i n e d by the number of c o r r e c t answers to f a c t u a l q u e s t i o n s about 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 . The l e v e l of a t t i t u d e i s d e f i n e d by the number o f answers to q u e s t i o n s about 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 which i n d i c a t e a p o s i t i v e a t t i t u d e towards behaviours t h a t reduce the r i s k . The l e v e l s of behaviour are d e f i n e d by the responses to qu e s t i o n s about a c t u a l behaviour of the s u b j e c t . A c t i v i t y l e v e l i s d e f i n e d by the l e v e l of p h y s i c a l f i t n e s s as measured by the Canada Home F i t n e s s T e s t . In t h i s study i t i s expected t h a t students who are exposed to the e d u c a t i o n a l program w i l l answer c o r r e c t l y more qu e s t i o n s about the e f f e c t s of smoking, p h y s i c a l i n a c t i v i t y and h i g h - f a t d i e t on the f u n c t i o n i n g of the h e a r t . I t i s expected t h a t students exposed to the e d u c a t i o n a l program w i l l answer more questions i n a manner which i n d i c a t e s they have a p o s i t i v e a t t i t u d e towards the importance of r e d u c i n g smoking, i n c r e a s i n g a c t i v i t y and e a t i n g a d i e t low i n f a t s . I t i s expected t h a t students exposed to the program w i l l i n d i c a t e by t h e i r responses to ques t i o n s a s k i n g about behaviours t h a t they smoke l e s s , are more a c t i v e and e a t l e s s f a t than students not exposed to the program. - 2 3 -Re search. Design A p r e t e s t , p o s t t e s t c o n t r o l d e sign was used i n t h i s study. Two groups were employed i n t h i s d esign; one group, the e x p e r i -mental group, r e c e i v e d a treatment, while the second group, the c o n t r o l group, d i d not. Both groups were gi v e n a p r e t e s t and posttes-t. The assignment of s u b j e c t s to both groups was done on a random b a s i s . By the u t i l i z a t i o n o f a c o n t r o l group, which has a l l the same experiences as the experimental group, other than the experience of the treatment i t s e l f , t h i s d e s i g n c o n t r o l s f o r h i s t o r y , maturation and r e g r e s s i o n . By randomizing s u b j e c t s across experimental and c o n t r o l c o n d i t i o n s , both s e l e c t i o n and m o r t a l i t y are c o n t r o l l e d . T h i s d e s i g n c o n t r o l s many t h r e a t s to v a l i d i t y or source o f b i a s . One problem w i t h t h i s d e s i g n i s t h a t i t does not c o n t r o l f o r g a i n i n the p o s t t e s t due to l e a r n i n g i n the p r e t e s t and t h i s may reduce i n t e r n a l v a l i d i t y . A study has i n t e r n a l v a l i d i t y i f the outcome of the study i s the f u n c t i o n of the program being t e s t e d r a t h e r than the r e s u l t of o t h e r causes not s y s t e m a t i c a l l y d e a l t w i t h i n the study. F a c t o r s which, i f not c o n t r o l l e d , may be a source of i n t e r n a l i n v a l i d i t y i n c l u d e h i s t o r y , maturation, t e s t i n g , i n s t r u m e n t a t i o n , s e l e c t i o n , e xperimental m o r t a l i t y or s t a t i s t i c a l r e g r e s s i o n . A study has e x t e r n a l v a l i d i t y i f the r e s u l t s o b tained would apply i n the r e a l world to other s i m i l a r programs and approaches. The more c o n t r o l l e d and s p e c i f i c the study i s the more d i f f i c u l t i t i s to - 2 4 -g e n e r a l i z e the r e s u l t s to other s i t u a t i o n s . Th.e p r e t e s t scores f o r each group were compared to assess p r e - e x p e r i m e n t a l e q u i v a l e n c e of groups and then the p o s t t e s t scores f o r each group were compared to determine the e f f e c t s of the treatment. Measuring Instruments The measuring instruments used were a paper and p e n c i l q u e s t i o n n a i r e and the Canada Home F i t n e s s T e s t . The q u e s t i o n n a i r e was used to measure what the students knew, what the students- b e l i e v e d , and s e l f - r e p o r t e d b e haviours. The i n f o r m a t i o n was d e s c r i b e d by counting the number of students who gave a p a r t i c u l a r response. Some q u e s t i o n items were i n the form of qu e s t i o n s r e q u i r i n g a "yes", "no", or a " t r u e " , " f a l s e " response. Some quest i o n s r e q u i r e d the student t o f i l l i n a blank w i t h a c o r r e c t word. Some quest i o n s r e q u i r e d the student to make a ch o i c e of the c o r -r e c t answer from s e v e r a l o f f e r e d responses. In p r e p a r i n g the q u e s t i o n n a i r e the content of the program was d e l i n e a t e d and the o b j e c t i v e s examined i n an attempt to develop t e s t items which r e f l e c t e d the content and o b j e c t i v e s of the program. The q u e s t i o n n a i r e was not t e s t e d f o r r e l i a b i l i t y . A p i l o t t e s t was not done and t e s t items were not t e s t e d f o r d i f f i c u l t y nor f o r d i s c r i m i n a b i l i t y . The q u e s t i o n n a i r e used was not a stand-a r d i z e d t e s t so i t s v a l i d i t y cannot be r e p o r t e d . -25-The data generated fay "the q u e s t i o n n a i r e was nominal d a t a . C a t e g o r i c a l responses were obtained on s i n g l e items and the number of respondents who gave a p a r t i c u l a r response to t h a t item were counted. The Canada Home Fitness: T e s t was used as a measure of f i t n e s s as a product of a c t i v i t y . The Canada Home F i t n e s s T e s t was a d m i n i s t e r e d to f i f t e e n students a t one time u s i n g the s p e c i a l l y - c o n s t r u c t e d s:tep benches. The students were taught to take t h e i r p u l s e . Several, p r a c t i c e runs and t e s t s f o r accuracy were made. The TO second r e s t i n g p u l s e a f t e r three minutes o f e x e r c i s e was recorded. The r e c o r d i n g was done by s e n i o r students who recorded the p u l s e as r e p o r t e d to them by the p a r t i c i p a n t s . The Canada Home F i t n e s s T e s t i s a s e l f - a d m i n i s t e r e d procedure i n which the p a r t i c i p a n t steps a t a p a r t i c u l a r r a t e designed f o r each age group and c o n t r o l l e d by recor d e d music. The p u l s e i s pa l p a t e d immediately f o l l o w i n g a c t i v i t y . V a l i d a t i o n o f the t e s t has shown a c o r r e l a t i o n o f 0.72 with the r e s u l t s o f a standard submaximum b i c y c l e ergometer t e s t , w h i l e the d i r e c t l y - m e a s u r e d maximum oxygen i n t a k e i s c o r r e l a t e d even more c l o s e l y (r = .88} w i t h the a t t a i n e d s t e p p i n g r a t e , body weight and re c o v e r y h e a r t r a t e . Given modest t r a i n i n g , s u b j e c t s c o u l d measure t h e i r immediately p o s t - e x e r c i s e h e a r t r a t e ( c o r r e l a t i o n w i t h e l e c t r o - c a r d i o g r a p h i c data P = 0.94), although the 10 second counts underestimated the tr u e r a t e by an average of seven b e a t s . (Shephard, 1976.) -26-Sampling Methods The study sample c o n s i s t e d o f a l l the students i n grade 9 and o n e - h a l f o f the students in,grades ; 10. and 11, and numbered 510. A l l o f these students attended guidance c l a s s e s d u r i n g the second semester from January to June, 1977, which was the time i n which the study was c a r r i e d o u t . The students were randomly a s s i g n e d to the guidance c l a s s e s a t the b e g i n n i n g o f the semester. Of the t o t a l o f 510 students i n the study, 287 were randomly a s s i g n e d to the i n t e r v e n t i o n group and 14 8 to the non-i n t e r v e n t i o n group. A t h i r d group o f 74 students were a s s i g n e d to a group to be p o s t t e s t e d o n l y . I t was l a t e r d e c i d e d to exclude t h i s group from the study. A t o t a l o f 192 students from the 287 students a s s i g n e d to the i n t e r v e n t i o n group completed both the p r e - and p o s t -q u e s t i o n n a i r e s and 109 o f the 148 a s s i g n e d to the n o n - i n t e r v e n t i o n group completed both the p r e - and p o s t - q u e s t i o n n a i r e s . Of the 192 students i n the i n t e r v e n t i o n group who completed both the pre- and p o s t - q u e s t i o n n a i r e s , 176 took p a r t i n both the p r e - and p o s t - f i t n e s s t e s t i n g . Of the 109 students i n the n o n - i n t e r v e n t i o n group who completed both the p r e - and p o s t - q u e s t i o n n a i r e s , 89 took p a r t i n both, the p r e - and p o s t - f i t n e s s t e s t i n g . - 2 7 -Implementation of Study The p r o j e c t was d i s c u s s e d with, the s c h o o l p r i n c i p a l wh.o was encouraging. A meeting was then h e l d with, the Guidance and P h y s i c a l E d u c a t i o n a l Department heads to e x p l a i n the p r o j e c t to them and ask f o r t h e i r support. The P h y s i c a l E d u c a t i o n a l Department head arranged f o r time and s c h e d u l i n g of the f i t n e s s t e s t i n g . The Guidance Department head arranged f o r the d i s t r i -b u t i o n , s u p e r v i s i o n and c o l l e c t i o n of the q u e s t i o n n a i r e s and the s c h e d u l i n g o f the e d u c a t i o n a l program. The h e a l t h educator o f the B.C. Heart Foundation agreed to pr o v i d e the e d u c a t i o n a l program d u r i n g the r e q u i r e d time. The program pr o v i d e d was s i m i l a r to one r e g u l a r l y p r o v i d e d on re q u e s t throughout the schools i n B r i t i s h . Columbia. The Y.M.C.A. was approached to pr o v i d e . t h e p e r s o n n e l to adm i n i s t e r the Canada Home F i t n e s s T e s t . T h i s i s a s e r v i c e s u p p l i e d t o schools and othe r groups on r e q u e s t . The m a t e r i a l s were s u p p l i e d by A c t i o n B.C. The q u e s t i o n n a i r e was produced w i t h the c o o p e r a t i o n of U.B.C., the Vancouver H e a l t h Department and the Vancouver School Board. The t y p i n g of the q u e s t i o n n a i r e was done by the Vancouver H e a l t h Department and the mimeographing by the o f f i c e s t a f f a t E r i c Hamber S c h o o l . The knowledge questions, o r i g i n a t e d d i r e c t l y from the w r i t t e n m a t e r i a l s u p p l i e d by the B.C. Heart Foundation. The d e s i g n f o r the benches used f o r the s t e p - t e s t i n g was r e c e i v e d from A c t i o n B.C. and the benches, l a r g e enough to t e s t - 2 8 -2Q students a t one time, were b u i l t by the Woodworking Depart-ment of E r i c Hamber S c h o o l . An o u t l i n e of the p r o j e c t was submitted f o r approval t o th.e research, e v a u l a t i o n committees of the Vancouver School Board and the Vancouver H e a l t h Department and approval was granted. Procedure The students d e s c r i b e d above were assigned randomly to Group A and Group B. Group A was d e f i n e d as the i n t e r v e n t i o n group and Group B the c o n t r o l group. The guidance c o u n s e l l o r s were approached and given i n -s t r u c t i o n s on how to p r e s e n t the q u e s t i o n n a i r e to the c l a s s so t h a t each c l a s s r e c e i v e d i t i n an i d e n t i c a l way. The guidance c o u n s e l l o r s a d m i n i s t e r e d the q u e s t i o n n a i r e to each c l a s s i n Group A and Group B. The f o l l o w i n g week the p h y s i c a l e d u c a t i o n teachers sche-duled a l l of the c l a s s e s i n Groups A and B to take p a r t i n the Canada Home F i t n e s s T e s t which was admin i s t e r e d i n an i d e n t i c a l way t o each c l a s s by the i n s t r u c t o r s from the Y.M.C.A. One week l a t e r a l l the students i n Group A were scheduled to be exposed to the e d u c a t i o n a l program d u r i n g t h e i r r e g u l a r guidance c l a s s . Students i n Group B r e c e i v e d r e g u l a r guidance i n s t r u c t i o n d u r i n g t h i s hour. -29-Three months; l a t e r , a t the end of the second semester, the same guidance counsellors- again a d m i n i s t e r e d the same q u e s t i o n n a i r e u s i n g the same method to a l l the students i n Groups A and B. The same i n s t r u c t o r s from the Y.M.C.A. admi n i s t e r e d the Canada Home F i t n e s s T e s t u s i n g the same methods, to a l l the students i n Groups A and B. The r e s u l t s o f the q u e s t i o n n a i r e and the f i t n e s s t e s t were prepared f o r computing and the " S t a t i s t i c a l Package f o r the S o c i a l S c i e n c e s " was used to generate frequency t a b l e s and s t a t i s t i c a l t e s t s . D i f f e r e n c e s were examined u s i n g the c h i - s q u a r e s t a t i s t i c a l t e s t . A s i g n i f i c a n c e l e v e l o f .05 was s e l e c t e d . -30-CHAPTER IV  RESULTS A t o t a l o f 192 students i n the i n t e r v e n t i o n group completed both, the p r e - and p o s t - q u e s t i o n n a i r e s and a t o t a l of 109 students i n the n o n - i n t e r v e n t i o n group completed both the pre- and p o s t - q u e s t i o n n a i r e s . The few non-responses were excluded from the c h i - s q u a r e s t a t i s t i c a l t e s t i n g . The data c o l l e c t e d from the q u e s t i o n n a i r e s o f the two groups was t e s t e d f o r d i f f e r e n c e s . In t h i s s e c t i o n I would l i k e to address the t h r e e hypotheses. Hypothesis I Students exposed, to an e d u c a t i o n a l program d i r e c t e d towards r e d u c i n g c a r d i o v a s c u l a r r i s k - b e h a v i o u r s w i l l have more knowledge about c a r d i o v a s c u l a r r i s k - b e h a v i o u r s than students who are not exposed to the program. T h i r t y - f o u r q u e s t i o n s were asked to measure the knowledge of the students about the f u n c t i o n i n g of the h e a r t and c a r d i o v a s c u l a r r i s k s . - 3 1 -T h e f r e q u e n c y d a t a g e n e r a t e d w a s e x a m i n e d f o r d i f f e r e n c e s i n f o u r d i r e c t i o n s : C I ) b e t w e e n p r e t e s t s o f i n t e r v e n t i o n a n d n o n - i n t e r v e n t i o n g r o u p s ; ( 2 ) b e t w e e n p o s t t e s t s o f i n t e r v e n t i o n a n d n o n - i n t e r v e n t i o n g r o u p s ; ( 3 ) b e t w e e n t h e p r e - a n d p o s t t e s t s o f t h e i n t e r v e n t i o n g r o u p ; C4) b e t w e e n t h e p r e - a n d p o s t t e s t s o f t h e n o n - i n t e r v e n t i o n g r o u p . T h e d a t a i s d e m o n s t r a t e d i n d e t a i l i n T a b l e s I - X I . E x a m i n a t i o n o f t h e f r e q u e n c y d a t a o n t h e r e s p o n s e s t o t h e 3 4 k n o w l e d g e q u e s t i o n s i n d i c a t e d n o d i f f e r e n c e s b e t w e e n t h e p r o p o r t i o n o f c o r r e c t r e s p o n s e s o n t h e p r e t e s t s o f t h e i n t e r v e n t i o n a n d n o n - i n t e r v e n t i o n g r o u p s . -32-The frequency data on the responses to the 34 knowledge que s t i o n s i n d i c a t e d t h a t a s i g n i f i c a n t l y l a r g e r p r o p o r t i o n o f students i n the i n t e r v e n t i o n group gave c o r r e c t answers to the f o l l o w i n g 11 q u e s t i o n s on the p o s t t e s t s : (1) I s i t t r u e o r f a l s e t h a t people under 40 get h e a r t d i s e a s e ? (2) Is i t t r u e or f a l s e t h a t a man who i s p h y s i c a l l y f i t w i l l have a hig h e r h e a r t r a t e than a man who i s u n f i t ? (.3) Is i t t r u e o r f a l s e t h a t cancer i s the o n l y s e r i o u s d i s e a s e a s s o c i a t e d w i t h smoking? (4) Check three foods i n the f o l l o w i n g l i s t t h a t are h i g h i n c h o l e s t e r o l : (a) whipped cream (b) r i c e (c) sausages (d) coke (e) eggs -33-(5) Is i t t r u e or f a l s e t h a t people who have eaten a d i e t h i g h i n c e r t a i n f a t s a l l t h e i r l i f e are more l i k e l y to have a h e a r t a t t a c k ? C6) Is i t t r u e or f a l s e t h a t changes i n the a r t e r i e s t h a t cause h e a r t a t t a c k s b e g i n i n very young people? (.7) Is i t t r u e or f a l s e t h a t smokers run an e x t r a r i s k o f having a h e a r t a t t a c k ? (8) Is i t t r u e or f a l s e t h a t smoking makes the h e a r t beat f a s t e r i n most people? C9) and (10) More students i n the i n t e r v e n t i o n group c o r r e c t l y answered p a r t s "c" and "d" i n the f o l l o w i n g q u e s t i o n : Which three of the f o l l o w i n g have been found to be c l o s e l y a s s o c i a t e d w i t h coronary a r t e r y d i s e a s e (heart a t t a c k ) ? (a) overweight (b) r e g u l a r strenuous e x e r c i s e -34-Cc) smoking Cd) d r i n k i n g 1 - 2 ounces o f a l c o h o l a day (e) h i g h blood pressure Cf) a tragedy i n the f a m i l y (11) Is i t t r u e or f a l s e t h a t d r i n k i n g 1 - 2 ounces of a l c o h o l a day i s c l o s e l y a s s o c i a t e d w i t h coronary a r t e r y d i s e a s e ? The f o l l o w i n g 22 q u e s t i o n s generated responses t h a t i n d i c a t e d no p o s t t e s t d i f f e r e n c e s between the i n t e r v e n t i o n and n o n - i n t e r v e n t i o n groups: (1) Name one food from each o f the b a s i c f o u r food groups? (2) Is i t t r u e or f a l s e t h a t changes i n the d i e t can change the l e v e l of c h o l e s t e r o l i n the blood? (3) (4) , (5) and (6) There were no d i f f e r e n c e s between the i n t e r v e n t i o n and n o n - i n t e r v e n t i o n groups on t h e i r responses to p a r t s ( a ) , (b), (e) and (f) o f the f o l l o w i n g q u e s t i o n : -35-Which t h r e e o f the f o l l o w i n g have been found to be c l o s e l y a s s o c i a t e d w i t h coronary a r t e r y d i s e a s e (heart a t t a c k ] ? , Check three o n l y . Ca) overweight Cb) r e g u l a r strenuous: p h y s i c a l e x e r c i s e • (c) smoking (d) d r i n k i n g 1 - 2 ounces of a l c o h o l a day (e) h i g h blood p r e s s u r e Cf) a tragedy i n the f a m i l y (7) Is i t t r u e o r f a l s e t h a t t h e r e i s no r i s k i n smoking c i g a r e t t e s i f you don't i n h a l e ? C8) Is i t t r u e o r f a l s e t h a t the more c i g a r e t t e s you smoke the g r e a t e r the r i s k ? (.9) Is i t t r u e or f a l s e t h a t smoking i s more of a h e a l t h hazard f o r males than females? (10) Is i t tr u e o r f a l s e t h a t there are programes a v a i l a b l e to h e l p people stop smoking? -36-(.11) I s i t t r u e o r f a l s e t h a t m o s t p e o p l e c a n smoke a f e w c i g a r e t t e s w i t h o u t g e t t i n g t h e h a b i t ? C I2) I s i t t r u e o r f a l s e t h a t s t u d i e s h a v e shown t h a t o v e r w e i g h t i n a d o l e s c e n t s i s more o f t e n due t o i n a c t i v i t y t h a n o v e r e a t i n g ? (1.3)" I s i t t r u e o r f a l s e t h a t i f y o u d o n ' t e x e r c i s e r e g u l a r l y y o u a r e b e t t e r o f f n o t t o e x e r c i s e a t a l l ? (14) I s i t t r u e o r f a l s e t h a t t h e n o r m a l h e a r t r a t e i s 78 b e a t s p e r m i n u t e ? (15) I s i t t r u e o r f a l s e t h a t h i g h b l o o d p r e s s u r e a d d s t o t h e work l o a d o f t h e h e a r t a n d a r t e r i e s ? J o i n b y a s t r a i g h t l i n e t h e body p a r t w i t h t h e a c t i o n i t p e r f o r m s : - 3 7 -(16) Heart C a r r i e s blood from c e l l s back to h e a r t . C17I A r t e r i e s Pump which d r i v e s b l o o d . C18) C a p i l l a r i e s C a r r i e s blood from h e a r t to c e l l s . C19) Veins Place where in t e r c h a n g e o f waste products, food and gas takes p l a c e . (20) Mark the one c o r r e c t answer: The p u l s e r a t e measures: (a) the flow o f b l o o d through an a r t e r y (b) the number of times the h e a r t pumps i n a minute (c) the number o f times you breath i n a minute (21) Is i t t r u e or f a l s e t h a t t h e r e i s a r e l a t i o n -s h i p between c i g a r e t t e smoking and h e a r t d i s e a s e ? -38-C22) I s i t t r u e o f f a l s e t h a t f i l t e r s make c i g a r e t t e s s a f e r ? The responses to the IT q u e s t i o n s t h a t i n d i c a t e d a s i g n i f i c a n t p o s t t e s t d i f f e r e n c e between the i n t e r v e n t i o n and n o n - i n t e r v e n t i o n groups are d e s c r i b e d i n d e t a i l i n the f o l l o w i n g t a b l e s . - 3 9 -V a r i a b l e 4 5 Responses to the q u e s t i o n , "Is i t true or f a l s e t h a t changes i n the a r t e r i e s t h a t cause h e a r t a t t a c k s begin i n very young people?" i n d i c a t e d a s i g n i f i c a n t d i f f e r e n c e between the p r e - and p o s t t e s t s of the i n t e r v e n t i o n and n o n - i n t e r v e n t i o n group CP = . 0 0 0 4 ) and between the p o s t t e s t of the i n t e r v e n t i o n and n o n - i n t e r v e n t i o n groups CP = . 0 1 8 9 ) . The responses i n d i c a t e d t h a t more s t u d e n t s i n the i n t e r v e n t i o n group were able to answer t h i s q u e s t i o n c o r r e c t l y (See Table I ) . -40-TABLE I VARIABLE: 45 QUESTION: Changes- i n the a r t e r i e s t h a t causre h e a r t a t t a c k s begin i n very young people? ANSWER: True". ABSOLUTE AND RELATIVE FREQUENCIES NON-RESPONSE ;# • • • CORRECT # % INCOl f RRECT % PRETEST INTERVENTION NON-INTERVENTION X 2 = .2359 P = .6272 2 3 . 65 33 33.9 3 0 . 3 : 125 73 65.1 67 192 109 5 . , 98 198 301 POSTTEST INTERVENTION NON-INTERVENTION X 2 = 5.517 P = .0189 6 6 98 39 51.0 36 .1 88 63 45.8 58.3 192 108 12 137 151 300 INTERVENTION PRETEST POSTTEST X 2 = 13.067P = .0004 2 6 65 9 8 33.9 51.0 125 88 65.1 45. 8 192 192 8 163 213 384 NON-INTERVENTION PRETEST POSTTEST X 2 = 1.0567P = .3040 3 6 33 39 30.3 36.1 73 63 67 58.3 109 108 9 72 136 217 -41-V a r i a b l e 4 8 Responses: to the q u e s t i o n , "Is i t t r u e or f a l s e t h a t smoking makes the h e a r t beat f a s t e r i n most people?" i n d i c a t e d a s i g n i f i c a n t d i f f e r e n c e (to the .05 l e v e l ) between the p r e - and p o s t t e s t s of the i n t e r v e n t i o n group (P = .0013) and between the p o s t t e s t s o f the i n t e r v e n t i o n and n o n - i n t e r v e n t i o n groups (P = .0044). The responses i n d i c a t e d t h a t more students i n the i n t e r v e n t i o n group were able t o answer t h i s q u e s t i o n c o r r e c t l y (See Table II) . -42-TABLE I I VARIABLE: 48 QUESTION: Smoking makes the h e a r t beat f a s t e r i n most people? ANSWER: True. ABSOLUTE AND RELATIVE FREQUENCIES NON-RESPONSE # CORRECT # % INCO] RRECT % PRETEST INTERVENTION NON-INTERVENTION X 2 = 1.043 P = .3072 7 3 . 114 71 59.4 65.1 71 34 37 32.1 192 109 1.0 185 105 300 POSTTEST INTERVENTION NON-INTERVENTION X 2 = 8.145 P = .0044 3 1 146. 66 76 .0 61.1 43 41 22.4 38 192 108 4 212 84 300 INTERVENTION PRETEST POSTTEST X 2 = 10.77 P = .0013 7 3 114 146 59.,4 76 71 43 37 22.4 192 192 10 260 114 384 NON-INTERVENTION PRETEST POSTTEST X 2 = .8170 P = .3661 3 1 71 66 65.1 61.1 34 41 32.1 38 108 108 4 137 75 216 -43-V a r i a b l e 49 Responses to the q u e s t i o n , "Is i t t r u e or f a l s e t h a t smokers run an e x t r a r i s k of having a h e a r t a t t a c k ? " i n d i c a t e d a s i g n i f i c a n t d i f f e r e n c e (to the .05 l e v e l ) between the number of c o r r e c t responses of the pre- and p o s t t e s t s of the i n t e r v e n t i o n group (P = .0148) and the p o s t t e s t s of the i n t e r v e n t i o n and n o n - i n t e r v e n t i o n groups (P = .0066). The responses i n d i c a t e d t h a t more students i n the i n t e r v e n t i o n group were able to answer t h i s q u e s t i o n c o r r e c t l y (See Table I I I ) . -44-TABLE I I I VARIABLES 49 QUESTIONS Smokers run an e x t r a r i s k o f h a v i n g a h e a r t a t t a c k ? ANSWER: True. ABSOLUTE AND RELATIVE FREQUENCIES NON-RESPONSE •#••• CORRECT f % INCO' 1 RRECT % PRETEST INTERVENTION NON-INTERVENTION X 2 = .552 P = .9071 3 3 175 96 91.1 89 14 10 7.3 9.2 192 109 6 271 24 301 POSTTEST INTERVENTION NON-INTERVENTION X 2 * 5.227 P = .0066 • r -• 2 187 98 97.4 90.7 4 8 2.1 7.4 192 , 108 3 285 12 300 INTERVENTION PRETEST POSTTEST X 2 = 5.942 P = .0148 3 1 175 187 91.1 97.4 14 4 7.3 2.1 192 192 4 352 18 384 NON-INTERVENTION PRETEST POSTTEST X 2 = .2428 P = .6222 2 2 96 9R 89 9.0.7., 10 R 9.2 7.4 108 108 4 194 18 216 -45-V a r i a b l e 30 Responses to the q u e s t i o n , "Is i t t r u e or f a l s e t h a t d r i n k i n g 1 t o 2 ounces of a l c o h o l a day i s c l o s e l y a s s o c i a t e d w i t h coronary a r t e r y d i s e a s e ? " i n d i c a t e d a s i g n i f i c a n t d i f f e r e n c e (to the .05 l e v e l ) between the number of c o r r e c t responses o f the p r e - and p o s t t e s t s of the i n t e r v e n t i o n group (P = .0001) and a s i g n i f i c a n t d i f f e r e n c e between the p o s t t e s t of the i n t e r v e n t i o n and n o n - i n t e r v e n t i o n groups (P =' .0085). The responses i n d i c a t e d t h a t more students i n the i n t e r v e n t i o n group were ab l e to answer t h i s question" c o r r e c t l y (See Table I V ) . -46-TABLE IV VARIABLE: 30 QUESTION: D r i n k i n g 1 - 2 ounces of a l c o h o l a day i s c l o s e l y associated, with coronary a r t e r y d i s e a s e ? ANSWER: F a l s e . ABSOLUTE AND RELATIVE FREQUENCIES NON-RESPONSE # CORRECT # % INCO] f RRECT % PRETEST INTERVENTION NON-INTERVENTION X 2 = .5 818 P = .4456 0 3 127 7 4 66.1 67.9 65 32 33.9 29.4 192 109 3 201 97 301 POSTTEST INTERVENTION NON-INTERVENTION X 2 =6.9418 P = . .0085 4 1 162 79 84.4 73.1 26 28 13.5 25.9 192 108 5 241 54 300 INTERVENTION PRETEST POSTTEST X 2 =20.913. P = .0001 0 4 127 162 66.1 84.4 65 26 33.9 13.5 192 192 4 289 91 384 NON-INTERVENTION PRETEST POSTTEST X 2 =2.3536 P = .5548 3 1 74 79 67.9 7,3.1.. 32 28 29.4 25 . 9 109 1 OR 4 153 60 217 - 4 7 -V a r i a b l e 29 Responses to the q u e s t i o n , "Is i t true or f a l s e t h a t smoking i s c l o s e l y a s s o c i a t e d with coronary a r t e r y d i s e a s e ? " i n d i c a t e d a s i g n i f i c a n t d i f f e r e n c e (to the .05 l e v e l ) between the number o f - c o r r e c t responses to the p r e - and p o s t t e s t s of the i n t e r v e n t i o n group (P = .0001) and the p o s t t e s t s o f the i n t e r v e n t i o n and n o n - i n t e r v e n t i o n groups (P = .0001). The responses i n d i c a t e d t h a t more students i n the i n t e r v e n t i o n group were able t o answer t h i s q u e s t i o n c o r r e c t l y (See Table V ) . -48-TABXiE V VARIABLE: 29 QUESTION: Smoking is: c l o s e l y a s s o c i a t e d with, coronary a r t e r y d i s e a s e ? ANSWER: True. ABSOLUTE AND RELATIVE FREQUENCIES NON-RESPONSE #, CORRECT # % INCO] f RRECT % PRETEST INTERVENTION NON-INTERVENTION X 2 = .0518 P = .8198 0 3 144 80 75 73.4 48 26 25 23 .9 192 109 3 224 74 301 POSTTEST . INTERVENTION -NON-INTERVENTION X 2 = 15.96 P = .0001 4 2 170 > 77 88.5 71.3 18 29 9.4 26 .9 192 108 6 247 47 300 INTERVENTION PRETEST POSTTEST X 2 =15.74 P = .0001 0 4 144 170 75 . 88.5 48 18 25 9.4 192 192 4 314 66 . 384 NON-INTERVENTION PRETEST POSTTEST X 2 = .3488 P = .5548 3 2 80, 77 73.4 71.3 26 29 23 .9 26.9 109 108 5 157 55 217 V a r i a b l e 23 Responses to the q u e s t i o n , "Is there a r e l a t i o n s h i p between smoking and h e a r t d i s e a s e ? " i n d i c a t e d a s i g n i f i c a n t d i f f e r e n c e (to the .05 l e v e l ) between the number of c o r r e c t responses on the p r e - and p o s t t e s t s of the i n t e r v e n t i o n group CP = .0050) and the p o s t t e s t s of the i n t e r v e n t i o n and non-i n t e r v e n t i o n groups CP = .0111). The responses i n d i c a t e d t h a t more students i n the i n t e r v e n t i o n group were able to answer t h i s q u e s t i o n c o r r e c t l y (See Table V I ) . -50-TABLE VI VARIABLE: 23 QUESTION: Is there a r e l a t i o n s h i p between smoking and h e a r t d i s e a s e ? ANSWER: Y e s / ABSOLUTE AND RELATIVE FREQUENCIES NON-RESPONSE '# CORRECT 1 % : INCO! £ RRECT % PRETEST INTERVENTION NON-INTERVENTION X 2 * .1024 P = .7492. 1 4 . . 166 89 86.5 81.7 25 16 13 14.7 192 109 5 . • • 255 41 301 POSTTEST INTERVENTION NON-INTERVENTION X 2 = 6. 4568P =• .0111 5. 1 17 8 . 93 92.7 86.1 9 14. 4.7 13.0 192 108 6 271 23 280 INTERVENTION PRETEST POSTTEST 2 X = 7.906 P = .0050 1 5 166 178 86.5 92.7 25 9 13 4.7 192 192 6 344 34 384 NON-INTERVENTION PRETEST POSTTEST X 2 = .07975 P = .7777 4 1 89 93 81.7 86.1 16 14 14.7 13 109 108 5 182 30 217 -51-V a r i a b l e 47 Responses t o t h e q u e s t i o n , "Is i t t r u e o r f a l s e t h a t people w h o h a v e e a t e n a d i e t h i g h i n c e r t a i n f a t s a l l t h e i r l i f e a r e m o r e l i k e l y t o h a v e a h e a r t a t t a c k ? " i n d i c a t e d a s i g n i f i c a n t d i f f e r e n c e C t o t h e .05 l e v e l ) ; b e t w e e n t h e n u m b e r o f c o r r e c t r e s p o n s e s o n t h e p o s t t e s t s o f t h e i n t e r v e n t i o n g r o u p (P = .0563). The r e s p o n s e s i n d i c a t e d t h a t m o r e s t u d e n t s i n t h e i n t e r v e n t i o n g r o u p w e r e a b l e t o a n s w e r t h e q u e s t i o n s c o r r e c t l y (See Table V I I ) . -52-TABLE VII VARIABLE: 47 QUESTION: People who have eaten a d i e t h i g h i n c e r t a i n f a t s a l l t h e i r l i f e are more l i k e l y to have a h e a r t a t t a c k ? ANSWER: True. ABSOLUTE AND RELATIVE FREQUENCIES NON-RESPONSE •.#•••• CORRECT # % INCO] SRECT % PRETEST INTERVENTION NON-INTERVENTION X 2 = .7251 P = .3945 . 4 3 14 8 87 77.1 79.8 40 1 9 20.8 17.4 192 ,109 7 2 35 59 301 POSTTEST INTERVENTION NON-INTERVENTION X 2 = 3.3729 P = .0563 6 . 4 •• 159 , 80 82.8 74.1 27 24 14.1 22.2 192 i ns 10 239 51 300 INTERVENTION PRETEST POSTTEST 2 X =2.9059 P =.0883 4 6 148 15 9 77.1 82 .8 44 33 27. 9 17.2 192 192 10 307 77 384 NON-INTERVENTION PRETEST POSTTEST 2 X =1.145 P =* .2845 3 4 87 80 79.8 74.1. 22 28 20.2 25.9 109 1 08 7 167 40 217 -53-V a r i a b l e 33 Responses to the q u e s t i o n , "Is i t true or f a l s e t h a t a t r e s t a man who i s p h y s i c a l l y f i t w i l l have a h i g h e r h e a r t r a t e than a man who i s u n f i t ? " i n d i c a t e d a s i g n i f i c a n t d i f f e r e n c e (to the .05 l e v e l ) between the c o r r e c t responses on the p r e -and p o s t t e s t s of the i n t e r v e n t i o n group CP = .0159). The responses i n d i c a t e d t h a t more students i n the i n t e r v e n t i o n group were able to answer the q u e s t i o n s c o r r e c t l y CSee Table V I T I I . - 5 4 -TABLE V I I I VARIABLE: 3 3 QUESTION: At r e s t a man who i s p h y s i c a l l y f i t w i l l have a hig h e r h e a r t r a t e than a man who i s u n f i t ? ANSWER: F a l s e . ABSOLUTE AND RELATIVE FREQUENCIES NON-RESPONSE CORRECT ' I • % INCO] f RRECT % PRETEST INTERVENTION NON-INTERVENTION X 2 = 2 . 1 6 9 P = . 1 4 0 8 1 1 • 1 5 9 9 6 8 2 . 8 8 8 . 1 3 2 1 2 1 6 . 7 1 1 , 0 1 9 2 1 0 9 2 2 5 5 4 4 3 0 1 POSTTEST INTERVENTION NON-INTERVENTION X 2 = 2 . 3 7 5 P = . 1 2 3 3 4. 3 1 7 2 . , 9 0 8 9 . 6 8 3 . 3 , 1 6 1 5 8 . 3 1? Q 1 9 2 1 0 8 7 2 6 2 3 1 3 0 0 INTERVENTION PRETEST POSTTEST X 2 = 5 . 8 2 0 P = . 0 1 5 9 1 4 1 5 9 . 1 7 2 8 2 . 8 8 9 . 6 3 2 1 6 1 6 . 7 8 . 3 1 9 2 1 9 2 5 3 3 1 4 8 3 8 4 NON-INTERVENTION PRETEST POSTTEST X 2 = . 3 4 8 8 P = . 5 5 4 8 1 3 9 6 9 0 8 8 . 1 8 3 . 3 1 2 . 1 5 1 1 1 3 . 9 1 0 9 1 0 8 4 1 8 6 2 7 2 1 7 -55-V a r i a b l e 43 Responses to the q u e s t i o n , "Choose three of the f o l l o w i n g t h a t are h i g h i n c h o l e s t e r o l : whipped cream, r i c e , sausages, eggs, coke?" i n d i c a t e d a s i g n i f i c a n t d i f f e r e n c e (to the .05 l e v e l ) Between the c o r r e c t responses on the p r e - and p o s t t e s t s of the i n t e r v e n t i o n group (P = .0458). The responses i n d i c a t e t h a t more students i n the i n t e r v e n t i o n group were able to answer the questions' c o r r e c t l y (See Table IX) . TABLE I X VARIABLE: 43 QUESTION: Choose three of the f o l l o w i n g t h a t are high i n c h o l e s t e r o l -whipped cream, r i c e , sausages, eggs, coke. ANSWER: Whipped cream, sausages, and eggs. ABSOLUTE AND RELATIVE FREQUENCIES NON-RESPONSE # CORRECT 0 . 1 2 3 # Q, "5 # a o # o. "o # Q. "O PRETEST INTERVENTION NON-INTERVENTION X 2 = 3.746 P = .3002 0 0 1 0 11 8 5.7 7.3 91 40 47. 4 36.7 89 60 46 .4 56.0 192 108 0 1 19 131 149 300 POSTTEST INTERVENTION NON-INTERVENTION X 2 = 1.4302 P .= ' .7085 4 4 2 1 1.0 .9 7 6 3.6 5.6 66 41 34.4 38.0 113 56 58.9 51.9 192 108 8 3 13 107 169 300 INTERVENTION PRETEST POSTTEST X 2 = 8.013 P = .0458 0 4 1 2 .5 1.0 11 7 5.7 3.6 91 66 47.4 34.4 89 113 46 .4 58.9 192 192 4 3 18 157 202 384 TABLE IX (Cont'd) ABSOLUTE AND RELATIVE FREQUENCIES NON- , CORRECT RESPONSE 0 1 1 2 3 # # Q. # o, "5 # g, "O # o, "o NON-INTERVENTION PRETEST POSTTEST X 2 = 5.435 P = .6350 1 4 0 1 .9 8 6 7.3 5.6 40 41 36.7 38.0 60 56 56.0 51.8 109 108 5 1 14 81 116 217 -58-V a r i a b l e 24 Responses to the q u e s t i o n , "Do people under 40. get h e a r t a t t a c k s ? " i n d i c a t e d a s i g n i f i c a n t d i f f e r e n c e (to the .05 l e v e l ) between the number of c o r r e c t responses on the p r e - and p o s t t e s t s of the i n t e r v e n t i o n group (P = .0128) and between the p o s t t e s t s of the i n t e r v e n t i o n and n o n - i n t e r v e n t i o n groups (P = .0537). The responses i n d i c a t e d t h a t more students i n the i n t e r v e n t i o n group were a b l e t o answer the q u e s t i o n s c o r r e c t l y (See Table X). -59-TABLE X VARIABLE s QUESTION: 24 Do people under f o r t y get h e a r t d i s e a s e ? ANSWER: Y e s . NON-RESPONSE #, CORRECT •f • % INCO! * FLRECT % PRETEST INTERVENTION NON-INTERVENTION X 2 « . 8127 P = .3674. 1 3 -144 8 4 75 7 7.1 47 22 2 4.5 20.2 192 109 . .4 . . 228 69 301 POSTTEST INTERVENTION NON-INTERVENTION X 2 = 3.724 P = .0537 .. 5 1 -• •160. 82 83.3 75.9 27 25 .14.1 23.1 192 108 6 242 52 300 INTERVENTION PRETEST POSTTEST X 2 = 6.2058P = .0128 1 5 144 160 75 . 83.3 47 27 24.5 14.1 192 192 6 304 74 384 NON-INTERVENTION PRETEST POSTTEST X 2 = .3530 P = .5524 3 1 84 82 77.1 75.9 22 25 20.2 23.1 109 108 166 47 217 -60-V a r i a b l e 36 Responses to the questions,, "Is i t true t h a t lung cancer i s the o n l y s e r i o u s d i s e a s e a s s o c i a t e d w i t h smoking?" i n d i c a t e d a s i g n i f i c a n t d i f f e r e n c e Cto the .05 l e v e l ] between the p r e -and p o s t t e s t s of the i n t e r v e n t i o n group CP = .0118]. The responses i n d i c a t e d more students i n the i n t e r v e n t i o n group were ab l e to answer th.e q u e s t i o n s c o r r e c t l y (See Table XI) . - 6 1 -TABLE X I VARIABLE: 36 QUESTION: Lung cancer i s the o n l y s e r i o u s d i s e a s e a s s o c i a t e d with smoking. ANSWER: No " . . ABSOLUTE AND RELATIVE FREQUENCIES NON-RESPONSE ' '# • CORRECT # % INCO] f RRECT % PRETEST INTERVENTION NON-INTERVENTION X 2 = .00716 P = .0674 0 2 155 87 80.7 79.8 37 20 19.3 18.3 192 109 2 242 27 301 POSTTEST INTERVENTION.. NON-INTERVENTION X 2 = 1.686 P = .1941 ... 4 3 169 89 8 8-0 82.4 19 16 9.9 14.8 192 108 7 . 258 35 300 INTERVENTION PRETEST POSTTEST 2 X = 6.34 P = .0118 0 4 155 169 80.7 88 .0 37 19 19.3 9.9 192 192 4 324 56 384 NON-INTERVENTION PRETEST POSTTEST X 2 = .4911 P = .4835 2 3 87 89 79.8 82.4 20 16 18.3 14.8 109 108 5 176 36 217 -62-Summary - Hypothesis I In regard to Hypothesis I, Students exposed to an e d u c a t i o n a l program d i r e c t e d towards r e d u c i n g c a r d i o v a s c u l a r r i s k - b e h a v i o u r w i l l have more knowledge about c a r d i o v a s c u l a r r i s k - b e h a v i o u r s than students who are not exposed to the program, the r e s u l t s o f the responses to the knowledge q u e s t i o n s i n d i c a t e t h a t students who were exposed to the e d u c a t i o n a l program had more f a c t u a l knowledge about 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 than students who were not exposed to the program. Hypothesis I I Students exposed to an e d u c a t i o n a l program d i r e c t e d towards r e d u c i n g c a r d i o v a s c u l a r r i s k - b e h a v i o u r s w i l l have a more p o s i t i v e a t t i t u d e towards r e d u c i n g c a r d i o v a s c u l a r r i s k - b h e a v i o u r s than students who are not exposed to the program. El e v e n q u e s t i o n s were asked i n an attempt to measure the a t t i t u d e of the students towards changing behaviours t h a t a f f e c t c a r d i o v a s c u l a r r i s k . The frequency data generated was examined f o r d i f f e r e n c e s i n f o u r d i r e c t i o n s : (1) between p r e t e s t s o f i n t e r v e n t i o n and n o n - i n t e r v e n t i o n groups; C2) between p o s t t e s t s o f i n t e r v e n t i o n and n o n - i n t e r v e n t i o n groups; -63-C3) between the p r e - and p o s t t e s t s of the i n t e r v e n t i o n group; (4) between the p r e - and p o s t t e s t s o f the non-i n t e r v e n t i o n group. The responses to the f o l l o w i n g 11 q u e s t i o n s i n d i c a t e d no d i f f e r e n c e s between the groups on the p r e t e s t or p o s t t e s t q u e s t i o n n a i r e s . The f o l l o w i n g 11 q u e s t i o n s were asked to determine the a t t i t u d e of the students towards c a r d i o v a s c u l a r r i s k : C I ) I t h i n k i t i s important f o r my h e a r t not to s t a r t smoking? Yes or No. C2) I t h i n k a d u l t s should stop smoking? Yes o r No. C3) I t h i n k i t i s b e t t e r not to s t a r t smoking when you are young? Yes or No. (.4) I t h i n k r e g u l a r e x e r c i s e i s important o r not important f o r p r e v e n t i o n o f h e a r t t r o u b l e ? (.5) I t h i n k m a i n t a i n i n g an average weight i s worthwhile or very important? (.6) I t h i n k keeping f i t i s worthwhile o r v e r y important? C7) I s i t t r u e or f a l s e t h a t I t h i n k t h a t most people can l i m i t themselves to a few c i g a r e t t e s a day? - 6 4 -C8) Is i t t r u e or f a l s e t h a t I t h i n k t h a t most teenagers who s t a r t w i t h a few c i g a r e t t e s become h a b i t u a l smokers? C9) I s i t t r u e or f a l s e t h a t I am convinced t h a t smoking i s harmful, to my h e a l t h ? CIO) I s i t t r u e or f a l s e t h a t i f I am not s i c k I must.be e a t i n g the r i g h t food? (.11) Is i t t r u e o r f a l s e t h a t I t h i n k i t i s important to l i m i t the amount of f a t i n my d i e t ? Summary - Hypothesis II In r e g a r d t o Hypothesis I I , Students exposed to an e d u c a t i o n a l program d i r e c t e d towards r e d u c i n g c a r d i o v a s c u l a r r i s k - b e h a v i o u r s w i l l have a more p o s i t i v e a t t i t u d e towards r e d u c i n g c a r d i o v a s c u l a r r i s k - b e h a v i o u r s than students who are not exposed to the program, the responses to the above 11 q u e s t i o n s i n d i c a t e there were no d i f f e r e n c e s between the two groups. Hypothesis I I I Students exposed to an e d u c a t i o n a l program d i r e c t e d towards r e d u c i n g c a r d i o v a s c u l a r r i s k - b e h a v i o u r s w i l l change t h e i r behaviour i n such a way as to p r a c t i c e fewer r i s k -behaviours than s t u d e n t s who are not exposed to the program. -65-T h i r t e e n q u e s t i o n s were asked to determine c a r d i o v a s c u l a r r i s k - b e h a v i o u r s . The frequency data generated was examined f o r d i f f e r e n c e s i n f o u r d i r e c t i o n s : CI ) between p r e t e s t s o f i n t e r v e n t i o n and n o n - i n t e r v e n t i o n groups; C2J between p o s t t e s t s o f . i n t e r v e n t i o n and n o n - i n t e r v e n t i o n groups; C3) between the pre-,and posttests- o f the i n t e r v e n t i o n group; C4) between the pre- and p o s t t e s t s o f the n o n - i n t e r v e n t i o n group. No d i f f e r e n c e s were found between the i n t e r v e n t i o n and n o n - i n t e r v e n t i o n groups on the responses on the p r e t e s t and p o s t t e s t q u e s t i o n n a i r e s . The f o l l o w i n g 13 q u e s t i o n s were asked t o determine behaviour of the students i n both groups: CI). I smoke tobacco c i g a r e t t e s (check one only) (2) I p l a y s p o r t s : (check one only) Ca) not at all (b) less than 5 cigarettes a day Cc) 5-20 cigarettes a day (d) more than 20 cigarettes a day (a) less than 30 minutes a day 1  (b) between 30 minutes and one hour a day Cc) more than one hour each day -66-C.3) I walk: (check one only) Ca) less than 10 blocks a day (b) between 10 and 20 blocks a day Cc) more than 20 blocks a day C.41 I have smoked tobacco cigarettes for years Answer the following questions "yes" or "no". C5) I drink 2 or more glasses of skim milk a day. C6) I drink 2 or more glasses of whole milk a day, C7) I eat more than 7 eggs a week, (8) I know how much I weigh; (9) I eat chips Cfrench f r i e s ) more than four times a week. • • - • CIO) I know my ide a l weight. (.11) I am overweight, (.12) I eat fresh f r u i t every day. (.13) I eat 2 servings of vegetables every day, Canada Home F i t n e s s T e s t The Canada Home Fitness Test was performed by the students as a measure of t h e i r f i t n e s s levels as an indicator of physical a c t i v i t y . The 10 second pulse was recorded and the frequency data generated was examined for differences i n four d i r e c t i o n s : -67-(11 between p r e t e s t s of i n t e r v e n t i o n and n o n - i n t e r v e n t i o n groups; C2) between p o s t t e s t s o f i n t e r v e n t i o n and n o n - i n t e r v e n t i o n groups; (3) between the p r e - and p o s t t e s t s o f the i n t e r v e n t i o n group; (4) between the pre- and p o s t t e s t s of the n o n - i n t e r v e n t i o n group. Frequency data on 176 students i n the i n t e r v e n t i o n group who had a l s o completed both the pre- and p o s t - q u e s t i o n n a i r e s and frequency data on 89 students i n the n o n - i n t e r v e n t i o n group who had completed both, the p r e - and p o s t t e s t q u e s t i o n n a i r e s was examined. The r e s u l t s were c a t e g o r i z e d i n t o three groups, very f i t , f i t and u n f i t . Those wi t h a 10 second p u l s e r a t e o f 28 or g r e a t e r were c l a s s i f i e d , as u n f i t , those w i t h a p u l s e r a t e o f 27 to 21 were c l a s s i f i e d as f i t , those w i t h a p u l s e r a t e of 20 or l e s s were c o n s i d e r e d very. f i t . The r e s u l t s are summarized i n Table X I I . -68-TABLE XII 10 Second Pulse Recorded During Canada Home F i t n e s s T e s t . RELATIVE FREQUENCIES VERY FIT FIT UNFIT # o. • #. g. "o # Q. "5 PRETEST INTERVENTION 35 19.8 116 65 .9 25 14.2 176 NON-INTERVENTION o 12 13.4 59 65.5 18 22 89 Y — 9 S Q O r> — T f l / i A — Z.uoo Jr — .ZDXU' 47 43 266 175 POSTTEST INTERVENTION 4 0 22.7 119 67.7 17 9.6 176 NON-1 NTERVEN.TI ON 2 27 30 .7 54 60.3 8 8.9 89 X =1.81804 P = . 4 1 3 0 -67 173 25 266 INTERVENTION PRETEST 35 19 .8 116 65.9 25 14.2 176 POSTTEST X 2 = 1.895 P = .3877-40 22.7 119 67.6 17 9.6 176 75 235 42 352 NON-INTERVENTION PRETEST 12 13.4 59 65.5 18 22 89 POSTTEST 27 30.7 54 60.3 8 8.9 89 2 x = 9.8366 p ~ .0074 39 113 26 178 -69-Uaing the data recorded d u r i n g the Canada Home F i t n e s s T e s t , changes i n f i t n e s s l e v e l s w i t h i n s u b j e c t s were examined. The 10 second p u l s e r a t e recorded on the p r e t e s t was s u b t r a c t e d from the 10 second p u l s e r a t e on the p o s t t e s t . T e s t d i f f e r e n c e s o f 176 students i n the i n t e r v e n t i o n group, who completed both, the pre- and p o s t t e s t q u e s t i o n n n a i r e s and p r e - and p o s t t e s t Canada Home F i t n e s s t e s t s were examined. T e s t d i f f e r e n c e s o f 89 students i n the n o n - i n t e r v e n t i o n group who completed both the pre- and p o s t t e s t q u e s t i o n n a i r e s and the pre- and p o s t t e s t Canada Home F i t n e s s Tests were examined. The r e s u l t s are summarized i n Table XITT. -70-TABLE X I I I Number and Percentage D i s t r i b u t i o n of changes i n 10 second p u l s e r a t e between p r e t e s t and p o s t t e s t . 10 second p u l s e r a t e I n t e r v e n t i o n Non- I n t e r v e n t i o n • # Q, "5 # Q. O Reduced 97 54.8 52 58.3 No Change 24 13.6 16 17. 4 Increased 55 31.1 21 23 .5 X 2 = 2.06 P = .3569 -71-Summary - Hypothesis I I I In r e g a r d to Hypothesis I I I , Students exposed to an e d u c a t i o n a l package d i r e c t e d towards r e d u c i n g c a r d i o v a s c u l a r r i s k - b e h a v i o u r w i l l change t h e i r behaviour i n such a way as to p r a c t i c e fewer r i s k -behaviours than students who are not exposed to the program, the response to 13 qu e s t i o n s asked to determine the s e l f - r e p o r t e d c a r d i o v a s c u l a r r i s k - b e h a v i o u r s o f the students i n d i c a t e d no d i f f e r e n c e s between the two groups. The r e s u l t s o f the Canada Home F i t n e s s T e s t i n d i c a t e d no s i g n i f i c a n t d i f f e r e n c e i n the d i s t r i b u t i o n o f d i f f e r e n c e s between the pre- and p o s t t e s t r e s u l t s o f the i n t e r v e n t i o n and non-i n t e r v e n t i o n groups. The r e s u l t s of the Canada Home F i t n e s s T e s t i n d i c a t e d no d i f f e r e n c e i n the f i t n e s s l e v e l s between the i n i t i a l p r e t e s t s , o r the p o s t t e s t o f both groups. There was no s i g n i f i c a n t d i f f e r e n c e shown between the pr e - and p o s t t e s t s o f the i n t e r v e n t i o n group. Examination o f the frequency data from the Canada Home F i t n e s s T e s t r e v e a l e d a s i g n i f i c a n t d i f f e r e n c e between the pre-and p o s t - f i t n e s s l e v e l s o f the n o n - i n t e r v e n t i o n group. T h i s un-expected r e s u l t c o u l d not be e x p l a i n e d by e r r o r s i n the process o f ha n d l i n g the data from c o l l e c t i o n , to coding, to key punching and computing. A s p i l l over e f f e c t from.the i n t e r v e n t i o n group to the n o n - i n t e r v e n t i o n group cannot be r u l e d out and f u r t h e r s t u d i e s are suggested. -72-CHAPTER V  DISCUSSION AND CONCLUSION D i s c u s s i o n T h i s study suggests t h a t h i g h s c h o o l students do l e a r n some f a c t u a l i n f o r m a t i o n i f exposed.to a short-term h e a l t h e d u c a t i o n a l program. The r e s u l t s o f the p r e t e s t q u e s t i o n n a i r e i n d i c a t e d t h a t 80 to 90 p e r c e n t o f students were ab l e to answer b a s i c knowledge q u e s t i o n s about the f u n c t i o n i n g o f the h e a r t and the r i s k s o f smoking, p h y s i c a l i n a c t i v i t y and h i g h - f a t d i e t . S t u d i e s (Swisher, 1971, 1972, 1973; Tennant, 1973; S p i t z n a g e l , 1978; P o d e l l , 1978) have demonstrated t h a t h e a l t h e d u c a t i o n a l programs i n sc h o o l s do i n c r e a s e knowledge. T h i s study supports these s t u d i e s by demon-s t r a t i n g a s i g n i f i c a n t i n c r e a s e i n the knowledge o f the studen t s , who took p a r t i n the program, about the r i s k s o f smoking, p h y s i c a l i n a c t i v i t y and h i g h - f a c t d i e t on the f u n c t i o n i n g o f the h e a r t . S t u d i e s have shown t h a t students l e a r n from an e d u c a t i o n a l program depending on the content o f the program, the c h a r a c t e r -i s t i c s o f the teacher, the c h a r a c t e r i s t i c s o f the st u d e n t s , the method o f t e a c h i n g and the environment. (McGuire, 1969) . The i n c r e a s e i n knowledge c o u l d be expected i n t h i s study as the e d u c a t i o n a l program was conducted i n the s c h o o l environment where the e x p e c t a t i o n i s t h a t students attend and comprehend m a t e r i a l t h a t i s presented to them i n c l a s s . The w r i t t e n m a t e r i a l was c o r r e c t and i n t e l l e c t u a l l y s u p p o r t a b l e . The m a j o r i t y o f the -73-students came from m i d d l e - c l a s s homes where good h e a l t h i s v a l u e d . B a r r i e r s t o knowledge i n the study may have been t h a t the teacher was a middle-aged woman wi t h no e s t a b l i s h e d s c i e n t i f i c or medical q u a l i f i c a t i o n s and who smoked. A l s o , the f i l m p r e s e n t a t i o n p o r t r a y e d a middle-aged man smoking, being p h y s i c a l l y i n a c t i v e and e a t i n g a h i g h - f a t d i e t and subsequently s u f f e r i n g a h e a r t a t t a c k , a r i s k they would tend to i d e n t i f y w i t h t h e i r parents r a t h e r than w i t h themselves. A f u t u r e study might look a t the e f f e c t o f f i l m s more r e l e v a n t to ado l e s c e n t b ehaviour. The r e s u l t s o f t h i s study d i d not demonstrate, on comparison of p o s t t e s t r e s u l t s , the hoped f o r d i f f e r e n c e s i n a t t i t u d e o r behaviour between the group t h a t was exposed to the e d u c a t i o n a l program and the group t h a t was not exposed to the program. A t t i t u d e s and behaviour are complex and l e a r n e d over a number o f years (Baum, 19 77). The development o f a t t i t u d e s and behaviours i n v o l v e s the sy n t h e s i s o f m u l t i p l e i n t e r n a l and e x t e r n a l f a c t o r s . T h i s study supports the f i n d i n g s o f a number of s t u d i e s e v a l u a t i n g h e a l t h e d u c a t i o n a l programs where an i n c r e a s e i n knowledge occured, but l i t t l e o r no a t t i t u d i n a l or b e h a v i o u r a l change was demonstrated. ( S p i t z n a g e l , 1969; Amendolara, 1973; Swisher, 1973; P o d e l l , 1978) . However, a l l o f these s t u d i e s have looked a t the sho r t - t e r m e f f e c t s o f h e a l t h e d u c a t i o n . In order to determine the i n f l u e n c e o f h e a l t h knowledge on a t t i t u d e and behaviour, a long-term study would be necessary. Examination o f the d i f f e r e n c e s between the pr e - and p o s t t e s t r e s u l t s o f the n o n - i n t e r v e n t i o n group on the Canada Home F i t n e s s T e s t i n d i c a t e d a change w i t h i n t h i s group. The p o s s i b i l i t y t h a t - 7 4 -the e d u c a t i o n a l program a f f e c t e d , t h i s group i n some i n d i r e c t way cannot be r u l e d out and f u r t h e r s t u d i e s are recommended. The r e s u l t s demonstrated by the p r e t e s t s o f a l l the students i n d i c a t e d about 80. percent of the students d i d not smoke, were p h y s i c a l l y a c t i v e , and ate a l o w - f a t d i e t . A s u g g e s t i o n f o r f u t u r e r e s e a r c h would be to i n v o l v e the 20 p e r c e n t o f students w i t h r i s k - b e h a v i o u r s i n a v a r i e t y of programs d i r e c t e d towards behaviour change and e v a l u a t e the e f f e c t i v e n e s s . For the 80 percent who showed evidence of a b a s i c knowledge of r i s k , who had p o s i t i v e a t t i t u d e s and behaviours, a program d i r e c t e d towards r e i n f o r c e m e n t o f e x i s t i n g a t t i t u d e s and behaviours might be more e f f e c t i v e i n the long-term. C o n c l u s i o n This study demonstrated t h a t students i n a h i g h - s c h o o l i n Vancouver l e a r n e d some f a c t u a l , knowledge about c a r d i o v a s c u l a r r i s k from a s h o r t - t e r m e d u c a t i o n a l program prepared by the B.C. Heart Foundation. 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I n t e r n a t i o n a l Seminar on Health: E d u c a t i o n , Hamburg, Germany, (.1969) . Ste r n , N.P.; Farquhar, J.W. ; Macoby, N. and R u s s e l l , S.H. "Results of a Two Year H e a l t h . E d u c a t i o n a l Campaign on D i e t a r y Behaviour." C i r c u l a t i o n S4, (1976). 826. Swisher, J.D. and Crawford, J.L., J r . "An E v a l u a t i o n o f a Short Term Drug E d u c a t i o n a l Program." The School Counselor, 18, C1.971I, 265-272 . Swisher, J.D.; Warner, R.W.., J r . and Herr, E.L. "Experimental Comparison of Four Approaches to.Drug Abuse P r e v e n t i o n Among or With E l e v e n t h Graders." J o u r n a l o f C o u n s e l l i n g Psychology, 19 C1972), 328-332. ~ ~ a Y ' Swisher, J.D.; Warner, R.W., J r . ; Spence, C C . and U p c r o f t , M.L. Four Approaches to Drug Abuse'Prevention Among C o l l e g e Students." J o u r n a l of C o l l e g e Student Personnel, (May, 19 73) 231—235. Tennant, F.S., J r . ; Weaver, S.C. and Lewis, C.E. "Outcome of Drug E d u c a t i o n : Four Case S t u d i e s . " P e d i a t r i c s , 52, C19 73) 246-251. ' The P o o l i n g P r o j e c t Research Group " R e l a t i o n s h i p o f Blood P r e s s u r e , Serum C h o l e s t e r o l , Smoking H a b i t , R e l a t i v e Weight and ECG A b n o r m a l i t i e s to Incidence of Major Coronary Events." F i n a l Report of the P o o l i n g P r o j e c t , J . Chron i c D1S31, (1978), 201--81-Turner, R. and B a l l , K. " P r e v e n t i o n of Coronary Heart Disease: A C o u n t e r b l a s t t o Pre s e n t i n a c t i v i t y . " Lancet 2, (.1973)!,' 1137-114Q. U.S. P u b l i c H e a l t h S e r v i c e "Teenage Smoking, N a t i o n a l P a t t e r n s of C i g a r e t t e Smoking, Ages 12 - 18 i n 1972 and 1974." DHEW P u b l i c a t i o n No. (NIH) 76, (1976), 931. Walster, E.; Aronson, V. and Abrahams, D. "Importance of P h y s i c a l A t t r a c t i v e n e s s i n Dat i n g Behaviour." J o u r n a l  of P e r s o n a l i t y and S o c i a l ' Psychology, 4, (1966) . White, C.W.; Albanese, M.A.; Anderson, E.E. and Kaplan, R.M. "The Status of C a r d i o v a s c u l a r Health. Knowledge among S i x t h , Seventh and Eighth. Grade C h i l d r e n . " C i r c u l a t i o n V o l . 56, No. 3, (September 1977)> 480-484 . Wicker, A.A. "An Examination of the 'Other V a r i a b l e s ' E x p l a n a t i o n of the A t t i t u d e - B e h a v i o u r I n c o n s i s t e n c e . " J o u r n a l of P e r s o n a l i t y and S o c i a l Psychology, 19, (1971). Wightman, F.L. and Green, D.M. "The P e r c e p t i o n of P i t c h . " American S c i e n t i s t , 62, (1974). W i l l i a m s , T.M. "Summary and I m p l i c a t i o n s of Review of L i t e r a t u r e R e l a t e d to A d o l e s c e n t Smoking." Report of C o n t r a c t No. HSM  110-71-145, Department of He a l t h , E d u c a t i o n and Welfare, (1972) . W i s s l e r , R.W. "Development o f the A t h e r o s c l e r o t i c Plague." H o s p i t a l P r a c t i c e , 8, (1973), 61-72. APPENDIX "A QUESTIONNAIRE PART A 5. I smoke tobacco c i g a r e t t e s : (.check one onl y i n box provided) a) not a t a l l b) l e s s than 5 c i g a r e t t e s a day c) 5-20 c i g a r e t t e s a day d) more than 20 c i g a r e t t e s a day 6 . 1 p l a y s p o r t s : a) l e s s than 30 minutes a day b) between 30 minutes and one hour a day c) more than one hour a day 7. I walk: a) l e s s than 10 b l o c k s a day b) between 10 and 12 bl o c k s a day c) more than 20 b l o c k s a day 8. I have smoked tobacco c i g a r e t t e s f o r years Answer q u e s t i o n s 9 - 1 7 "yes" or "no" i n column provided. 9. I d r i n k 2 or more g l a s s e s of skim mi l k a day. 9. 10. I d r i n k 2 or more g l a s s e s of whole milk a day. 10. 11. I e a t more than 7 eggs a week. 11. 12. I know how much. I weigh. 12. 13. I e a t ch i p s (french f r i e s ) more than f o u r times a week. 13. -83-PART A - Pg. 2 14. I know my i d e a l weight. 15. I am over weight. 16. I e a t fresh, f r u i t every day 14 15 16 17. I e a t 2 s e r v i n g s of veg e t a b l e s every day, 17 PART B J o i n by a s t r a i g h t l i n e the body p a r t with the a c t i o n i t performs, 18. Heart C a r r i e s blood from c e l l s back to h e a r t . 19. A r t e r i e s Pump which d r i v e s b l o o d . 20. C a p i l l a r i e s C a r r i e s blood from h e a r t to c e l l s 21. Veins P l a c e where interchange of waste products, food and gas takes p l a c e . Mark c o r r e c t answer Cone only) i n box p r o v i d e d . 22. The pulse r a t e measures: a) the flow o f bloo d through an a r t e r y Q b) the number o f times the h e a r t pumps i n a minute Q c) the number of times you breathe i n a minute Q Answer "yes" or "no" i n th.e column provided, 23. There i s a r e l a t i o n s h i p between c i g a r e t t e smoking and h e a r t d i s e a s e . 23. -84-PART B - Pg. 21 24. People under 4Q get h e a r t d i s e a s e . 24. _ 25. High, blood p r e s s u r e adds to the work l o a d of the h e a r t and a r t e r i e s . 25. 26. F a i n t i n g i s u s u a l l y a s s o c i a t e d with i n c r e a s e d b l o o d p r e s s u r e s . 26. Which, three of the f o l l o w i n g have been found to be c l o s e l y a s s o c i a t e d w i t h coronary h e a r t d i s e a s e (heart a t t a c k ) . Check 3 o n l y i n box p r o v i d e d . 27. Overweight a) [] 28. Regular strenuous p h y s i c a l e x e r c i s e . b) Q 29. Smoking. c) [] 30. D r i n k i n g 1 - 2 ounces of a l c o h o l a day. d) [] 31. High b l o o d p r e s s u r e . e) [] 32. A tragedy i n the f a m i l y . f) [] W r i t e t r u e "T" or f a l s e "F" i n the column p r o v i d e d . 33. A t r e s t a man who i s p h y s i c a l l y f i t w i l l have a h i g h e r h e a r t r a t e than a man who i s u n f i t . 33. 34. I f you don't e x e r c i s e r e g u l a r l y you are b e t t e r o f f not e x e r c i s i n g a t a l l . 34, 35. The normal h e a r t r a t e i s 78 beats per minute. 35 Write t r u e "T" or f a l s e "F" i n the column p r o v i d e d . 36. Lung cancer i s the o n l y s e r i o u s d i s e a s e a s s o c i a t e d w i t h smoking. 36, -85-PART B - pg. 3 37. There i s no r i s k i n smoking c i g a r e t t e s , i f you don't i n h a l e . 37. 38. The more c i g a r e t t e s you smoke the g r e a t e r the r i s k . 38. 39. Smoking i s more of a health, hazard f o r males than females. 39 40. Are there programmes a v a i l a b l e to h e l p people stop smoking. 40. 41. Most people can smoke a few c i g a r e t t e s without g e t t i n g the h a b i t . 41, 42. Name one food from each, of the b a s i c four food groups. a) b) c) d) 43. Check three foods i n the f o l l o w i n g l i s t t h a t are h i g h i n c h o l e s t e r o l : a) whipped cream a) [] bj r i c e b) [] c) sausages c) [] d) coke d) Q e) eggs e) [] Write true "T" or f a l s e "F" i n the column p r o v i d e d . 44. S t u d i e s have shown t h a t overweight i n ad o l e s c e n t s i s more o f t e n due to i n a c t i v i t y than o v e r e a t i n g . 44. 45. Changes i n the a r t e r i e s t h a t can-; cause a t t a c k s begin i n very young people. 45. -86-PART B, - Pg. 4 46. Changes i n d i e t can change the l e v e l of c h o l e s t e r o l i n the blood. 46 47. People who have eaten a d i e t h i g h i n c e r t a i n f a t s a l l t h e i r l i f e are more l i k e l y to have a h e a r t a t t a c k . 47 48. Smoking makes the h e a r t beat f a s t e r . 48 49. Smokers- run an e x t r a r i s k of having a h e a r t a t t a c k . 49 50. F i l t e r s make c i g a r e t t e s s a f e . 50 51. The e a r l i e r you begin to smoke the g r e a t e r the r i s k to your h e a l t h i n f u t u r e y e a r s . 51 PART C Write the answer i n the column p r o v i d e d . 52. I t h i n k i t i s important f o r your h e a r t not to s t a r t smoking. a) yes b) no 52 53. I t h i n k a d u l t s should stop smoking. a) yes b] no 53 54. I t h i n k i t i s b e t t e r not to s t a r t smoking when you are young. a) yes b) no 54 55. I t h i n k r e g u l a r e x e r c i s e i s a) not important b) Important f o r p r e v e n t i o n of h e a r t t r o u b l e . 55 -87-PART C - Page 2 56. I thank m a i n t a i n i n g an average weight i s : (check one box) a I worthwhile [] b) not a bad i d e a [] c l q u i t e important [] d) very important [] 57. I th i n k keeping f i t i s : (check one box) a) worthwhile [] b) not a bad i d e a []] c) q u i t e important [] d) very important Q 58.. I t h i n k most people can l i m i t themselves to a few c i g a r e t t e s a day. a) yes b) no 58 59. I t h i n k most teenagers who s t a r t w i t h a few c i g a r e t t e s become h a b i t u a l smokers. a) yes b) no 59 60. I am convinced t h a t smoking i s harmful to my h e a l t h . a) yes b) no 60, 61. I f I am not s i c k I must be e a t i n g the r i g h t foods. a) yes b) no 61. 62. I thi n k i t i s important to l i m i t the amount of f a t i n my d i e t . a) yes b) no 62. 

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