Browsing Posts published in October, 2010

    The lack of onsite educational options, and absence of referral resources, prompted faculty from the USC/California Hospital Family Medicine Residency Program to develop the Take Charge class. The course was designed to promote lifestyle change through a group intervention in an overweight, inner-city minority patient population experiencing a variety of lifestyle-influenced chronic diseases. This paper uses a case study to illustrate the health education program.

    Methods
    The case study was developed by the course instructors with the assistance of an external researcher using quantitative and qualitative assessments. Information was triangulated to increase the validity of findings.

    The course was delivered to 13 cohorts of patients. Weights were collected from cohorts 1 and 2 (n= 31) to measure change before and after the eight week course, as well as at three month follow-up intervals, using one-tailed paired t-tests for significance. Evaluation questionnaires measuring individual perceptions of class content were given to cohorts 4, 5, and 6 on the last day of the course (n= 34: 25 Spanish, 9 English). Long-term follow-up phone interviews were also conducted. External interviewers were used to promote honest responses. The follow-up interviews were designed to control for the temporal dimensions of course acceptance and life-style change. Phone interviews were conducted with cohorts 1, 2, 3 and 5 (n= 49). Average time since graduation was 21 months (range = 12-26). Since the course instructors thought there might be an upward bias in graduation-day evaluation responses, the long-term evaluation sample included both graduates and “drop-outs” and analyses compared the responses of each group.

    The Lifestyle Change Intervention
    The Take Charge course was developed and facilitated by a Family Physician and a doctor of Public Health. The course consisted of 2-hour sessions held on a weekly basis for eight weeks. Courses were conducted separately in English and Spanish.

    California Hospital is home to a Family Medicine residency which operates a primary care Family Practice Center (FPC) across the street from the hospital near the garment district of Los Angeles. For the Take Charge class, faculty members outfitted a large conference room at the FPC, normally used for physician education, with large chairs, some cooking equipment, and educational materials.

    FPC patients were referred to the class by their primary care providers. As word of the class spread, patients from neighboring community clinics were also referred. To make the classes more accessible for these outside patients, some sessions were conducted offsite. 124 participants were enrolled in 13 cohorts over four years. The average weight of participants was 237 pounds (95% confidence interval=217-258, range=122-503). This population had multiple related co-morbidities, including: hypertension, coronary artery disease, congestive heart failure, hyperlipidemia, diabetes, arthritis, chronic back pain, depression, and hypothyroidism. Other co-morbidities included: anemia, addiction, blindness, chronic obstructive pulmonary disease, glaucoma, lupus, multiple sclerosis, and seizure disorder.

    Participants attending six or more of the eight sessions received graduation certificates. Seventy-four participants graduated and were invited to join alumni activities.

    In low-income minority communities, there is high prevalence and clustering of obesity, coronary heart disease, dyslipidemia, hypertension and diabetes mellitus. Evidence suggests one way to treat and prevent these conditions is through a very low-fat, high fiber, vegetarian diet. A feasibility study was conducted to determine whether inner-city African American and Latino patients will accept a low-fat vegetarian diet and to assess attitudes about the life-style intervention. Reductions in fat and animal products were acceptable, though complete conversion to vegetarianism was not. Meanwhile, group support was the most highly rated component of the class. Contrary to common perceptions of immigrants needing to maintain traditional habits, the Latino participants enthusiastically adopted new concepts and incorporated new recipes into their diet. Weight loss was achieved during the 8 week course and continued through 18 month follow-up. It appears that individual empowerment through the group intervention, coupled with simple diet messages, supported life-style change in a high-risk group.
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    Several studies suggest that the optimal diet for prevention as well as treatment of obesity, dyslipidemia, coronary artery disease, hypertension and diabetes is a very low-fat, high-fiber, vegetarian or near-vegetarian diet (Anderson, Gustafson, Bryant, & Tietyeb-Clark, 1987; Barnard, 1991; Barnard, Jung, & Inkeles, 1994; McDougall, Litzau, Haver, Saunders, & Spillers, 1995; Ornish et al., 1998; Singh, Rastogi, Verma, & et al, 1992). However, most physicians stop short of prescribing such diets for their patients because they believe that patients will not accept a vegetarian diet or one that is very low in fat. Contrary to this view held by many physicians, several studies indicate that patients can and will accept such diets, both in the short term (Barnard et al., 1994; McDougall et al., 1995) and in the long-term (Anderson et al., 1987; Ornish et al., 1998) subsequently experiencing several positive results, such as improved cholesterol, diabetes control, weight loss, and regression of coronary artery disease. A program for Native Hawaiians promoting low fat traditional foods without calorie restriction demonstrated similar long-term success (Shintani, Beckham, Tang, O’Connor, & Hughes, 1999). There is nothing in the literature regarding acceptance of such diets in low-income Latino and African American communities in the United States. This paper describes a health intervention program designed for low-income minority patients and its impact on members of these communities.

    Los Angeles is home to a diverse population. In the inner-city, residents are predominantly low-income Latino or African American. Income, race and ethnicity are associated with a higher prevalence of common lifestyle related chronic diseases, and a greater burden of complications and mortality from them.(U.S. Department of Health and Human Services, 2003). The prevalence of diabetes, coronary heart disease, and hypertension, for example, are higher in Hispanics and Blacks than in Non-Hispanic whites (Centers for Disease Control, 2003). These problems are believed to be more aggravated by limited resources in the inner-city for lifestyle change: food choices in restaurants and supermarkets are more limited, opportunities for exercise and healthy recreation are scarce, and education classes are difficult to access. Lifestyle and disease management classes offered by some health plans and community agencies remain underutilized by inner-city patients in Los Angeles because patients are often faced with difficulties in accessing classes offered across town or feel compelled to restrict their movement due to safety concerns in certain neighborhoods.

    This study filled a gap in the gerontological literature and showed that exposure to a 6-month Tai Chi exercise program can effect long-term changes in HRQL identified by the General Health Survey, a well-established HRQL measure which includes distinct dimensions of quality of life indicators.
    On all measures, Tai Chi exercise resulted in significant changes in the HRQL indicators except social functioning, compared to the no-Tai Chi waiting-list control. Overall, Tai Chi participants reported significant improvements over the 6-month period in physical-, role-functioning, bodily pain, mental health, and health status.
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    Over the 6-month intervention, we observed an 18% drop-out rate in the Tai Chi group. This is relatively low given the fact that many who decide to become more physically active return to a sedentary lifestyle within three to six months (Dishman, 1988; Martin & Sinden, 2001). Failure to complete the study was attributed to traveling or family-related commitments rather than dissatisfaction with the program itself. In fact, people who completed the study looked forward to enrolling in further courses offered in the community. Such a finding corroborates findings of Wolf et al. who noted that almost half of their Tai Chi participants chose to continue meeting informally after the study was completed.

    Results from present study have a number of implications. First, important domains of HRQL such as physical and psychological health can be enhanced through Tai Chi because it improves balance and coordination in a framework of meditation and concentration thus, theoretically, integrating one’s physical and mental states. This is important because global wellness is predicated not merely on the functioning of each domain but the interaction between the two.

    Second, physical functioning is an important HRQL indicator which affects continued independence of older adults. As with other studies that have shown difficult-to-observe change in physical functioning (Kutner et al., 1997; Stewart et al., 1997), this study demonstrated that physical functioning could be improved through a relatively short 6-month Tai Chi program. Overall, the Tai Chi group had 83% improvement across the six individual functional status items, suggesting the Tai Chi intervention enabled participants to improve aspects of their physical functioning. Thus, Tai Chi should be considered favorably as a health promoting program for older adults with or without physical limitations. Finally, results from this study appear to support health promotion and disease prevention benefits of Tai Chi in older adults, which may be achieved without the strenuous physical impact of more common activities such as jogging or aerobics.

    There are several limitations of the current study. First, the study used exclusively self-report (self-rated) health measures, which rely on respondents’ memories. Future studies need to consider use of objective physical health measures (e.g., functional tests) that would not only allow us to confirm the current findings but also more rigorously examine the effects of Tai Chi on quality of life. Another limitation is that the study sample was comprised of volunteers who might have been more highly motivated to participate in activity than the typical sedentary older adult population. Additionally, the mode of advertising the study (local newspapers, senior center flyers, retirement community notices) could also have created a selection bias toward people who receive and read newspapers and those who live in or visit certain locales in the community. Therefore, the sample might not be representative of the older adult population as a whole. Finally, although the randomized nature of the study is a strength, we must be mindful of the absence of an attention control group. This experimental protocol does not control for the influence of attention on the outcome measures. It is possible that the participants in the Tai Chi group were benefiting from the social support and attention provided by the instructors and members of the classes, with respect to both the outcome variables and compliance. Further studies should control for this effect by having the control participants attend non-exercise health education classes in a group format (Wolf et al., 1996).

    In summary, we conclude that Tai Chi classes taught by experienced Tai Chi teachers improved self-reported quality of life among older persons in a 6-month randomized controlled study. The results confirm that Tai Chi can also be considered a suitable and acceptable health promoting activity for older adults over a long term period, as evidenced by the low rate of attrition in the classes. The extent to which the Tai Chi – HRQL relationship is moderated by psychosocial variables could be explored in future studies. Similarly, it would be useful to replicate our findings using individuals with functional deficits and psychological impairment.

    Baseline Characteristics of Participants and Dropouts
    Preliminary analyses (t-tests or chi-square tests) comparing participants in the Tai Chi group (n = 49) and the control group (n = 45) indicated that the two conditions did not differ significantly (p.09) at baseline on any of the demographic measures involving age, gender, income, and education. Additionally, there were no significant differences (p.13) by group on any of the HRQL measures at baseline. These results indicated no need for adjusting any demographic and/or baseline measures in the subsequent main analyses.
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    Furthermore, two (completion status: drop vs. remain) by 2 (condition) analysis of variance (ANOVAs) on age, gender, income, and education revealed that there were no significant differences between those who dropped (n = 22) and those who remained (n = 72), nor were there any interactions between completion status and conditions (p=.25).

    Change Over Time in HRQL Measures
    The outcomes of the study were tested by comparing participants receiving Tai Chi with those on the waiting-list condition on change in HRQL measures from pretest to posttest. Scores from the various dimensions of SF-20 were entered into univariate repeated measures ANOVAs to test for differences in follow-up HRQL scores between individuals in the Tai Chi and control groups. Because preliminary analyses indicated that the participants who dropped out were similar to those who adhered to intervention on the demographic and outcome variables, we analyzed the change in HRQL measures with participants who completed the study (n = 72).

    The results of ANOVAs indicated that, over the course of the study, individuals receiving Tai Chi had better outcomes had those on the waiting list on all the SF-20 subscales (significant Group by Time interaction): F(2,69) = 4.234, P < .02, for physical functioning; F(2,69) = 2.953, P < .05 for social functioning; F(2,69) = 5.369, P < .007, for role functioning; F(2,69) = 4.630, P < .05 for bodily pain; F(2,69) = 2.763, P < .01, for mental health; and F(2,69) = 6.653, P < .002, for health perceptions.

    Higher scores indicate an increase/improvement in HRQL measures over time. Examination of means for each condition showed that, in general, participants in the Tai Chi group reported a significant improvement (i.e., higher HRQL mean scores) over time in all domains of SF-20 measures. Identical results were obtained when these dropout individuals were also included in the analyses.

    Using the five-point difference as the criterion (Ware et al., 1993), only changes (i.e., from baseline to posttest) in Physical Functioning and Health Perceptions reached clinical significance.
    The effect sizes were: .69 (physical functioning), .92 for social functioning, .78 for role functioning, .5 for bodily pain, .56 for mental health, and .54 for change in health perceptions. Based on our criteria on effect size, these values were judged as meaningful treatment effects.

    All subscales were transformed to a 0 to 100 scale, with higher scores indicting better functioning, and five points “defines differences that are clinically and socially relevant” (Ware et al., 1993). In general, physical-, role-, and social-functioning subscales capture behavioral dysfunctioning caused by health problems. The dimensions of overall health, bodily pain, and particularly mental health reflect more subjective components of health and general-welling (Stewart et al., 1989). The consistency estimates of the four multi-item SF-20 measures varied from .77 (physical functioning) to .89(mental health) for Week 1, .78 to .88 for Week 12, and .79 to .86 for Week 24.

    Procedures
    All participants completed the measures described previously during an initial group orientation meeting (Week 1). Before beginning, participants signed consent forms, indicating the voluntary and anonymous nature of the study. Instructions were read aloud by the researcher, and sample questions were provided prior to the administration of the questionnaire. Additionally, participants were encouraged to clarify any questions/confusions they might have with regard to the questionnaire. No problems were encountered with participants understanding the questions or completing the questionnaire.
    Participants from the experimental group completed these measures a second (Week 12) and third (Week 24) time either at the end of class or at home within a week interval. Participants in the control group completed their second and third assessments by mail. Trained research assistants in compliance with institutional review board procedures for studies involving human subjects, administered the survey measures.

    Program Compliance
    From the initial sample of 94 participants, seventy-two completed all assessments. Nine participants in the Tai Chi group (18% attrition rate) dropped out of the study for reasons such as traveling and family-related commitments. Thirteen participants dropped out of the control group (29% attrition rate) because of unwillingness to wait for the Tai Chi class offered at the end of the study. Thus, the total attrition rate at the end of the study was 23%. Class attendance was recorded for each subject in the experimental group. The average attendance rate (2 times/per week, a total of 48 possible sessions) in the Tai Chi group was approximately 90% with a median compliance of 41 sessions, and ranging from 29 to 47 sessions. Reasons for missing sessions included inclement weather, holidays, and family commitments.

    Statistical Analyses
    Before conducting the primary analyses of the study, we examined whether attrition influenced the representativeness of the remaining subject sample and whether the experimental participants were different on demographic variables that were not controlled in the random assignment procedure. All tests were completed using the analysis of variance (ANOVA) procedure. Following these preliminary tests, repeated measures ANOVA procedures (with Group as a between-subjects factor and Time as a within-subject factor) were used to examine changes over time and differences between Tai Chi and control groups. An interaction between Group and Time indicated a difference in group responses on HRQL measures, suggesting a treatment effect. The primary outcomes (dependent variables) analyzed were the six dimensions of SF-20. Statistical significance was defined as a P value of less than .05; all P values are two-tailed.

    Three Tai Chi instructors auditioned and were selected by one of the investigators (FL) to teach the classes. All instructors had a minimum of 10 years prior Tai Chi teaching experience and came from different ethnic and cultural backgrounds. The Tai Chi intervention was the classical 24-Form Yang style incorporating elements of balance, postural alignment, and concentration (China National Sports Commission, 1983; Yan & Downing, 1998).
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    Participants in the intervention group attended a 60-minute Tai Chi practice session twice a week for 6 months. The sessions consisted of a 15-minute warm-up, 30-minutes of Tai Chi, and a 15-minute cool-down period. During the practice, participants were led by an instructor and replicated the motions, postures, and speed of movement of the instructor.
    Participants in the control group were instructed to maintain their routine daily activities and not to begin any new exercise programs. These participants were promised a 4-week Tai Chi program at the end of the 26-week intervention study period.

    Measures
    Background information. A short inventory was administered at baseline to assess demographic characteristics such as age, gender, education, income, and race/ethnicity.
    Health-Related Quality of Life. HRQL was assessed with the Short-Form General Health Survey (Stewart et al., 1988) measured at baseline (Week 1), middle (Week 12), and termination (Week 24) of the study. The SF-20 was designed for use in clinical practice, research, health policy evaluation, and general population surveys. The SF 20 has proven useful in monitoring general and specific populations, comparing the burden of different diseases, differentiating the health benefits produced by different treatments, and in screening individual patients. The instrument comprises twenty items representing six domains of HRQL: physical functioning, role functioning, social functioning, bodily pain, mental health, and health perceptions. Each is defined below.
    Physical function was assessed by six items assessing the extent to which health interferes with a variety of activities (e.g., carrying groceries, climbing stairs, and walking). Each item was measured on 3-point scale ranging from 1 (= limited for more than 3 months) to 3 (= not limited at all). Higher scores indicate better physical functioning.
    Role functioning was assessed by two items assessing the extent to which health interferes with usual daily activity such as work or housework. Each item was measured on a 3-point scale ranging from 1 (= yes, for more than 3 months) to 3 (= no). Higher scores indicate better role functioning.

    A single item determined participants levels of social functioning and measured the extent to which health interferes with normal social activities such as visiting with friends during past month. This item scale was measured on a 6-point scale ranging from 1 (= none of the time) to 6 (= all of the time) with higher scores indicating better social functioning.
    Mental health was assessed by five items assessing general mood or affect, including depression, anxiety, and psychological well-being during the past month. Each item was measured on a 6-point scale ranging from 1 (= all of the time) to 6 (= none of the time) with higher scores representing better mental health.

    The health perceptions dimension used five items designed to provide overall ratings of current health in general. Each item was measured on a 5-point scale from 1 (= definitely true) to 5 (= definitely false). Higher scores represent better health perceptions.

    The scale of bodily pain was measured by a single item assessing the extent of bodily pain in previous four weeks. This item was measured on a 5-point scale from 1 (= none) to 5 (= severe). The bodily pain subscale was recoded so that a high score represents less pain.

    Research to date has indicated health-related benefits of Tai Chi for older adults including improved balance control (Tse & Bailey, 1991) and reduction in the incidence of falling (Wolf et al., 1996; Li, Fisher & Harmer, in press), improved cardiovascular fitness (Lan et al., 1998; Lan et al., 1999; Young et al., 1999), enhanced psychological well-being (Li et al., 2001a) and increased perceptions of self-efficacy (Li et al., 2001b; Li et al., in press), and physical function (Li et al., 2001c). Less is known, however, about the effects of Tai Chi on overall health-related quality of life (HRQL). Given that the most important long-term endpoint for any practical and therapeutic intervention is not just improved physical and psychological benefits for its participants but enhanced HRQL, research is needed to establish the quantitative relationships between Tai Chi exercise and HRQL in older adults.

    However, only one study to date (Kutner et al., 1997) has examined the relationship between Tai Chi and HRQL measures defined by the generic Health Status Battery (Ware & Sherbourne, 1992. Also known as MOS SF-36). In a 15-week intervention program, Kutner et al. (1997) compared Tai Chi practice group with balance training and education groups and reported no significant differences between intervention groups or any differences over time in perceived health status assessed by the Health Status Battery. Given the relatively short training period (15 weeks) employed, these findings may not be surprising. Determining the long-term effects of Tai Chi interventions on HRQL is warranted.
    The purpose of this study was to extend our knowledge of Tai Chi’s effects on HRQL by examining its influence on multidimensional health status using a well-established medical outcome measure: the General Health Survey (Stewart et al., 1988). These self-report health survey data, which have not been previously reported, reflect participants’ perceptions of their function and well-being. Specifically, we examined the effects of a 6-month Tai Chi intervention on physical-, role-, and social-functioning, bodily pain, mental health, and change in health perceptions. It was hypothesized that Tai Chi practice would enhance these HRQL measures and that these changes would be characterized by mean changes that differed between the experimental and control groups.
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    Participants were community-dwelling older adults recruited from a rural city in the Willamette valley, Oregon. Full details of recruitment and randomization are described elsewhere (i.e., Li et al., 2001a; Li et al., 2001c). Briefly, a total of 148 individuals responded to local newspaper advertisements and flyers at senior centers seeking volunteer participation in a longitudinal physical activity study. Inclusion criteria were: (a) aged 65 years or above, (b) low active, defined as non-involvement in a regular exercise program in the month prior to participation in the study, (c) healthy to the degree that participation in an exercise program would not exacerbate any existing health condition, and (d) willingness to be randomly assigned to a treatment condition. To screen for prior physical activity level, each respondent was interviewed by telephone using the Physical Activity Scale for the Elderly (Washburn et al., 1993).
    Ninety-eight respondents (ranging from 65 to 96 years old (M age = 73.2 years, SD = 4.9), who met the inclusion/exclusion criteria and provided written informed consent before entry into the study, were randomized into the experimental conditions using a list of random numbers. Four individuals withdrew prior to the intervention. Of the remaining 94 qualified participants, 49 were assigned to the intervention group of Tai Chi practice (M age = 72.8, SD = 4.7) and 45 were assigned to a wait-list control group (M age = 72.7, SD = 5.7).

    This study examined the effects of a 6-month Tai Chi exercise program on health-related quality of life (HRQL) in older individuals. Using a randomized controlled trial, ninety-four local community-residing volunteers aged 65-96 (M age = 72.8 years, SD = 5.1) were randomly assigned to a 6-month, twice a week, Tai Chi condition or a wait-list control condition. The Short-Form General Health Survey (SF-20) was used to assess change in multiple dimensions of health status involving physical-, social-, and role-functioning, bodily pain, mental health, and health perceptions. Results showed that, compared to the control group, participants in the Tai Chi group reported significant improvements in all functional domains of HRQL over the course of the 6-month intervention. It was concluded that a 6-month Tai Chi exercise program is effective for improving HRQL among older adults. Tai Chi, a self-paced and low intensity activity appears to be an effective, low-cost approach for promoting health in older persons.

    Accumulating research suggests that physical exercise may be an effective strategy for optimizing health-related quality of life (HRQL) (McAuley & Katula, 1998). Several studies have demonstrated a positive relationship between physical activity and HRQL in the elderly (McMurdo & Burnett, 1992; Ruuskanen & Ruoppila, 1995; Wood et al., 1999) (for a review see King et al., 1999; McAuley & Rudolph, 1995). Whereas higher-intensity exercise programs offer significant health benefits (Fiatarone et al., 1990; King, Rejeski, & Buchner, 1998), in the later years of life such programs are more likely to be associated with increased rates of injury (Pollock et al., 1991). Additionally, many training programs require expensive and technically sophisticated equipment and highly qualified staff (Blair & Garcia, 1996). Therefore, a cost-effective and low-to-moderate intensity exercise program aimed at slowing age-related physiological and psychological decline and preventing disability should be considered for maximizing HRQL for older persons and improving long-term adherence to healthy behaviors (Centers for Disease Control & Prevention, 2001 – National Blueprint).

    Tai Chi is a traditional form of Chinese exercise that can promote health and fitness, prevent disability, and maintain physical performance in later life. It is particularly suitable for older adults because it entails whole body weight-bearing conducted in a slow, controlled fashion. Its movements reflect physical skills required for useful independent locomotion including weight shifting with changing center of gravity and turning (Li, Fisher, Harmer & Shirai, 2003; Wolf et al., 1997). In addition, Tai Chi emphasizes the importance of psychosomatic integration for optimal health by integrating meditation and concentration components with the physical. Finally, from a pragmatic standpoint of cost and convenience, Tai Chi is an attractive activity because it does not require any special equipment and can be practiced any time or anywhere, once the basics have been learned (Li et al., 2003). Given the transportation and other barriers often encountered by older individuals, these features should enhance involvement and adherence.

    Eligible entries were received from 76 students at 14 schools in the Arlington, VA and Washington, DC school districts. Almost all of the posters showed a good knowledge of nutrition by the students. The posters displayed a variety of themes around healthy eating, and the level of creativity and artistic talent was very high. It is not known whether any of the schools requested the Dole Foods educational aterials. Some of the teachers who gained the participation of their students were art or physical education teachers.

    The poster entries were displayed in the main entryway of the national SOPHE conference, and an awards ceremony was held for the winners on November 6, 2004 (see Slideshow 1 .EXE or .ZIP). Many of the children enjoyed the ceremony with their family members and/or teachers joining them.

    Discussion
    It was encouraging to see that almost all of the posters developed by the children displayed a great knowledge of which foods are healthy for them. It is not known how much educational assistance was provided by the teachers. It could be that these students learned about healthy eating in conjunction with this contest, or the students who chose to enter may have already been aware of which foods were healthy for them. It would be interesting in a future project to be able to track the awareness of healthy foods and eating habits of children before and after a similar contest to determine if participation would influence knowledge and/or eating patterns.

    The children seemed motivated by the monetary reward and the awards ceremony. They also enjoyed showing off their works of art to their family members and teachers before and after the ceremony.
    The schools proved to be a good method of publicizing the contest. However, it is recommended to contact the schools more than six weeks prior to the deadline to allow for more time to reach the most appropriate people in the school districts to help promote the contest.

    Summary
    National Health Education Week themes that are specific to children should encourage participation among schools, teachers and parents. The partnership between SOPHE, NCHE, SNP-SOPHE, NCA-SOPHE and Charter Health Plan offers possibilities for dissemination of other public health education campaigns. Furthermore, a children’s poster contest about healthy eating in schools in the Washington, DC area was successful in gaining 76 entries from 14 schools. Children in 3rd through 5th grades displayed a high level of knowledge of which foods were healthy for them and a high level of creativity and artistic talent. The children with the winning posters received cash prizes and were honored at an awards ceremony in their honor.

    Since 1995, National Health Education Week (NHEW) has been recognized as a federal health observance and is solely sponsored by the National Center for Health Education (NCHE). NHEW is celebrated during the third week of October. Since 1998, SOPHE has partnered with the National Center for Health Education to focus national attention on a major public health problem, provide public education on the issue and improve consumer’s understanding of the role of health education in promoting the public’s health. Each year a theme is selected for the week, materials and resources related to the theme, and program planning activities are developed, and disseminated to health education professionals and other stakeholders. Past themes have included healthy living, pediatric diabetes, asthma, medicine education, physical activity related to reducing obesity, and healthy eating related to reducing obesity.

    A poster contest for children was conducted through schools in the Washington, DC metro area in conjunction with the 2004 National Health Education Week’s campaign, “Healthy Eating – Every Bite Counts!”. The contest encouraged children in 3rd, 4th, and 5th grades to learn about good nutrition and display their knowledge in an attractive poster. Six winners were chosen for each grade, and they were honored with their prizes at the Society for Public Health Education (SOPHE) annual meeting on November 6, 2004.

    The contest was co-sponsored and developed jointly by the Student and New Professional Caucus of SOPHE (SNP-SOPHE) and the National Capital Area chapter of SOPHE (NCA-SOPHE). Financial assistance was provided by Chartered Health Plan, a Washington, DC-based managed health care company for Medicaid beneficiaries receiving Temporary Assistance for Needy Families (TANF). Educational assistance came from the Dole Food Company.

    The contest was open to children in 3rd, 4th, and 5th grades in the Washington, DC area. Children were requested to develop a poster on 8-1/2 x 11 paper that depicted the theme of “Healthy Eating – Every Bite Counts!”. The contest was publicized to the schools by contacting the major school district offices in the Washington, DC area approximately 6 weeks before the deadline with a phone call, an official letter, and a flyer that they could distribute to their teachers and students. In addition, participating schools could receive nutrition and educational materials from Dole Foods, including Dole’s “5 A Day Adventures” CD-ROM. The popular “5 A Day Adventures” engages students in fun, action-packed adventures in “5 A Day Land” as they learn about nutrition, physical activity, and the importance of eating 5 to 9 servings of fruits and vegetables a day.
    In addition to the primary National Health Education Week theme, interested students could develop their own slogans around healthy eating. Some suggestions were given in the letter to the schools, such as:
    • Put a Rainbow on Your Plate (Dole 5-A Day Campaign)
    • Eat enough fiber to prevent certain kinds of cancers.
    • Healthy eating helps you get up and go!
    • Healthy eating puts a tiger in your tank
    • Fish is a good way to get lean protein

    The posters were collected from the students and judged by grade level. Judging was performed individually by members of SNP-SOPHE and NCA-SOPHE. Each poster received at least four scores, and all grade levels were judged separately by the same set of judges. All identifying information such as name of the child and school was removed for judging.