IMPROVING BONE HEALTH IN ADOLESCENCE THROUGH TARGETED BEHAVIORAL INTERVENTION

• Sponsoring Institution: State Agricultural Experiment Station
• Project Status: COMPLETE
• Funding Source: STATE
• Reporting Frequency: Annual
• Accession No.: 0189846
• Project Start Date: Oct 1, 2000
• Project End Date: Sep 30, 2004
• Program Code: [(N/A)]- (N/A)

Recipient Organization
UNIV OF HAWAII
3190 MAILE WAY
HONOLULU,HI 96822

Performing Department
HUMAN NUTRITION, FOOD & ANIMAL SCIENCES

Non Technical Summary
The proposed targeted behavioral intervention is designed to improve calcium intakes and bone health among Asian, Caucasian and white Hispanic adolescents, likely reducing their risk for osteoporosis later in life. The objective of the project is to develop, implement and evaluate a targeted behavioral intervention that will alter dietary behavior to include adequate calcium (dairy and nondairy food sources) in the diet of Asian, Hispanic and Caucasian adolescents and to determine if this change in dietary behavior translates to improved bone health.

Animal Health Component

50%

Research Effort Categories

Basic

25%

Applied

50%

Developmental

25%

Classification

Knowledge Area (KA)	Subject of Investigation (SOI)	Field of Science (FOS)	Percent
702	6010	1010	20%
702	6010	1020	20%
702	6010	1170	20%
703	6010	3020	20%
703	6010	3070	20%

Knowledge Area
703 - Nutrition Education and Behavior; 702 - Requirements and Function of Nutrients and Other Food Components;

Subject Of Investigation
6010 - Individuals;

Field Of Science
3070 - Psychology; 3020 - Education; 1010 - Nutrition and metabolism; 1020 - Physiology; 1170 - Epidemiology;

Keywords

calcium

osteoporosis

adolescence

ethnic groups

diet

human nutrition

intervention

human behavior

bones

lactose

human psychology

human health

nutrient requirements

nutrition education

human physiology

epidemiology

behavior modification

program planning

health care

females

asian americans

whites

spanish americans

nutrient intake

density

lactose intolerance

digestion

age

performance evaluation

demonstration

cd roms

questionnaires

data collection

comparative analysis

educational materials

controls

body composition

information dissemination

Goals / Objectives
1) To establish a technologically driven behavioral intervention program that can be readily expanded to meet the needs of educational professionals, health care providers, and health and nutrition educators on a national basis. 2) To recruit 900 healthy 11-12 year old females, equally divided betwen Asian, Caucasian, and white Hispanic youth from 6 states, for participation in a two-year behavioral intervention designed to increase calcium intake, thereby enhancing the rate of increase in bone mineral density. 3) To measure the occurrence of lactose maldigestion among healthy 11-12 year old females representing Asian, Caucasian, and white Hispanic ethnic groups. 4) To demonstrate, by psychological assessment measures, the advantages of applying predictive schemes for targeted behavioral intervention.

Project Methods
An interactive integrated DVD/CD-ROM curriculum will be created, which will include a food frequency questionnaire that will measure calcium intake, a key intermediary outcome of the intervention. Community based programs will be recruited to participate in the program, based on distance from the study center, ethnic diversity, the program's potential for intervention, and commitment to offer the program on a regular basis over 2 years. Programs must also be willing to cooperate with random assignment to treatment or control and to use computer-based technology. The Data Coordinating Center at Purdue University will do the randomization. Calcium intake and stage of change will be collected for both the intervention group and the control group using computer administration. However, the control group will not have access to the educational portion of the DVD/CD-ROM until completion of the intervention. In this way, the educational curriculum will be disseminated to all children by the end of the study. Intervention Site Directors will retrieve and store data for each session, and transmit data to Purdue University following secure protocols. Bone mineral content, vertebral dimensions, total body calcium, and body composition will be determined by Dual Energy X-Ray Absorptiometry (DXA). These measures will indicate differences in bone mass between intervention and control groups, an indicator of success of the intervention. Lean body mass from DXA will also be measured and differences between groups assessed. Intellectual ability will be assessed using the Raven's Standard Progressive Matrices and the level of adolescent depression will with the Center for Epidemiologic Studies Depression Scale (CES-D). Individual differences in the degree to which adolescents believe that they have the capability to resist peer pressures that can adversely affect their health status will be assessed using the factor based self-regulatory subscale of the Self-Efficacy Scales developed and validated by Bandura. To assess level of stress exposure adolescents will be given a list of major life stress events and to indicate whether any of these events occurred in the past year and to rate the perceived level of the stress using a 5 point rating scale. Each measure described above will be assessed prior to the start, and at the end of the intervention. Subjects will be challenged with 0.35 g lactose/kg body weight(in 1% milk), and assisted by trained staff in collecting breath hydrogen samples and reporting symptoms every hour for 3 hours following the milk challenge. The samples will be analyzed for hydrogen concentrations using the Quintron Model CM2 Hydrogen Analyzer (Quintron Instruments, Milwaukee, WI). A rise in breath hydrogen of >20 parts per million (ppm) (0.9 mmol hydrogen/L air) after the challenge dose of lactose will define a lactose maldigester. Lactose maldigesters will have a particular interest in the portion of the intervention that shows how to improve tolerance and obtain adequate calcium. If proven efficacious, the CD/DVD intervention program will be available to community programs.

Progress 10/01/00 to 09/30/04

Outputs
We have recruited 117 subjects from 8 private schools in Hawaii. Recruited intervention schools include Sacred Hearts Academy, Maryknoll School, St. Andrew's Priory and Punahou School. Kamehameha School, Iolani School, St. Franics School and Hawaii Baptist Academy were recruited as control schools. Additional control schools were recruited from public schools (CRIS # 0191122). A total of 136 girls were recruited for this study. Of the 136, 96 were from intervention schools and 40 were from control schools. We have a current retention rate of 99% (1 girl dropped out). The 3rd of three visits to measure DXA body composition and bone is ongoing. All visits will be completed by Summer 2005.

Impacts
Current research indicates that the greater accretion of bone mass prior to the period of bone loss (adulthood, particularly the later years) lowers the incidence of osteoporosis. Peak bone mass is, in part, affected by calcium intake in childhood, adolescence, and early adulthood. Unfortunately, calcium intake actually declines during adolescence particularly in young women. Therefore, there is a pressing need to develop behaviorally based interventions for the youth of America. This project has developed and is testing and educational intervention in a classroom setting among multiple ethnic groups. The impact on calcium intake and bone health will be determined.

Publications

• No publications reported this period

Progress 10/01/02 to 09/30/03

Outputs
The intervention development is complete. Recruitment of subjects and classroom intervention began in Nov 2002 and is expected to be completed April 2004. Recruited intervention schools include Sacred Hearts Academy, Maryknoll school, St. Andrew's Priory and Punahou school. Kamehameha was recruited as a control school. An approval from the Dept of Education is pending for the recruitment of several public schools, including Stevenson Middle School as an intervention school and Kawananakoa Middle School, Washington Middle School, Kaimuki Middle School and King David Kalakaua Middle School. The target recruitment has increased from 150 to 186 6th grade female subjects per the coordinating center at Purdue (98 intervention and 88 control). 39 intervention and 5 control subjects have been measured to date. Recruitment and intervention is ongoing.

Impacts
Current research indicates that the greater accretion of bone mass prior to the period of bone loss (adulthood, particularly the later years) lowers the incidence of osteoporosis. Peak bone mass is, in part, affected by calcium intake in childhood, adolescence, and early adulthood. Unfortunately, calcium intake actually declines during adolescence particularly in young women. Therefore, there is a pressing need to develop behaviorally based interventions for the youth of America.

Publications

• No publications reported this period

Progress 10/01/01 to 09/30/02

Outputs
Recruitment of schools started in Feb 2002. Sacred Hearts Academy and Maryknoll Grade School were successfully recruited and randomized to intervention sites, and Kamehameha School and St. Andrew's Priory were recruited and randomized to control schools. We are actively recruiting students from these four schools. Baseline measures have been taken from several girls at the Kapiolani Clinical Research Center and we are preparing to start the first intervention session in November.

Impacts
The behavioral intervention has the potential to decrease future osteoporosis rates, by assisting youth to attain greater bone density when bone is being laid down. This would avert some of the 1.3 million fractures per year at a cost of $7-10 billion/year.

Publications

• No publications reported this period

Progress 10/01/00 to 09/30/01

Outputs
In this year the CD/DVD intervention content has been completed by the Curriculum Research and Development Team in Hawaii. Protocol development, including IRB approval, has been initiated. Equipment has been purchased and staff hired in preparation for implementation next year. Collection of biologic measures will be done at the Clinical Research Center at Kapiolani Health Center in Honolulu. A list of schools has been generated that are close to Kapiolani, from which schools will be selected for the intervention by the Coordinating Center at Purdue University.

Impacts
This project will develop and test a behavioral intervention targeted to White, Asian and Hispanic adolescents. The purpose of the intervention is to increase dietary calcium intake and bone density. The intervention will be implemented on CD/DVD in regular school classrooms. If effective the intervention will increase bone density and decrease medical costs associated with development of osteoporosis.

Publications

• No publications reported this period