Thesis Poster

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Background: Bone health education is beneficial to start in childhood to build healthy bones prior to reaching peak bone mass. Knowledge of influences and values can be used to improve selection of bone-healthy behaviors. Objectives: The study aimed to determine factors that influence bone-health behaviors and increase bone-health knowledge in a school-aged population. Methods: A pretest, posttest and 21-day posttest, quasi-experimental study tested the efficacy of Batter Up For Bone Health (BU4BH) intervention based on Social Cognitive Theory (SCT) constructs measuring factors the impact bone-healthy behaviors. School and summer camp settings were used. Statistical testing (SPSS Version 22) included Chi-square tests, t-tests and ANOVA’s. A Principal Components Analysis was performed on SCT questions with Cronbach alpha evaluating the internal reliability of new variables. Results: A total of 168 participants [school (n=99); camp (n=69)] completed BU4BH. There was an increase in bone health knowledge gained (p=0.003). Participants were likely to be influenced by others drinking milk (p<0.0001). The participants (94%, n=112) felt that it was “very important” for kids their age to have healthy bones. At 21-day post-test, participants (63%, n=78) planned to eat foods that are healthy for their bones. Conclusions: Children are influenced by the behaviors of others, thus educating teachers and parents to be positive role models can contribute to bone healthy behaviors. Participants displayed increases in self-efficacy showing that an interactive bone health intervention (BU4BH) can increase knowledge, promote self-efficacy and instill beneficial bone health behaviors.

ABSTRACT

INTRODUCTION & OBJECTIVES

Batter-up for Bone Health (BU4BH) is a one day intervention incorporating active learning to strengthen knowledge related to bone health within the framework of baseball: Calcium (pitching mound), Vitamin D (first base), Ground force activity (2nd base), Joint force activity (3rd base) and MyPlate meal planning (home plate).

Behavioral theory component: The BU4BH program used the Social Cognitive Theory (SCT) to examine personal, social and environmental influences on children’s bone healthy behaviors questions comparing family members, peers, and teachers influences on impacting children’s bone healthy behaviors in addition to knowledge-based questions on bone health

Tools: Pre-test, post-test, post-test at 21 days.

Study settings: School (physical education class) and summer camp

School received nutritional and physical activity tips during the three week break. The camp did not.

Ages: 7-11 years old

Statistical analysis: Data were analyzed using IBM SPSS Statistics (Version 22). Environment and behavior questions were analyzed by running a Principal Components Analysis (PCA) to re-group the data into fewer, stronger factors. Cronbach alpha evaluated the internal reliability of new variables.

MATERIALS & METHODS RESULTS STRENGTHS & LIMITATIONS

Strengths:

● BU4BH is framed within SCT constructs

● Activities reinforce SCT influences

● Assessment tool incorporated social cognitive theory constructs

Limitations:

● Constraints for time allotted to run the game, perform assessment

● Language barriers during the camp session

CONCLUSIONS & IMPLICATIONS

Bone health is important to the school-age population

Positive bone health behaviors will be modeled

Influences were similar between genders

Influencers and understanding bone health importance can motivate positive bone health practices

Others drinking milk are a positive influence in school-age child drinking milk

School environment has limited impact on nutrition behaviors

Self-efficacy plays a role in behavior changes and motivation

School-age children believe in their ability to identify and choose bone-healthy foods and activities

ACKNOWLEDGEMENTS

Researchers are grateful to the respective administrators, teachers and BU4BH participants.

Introduction:

Promoting bone health in school-age, prior to adolescence, may positively impact bone healthy behaviors prior to reaching peak bone mass. A better understanding on how a child’s behavior guides his or her decision-making process, especially regarding food choices and healthy behaviors, is helpful in reaching the school-age children to strengthen bone-building habits. Studying the impact of various constructs of behaviors through theory-based interventions has emerged as a key component for instilling proper lifestyle changes in favor of improved health. Influencers that impact one’s decision-making process include (but are not limited to) environment, parental role modeling, health beliefs, perceived susceptibility of disease, and peer influence. Knowing what motivates and influences those behaviors are critical to improve understanding and target messages and interventions to promote positive bone healthy behavior change in the school-age population.

BU4BH Objectives:

1.Improve bone health knowledge and behaviors for school-age population.

2.Educate children on foods rich in vitamin D and calcium.

3.Promote physical activities that support healthy bone development.

1Nutrition Department, Benedictine University, Lisle, IL

Factors Influencing School-age Children to Choose Bone Healthy Behaviors

Karen Plawecki1, PhD RD LDN, Sarah Allaben, MS RD LDN, Erica Auriemme, MS RD LDN, Alexis Blandine, MS RD LDN, Kiah Ehrke, MS RD LDN, Ellen Hashiguchi, MS MPH RD LDN, Maggie Tignanelli, MS RD LDN

Location Participants Females Males

School 59% (n=99) 51 48

Camp 41% (n=69) 38 31

Principal Components Analysis (PCA): Pre-test Questions New variable Cronbach

Alpha When I see my (friends, teachers, adults at home, brothers, sisters) drinking milk, I’m more likely to drink milk

Drinking milk .863

I like to eat what my teachers eat or when I see my teacher eat something, I like to eat that food too. My friends and I eat the same foods.

School environment

.666

I like the same foods my parents like or like to eat what my parents eat. I like to eat what my friends eat.

Home environment

.580

My family eats the same foods at mealtime. n/a n/a

Principal Components Analysis (PCA):21-day Post test Questions New variable Cronbach

Alpha When I see my (friends, teachers, adults at home, brothers, sisters) drinking milk, I’m more likely to drink milk

Drinking milk .885

I like to eat what my friends/teachers eat. When I see my friends/teachers eat something, I like to eat that food too.

School environment

.295

I like to eat what my parents/friends eat. My family eats the same foods at mealtime.

Home environment

.604

BU4BH Timeline

Examining Self-Efficacy in Post-test “It is easy to choose a

snack that is good for your bones” (n=92)

Response Yes Chi-Square

P-Value*

Always 45 39.30

0.0001 Often 25

Sometimes 19

Never 3

DEMOGRAPHICS

*effect size: 0.81 (large)

Statement: “It is important for kids my age to have healthy bones.” Response (n=119)

Yes Chi-Square

P-Value

Effect Size

Very Important

112 198.17

0.0001

0.94

(Large) Kind of Important

6

Somewhat Important

1

Examining Self-Efficacy in Post-test “It is easy to choose

and activity that is good for your bones.” (n=74)

Response Yes Chi-Square

P-Value*

Always 40 15.60

0.0001 Often 21

Sometimes 13

Never 0 *effect size: 0.83 (large)

Ethnicity Participants

Caucasian 53% (n= 89)

Hispanic 33% (n=55)

African American 1% (n=1)

Hispanic & White 5% (n=8)

Other 7% (n=12)