Bienestar: A Diabetes Risk-Factor Prevention Program

Article excerpt

Overweight and dietary fat intake are established risk factors for diabetes. In Mexican Americans, the San Antonio Heart Study found a significant relationship between overweight and both the prevalence and 8-year incidence of diabetes.[1,2] Dietary fats, independent of body weight, are also reported to cause insulin resistance and diabetes in experimental and clinical studies.[3-6] Thus, health programs that decrease per cent body fat and/or decrease dietary fat intake may potentially prevent diabetes.

Greater adiposity and higher dietary fat intake are more common in Mexican-American children than in non-Hispanic White children. Mexican-American children have more centralized adiposity, higher body mass index, and larger skinfolds than non-Hispanic White children.[7,8] Mexican-American children also consume higher portions of dietary fats and lower portions of vegetables and fruits than that recommended by national standards.[9] Since diabetes is highly prevalent in Mexican-American adults, and both diabetes risk factors are more common in Mexican-American children, a prudent measure would be to explore health education programs aimed at decreasing overweight and dietary fat intake in Mexican-American children.

Preliminary results from the Bienestar (Well-being) Health Program are described. The Bienestar Health Program is a school-based diabetes risk-factor prevention program, and results from the pilot study contributed to program refinement. The program was designed to be implemented for fourth grade Mexican-American children from poor school districts, since the disparity in body fat between Mexican-American and non-Hispanic White children is evident as early as eight years for boys and 13 years for girls.[8] Diabetes and overweight also are more common in Mexican-American adults from lower than from higher socioeconomic status.[1,10]

The primary goals of the Bienestar Health Program are to decrease body fat and/or to decrease dietary fat intake in children. Body fat is measured by bioelectric impedance analysis (BIA) and body mass index (BMI), and dietary fat intake is measured by three 24- hour dietary recalls. Secondary goals are to increase vegetable and fruit intake, health knowledge, self-efficacy, self-esteem, and level of activity.

PROGRAM DEVELOPMENT

Theoretical Framework

The Bienestar Health Program is based on Social Cognitive Theory.[11] This conceptual model describes behavior as being motivated and regulated by internal standards and self-evaluation. According to this model, social systems in the individual's environment in addition to self-evaluation mediate the relationship between an individual's knowledge and attitudes and his/her consequent behaviors.

Program Description

Using social systems structure, interventions were developed for the four social systems that conceptually should exert the most influence on children's health behaviors. The four social systems are parents, school classroom, school cafeteria, and after-school care. These four separate components were integrated by content, chronology, and culturally relevant themes and operated from September through April.

The parent health education intervention consists of a nutrition education seminar to provide content knowledge, cooking classes to provide an opportunity to practice with feedback (including taste), a theatrical play with health topics presented by the children to provide affective motivation, a series of health newsletters written by the children to inform parents of ongoing activities and reinforce earlier activities, and an individual dietetic consultation to discuss their respective child's nutritional data and therapy recommendations to inform parents about their child's level of risk.

The school classroom intervention was the Bienestar health curriculum. Developed by staff from the Social & Health Research Center and the departments of education at Southwest Texas State University and University of Texas at San Antonio, the Bienestar health curriculum was designed to supplement the existing health curriculum so as not to eliminate or reduce important content coverage not related to diabetes prevention. …