A great deal of attention is being paid to primary prevention of noncommunicable disease among children and adolescents. Such programs have a number of advantages over those implemented with adults. The most important may be the initiation of life-long patterns of healthful behavior.
The "Achilles heel" of programs for children and adolescents is the difficulty in creating approaches that are appealing and meaningful for them, particularly when health-enhancing behaviors may not be as highly valued as unhealthful behaviors. One of the obligatory components in the development of primary prevention programs is the search for the salient values and motivations of young people which can then be used in developing a lifestyle strategy. Since values change over the course of adolescence to adult concerns, the study of these changes may provide important clues for program structure.
Research data on attitudinal aspects of children's lifestyle are mostly confined to health-related behaviors (Story & Resnick, 1986; Perry et al., 1987; Nutbeam, 1987). In the present study, values on a broader spectrum of lifestyle patterns were assessed with the aim of identifying potential incentives for intervention. An attempt was made to answer the questions: To what extent do children and adolescents value specific health patterns as compared to other patterns, and how do these values change over time? To what degree do school-based preventive programs influence these values?
As a part of the Minnesota Heart Health Program (MHHP) (Blackburn et al., 1984), a seven-year study of sixth- through 12th-grade students was performed. The study included the five-year health-promotion program. The intervention community was made up of Fargo, North Dakota and Moorhead, Minnesota. Sioux Falls, South Dakota served as the reference community. Each community is an isolated urban center of approximately 110,000 population and is primarily white and middle class. All 6th graders (mean age 12.2 years) in both communities participated in a baseline study in 1983 (N = 2,406), and that grade cohort was followed annually through the 12th grade. Regardless of participation in earlier surveys, students were eligible to participate in the survey, forming both cohort and cross-sectional samples. Since developmental concerns are most critical to this examination, only data from the cohort sample were used.
A self-administered questionnaire assessed psychological factors and behavioral patterns. This was administered during school hours each spring, from 1983 through 1989. A section of the questionnaire concerned with various lifestyle factors and their importance to students was selected. The students were asked to respond to eight factors, on a Likert-type scale (Anastasi, 1979), to the question: "When you think about the things that really count in how you feel about yourself and life, how important to you is: (1) the number of friends students have; (2) the kind of food they eat; (3) the amount of money they can spend on themselves; (4) the amount of exercise they get; (5) the amount of TV they watch; (6) their physical appearance; (7) how well they do in school; and (8) how well they get along with their families?" The rating scale ranged from 1 (not at all important) through 5 (extremely important). These items were selected because they reflect the major arenas of adolescent life--family, school, peers, self, entertainment--and how these are valued compared with specific health-related concerns--food and exercise--that were targeted as part of the MHHP.
The overall model and design of the intervention program, called the Class of 1989 Study, is described in detail elsewhere (Perry, Klepp, & Sillers, 1989; Kelder, 1991). This school-based health promotion program was conducted for five years (grades 6 through 10) from 1983 to 1987. The theoretical factors used as guidance for intervention design were based on social learning theory (Bandura, 1977) and theory developed specifically for MHHP (Perry & Murray, 1982; Perry & Jessor, 1985). …