The Effects of Ethnicity, Sex and Fat Occupation on Heart Health Knowledge a Nutrition Behavior of School Children: The Texas Youth Health Awareness Sur z d M James N. Burdine, Meei Shia Chen, Nell H. Gottlieb, Fred L. Peterson, T. Dernetri Vacalis ABSTRACT zyxwvutsrq The relationships of ethnicity, sex and father’s occupation with heart health knowledge and nutrition behavior were studied in Texas seventh and eighth grade students. A questionnaire was administered to zyxwvutsr HGFEDCBA 2,695 children in schools chosen to represent the urbanlrural and ethnic mix of the state population. The findings indicated a strong need for heart health education and for culturally-relevant nutrition education aimed at specific target groups defined by ethnicity, sex and leisure activity. Analysis of eatingbehavior at school and home confirmed the importance of school feeding programs on the health of minority and low income children. Heartdisease has reached epidemic proportions in the United States and is the leading cause of death.’ The lifestyle health habits of not smoking, eating a diet low in salt and cholesterol, watching one’s weight and exercising regularly have been recommended for the primary prevention of heart disease.’ These habits, which are adopted in childhood, are key determinants of future heart health. There has been an upsurge of interest in heart health education for school-aged children. Iammarino et al,’ in a review of the school heart health educationliterature, establishedthe importance for cardiovascular disease preventionthrough improved diet, discouragement of smoking and promotion of exercise in children and youth. They concluded that there is a tremendous need for educating school children about heart health and that in many instances adolescents do not have sufficient knowledge upon which to make healthful decisions for the prevention of heart disease. Biles,‘ Schoenberger,’ Creswell‘ and Spiker’ all argue for the important role that schools can play in heart health education. Education, of course, is not the sole influence upon children’s health behavior. Modeling of behavior by parents, peers and media figures are important in the transmission of social norms for these behaviors.*-” A model depicting these influences has been specified for smoking.” The strength and direction of these influences likely vary with sex, social class and ethnicity. The purposes of this study were to determine the level of knowledge about heart health and the extent of healthful eating behavior of Texas seventh and eighth graders and then t o study the relationship of ethnicity, sex, father’s occupation, knowledge and television viewing to the children’s eating patterns. The results will further the understanding of the social epidemiology of heart disease risk and assess the needs of specific school-aged population groups for heart health education. METHODS In March, April and May, 1980, the Texas affiliate of the American Heart Association conducted a survey of Texas seventh and eighth grade students using a questionnaire administered in the classroom. A purposive sample of schools was selected to represent the geographic and ethnic mix of Texas. Completing the self-administered questionnaire of heart health knowledge and behavior were 2,695 seventh a eighth grade students from 52 schools in 22 cities and towns. The ethnic distribution, which closely approximated that in th state, was 13% black, 21.6% Mexican-American, 62% Anglo and 3.3% other. FI NDlNGS Knowledge Students were asked t o list three “things you can d o to lower your chances of having heart disease.” The highest proportion (62.2%) mentioned regular exercise followed by eating right or a proper diet (56.1%), not smoking (39.7%), eating fewer salty foods (1 1.4%) and losing weight or not getting fat (10.6%). Differences on these variables among groups defined by sex, ethnicity and father’s occupation were examined using chi-square analysis. The two differences foun related to ethnicity. Of those students responding to the question, Anglos (81.5%) were more likely to list regular exercise than were Mexican-Americans (52.2%) and blacks (57.3%) (X=11.57, 3 df, p zyx e .01). Mexican-Americans (100.0%) and Anglos (%.3vo) were more likely to mention no smoking as a way to lower heart disease risk (X = 5.99, 3 df, p < .05). The students were asked to match the definitions for five terms using a list of eight possible definitions. Cholesterol was correctly defined by 66.5% of the respondents; CPR by 55.7%, aorta by 49.7%, arteriosclerosis by 47.6% and hypertension by 15.6%. Tabular analysis, using chi-square tests for significance, showed ethnicity and father’s occupation to be significantly related (p q.001) to correct definitions of each of the terms and sex (p * .001) to two of the five. The numbers of correct responses to these itemswere summed to create the heart health knowledge index. Ethnicity (p e .001), sex p * zyx TSR . O l ) and father’s occupation (p * .001) were shown t o be significantly related to total score on the t using one-way analysis of variance. Anglos (x = 2.60). females ( x = 2 . 4 2 ) a n d c h i l d r e n o f f a t h e r ’ s w i t h professionaVmanageria1 occupations (x = 2.70) scored highest in these categories. The reliability of the test was not determined. Eating Patterns As indicatedin Table 1, Anglos and children with professionaVmanageria1 fathers were more likely than the respective peers to have at least three meals a day. Males, blacks and children of service workers or laborers were more likely to have three or more snacks per day. The respondents were asked to indicate on a five-point scale from “never” to “very often” how often they ate 15 different snack foods, both a t home and at school. Because o the small number selecting diet soft drinks, it was dropp from the analysis. The most frequently reportedsnack at home JOSH February 1984, Vol. 54, No. 2 87