At least one in three Americans will develop some type of cancer in their lifetime.[i]

Nutrition and physical activity play a tremendous role in cancer prevention.  As many as one third of all U.S. cancer deaths could be prevented through diet an exercise.[ii] Being overweight or obese is a risk factor for at least seven types of cancer.[iii] The National Institute of Health asserts that obesity prevention efforts must begin during childhood.  A diet with few nutrient-rich foods, a lack of physical activity, and tobacco use all increase a person’s risk of developing cancer.  The Centers for Disease Control (CDC) has concluded that education can be more effective than regulatory measures in long-term reduction of tobacco use. However, only 5% of U.S. schools have executed the CDC’s smoking prevention recommendations.[iv]

There are countless programs that target conditions that lead to chronic illnesses but very little work has been done in cancer prevention education.

According to Slawta J., et. al, health promotion programs for children are successful and may favorably alter obesity and the development of lifestyle-related diseases in adulthood.  A study discussing children’s knowledge and attitudes towards cigarette smoking and its damage illustrated that the students lacked knowledge with regard to the dangers of tobacco use, and it recommended that the topic should be incorporated in teacher’s lesson plans.[v] The study also noted that physicians, nurses and educational advisors suggested that health education should be implemented beginning in first and second grade.

Thus, effective health education is a sound investment in the future.

According to the USDA, healthy diet could prevent at least $71 billion per year in medical costs, lost productivity, and lost lives.[vi] Tobacco use causes 440,000 deaths annually and costs $75 billion just in direct medical costs.[vii] Keeping one child from smoking will save $230 per year in medical expenses throughout his life.[viii] Preventing one child from becoming obese will save her $395 per year.[ix] If Road of Life’s program saves just one child from dying of cancer, the value to society is estimated to be between $5.5 million and $7.5 million.[x] These figures show the high value of a modest investment in health education.

In light of this information, Road of Life is the only organization in the U.S. working exclusively on cancer prevention for children. Road of Life currently works with schools, hospitals, and youth-serving nonprofit organizations to help them incorporate health education with an emphasis on cancer prevention into their existing programs. The health education curriculum emphasizes nutrition, physical activity and the dangers of tobacco use and is aligned with the State Academic Standards as well as the National Health Education Standards. It is Road of Life’s mission to eradicate preventable cancers and diseases of excess by educating children about the smoking, fitness, and nutrition decisions they can make to lead healthier lives.

Road of Life Pilot Intervention Summary

Objective: To analyze the impact of Road of Life’s classroom curriculum education program on the knowledge, beliefs, and behaviors associated with nutrition, physical activity, and tobacco use.  In 2007, Road of Life released the classroom curriculum as well as the after-school curriculum that focuses on general health, nutrition, physical activity, and tobacco use awareness. To provide a greater understanding of the effects of our programs and health initiatives, Road of Life designed and conducted an evaluation to capture the impact of our health education curriculum.  Listed below is a brief summary of the initial evaluation outcomes of the Road of Life intervention study.

Classroom Curriculum Design
The students in the intervention group were given a 70 question pre-test survey before any Road of Life curriculum instruction.  This pre-test helped educators determine the participants’ current knowledge about nutrition, physical activity, and the dangers of tobacco use.  After learning the curriculum, the post-test was administered 6 months later to monitor the positive changes in students’ knowledge, beliefs and behaviors about nutrition, physical activity, and tobacco use.  The 70 questions are specific to the Road of Life curricula and were designed to demonstrate the knowledge and beliefs that the children learned concerning general health, nutrition, physical activity, and tobacco use awareness.  The behavioral questions are questions designed to analyze proper nutritional intake, physical activity, and tobacco use.

Subjects
The students in the intervention group were from a rural/small town with moderate to median family incomes, as determined by the categories designated by the Ohio Department of Education.  The participants were:

• 69 girls and 66 boys, elementary school-aged and in the third and fourth grades.

Of the 135 student participants 97% were white and the remaining, 3% were other, American Indian or Alaska Native.

Results

Statistical significance was set at p <= .1 (90% confidence interval).  Overall the sample showed a statistically significant improvement in a range of questions from all three core areas: knowledge, beliefs, and behavior.  Over 51% of both the knowledge and belief section questions demonstrated statistically significant improvement in student responses between the pre- and post-test survey.  In addition, 40 % of the behavior section questions showed statistically significant improvement in student responses.  In the knowledge and beliefs sections students showed even greater statistically significant improvement (p <=.05 or 95% confidence interval) on 37% of the questions regarding nutrition, physical education, and tobacco use curricula.  Furthermore, 34% of the questions (in the behavior section showed this greater statistically significant improvement (p <=.05) in the area of nutrition, physical education, and tobacco use (Table 1).

Further analysis revealed specific significant improvements in the area of nutritional knowledge on questions about caffeine dehydration, food labels, and serving sizes.  In addition, students showed an increased knowledge in available locations to be physically active, high-energy activities, and stretching in the area of physical activity knowledge.  Students also showed statistically significant increased knowledge of the dangers of tobacco on questions related to the short term consequences of smoking and various tobacco products.  In respect to beliefs, specific nutrition questions about healthier food options, the importance of breakfast, and appropriate fruit and vegetable intake showed statistically significant improvements.  The belief questions regarding the image of people who smoke and safety in physical activity also showed statistically significant improvements in student responses.  The majority of the statistically significant questions in the area of behavior were about positive nutritional food changes and an increase in physical activity (see Appendix for a listing of the specific questions).

Conclusions and Implications

The effects of nutrition, physical education, and tobacco use curricula were measured in terms of knowledge, beliefs, and behaviors.  The results of the difference between pre- and post- tests revealed that students showed a statistically significant improvement in a range of questions on nutrition, physical activity, and tobacco use from the three core areas of knowledge, beliefs, and behavior.

School health programs can help children and adolescents reach good health by providing them with the knowledge, skills, social support, and environmental reinforcement they need to adopt long-term, healthy nutrition and physical fitness behaviors. Road of Life’s strategy is shown to be effective in promoting significant improvements in knowledge, beliefs, and behavior regarding nutrition, physical education, and tobacco use.  The curriculum Road of Life provides is a beneficial and essential resource for schools lacking comprehensive health programs.

Research indicates that the participants that learn healthy habits during early adolescence have a better chance of maintaining these habits throughout adulthood.  By educating youth about the importance of healthy lifestyle choices in childhood, the Road of Life programs can help to reduce adult rates of cancer and diseases of excess including diabetes and obesity in adulthood. This initial pilot study shows that students exposed to the Road of Life Classroom Curriculum 2.0 show statistically significant improvements in their knowledge, beliefs and behaviors relating to nutrition, physical education, and tobacco use.

Table 1: The Percentage and Number of Questions in Each of the Core Areas Demonstrating Statistical Significance

Appendix

Below are the questions that the students demonstrated statistically significant (p<=.1 or 90% confidence interval) improvement between the pre and post test survey.

Knowledge Section : *Indicates p<=.05 (95% confidence interval)

1. High-energy activities make your heart beat faster and help to reduce stress.
2. Caffeine, which is found in soda pops, dehydrates your body.
3. * Not stretching before working out can cause you to break your muscles.
4. * Chewing tobacco is much safer than smoking cigarettes and cigars.
5. * Some short term consequences of smoking include: yellowing of teeth and trouble breathing.
6. High energy activities can be done in all seasons.
7. * Both an empty field and the YMCA offer a chance to be physically active.
8. TV commercials often express the opinions of the products manufacturer.
9. * Food labels tell us how many nutrients are in an entire box or package of food.
10. * A serving size is the amount of food a person should eat at one time.
11. * One serving of a fruit or vegetable is the size of a baseball.

Belief Section: *Indicates p<=.05 (95% confidence interval)

1. * When eating out, it best to order fruit for dessert.
2. * People smoke to look cool, look older, to fit in with friends and to seem tough or independent.
3. * People can be physically active in every community.
4. * All sugars should be avoided.
5. * Eating at least five fruits and vegetables a day will make me healthy.
6. There are negative consequences to skipping breakfast.
7. * It is easier to develop healthy habits as and adult rather than a kid.

Behavior Section: *Indicates p<=.05 (95% confidence interval)

1. * Yesterday, did you eat any vegetables? Vegetables are all cooked and uncooked vegetables; salads; and boiled, baked and mashed potatoes. Do not count French fries or chips.

-No, I didn’t eat any vegetables yesterday.

-Yes, I ate vegetables 1 time yesterday.

-Yes, I ate vegetables 2 times yesterday.

-Yes, I ate vegetables 3 or more times yesterday.

2. Yesterday, did you drink any punch, Kool-Aid®, sports drinks, or other fruit-flavored drinks? Do not count 100% fruit juice.

-No, I didn’t drink any of these drinks yesterday.

-Yes, I drank one of these drinks 1 time yesterday.

-Yes, I drank one of these drinks 2 times yesterday.

-Yes, I drank one of these drinks 3 or more times yesterday.

3. Yesterday, did you eat sweet rolls, doughnuts, cookies, brownies, pies, or cake?

-No, I didn’t eat any of the foods listed above yesterday.

-Yes, I ate one of these foods 1 time yesterday.

-Yes, I ate one of these foods 2 times yesterday.

-Yes, I ate one of these foods 3 or more times yesterday.

4. * Yesterday, did you have a snack? A snack is food or drink that you eat or drink before, after, or between meals.

-No, I didn’t have any snacks yesterday.

-Yes, I had a snack 1 time yesterday.

-Yes, I had a snack 2 times yesterday.

-Yes, I had a snack 3 or more times yesterday.

5. * Yesterday, how many times did you eat food from any type of restaurant? (Restaurants include fast food, sit down restaurants, pizza places, and cafeterias.)

-None    -1 time    -2 times   – 3 or more times

6.  * On how many of the past 7 days did you exercise or take part in physical activity that made your heart beat fast and made you breathe hard for at least 20 minutes? (For example: basketball, soccer, running or jogging, fast dancing, swimming laps, tennis, fast bicycling, or similar activities)

-0 days    -1 day    -2 days    -3 days    -4 days    -5 days    -6 days    -7 days

7. * Yesterday, how many hours did you watch TV or video movies away from school?

-I didn’t watch TV yesterday    -1 hour    -2 hours

-3 hours    -4 hours    -5 hours    -6 hours or more

8. * Skipping meals such as breakfast or lunch makes it hard for me to do well in my classes.

-Yes, all of the time     -Yes, sometimes     -No

9. * Yesterday, how many TV shows did you watch?

-1 show    -2 shows    -3 shows    -4 shows    -More than 4 shows

10. * Do you currently take part in any other organized physical activities or take lessons, such as martial arts, dance, gymnastics, or tennis?

-Yes    -No

11.  Do you have a computer at home?

-No, I do not have a computer at home.

-Yes, I have a computer at home but I do not have internet

-Yes, I have a computer and internet at home

12. Do you encourage your friends and family to be physically active?

-Almost always or always    -Sometimes    -Almost never or never

13. * Do you eat foods and drink beverages that you see in advertisements?

-Almost always or always    -Sometimes    -Almost never or never

14. * Do you make a schedule and plan for physical activity each day?

-Almost always or always    -Sometimes    -Almost never or never

[x] Murphy, Kevin and Robert Topel.  “The Value of Health and Longevity.” Working Paper No. 11405, Issued in June 2005.  National Bureau of Economic Research.  http://www.nber.org/papers/w11405.pdf