The percentage of children ages 6 to 11 who are overweight increased from 4 percent in the early 1970s to nearly 19 percent in 2004, and grew from 6 percent to 17 percent for youth ages 12 to 19 over the same period, according to the Centers for Disease Control and Prevention. Health advocates point to the estimated 40,000 commercials viewed by children each year – many of which are about foods high in sugar, fat or sodium – as one of the key factors in the rise of childhood obesity.
Media-Smart Youth is an after-school curriculum designed to teach youths ages 11 to 13 how to analyze, evaluate and create media messages about nutrition and physical activity, and how such messages can influence their lives. The Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD) contracted with the Academy for Educational Development (AED) in 2001 to develop the program as part of the U.S. Department of Health and Human Services’ Youth Media Campaign, in conjunction with the Healthy People 2010 initiative.
In mid-2006, the program was launched at 18 pilot sites (nine matched treatment and nine control pairs) in the Washington, D.C., metropolitan area.
The curriculum consisted of ten 90-minute lessons delivered by a trained adult facilitator. Each lesson contained three learning activities, as well as breaks for a healthy snack and physical activity, which were designed to reaffirm concepts taught that day. Each lesson also included a “Mini Production” media activity, such as the creation of an advertisement or jingle, or the invention of an action hero.
Among the 10 lessons were such segments as “Media and Health – What’s the Connection?” “Cutting Back on Fat and Added Sugar,” “What’s on the Label?” “Thinking about Body Image” and “Being Active: What Makes it Easy?”
Designed for groups of up to 15 youths per site, curriculum delivery could take place twice a week, once a month, or in daily sessions over a two-week period. At the end of the program, treatment youth created and presented a media project, referred to as “The Big Production,” that promoted healthy nutrition and activity to their peers.
Group-randomization was achieved by recruiting 20 participating sites (two later dropped out), matching the groups into pairs for location, socioeconomic status and composition, and then randomly assigning designations across the pairs as either a treatment group or a control group.
To ensure an overall rigorous design, AED organized a program on career development for the control sites to minimize attrition and to make the control group experience more enriching. To enhance the fidelity of curriculum delivery, all facilitators received their half-day of training at the same time. Finally, the researchers collected qualitative data on the after-school sites, facilitators and the participating youth.
The sites recruited youth into the study by posting and handing out flyers, making presentations, and approaching youths individually. Two sites contacted parents directly with information about the study.
The pre- and post-curriculum surveys were administered at each treatment site before the first lesson and after the last lesson. “Knowledge-assessment” surveys about the media, nutrition and exercise were administered at control sites during the same week their matched treatment site was surveyed. The surveys took 15 to 20 minutes to complete.
Facilitators had to submit lesson logs within two days of the lesson’s delivery. They logged the number of minutes each component of the lesson took, any modifications they made and any challenges they faced implementing the lesson. AED staff members observed all facilitators delivering the fourth lesson of the program, and completed a checklist that rated the facilitator on a 4-point scale as a person, a classroom manager/organizer, and an instructor.
Each treatment site was awarded $1,000 upon completion of the evaluation; control sites received $100. All youth participants who completed their final survey received a $25 gift card for a local book or athletic store.
What They Were Looking For
The program evaluation was designed to measure the impact of Media-Smart Youth on participants’ knowledge of nutrition and physical activity, intent to behave in nutrition-healthy and physically active ways, knowledge of the media and media analysis skills.
The pre- and post-test surveys contained 10 statements about youths’ intentions to change their eating behavior (seven items) and their level of physical activity (three questions). Participants responded using a 5-point scale ranging from “Strongly Disagree” to “Strongly Agree.” A typical statement read, “I intend to be more physically active during the next month.”
The process evaluation was designed to discern whether the sites could recruit and sustain the attendance of a diverse group of youth for the duration of the curriculum delivery, whether the curriculum could be implemented with fidelity, and what problems the facilitators encountered during implementation.
What They Found
Three of the nutrition/physical activity statements showed differences at significant, or near-significant levels for the treatment group as opposed to the control group: “I intend to do more weight-bearing activities during the next month,” “I intend to eat less high-fat snack foods during the next month,” and “I intend to eat or drink more foods with calcium during the next month.”
According to the study authors, the findings “suggest a trend among intervention participants toward increased intention to positively change behavior.” They attributed the weak findings to weaknesses in the survey instruments, and the loss of two sites in the sample.
Identified challenges for the implementation of Media-Smart Youth in after-school settings included:
• Securing sites willing to participate.
• Obtaining consent of youth and parents.
• Maintaining youth attendance over the course of the curriculum while competing with other after-school activities.
• Having enough allotted time to complete prescribed activities.
Since its launch in April 2006, more than 13,000 Media-Smart Youth program kits have been distributed to youth-serving and after-school programs throughout the country.
Also in 2006 – two years before these evaluation findings were released – the program was implemented as a pilot by seven nationally recognized youth-serving organizations, including the Girl Scout Council of Greater Minneapolis, the YMCA of Westfield, N.J., and the Latin American Youth Center in Washington, D.C.
Current staff members at both the YMCA and the Latin American Youth Center said they do not remember the program and did not know whether their organization still used the Media-Smart Youth curriculum. A spokeswoman for the Girl Scouts of Minnesota and Wisconsin River Valleys (which merged with the Council of Greater Minneapolis) said the organization did not continue the program past the initial pilot project.