Health Behavior Survey ot

California School Health Educators Raymond M. Nakamura, Charleen M. Lescault

ABSTRACT

7 t i r piirpow t i t this survey was to assw the health behaviors of California Wiciiil I k a l t h A\cociation membcrs to determine whether or not these indi! idr ial\ iitilired their professional knowledge to maintain themselves at a high Ir%rl ( 1 1 hcalth and consequently act as poritive role models in the tchool health pio$rani. The w v e y was de5igned to inve\ttgate behavior patterns in caiegorie\ i c l ~ i t i n p to iiiitrition. druss. exercise. risk and medical profiles. A que\tionnaire !\a\ dr\igncd to determine what percent of the respondents practiced potitive hcaltli behavior\ The wrvey results provide strong evidence that the majority of !how wrvcved practiced what thev have learned and teach. Sound nutritional hahii. ucrr euhibited. Reasonable drug and risk taking behavior wa< practiced. I wellci i t nicdicnl profiles alro were maintained. Exercire was a bayic component 1 0 i i i c > \ t (11 [tic rc\pondents h e \ . however. Increased participation and regular cxerciw proprani* could he improved The results showed good overall health ~ p r x ~ i c ~ ~ \ , making CSHA member\ potentially good role models.

INTRODUCTION Not all communication is verbal, especially in the

educational setting. Much of what students learn takes place through observation. People often behave like people they see. Psychologists refer to this as imitation. Studies have shown that both children and adults learn many behaviors by imitating a model.’.2 Similarly, studies have shown that children are more likely to imitate others who have prestige and who control the reinforcements they receive.’,4 Because of this, effective teachers are always careful in the way they behave since they know that children often behave as they behave. Modeling is an important factor in the education process, serving to either greatly enhance or completely destroy the verbal message of human hea1th.l

Teachers can use modeling as an effective means of teaching by behaving the way they want students to behave. Modeling becomes a powerful means, not only for increasing the occurence of behaviors already within the individual’s repertoire, but also for establishing new behaviors and reducing undesirable ones. Teachers Fhould always model the behavior they are trying to develop. I f learners are to be enthusiastic, so should the teacher. I f students are to display empathy, so should the teacher.

For better or worse, the health educator serves as an important model for students. Thus, the health educa- tors personal values, ideals, attitudes and behavior patterns can affect the outcome of the school health program, and more specifically, health instruction. This raises the question, “do health educators serve as positive role models or do they exemplify a contradic-

tion between understanding and promoting funda- mental health concepts and displaying good health behavior? ”

If, through observation, students find this contra- diction present, a loss of credibility and motivation may occur. Health educators must realize that many positive outcomes of the health education process are directly related to their personal motivations and behaviors. They can expect students to participate at a level pro- portional to their own investment. This emphasis on observational learning does not place the verbal message on a lower importance scale. It is done, in this context, to point out the constant interrelationship between both variables.

In theory, health educators are individuals con- cerned with the health and well-being of others. But do they carry their concern over to their own health and well-being, providing themselves as positive role models? Serving as a positive role model is a large responsibility and a difficult personal endeavor. This involves the externalization of attitudes, beliefs and values to positive overt behavior. The intrinsic nature of the health educator’s role, the process of role per- formance and the context in which the role is performed will serve as contributing factors to the success or failure of the health education process.6 The health educators’ actions are observed by students who form mental pictures of these actions. I t is this picture that is often recalled, more so than any verbal message.

Festinger states that inappropriate behaviors would be modified by knowledge about why the behavior was inappropriate. Knowledgeable persons would then form appropriate attitudes about the behavior.’ Unfortunate- ly, human beings do not follow steadfast ruies or theories. Thus, Festinger’s theories are not true of all knowledgeable persons. For instance, one may find that being professionally active in the health area does not guarantee consistency in appropriate health habits. A teacher may teach a class about the dangers of smoking and in the next hour be seen smoking a cigarette in the teacher’s lounge. A 250-pound educator may expound the importance of exercise and nutrition and not have the energy to walk up two flights of stairs. It is not enough to know right from wrong. No matter how much they may pride themselves in being both rational and con-

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Fcientious in their health behaviors, i t is still evident that some health educators bend their health knowledge to f i t their wishes.’ Thus, the necessary focal point of health educators becomes the consistent application of health knowledge in relation to their own health be- haviors. I f health educators proceed to ignore the personal use of their health knowledge, they act as poor role models and they stand to lose a great deal of credi- bility for their profession. Students will recognize the contradiction in “do as I say, not as I do.” Health educators must be consistent in their instruction and their behavior. Do health educators exemplify positive health behaviors based on accurate knowledge and sound values or is there a contradiction evident between knowledge and behavior patterns? Answering these basic questions was the major goal of this study.

The survey’s purpose was to assess the health be- haviors of California School Health Association mem- bers to determine whether or not they used their profes- sional knowledge to maintain themselves at a high level of health and consequently act as positive role models for their students.

INSTRUMENTATION AND METHODOLOGY A questionnaire was designed to determine the

health behaviors of all the members of the California School Health Association (CSHA). The questionnaire consisted of dichotomous and multiple choice ques- tions. Seventy percent of the 57 questionnaires mailed were returned. The 40 respondents consisted of six males and 34 females ranging from 30 to more than 60 years in age. Twenty-three of the females and four of the males were more than 50 years of age. Thirty-two different California cities were represented.

The survey questions attempted to assess behavioral patterns in the following five related areas:

1 . Nutritional Habits. This section assessed the basic nutritional habits of the respondents in regards to rypes, quantity and frequency of foods eaten. Addition- al questions concerning body weight also were included.

2 . Risk and Related Behavior. This section assessed the respondent’s risk and safety behaviors in regards to \uch behaviors as seat belt use, occupational stress, occupational environments, bike safety and alcoholic consumption and driving.

3. General Exercise Practices. This section assessed the general exercise patterns in regards to type, fre- quency and intensity of exercise.

4. Drug Taking Behavior. This section assessed the general drug taking patterns in regards to both licit and ilicit drugs.

5. Medical Profiles. This section assessed the respondent’s personal medical profiles and included

medical histories, medical examinations and daily health practices such as oral health and sleeping pat terns.

The instrument consisted of questions designed by the authors and items extracted from existing instru- ments.R,9 The instrument was an anonymous question- naire and worded in a non-threatening manner to elicit the most honest response. This was done to increase the reliability and validity of the questionnaire. A pilot study established reliability and readability of the instrument. The reliability of the health behavior inventory was assessed by a test-retest method. A one- month interval separated the two administrations, and the scores for each question correlated.

RESULTS Nutritional Behavior

Many CSHA members are practicing sound nutri- tional habits. Most of the respondents (77.5%) eat three meals daily and almost all (92.5%) partake of foods from the basic four food groups daily. In addition, 87.5% eat some type of fruit and vegetable daily. How- ever, 27 .5% included processed foods containing re- fined sugars on a daily basis with a reasonable number (32.5%) indulging only two-four times a month. Fifty- seven and one-half percent do not use salt in their cook- ing or at the table. However, 47.5% do snack between meals and 27 .5% of the CSHA members felt they were at least 10 pounds overweight according to standard weight scales.

Risk Behavior Risk-taking behavior was a broad category that in-

cluded a wide spectrum of related areas. Eighty percent take at least one hour a day for some form of leisure (i.e., relaxation, exercise or recreation). Forty-two and one-half percent rated their job as very stressful and 52.5% as moderately stressful. However, a large portion (76%) of the respondents considered the school they worked in as a healthful environment. Forty per- cent of the respondents always wear seat belts, but 15% claim to never wear them. In addition, only 30% stated they always wear a shoulder harness; 35% never wear a shoulder harness. When asked about riding a bicycle after dark, 95% responded that they do not ride after dark without a light or reflective clothing. Two ques- tions were asked about alcohol and driving. The first asked how often they ride with someone under the influ- ence of alcohol. The responses were 55% never and 45Vo sometimes. When asked how often they drive under the influence of alcohol the responses changed somewhat. A total of 72.5% stated they never drive under the influence of alcohol. One quarter of the respondents do occassionally.

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Exercise Behavior A irariety of questions were asked to determine

exercise practices. The first question indicated that 22.5% participate in daily exercise, 30% three-five times per week, 25% one-two times per week, and 22.5% less than once a week. The second question determined that 50% of the respondents did not participate in any pro- gram of regular exercise. The amount of time spent exercising varied immensely; from 33.4% exercising 5-10 minutes daily to 12.8% exercising more than one hour on a daily basis. More than half of the respondents (56.4%) participate in leisure activity in the form of physical exercise. The appropriate intensity level of exercise as perceived by each respondent was 55.3% moderate, 39.5% mild and only 5.2% severe.

Drug Taking Behavior Several questions were formulated to determine the

drug taking behavior of the survey participants. Only 25% of the respondents said they drink three or more cups of coffee daily. The tobacco results showed that 15% smoke cigarettes, 2.5% smoke cigars and no respondents smoke a pipe. When asked about other drugs, 95% responded they never smoke marijuana and 97.5% responded that they never use PCP, morphine, heroin or opium. There were several questions concern- ing alcohol consumption. The results showed that 90.6% drink less than one bottle or can of beer per week, 74.3% drink less than one glass of wine per week and 64.1% d o not drink any hard liquor. These ques- tions were followed by an inquiry of the respondents' drinking behavior. Of those responding, 83.3% stated that they never get drunk when they drink and only 2.8% stated that when they drink they tend to get drunk. Questions concerning pill taking behavior determined that 5 5 % take aspirin occasionally and that nearly one third (30%) never do. The results also showed tht 85% of the respondents never take a sleeping aid and the remaining 15% use this type of aid only sometimes. Vitamins was the final category considered. When reporting the results in this area, sex was taken into consideration. A total of 57.5% reported taking vitamins, but this group was 83% female and 17% male. This female-dominated behavior also was apparent when the type of vitamins consumed were checked.

Medical Profile The medical profile category dealt with general

health-care maintenance. The results varied consider- ably. Forty-two and one-half percent reported having one physical exam per year. Thirty-two percent stated that they have a physical exam once every two years, and 12.8% once every six months. As many as 87.5%

reported having updated all of their irnmunimt ions; 80% have immunization records. A total of 9Soio knew their blood pressure. Only 13.5% have high blood pres- sure. Only 36.6% of the respondents have ever had a venereal disease check-up. Ninety-five percent of those surveyed have an annual dental check-up; 70% have their teeth cleaned once every six months. One question combined brushing and flossing and the responses showed a large percentage (87.5%) brush and floss daily. The average amount of sleep obtained by 67.5% of this group was six-eight hours nightly, with 20% sleeping eight or more hours. The final two questions of the questionnaire were restricted to women. All females reported they have annual Pap tests. The data also indicated that 42.5% d o monthly breast self-examina- tions, and that 57.6% d o these examinations occasional- ly o r rarely.

DI SC USSl ON Upon completion of the categorical break down o f

the survey results, i t appears that the overall health habits of the CSHA members surveyed are good.

The members are relatively well balanced in their nutritional practices, eating three daily meals that in- clude selections from the basic four food groups, and avoiding salty foods and excessive sugar. Behavior patterns could be improved by reducing between meals snacks, reducing the intake of animal fats and dairy products and by cutting overall caloric intake to assist weight reduction.

Improvements in the risk behavior category should begin with reducing job stress whenever possible and in- creasing seat belt and shoulder harness use. Another area that deserves serious consideration is driving under the influence, o r riding with someone else under the in- fluence of alcohol. Although the percentages might be considered relatively low, one drunk is still too many for true road safety. A positive aspect of the risk behavior category was the high percentage of those allocating time for daily leisure activities. If job stress cannot be reduced, the leisure activity should aid individuals in controlling the effects of stress in their lives.

Although exercise regularity, duration and intensity was relatively low, a positive aspect of this category was that for many, their leisure activity was some form of physical activity and that very few lacked at least some form of exercise.

Behaviors related to drug use are difficult to define because of the fine line between use and abuse. The survey indicated low levels of caffeine, tobacco, mari- juana, sedative, aspirin, alcohol and hard drug use. Vitamin usage was very low and primarily a female trait. This might be attributed to the sound nutritional

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habits of‘ the respondents and a belief that it is not necessary to supplement a healthy diet.

The medical profiles of the CSHA members taking the survey were excellent with a high percentage of those having updated their immunizations and possessing records of them. There was a high percentage of those knowing their blood pressure and a low percentage of those with high blood pressure. Women were very con- scientious about checking for cervical and breast cancer. And finally, a high percentage maintained good oral health practices.

From this study of health behavior patterns the fol- lowing conclusions are summarized:

1 . There was a low percentage of individuals ex- hibiting drug taking behaviors.

2. There was a low percentage of risk taking be- haviors.

3 . There was a high percentage practicing proper nutritional habits.

4. There was a high rate of daily exercise. 5. There was a high percentage of individuals main-

taining good medical profiles. The CSHA members, through their overall sound

health practices, facilitate a good health education environment and in obvious and subtle ways influence positive learning in the classroom. The CSHA members do not contradict themselves with the “do as I say, not as I do” philosophy. Their health investments are sound and their instruction and behavior consistent with the role of an effective model. Their actions appear to speak louder than wnords.

The underlying premise of the survey was to answer the question: “do health educators serve as good role models or do they exemplify a contradiction between the understanding and promoting fundamental health concepts and displaying good health behaviors?” The results of the health habits questionnaire indicate the majority of the CSHA members have good overall health practices, making them potentially good role models.

References

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2. Bandura A, Ross D, Ross SA: Imitation of Filni-niediaicd Aggressive Models. J Abn and Soc P.y.vch 66:3-1 I . 1963.

3. Holland J , Skinner BF: The Ano/~~ .s i .~ of Aehaiior. New Yorh. McGraw-Hill, 1961.

4 . Stoland E, Hillmer ML.: Identification. Authoriiarian defen- siveness and self-esteem. J Ahn and Soc Prvc’h 64:334-342. 1962.

5 . Glover E: Modeling - A Powerful Change Agent. J Sch Health 44:175-176, 1978.

6 . Grace CR: Role Conflict and the Teacher. I ondon, Routledgc and Kegan Paul, 1972.

7. Festinger L: Conflict, Decision ond Dis.vonunt.c~. Palo Alto. Stanford University Press. 1964.

R . Cox SG, Doyle K . Kamrnermann S. Valoir R K : H’el lne~.~ R.S. V.P. Menlo Park, California. The Renjamin/C’umniingc Publishing Company, 1981.

9. Sorochan WD: Promoring Your Health. New York. John Wiley & Sons, 1981.

Raymond M. Nakamura, PhD, Associate Professor, and Charleen M . Lescault, MS, Califarniu Polytechnic State University, San Luis Obispo, CA 93407.

Course to focus on learning disorders The Pediatric Assessment of Learning Disorders will be offered March 19-22, 1984 at the

Meridien Hotel in Boston. Sponsored by the Harvard Medical School and The Children’s Hospital, this course will focus on developmental variations and learning disorders in children seven to 15 years of age.

Participants will learn to perform and interpret pediatric neurodevelopmcntal assessments.

Tuitition for the program is $450 for physicians and $350 for nurses, residents and fellows. Accreditation has been requested through the Massachusetts Nursing Association arid 26 Category I CME hours will be available.

For more information, contact the Department of Continuing Education, Harvard Medial School, 25 Shattuck St., Boston, MA 021 15.

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