This study is designed to develop an effective, generalizable school and community-based intervention to reduce tobacco use, increase heart- healthy food consumption, and increase aerobic exercise, among 9th grade youth in East San Jose, CA. Both a school-based and a community participation intervention are proposed. Although our previous research in school-based cardiovascular disease (CVD) prevention has been successful in altering risk behaviors, evidence from diverse studies on participation suggest that these effects may be magnified by adding active community participation. In this study, community participation will include activities related to changing the political, environmental, economic, and regulatory factors that influence CVD risk behaviors. A six school efficacy trial using a classroom-based curriculum for CVD prevention has already been funded by the NHLBI. In this grant, we propose adding three additional schools to evaluate the effects of combining a computer-based CVD curriculum with active community participation. Summary of Design and Hypotheses Nine high schools in East San Jose, California (N=approximately 4,500 9th grade students) will assigned randomly to one of three experimental groups: Experimental Group 1 - computer assisted instruction on injury prevention (attention-placebo); Experimental Group 2 - computer assisted instruction on cardiovascular disease prevention (CVD CAI); Experimental Group 3 - computer assisted instruction on cardiovascular disease prevention plus an active community participation program (CVD CAI plus community participation). The work in this proposal will test the primary hypothesis that students in schools that receive the CVD CAI plus community participation intervention will demonstrate significantly more change than students in schools receiving the other two interventions for the following outcomes; (a) increased self-reported tobacco cessation rate among experimental users and decreased initiation rate among non- users; (b) decreased self-reported consumption of dietary fat; (c) increased self-reported aerobic physical activity; (d) increased knowledge of CVD risk factor processes; and (e) increased self-efficacy in taking community health action. Students in schools receiving CVD CAI alone are hypothesized to demonstrate greater change than students in attention-placebo on all variables except self-efficacy in taking community health action. Relevance to Nursing This study is consistent with the overall goals of community health nursing a research and practice. Furthermore, substantial budget cuts for nurses and nursing-related projects both in Santa Clara County (where San Jose resides) and in San Jose schools have highlighted the need to expand the role of nurses from the current situation - providing treatment services to individuals - to broad community-based health promotion and disease prevention. The proposed collaboration on this grant between Stanford University and the School of Nursing at San Jose State University is intended to begin fulfilling this vision.
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