Healthy Habits Healthy U A SchoolBased Cancer Education

Healthy Habits, Healthy U: A School-Based Cancer Education Program Kyle Young, RA Mikayla Finley, RA Kayla George, RA Mary Pritchard, Ph. D Carrie Smith, RA Caile Spear, Ph. D

OVERVIEW §Background §What is HHHU? §Previous Studies §Methods §Results §Discussion §Future Studies and Moving Forward

BACKGROUND • Cancer is the leading cause of death in Idaho since 2008 (2 nd in the U. S. ) • 22% of all deaths in Idaho (2, 700) • Approx. 8, 000 new cases every year • Lifestyle choices – 50% • Tobacco, exercise/healthy weight, nutrition/Sugar-sweetened beverages, UV exposure • Cost (Idaho) • 2010 - $732, 000 • 2015 - $1, 008, 000 • 2020 - $1, 398, 000

WHAT IS HHHU? • School-based cancer prevention program • Boise State University, St. Luke’s Mountain States Tumor Institute, and the Boise School District • Started in April 2013 as a community outreach initiative designed to teach and reinforce positive health habits in children • Lessons target 8 th grade students highlighting the relationships among: • Nutrition • Physical activity • Sugar-sweetened beverages • Cancer risks

PREVIOUS STUDIES • Fall 2014/Spring 2015 • Process evaluation • Survey and lesson refinement based on teacher and student feedback • Fall 2015/Spring 2016 • Short-term outcome evaluation

METHODS • Participants* • 691 8 th grade students (Up from 439 in Fall 2015 study) • Enrolled in health class • School-District fully incorporated program in the curriculum • *Not allowed to collect demographic data, but we know that the student population in these schools is approximately: • 48% female • 78% Caucasian, 10% Hispanic, 4% Asian, 4% Black, 2. 5% mixed race, and the remainder American Indian/Pacific Islander

METHOD • Procedures • 1 st Day • Teacher taught • 2 nd Day (One week later) • HHHU staff teach • Worksheet • (Pre & Post) Likert Questions • (Pre & Post) Multiple Choice questions • (Post) Three statements to replace unhealthy habits with healthy • DTENSSc. St. O • (Post) Behavioral intention likert questions • (Post) Identification of organs (Unhealthy vs. Healthy)

Pre & Posttest Post-test

Organ Identification (Post-test)

RESULTS

Pre & Posttest Post-test

RESULTS Likert-Scale Survey Questions Comparing Pre & Post-test Knowledge Scores Paired Samples Statements T-Test 1. Cancer is a disease caused by rapid abnormal cell growth. T (653) = 18. 08* 2. Our bodies usually destroy mutated cells. T (680) = 9. 97* 3. Physical activity decreases my risk of developing cancer. T (652) = 18. 69* 4. Eating fast food/processed food increases my risk of developing cancer. T (661) = 15. 50* 5. The consumption of two or more sodas in a week is linked to cancer. T (550) = 17. 87* 6. Chemotherapy only targets cancer cells. (Reverse Coded) T (676) = 9. 18* *P = 0. 00

Pre & Posttest Post-test

RESULTS Likert-Scale Survey Questions Comparing Pre & Post-test Knowledge Scores Paired Samples Statements T-Test 7. Eating fruits and vegetables increases my risk of developing cancer. (Reverse Coded) T (670) = 8. 93* 8. Sedentary behaviors increases my risk of developing cancer. T (666) = 22. 50* 9. Exercise improves health in all ways EXCEPT: Increases my risk of cancer T (672) = 1. 45 10. When a cell’s set of instructions or DNA makes a “typo” it is called a: Mutation T (672) = 9. 48* 11. Drinking sugar-sweetened beverages: ‘All of the above’ on worksheet T (558) = 5. 58* 12. Check all of the health habits that can reduce your cancer risks: 3 correct answers T (554) = 3. 70* *P = 0. 00

Pre & Posttest Post-test

RESULTS Percent Correct on “Your Health Habits” Table Literature Review Percent Correct 0. 0 Healthy 22 Habits M = 88. 46% SD = 23. 67% 33. 0 67. 0 100. 0 Total 29 114 520 685 16

RESULTS DTENSSc. St. O Literature Review Topics Coded Times Mentioned in Healthy Habits Drugs 7 (1%) Tobacco 10 (1. 4%) Exercise/Sedentary Activity 436 (63. 1%) Nutrition 506 (73. 2%) Sugar Sweetened Beverages 376 (54. 4%) Sunscreen 131 (19%) Screentime (i. Phone, i. Pad, i. Pod, etc. ) 174 (25. 2%) Other (water intake, sleep, pollution) 78 (11. 3%) *Percentage is out of total number of participants/worksheets

Pre & Posttest Post-test

RESULTS Reducing risks in the next two weeks Literature Topics Coded Agree/Strongly Agree Review Physically active each day for 60 506 (73. 2%) minutes Eat at least 5 servings of fruit/vegetables each day 469 (67. 8%) Decrease intake of Sugar-sweetened beverages to less than 1 serving per day 445 (64. 4%) Reduce how much time I spend sitting 461 (66. 7%) Reduce the amount of fast food I eat per week 456 (66%) Increase my water intake by 1 serving per day 521 (75. 3%)

Colon 1 2 Kidne y 3 4 Liver 5 6 Lung 7 8 Results: 569 (82. 3%) Correctly identified a healthy vs. sick

DISCUSSION • Students showed increased knowledge of risk factors that cause cancer • Their own unhealthy habits that might put them at risk • What cancer is and how to prevent it

FUTURE STUDIES AND MOVING FORWARD • Modify the worksheet used to collect data to ascertain whether students are truly understanding each question (i. e. , do students really believe that chemotherapy only targets cancer cells or is that an artifact of the way the question was worded on the worksheet)? • Delete question #9 (Exercise improves health in all ways EXCEPT: Increases my risk of cancer) • 3 rd study in a row where there is no statistical significance • Looking at taking the study into 4 th grade as well as 8 th grade

QUESTIONS?