Can Changes in Body-Image Knowledge, Attitude, and ... Body! Paper Final.pdfCan Changes in Body-Image Knowledge, Attitude, and Behaviors Result from a 4th- to 8th-Grade School Field

Can Changes in Body-Image Knowledge, Attitude, and Behaviors

Result from a 4th- to 8th-Grade School Field Trip?

By Lucille Lang Day, Do Kim, and Bertram H. Lubin

Lucille Lang Day, Ph.D., is Director Emerita of the Hall of Health, Children’s Hospital & Research Center Oakland; Do Kim is a former science/health education intern at the Hall of Health; and Bertram H. Lubin, M.D., is President and CEO of Children’s Hospital & Research Center Oakland. Correspondence: Lucille Lang Day, Ph.D., (510) 763-3874, [email protected]

Can Changes in Body-Image Knowledge, Attitude, and Behaviors 2 Result from a 4th- to 8th-Grade School Field Trip?

Abstract Background: Body dissatisfaction, eating disorders, and obesity, all of which can begin in

childhood, have serious health consequences. Purpose: This study evaluates the effectiveness of

Some Body!, a program on body image, eating disorders, and obesity. Methods: 1,000 students in

43 4th- to 8th-grade classes attended Some Body! at the Hall of Health museum in Berkeley, CA,

and completed pre- and post-surveys with 20 multiple-choice questions covering relevant facts,

attitudes, and behaviors. The experimental group had 616 students, the comparison group 384;

29 randomly selected experimental subjects were interviewed. Results: 2 weeks after the

program, the experimental group showed significant improvement (P<.0001) on nine out of 12

knowledge questions, and on all eight attitudes/behavior questions. The comparison group,

which completed both surveys before attending the program, improved significantly on seven

knowledge questions and six attitudes/behavior questions; however, their improvement on eight

of these questions was less than that of the experimental group. Discussion: Surveys, interviews,

and student and teacher ratings all revealed the program’s effectiveness. The interviews provided

a more in-depth look at behavioral changes students had made or planned. Translation into

Health Education Practice: Some Body! can be implemented at museums, health education

centers, community centers, and other venues.


BACKGROUND

Body dissatisfaction can appear in childhood, as early as age six to nine (Gardner, Friedman, and

Jackson 1999; Hendy, Cheryl, and Leitzel-Schwalm 2001). Poor body image often results in

such behaviors as irregular eating patterns and extreme dieting, and it can lead to eating disorders

and serious health consequences (Skemp-Arlt 2006). Many studies have shown that both media

and people within children’s and adolescents’ sphere of influence play major roles in shaping

their body image (Ferron 1997; Oliver and Thelen 1996; Druxman 2003; Hendy et al. 2001;

Murnen et al. 2003; Dunkley, Wertheim, and Paxton 2001). Some studies have indicated

associations between body dissatisfaction and obesity (Mellin, Irwin, and Scully 1992), and

between body image and nutrition (Ford et al. 2000).

How can parents and educators help children develop a positive body image? Many

studies have focused on school-based and community programs (Kilpatrick, Ohannessian, and

Bartholomew 1999; Sahota et al. 2001; O'Dea and Maloney 2000; Snow 2000). Snow (2000) has

identified additional encouraging methods, including facilitated group discussions, artistic

activities, field trips, and speakers. Skemp-Artl (2006) suggested identifying predictors of body

image and implementing a psycho-educational approach. Druxman (2003) emphasized the role

parents play in their children’s body-image development and recommended that parents be

careful about how they comment on their own appearance and their children’s appearance.

The present study attempts to show that a museum field-trip program can also help

children and adolescents acquire a positive body image. Although a strong correlation exists

between instruction hours and impact on health knowledge, attitudes, and practices (Connell,

Turner, and Mason, 1985; Walter, 1989), there are examples of brief health education programs,

such as a field trip, having significant effects on children. Evaluation of Nutrition for Life, a


school-based program in the New York school system, found that only three hours of the

program sufficed to show a modest, but significant, improvement in nutrition attitude, behavior,

and knowledge scores for seventh and eighth graders (Devine, Olson, and Frongillo, 1992). Two

weeks after attending field trip programs at the Hall of Health museum in Berkeley, California,

elementary school children reported increased engagement in healthful behavior and a greater

sense of control over illnesses ranging from colds and flu to heart disease (Day and Rodriguez,

2002).

PURPOSE

The Hall of Health (HOH), a hands-on health museum formerly operated by Children’s Hospital

& Research Center Oakland, implemented the Some Body! field-trip program to provide fourth-

through eighth-grade students with information about body image and help them to develop a

positive body image. Some Body! emphasizes making healthy food choices, getting plenty of

exercise, and developing a positive self-image. It also covers the possible consequences of

failing to do so—anorexia, bulimia, or obesity—as well as factors that influence body image,

including the media, family and friends, and our own health-related behaviors. With a

PowerPoint presentation and videos, the program capitalizes on young people’s receptivity to

information conveyed via electronic media (American Academy of Pediatrics 200l; Hemmelgarn

2005).

The present study was undertaken to determine whether the Some Body! program has at

least a short-term impact (measurable after two weeks) on students' knowledge and self-reported

attitudes and behaviors related to body image. It is an outcomes study aimed at demonstrating

the practical effectiveness of a brief informative program. Practical effectiveness is what works


in typical, real-life health education practice. This is in contrast to clinical effectiveness, which

includes data generated through randomized trials, in which participants are prescreened and

treatment is provided in controlled settings. Our research design, which includes an experimental

group and a comparison group, attempts to control relevant variables; nevertheless, we do not

claim to be demonstrating clinical effectiveness.

METHODS

Setting. HOH (1974-2009) was a small (6,200 square-foot) health museum in Berkeley,

California. Dedicated to promoting wellness and individual responsibility for health, the museum

was sponsored by Children’s Hospital Oakland. Each year, up to 24,000 visitors of all ages used

the hall’s interactive exhibits to learn about the workings of the human body and the practices

that promote good health. Many of the visitors were preschool through high school students on

classroom field trips. Volunteer docents and college-age interns have presentations, lead

discussions, and helped visitors use the exhibits.

In addition to museums, the Some Body! program can be implemented at health education

centers, community centers, schools, and other venues.

Program. Some Body! is a 45-minute program that includes activities, videos, discussion, and a

PowerPoint presentation. In addition to targeting body-image issues directly, the program

provides teachers with ideas to continue discussion of body image in the classroom and

incorporate the topic into their curriculum.

The original Some Body! program, developed by the Children's Health Education Center

of Wisconsin, was approximately 1.5 hours in duration. At HOH, the program was shortened to


allow students time to explore the museum’s hands-on exhibits, and was also modified based on

visitors’ feedback, including their requests to focus more on obesity.

The PowerPoint presentation covers influences on body image (people, media, nutrition),

obesity, eating disorders, dangers of dieting, healthy alternatives to dieting, and the effects of

poor body image. It concludes with a discussion of how to turn a poor body image into a positive

body image and a summary of the presentation’s key points. Throughout the presentation,

students are engaged in discussion of the various topics. For example, the slides on media

influence include multiple-choice questions and photos that the students respond to.

During the discussions of media influences and eating disorders, videos on these topics

are shown. In “In the Mix,” a video on media influences, adolescents talk about how media can

negatively impact people’s body image by making them feel that they need to have a certain

body size. In a video about anorexia and bulimia, children, adolescents, and adults define eating

disorders and discuss their dangerous effects.

The program also includes two activities on nutrition: “Sugar Attack” and “Taking

Control.” “Sugar Attack” shows students how much sugar various drinks contain. The docent

challenges two volunteers to place the drinks (water, milk, Gatorade, Snapple, juice, soda, etc.)

in order from the lowest sugar content to the highest sugar content. Through this activity,

students also learn to: (1) be wary of super-size servings by comparing the sugar content of a

one-serving soda can to that of a 2.5-serving, 20-oz. soda bottle, (2) question pictures of healthy

people in advertisements for non-nutritious foods such as fruit drinks that contain only 5 percent

juice, and (3) seek natural sugar such as lactose in milk rather than added sugar such as high

fructose corn syrup in fruit drinks. “Taking Control” focuses on opportunities to take control of

one’s health by deciding to eat one type of food instead of another in the same category, e.g.,


wheat bread instead of white bread. The students are asked to look at pairs of food, choose which

member of each pair is healthier, and explain why. The purpose of the activities is to encourage

students to think about their food choices and to make healthier ones.

Experimental Design. Prior to summative evaluation of the Some Body! program at HOH,

formative evaluation was conducted between October 1, 2004 and April 12, 2005. During the

formative-evaluation period, the shortened program was piloted with 251 students, and the

surveys were piloted with 69 students. Summative evaluation began on April 13, 2005 and

continued through June 30, 2006. All fourth through eighth grade classes that signed up for the

Some Body! field trip during this period were invited to participate in the study. Classes were

matched for grade level, school location (urban/suburban), and school type (public/private). One

class in each matched pair was then randomly assigned to the experimental group, and the other

class was assigned to the comparison group. Unfortunately, the suburban classes of the

comparison group and most of the private school classes of the experimental group either

dropped out of the study or did not complete the entire evaluation process and therefore had to be

eliminated. The attrition rate for the study was 25% of classes, which translated into 44% of

students, indicating that teachers with larger classes tended to drop out. Perhaps teachers with

more students were more likely to feel overwhelmed with what they needed to accomplish in the

classroom, and therefore were more likely to decide that they could not afford the time it would

take to have their students complete the surveys. Statistical analyses were undertaken to assess

the impact of the demographic differences between the two groups on the outcome of the study

and will be presented and discussed in later sections of this paper.

In all, 1,787 students, ages eight to 14, from 57 classes received the Some Body!


presentation during the study. Of these, 1,000 students in 43 classes completed both pre- and

post-surveys. There were 616 students in the experimental group, and 384 in the comparison

group. Six of the fourth grade classes also received instruction on obesity and nutrition as part of

a Hall of Health program entitled Health and Biomedical Science for a Diverse Community

(HBSDC). Three of these classes were assigned to the experimental group, and three to the

comparison group, so that any impact of the HBSDC instruction on obesity and nutrition would

equally affect both groups and therefore not affect any differences noted between them in the

present study.

Table 1 provides demographic information on the participants who completed both

surveys. Both the experimental and comparison groups included subjects from the following

ethnic groups: White/Caucasian, Black/African American, Hispanic, Asian/Pacific Islander, and

Native American.

The experimental group completed the pre-survey shortly before receiving the Some

Body! program, and the post-survey two weeks after receiving it. The comparison group

completed the pre-survey two weeks before receiving the program and post-survey shortly before

receiving it. The purpose of the comparison group was to determine whether the post-survey

results were affected either by having completed the pre-survey or by life and classroom

experiences during a typical two-week period.

Starting in January 2006, anonymous ratings from all students were collected at the

conclusion of the program. The rating sheet instructed them to rate the Some Body! program by

circling a number from 1 to 10 (1 = boring, 10 = very interesting); 519 students completed the

anonymous rating.


With the teachers’ consent, Hall of Health docents visited selected classes two weeks

after the Some Body! program to conduct student interviews. Students were randomly chosen by

their code names to keep their anonymity. Their participation was voluntary, and they were

interviewed in private. A total of 16 male and 13 female students were interviewed.

Surveys. The identical pre- and post-surveys were developed at the Hall of Health to evaluate the

effectiveness of the Some Body! program in increasing knowledge of body image issues and

helping students to achieve and/or maintain positive body images. Students provided their school,

age, grade, gender, and ethnic background. Self-selected code names ensured anonymity. Pilot-

testing of the surveys during the formative-evaluation period verified that students understood

how to complete the survey, could remember their code names, and provided consistent answers

on the pre- and post-surveys. Each survey had 20 multiple-choice questions with five possible

answers. The questions were designed to measure knowledge of body image, as well as attitudes

and behaviors relating to body image. Of the 20 questions, the first 12 targeted knowledge and

the last eight assessed attitudes and behaviors. All but two of the questions (#17 and #19) had

one correct answer. These two questions asked students to answer on a scale of 1 to 5, 1 being

the least favorable answer and 5 being the most favorable. Question #17 asked how often they

ate fruits and vegetables (1 = occasionally, 5 = 5 or more servings per day), and question #19

asked how often they exercised (1 = never, 5 = every day).

The surveys asked the following questions:

1. What is body image?

2. What influences body image?

3. An ad showing a beautiful model wearing stylish jeans is probably an ad for: __.


4. An ad showing a man running is probably an ad for:__.

5. People who buy a product after seeing a picture of a model in an ad for that product

are:__.

6. A person who is attractive and skinny most likely has: .

7. What happens to the weight of a person with bulimia (someone who eats, then

purge/vomits)?

8. What is the best way to maintain a healthy body?

9. If you have a healthy, well-balanced diet and exercise regularly, you probably have a:__.

10. What drink is the healthiest?

11. What influences obesity?

12. What is the best way for people with obesity to become healthy?

13. In general, what do you think/feel about your body?

14. What would you do if you thought that you were too heavy?

15. What do you think/feel about your body when you look at good-looking models or good-

looking people in the media?

16. What is the best action to take if you think your friend might have an eating disorder?

17. How often do you eat fruits and vegetable?

18. What would you take for an after-school snack?

19. How often do you exercise?

20. What do you think/feel when you look at other people who are greatly overweight?

Test-retest reliability was established by administering the survey to the comparison

group (N=384) on two occasions two weeks apart. Percentage agreement was calculated for all

twenty multiple-choice questions because the five choices for each question were not equal-


interval items. The agreement was 68.8%, which is low but could be expected with elementary

school students.

Student Interviews. The interview questions were as follows:

1. What was the most important thing you learned from the Some Body! program?

2. Can you tell me what body image is?

3. Can you tell me some things that influence body image?

4. If your friend keeps making fun of you by saying that you’re getting too fat, what can you

do about it?

5. Have you made any changes, or do you plan to make changes, in your eating habits since

attending the Some Body! program? If yes, describe.

6. Have you made any changes, or do you plan to make changes, in when you exercise, how

you exercise, or how often you exercise since attending the Some Body! program? If yes,

describe.

7. What did you learn was the danger of having a poor body image?

8. What did you learn about eating disorders?

9. What did you learn about obesity?

10. (a) What would you do if you thought your friend was obese? (b) What would you do if

you thought your friend had anorexia or bulimia?

11. On a scale from 1 to 10, please rate how interesting the program was for you (1 = boring,

10 = interesting).


Teacher Survey. Teacher evaluation surveys with self-addressed, stamped envelopes were given

out after the program. The survey asked teachers to provide their name, school, city, grade taught,

and date of visit, and to answer the following 11 questions:

1. How did the Some Body! program relate to the health curriculum you use in the classroom?

2. Did your students enjoy the program? How do you know if they did or did not enjoy the

program?

3. What did the students learn from the program?

4. How have the students’ behaviors changed as a result of the program?

5. What did you like most about the Some Body! program?

6. How could the Some Body! program be improved?

7. Were any questions left unanswered?

8. How could the docent’s delivery of the program be improved?

9. Would you bring your next class for the Some Body! program? Why or why not?

10. Have you ever brought a class to the Hall of Health before? If so, how does the Some Body!

program compare to other field-trip programs you have experienced here?

11. Please rate the educational value of the Some Body! program on a scale from 1 to 10 (1 =

poor, 10 = excellent).

Analysis of the Surveys. Chi-square was performed for each question to determine the

effectiveness of the program. Two-factor, repeated measure ANOVAs were performed for each

question to determine the impact of demographic variables and docent variation on the results

(significance level of p<.05). Separate analyses were done for the experimental and comparison

groups. A correct answer was given a score of 1, and an incorrect answer was given a score of 0


on all questions except #17 and #19, where the answers were on a scale of 1 to 5. For those two

questions, a score of 1 was given for answers of 4 and 5, and a score of 0 for answers of 1-3.

RESULTS

Student Survey. Table 2 shows the percentage of correct or optimal answers on the pre- and

post-surveys given by students in the experimental and comparison groups, the pre-/post-survey

change, chi-square value, Cramer’s V, and number of cases. For question 17 the table shows the

percentage of students who answered 4 or 5 (they eat 3 to 5 servings of fruits and vegetables per

day), and for question 19 it shows the percentage who answered 4 or 5 (they exercise twice a

week or every day). The experimental group's performance improved significantly (p<.0001) on

17 out of the 20 questions and declined on three. The comparison group improved significantly

(p<.0001) on 13 questions and declined or showed no change on seven. On eight of the questions

on which the comparison group improved significantly, the experimental group improved more.

Table 3 gives the percentage of correct or improved answers on the post-survey given by

students who answered incorrectly or less than optimally on the pre-survey, difference between

the experimental and comparison groups, chi-square value, Cramer’s V, and number of cases.

All of the performance changes shown in this table are statistically significant (p<.0001). The

experimental group improved more than the comparison group on all but four questions, and on

three of these questions, the difference between the experimental and comparison groups was

minimal (less than 1%). There was only one question (#8) on which the comparison group did

notably better than the experimental group (5.2%).


Differential Effects. For the experimental group, there were no differences in performance due

to gender or school type. Age differences affected only the outcome of question #11, on which

older students tended to do better. School location affected the outcome of questions #1-4 and

#11. On all five questions, suburban students did better than urban ones. Additional analyses

were done to ensure that the gains of the experimental group on these questions were not mostly

or entirely due to the suburban students in this group. Even after removing the suburban students

from the experimental group, the gains on questions #1-3 and #11 (30.6%, 2.6%, 1.1%, and 3,7%,

respectively) were still significant at the .0001 level and greater than the gains of the comparison

group. Excluding the suburban students, the experimental group’s decline on question #4 (-7.2%)

was greater than without them and also significant at the .0001 level. Docent differences affected

gains on questions #3, #6, #8, and #15. For these four questions, classes differed in their average

scores according to which of the six docents they had. However, no docent fared better than all

of the others on all four questions, nor did any docent fare worse.

For the comparison group, there were no differences in performance due to age, but

females did better than males on questions #5, #17, and #19, and males did better than females

on question #14. School type affected questions #2, #11, #14, and #16, with students attending

private schools doing better than students attending public schools on all four questions.

Student Rating. The average rating for 519 students was 7.43 out of 10 (1 = boring, 10 = very

interesting).

Student Interviews. The total number of answers to a question may exceed or be less than the

total number of students interviewed (29), because students could give more than one response to


a question or may have chosen not to answer a question.

All but two students remembered important information they learned from the Some

Body! program. When asked, “What was the most important thing you learned from the Some

Body! program?” 17 students responded that they learned how to stay healthy by focusing on

healthy habits rather than on one’s weight and/or by making healthier nutritional choices, three

talked about body image influences such as the media, two noted that they learned how they can

influence other people’s body images in a negative way if they judge others, two said they

learned that being big in size doesn’t always mean a person is unhealthy, two said they learned

about obesity and prevention of it, and one cited the importance of self-esteem. One student

answered that he was unsure what he had learned, and one responded that he learned nothing.

Nineteen students were able to correctly define body image as “how I think and feel

about my body.” Of the 10 students who answered the question, “Can you tell me what body

image is?” incorrectly, five made the mistake of defining body image as what you look like,

three responded that they didn’t know or had forgotten, one talked about how family and friends

can help someone be healthier and eat better (the student discussed body-image influences rather

than defining body image), and one responded that it is seeing a model and wanting to be like

him/her.

All but one student, who was unsure, responded appropriately to the question, “Can you

tell me some things that influence body image?” Fifteen students responded that the media, TV,

magazines, attractive models, and advertisements can change the way people feel about their

bodies. Twelve mentioned that people influence body image, 14 discussed how eating healthy

foods and exercising influence the way you see your body, i.e., that healthy habits help one


develop a positive body image, two mentioned that one’s appearance (“the way you look,”

“mirror image”) influences body image, and one said emotions influence body image.

Of the 24 students who were asked the question, “If your friend keeps making fun of you

by saying that you’re getting too fat, what can you do about it?,” 12 students said they would

ignore the negative comments, five said they would eat healthier foods and exercise more, three

responded they would tell their friend to stop their negative behavior and would tell an adult, two

said they would hit or beat up the person because they would see that person as not being their

friend anymore, one responded that she would tell the friend she was happy with her body, and

another said he would educate his friend about obesity.

When asked, “Have you made any changes or do you plan to make changes in your

eating habits since attending the Some Body! program? If so, how?,” 21 students answered that

they had made positives changes in their eating habits by drinking less soda and more water,

eating more fruits and vegetable, or eating less junk food. Two more said they planned to make

changes by eating healthier foods. The remaining six answered no to this question, but two of

them explained that it was because they already had healthy eating habits. When asked the same

question but about exercising, 20 students responded that they started exercising more after

attending the program, three said they had not made changes yet but planned on exercising more,

three said they had not made changes because they thought they already exercised enough, one

said he was unable to exercise more because he was physically disabled (in a wheelchair), and

one said she had neither made nor planned to make any changes.

Of the 25 students who responded to the question, “What did you learn was the danger of

having a poor body image?” 14 answered that poor body image can lead a person to develop an

eating disorder (bulimia or anorexia), four mentioned obesity, two spoke about how to prevent


poor body image by exercising and eating healthy foods, one said that it can lead a person to diet,

and five did not know. When asked, “What did you learn about eating disorders?” 27 students

answered by defining eating disorders, describing the health consequences of eating disorders,

and/or explaining that eating disorders are caused by poor body image and can lead to negative

health consequences. One student was not asked this question, and one spoke about obesity.

When asked, “What would you do if your friend had anorexia or bulimia?” four students

said they would seek the help of an adult, two said they would educate their friend about the

consequences, two would suggest exercising and eating healthier foods, two would tell their

friend to eat and be healthy, two would try to give the friend advice to help overcome the

disorder, one would stay away to avoid being influenced, one would try to help but wasn’t sure if

there was a cure, and one said he would find help-line phone numbers for the friend. Three

students said they would ignore it because they wouldn’t want to make the friend feel bad or

because they thought it was the friend’s decision, two did not know what they would do, and one

confused anorexia and bulimia with obesity.

In response to “What did you learn about obesity?” 14 students said that preventing

obesity requires eating a balanced diet, and five mentioned negative consequences such as heart

attacks, diabetes, and early death. Three students said they learned that factors such as genes play

a role in obesity, one said it is not good to judge others who are obese, and another responded

that obesity can lead to dieting and poor body image. Out of the remaining five students, four

confused obesity with eating disorders or said they did not know, and one said that obesity is

caused by eating a lot of junk food and eating without exercising.

When asked, “What would you do if your friend was obese?” nine students said they

would help their friend exercise by suggesting it or by doing it with them, six said they would


help their friend eat a healthier diet by suggesting it or by setting an example for them, and five

said they would not treat their friend differently, judge, or tease them. Three students said they

would talk to an adult about it, another three said they would not interfere, and one was unsure.

The 21 students who were asked to rate the program on a scale of 1 (boring) to 10

(interesting) gave the program an average score of 8.0. The other eight students were not asked

this question, because it was added to the protocol after they were interviewed.

Teacher Survey. Forty teachers completed the survey. Of these, 37 stated specific reasons why

they found the Some Body! program to be valuable, and 33 said they would bring their next class

back for the program. The teachers said that the program supported and enriched their teaching

on body image, obesity, nutrition, exercise, media influences on health, and maintaining healthy

lifestyles. They noted that their students were engaged in the program and learned about such

topics as body-image influences, nutrition, obesity, and eating disorders. Nineteen teachers

noticed changes in their students’ behavior after the program: the students were more open to

discussion of body-image issues, were asking more questions about healthy habits, and were

more aware of what they were eating and drinking. Some of the teachers said specifically that

students were drinking less soda and encouraging their peers to do the same. Some of the

suggestions the teachers made were to modify the language to match the grade level of the

students, have more time to discuss individual issues in depth, and include testimonials from

children or adolescents who have struggled with body image issues. Overall, the 40 teachers’

average rating of the educational value of the program was 8.7 on a scale of 1 (low) to 10 (high).

In comparing the Some Body! program to other field-trip programs at the Hall of Health, the

teachers rated the Some Body! program as equivalent or higher.


DISCUSSION

The experimental group improved significantly on nine out of 12 questions on body-image

knowledge, and on all eight questions on attitudes/behaviors relating to body image. The

comparison group improved significantly on seven knowledge questions and six

attitudes/behavior questions. However, their improvement on eight of these questions was less

than that of the experimental group. The comparison group's performance suggests that simply

doing the pre-survey and thinking about the questions leads to some improvement.

The experimental group showed its greatest increase on question #1, which asked for the

definition of body image: 77.6% of the students answered correctly on the post-survey,

compared to 44.3% on the pre-survey. Only 1.9% of the comparison group students improved on

this question.

The experimental group also had particularly large (greater than five percent) increases

on questions #2, #3, #5, #11, #12, and #20. Questions #2, #3, and #5 were concerned with

influences on body image, especially media influences. Questions #11, #12, and #20 were

concerned with obesity. Increasing understanding of these issues, the surveys show, are among

the program's greatest strengths.

The experimental group’s performance significantly declined on questions #4, #6, and #9.

Question #4 was similar to question #3, on which the experimental group improved greatly. Both

questions described hypothetical ads and asked students what they thought the ads were trying to

sell. The correct answer in both cases was "You cannot tell." Question #3 described an ad similar

to one discussed during the Some Body! presentation, but question #4 did not. This result shows

that the discussion needs to encourage students to apply what they are learning about media


influences to new situations. The comparison group improved slightly on question #4, although it

declined on question #3.

Question #6, another question on which the experimental group's performance declined,

asked, "A person who is attractive and skinny most likely has ?" The correct answer was,

"You cannot tell," but after the Some Body! presentation, more students answered "Anorexia" or

"Bulimia." The program needs to emphasize more strongly that only trained medical

professionals can make these diagnoses, and that a person who is attractive and skinny might be

perfectly healthy. The comparison group’s performance also declined on this question.

The experimental group also showed a small decline on question #9 ("If you have a

healthy, well-balanced diet and exercise regularly, you probably have a ?"). The correct answer

was "positive body image." On the pre-survey, 78.7% answered correctly, compared to 76.7% on

the post-survey. The presentation recommended a balanced diet and exercise as the best ways to

deal with obesity. Apparently, this led a few of the students to choose "need to lose weight" as

their answer. This demonstrates the importance of emphasizing that these behaviors help all of us

to stay healthy and have a positive body image, not just people who are overweight. The

comparison group improved slightly on this question.

On questions #15 (What do you think/feel about your body when you look at good-

looking models or good-looking people in the media?) and #18 (What would you take for an

after-school snack?), the experimental group and the comparison group both improved, but the

comparison group improved slightly more. Thus, it appears that the improvement on these two

questions was not due to the program, but may be a result of students’ thinking about them after

completing the first survey and possibly discussing them with adults or peers.

In the comparison group, there were eight questions on which females outperformed


males, males outperformed females, or private school students outperformed public school

students. None of these demographic differences were seen in the experimental group,

suggesting that the Some Body! program was effective in eliminating them. In the experimental

group, suburban students outperformed urban ones on five questions concerning the definition of

body image, influences on body image, media influences, and influences on obesity. The

superior performance of suburban students on these questions suggests that they might be more

generally aware of body image and its influences than their urban counterparts, and that more

time should be spent discussing media and other influences with urban classes.

Table 3 shows another way of looking at the data: this table presents the percentage of

correct or improved answers on the post-survey given by students who answered incorrectly or

less than optimally on the pre-survey. Looking at the data in this way, the comparison group did

substantially better than the experimental group on only one question, #8. The question was,

“What is the best way to maintain a healthy body?” and the correct answer was “exercise and eat

a balanced diet.” The experimental group did improve significantly on this question, but on the

post-survey, some students still selected “exercise” or “eat healthy food from the five food

groups.” They might have been confused by the word “diet” in the correct answer, because the

program discusses the negative health consequences of fad diets.

The student surveys and interviews, student and teacher ratings, and teacher surveys

reveal the effectiveness of the program. The student interviews provided a more in-depth look at

the behavioral changes students had made or planned to make. Responses showed that they were

applying the knowledge they gained from the program. In addition, the majority of teachers rated

the program highly, and many reported that they had observed positive changes in their students’

behavior. Given the recent rise in childhood obesity nationwide and the ongoing susceptibility of


young people to anorexia and bulimia, more preventive strategies and programs are needed. The

findings of this study indicate that the Some Body! program is one effective tool to help children

and adolescents develop a positive body image and avoid anorexia, bulimia, and obesity.

TRANSLATION TO HEALTH EDUCATION PRACTICE

The original, 1.5-hour Some Body! program is available from the Children’s Health Education

Center of Wisconsin (CHECW). The authors of this paper will provide the shorter Some Body!

program evaluated in this study at no charge to institutions that purchase the original program

from CHECW. The program can be implemented at museums, health education centers,

community centers, schools, and other venues.

ACKNOWLEDGMENTS

We are grateful to Samuel Park, Eloy Romero, and Kennedy Miranda, for assistance with

adaptation and implementation of the Some Body! program at the Hall of Health. This study was

made possible by Learning Opportunities Grant Number ML-02-03-0673-03 from the Institute

for Museum and Library Services (IMLS), and a Science Education Partnership Award (SEPA),

Grant Number R25RR020449, from the National Center for Research Resources (NCRR), a

component of the National Institutes of Health (NIH). Its contents are solely the responsibility of

the authors and do not necessarily represent the official views of IMLS, NCRR, or NIH.

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Table 1. Student participant demographics

Experimental Comparison All Respondents Variable Category N % N % N %

Age (1) 8 1 0.2 1 0.3 2 0.2 (2) 9 64 10.4 48 12.5 112 11.2 (3) 10 167 27.1 153 39.8 320 32.0 (4) 11 192 31.2 95 24.7 287 28.7 (5) 12 145 23.5 34 8.9 179 17.9 (6) 13 41 6.7 34 8.9 75 7.5 (7) 14 4 0.6 18 4.7 22 2.2 (11) Unmarked 2 0.3 1 0.3 3 0.3 Grade (1) 4 149 24.2 106 27.6 255 25.5 (2) 5 209 33.9 184 47.9 393 39.3 (3) 6 195 31.7 18 4.7 213 21.3 (4) 7 46 7.5 36 9.4 82 8.2 (5) 8 16 2.6 39 10.2 55 5.5 (7) Unmarked 1 0.2 1 0.3 2 0.2 Gender (1) Male 287 46.6 183 47.7 470 47.0 (2) Female 327 53.1 193 50.3 520 52.0 (3) Unmarked 2 0.3 8 2.1 10 1.0 School type (1) Public 585 95.0 266 69.3 851 85.1 (2) Private 31 5.0 118 30.7 149 14.9 School location (1) Urban 458 74.4 384 100 842 84.2 (2) Suburban 158 25.6 0 0 158 15.8 Ethnicity (1) White/Caucasian 118 19.2 103 26.8 221 22.1 (2) Black/African American 210 34.1 99 25.8 309 30.9 (3) Hispanic 173 28.1 105 27.3 278 27.8 (4) Asian/Pacific Islander 140 22.7 116 30.2 256 25.6 (5) Native American 29 4.7 19 4.9 48 4.8 (6) Other 40 6.5 19 4.9 59 5.9 (7) Unmarked 9 1.2 2 0.4 11 1.1


Table 2: Percentage of correct and optimal answers

Question Condition Previsit % Postvisit %

% Change

Chi-Square*

Cramer's V

Number of

Cases 1 Experimental 44.3 77.6 33.3 90.7 0.2 616 Comparison 53.6 55.5 1.9 208.8 0.4 384 2 Experimental 29.2 35.1 5.9 165.4 0.3 616 Comparison 35.4 30.7 -4.7 313.4 0.5 384 3 Experimental 13.5 20.5 7.0 145.4 0.2 615 Comparison 19.3 18.0 -1.3 618.1 0.6 383 4 Experimental 26.2 24.1 -2.1 242.2 0.3 615 Comparison 28.8 29.8 1.0 597.0 0.5 382 5 Experimental 43.6 49.9 6.3 355.5 0.4 613 Comparison 45.5 42.6 -2.9 680.8 0.6 380 6 Experimental 66.1 56.6 -9.5 372.4 0.3 610 Comparison 69.0 67.2 -1.8 515.5 0.5 381 7 Experimental 20.7 22.8 2.1 213.8 0.3 615 Comparison 21.1 22.1 1.0 307.5 0.4 384 8 Experimental 58.2 59.8 1.6 257.8 0.3 615 Comparison 58.3 65.1 6.8 233.1 0.5 384 9 Experimental 78.7 76.7 -2.0 515.6 0.4 614 Comparison 77.1 79.9 2.8 228.1 0.4 384

10 Experimental 70.8 74.2 3.4 112.3 0.2 616 Comparison 74.2 75.8 1.6 284.7 0.5 384

11 Experimental 33.3 41.3 8.0 133.0 0.2 615 Comparison 38.6 35.0 -3.6 549.0 0.5 383





16 Experimental 59.2 59.8 0.6 761.6 0.5 612 Comparison 59.2 56.8 -2.4 472.4 0.5 380




20 Experimental 46.6 57.0 10.4 671.4 0.5 611 Comparison 46.6 46.6 0 718.5 0.6 382

*All items significant at p=.0001


Table 3: Percentage of correct or improved answers on the post-survey given by students who answered incorrectly or less than optimally on the pre-survey

Question Condition Postvisit %

Difference (E% –C%)

Chi-Square*

Cramer's V

Number of

Cases 1 Experimental 71.1 41.1 54.6 0.2 343 Comparison 30.9 81.4 0.4 178 2 Experimental 26.6 15.7 105.9 0.3 436 Comparison 10.9 155.3 0.5 248 3 Experimental 16.5 7.1 102.8 0.2 532 Comparison 9.4 464.1 0.6 309 4 Experimental 17.8 4.9 190.2 0.3 454 Comparison 12.9 327.1 0.5 272 5 Experimental 28.0 13.0 133.0 0.3 346 Comparison 15.0 331.1 0.6 207 6 Experimental 33.2 -0.7 117.4 0.4 208 Comparison 33.9 145.1 0.5 118 7 Experimental 16.2 6.0 140.0 0.3 488 Comparison 10.2 161.0 0.4 303 8 Experimental 31.1 -5.2 63.4 0.2 257 Comparison 36.3 79.9 0.5 160 9 Experimental 40.5 -0.4 98.3 0.4 131 Comparison 40.9 37.1 0.4 88

10 Experimental 52.2 17.9 23.7 0.2 180 Comparison 34.3 60.9 0.5 99




14 Experimental 30.4 -0.4 407.4 0.6 296 Comparison 30.8 256.5 0.6 182







*All items significant at p=.0001

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