THE GREAT BODY SHOP is a comprehensive health, substance abuse and violence prevention curriculum, kindergarten through sixth grade used nationally It is utilized in large inner cities, medium sized metropolitan cities, suburban communities and rural and remote areas. The curriculum contains a Teacher's Guide, Student Issues, and Parent Bulletins that support ten monthly themes, which are taught through forty lessons. Weekly lessons range in length from 20 - 35 minutes at the primary level to 45- 60 minutes at the intermediate level. Weekly lessons, Reinforcement Activities, Substance Abuse/Violence Prevention Portfolio Activities and assessment tools support each monthly theme.

Each Teacher's Guide includes a classroom copy of the Student Issue and ten monthly instructional units. Monthly thematic units contain a variety of tools educators may choose to use for their prevention program. These tools allow teachers to customize their instruction to meet district guidelines and integrate the prevention lessons into other parts of the curriculum. Some of the tools found in the Teacher's Guide include the monthly Parent Bulletin, four scripted lessons, special education notes, materials list, quiz, homework, substance abuse/violence prevention portfolio activities, and teaching strategies. Additionally there are performance assessment sheets, cross-curricular reinforcement activities, black lined masters, for further reference resources that identify additional materials, community and national organizations, web sites, videos for classroom and family use.

The Children's Health Market assists school districts in staff development efforts in a variety of ways. A Training Menu and Rate Schedule outlines the many choices available to districts for designing a staff development program. In addition to a Basic Teacher Orientation, Special Topic Workshops target specific areas of interest to classroom teachers and are designed to address both content and educational pedagogy.

Each Consulting Trainer has been certified for their knowledge of content, training methods and expertise in special topics. Trainers provide a balance between theory and practice. Every participant has the opportunity to participate interactively and observe skills being modeled by the trainer. Teachers practice the new skills, while receiving reinforcement and practice. Trainers employ adult learning techniques and effective instructional strategies used in the program.

After initial training, customized technical assistance and follow-up training is offered. Consulting Trainers provide demonstration lessons, peer-planning, observation/feedback sessions, trouble-shooting meetings and debriefing discussions. Web sites, 800 numbers, and Consulting Coordinators (provided free for large inner-city school systems) provide on-going support in the effort toward successful implementation.

The content of THE GREAT BODY SHOP is divided among ten subjects or tracks, each of which is developed from one grade level to the next according to state and national guidelines. These are Injury Prevention, Personal Safety, Functions of The Body, Nutrition, Community Health and Safety, Violence Prevention, Self Worth, Growth, Development, and The Cycle of Family Life, Substance Abuse Prevention, HIV/AIDS & Illness Prevention, Environmental Health, Consumer Health, and Physical Fitness. Each grade level of the Program from Kindergarten through sixth grade is structured so that knowledge, values, life skills and critical thinking skills are introduced through concepts that are age appropriate and familiar. Knowledge is built sequentially. Positive health values and universal values such as trust, love, respect, honesty, perseverance and the pursuit of excellence are encouraged throughout. Substance abuse and violence prevention are integrated into every strand of the program, showing the connection of each to other health concepts.

The Children's Health Market uses multiple strategies to ensure that THE GREAT BODY SHOP has a successful impact upon changes in children's health attitudes, knowledge and behaviors. Combining current research in the fields of substance abuse and violence prevention, educational psychology, neuroscience and human behavior, THE GREAT BODY SHOP synthesizes accurate, developmentally appropriate content with effective instructional processes. Detailed attention to both "what is to be learned" and "how it is best learned" ensures that students receive a prevention program that matches the principles of effectiveness.

THE GREAT BODY SHOP also employs a systems approach to successful prevention. In addition to the forty lesson curriculum used by classroom teachers, children and their families receive monthly family resources designed to impact the health and well-being of the family system. Community service projects and resources further connect the educational system with that of the family and community. It is the use of current meaningful information, effective educational practices and a collaborative systems approach that make THE GREAT BODY SHOP capable of impacting children and their families.

1. Do students exposed to GBS use less health risk behaviors compared to students who are not exposed to GBS?
2. Do students exposed to GBS experience fewer health risk and more protective factors than students not exposed to GBS?
3. Do students exposed to GBS make greater gains in healthy behaviors and risk/ protective factors than comparison students?

Research Design

The study was conducted with permission of the Minnesota Department of Families, Children and Learning (MDFCL), which required that all district, school, and student identifiers be removed so anonymity of responses to the Minnesota Student Survey (MSS) was maintained in any reporting of results. This requirement presented unique problems which were resolved through the assistance of the MDFCL. After preparing a database of GBS exposure levels, proximity to an urban center, and a school economic variable organized by district name and school name, the MDFCL provided us with the MNN student responses, merged with our database, and stripped of all district, school and student identifiers. This database was used for all subsequent matching of GBS and comparison groups, and for analyses of the impact of GBS exposure on student outcomes.

Sample

Selection of GBS Districts, Schools and Students

The GBS group was selected by matching school names and addresses provided by the Children’s Health Market with the Minnesota Data Center Fall 1998 enrollment database (containing a total of 423 unique district names, and 2,192 unique school names). With both databases in hand we identified 43 schools in Minnesota with GBS exposure in 1995 or in 1998. An intermediary step, carried out by the MDFCL involved matching GBS schools with the student responses to the MSS. The MSS is voluntary – not all students agree to complete the survey – and the total number of GBS schools in the research database was reduced.

Selection of Matching Comparison Districts, Schools and Students

Student exposure to GBS may be influenced by the proximity of students to urban centers and their associated environmental distress. For each school district in Minnesota we calculated a proximity score in driving miles to serve as an index of environmental distress (described below under Measures and Variables).

The per student average of free and reduced lunches was also calculated for each school as an index of the economic resources available for each school (described below under Measures and Variables). The selection of comparison schools (and their associated student responses) was completed after the mean proximity values and economic values were determined for the GBS schools. The distribution of the proximity values and economic values for each GBS school were classified so as to facilitate the close matching of the two values with the comparison schools. Proximity was reclassified into 8 categories and economic resources was reclassified into 17 values based on the midpoints of each value.

Measurement and Study Procedures

Measures and Variables

Proximity to an urban setting and the number of free and reduced school lunches served as our control variables for selecting the comparison sample in this study. It was hypothesized that proximity to a city and the number of free and reduced lunches are good indicators of a community’s health risk characteristics. Families living in and close to city centers are more likely to experience a greater number of stressors and risk factors than families living in suburban and rural settings. Families and children living in communities with low numbers of free and reduced lunches as a percentage of their total enrollment are likely to live in communities with greater community resources, and are likely to experience fewer risks and stressors.

The research design called for selecting a comparison sample that matched the GBS exposed students on proximity to an urban setting and on the school district’s level of economic resources. The control variable “proximity” was calculated for every school district in Minnesota identified through the state’s data center fall 1998 enrollment data file. The variable for economic resources (number of free and reduced lunches as a percent of total student enrollment) was calculated for every school in the total Minnesota database (as reported by the Minnesota Data Center on fall 1998 enrollment).

Proximity – We calculated the driving distance from St. Paul, Minnesota to the city/town of the school district office using the American Automobile Association Travel Planner software program. The proximity to St. Paul is an index of the distance of a school district from an urban center, a continuous measure in miles from a large city. Proximity to an urban center helps define each district in some relation to an urban, suburban, or rural category. The mean of the proximity measure for both groups was 4.57 (N = 11,244, SD = 1.76) in 1995, and .4.38 (N = 13,041, SD = 1.69) in 1998.

Economic Resources – to measure the economic resources of each school in each district, we computed the total number of reported free and reduced school lunches and divided that number by the total school enrollment. This resulted in an economic resource index as a ratio of free and reduced lunches to total enrollment. The population mean for economic resources is 9.79 (N = 11,244, SD = 3.60) in 1995, and 9.29 (N = 13,041, SD = 3.82) in 1998.

Exposure to GBS –GBS exposure level is a measure of the average number of years of exposure to GBS for 6th grade students in schools using the GBS program. Each student using GBS receives his or her own subscription to the September through June monthly student issues of the program. GBS’ publisher maintains a database of subscriptions each year by individual schools. In order to calculate the student-years of GBS exposure in each school that had used GBS, specifically for 6th graders responding to the MSS in ’98, for each such school, the following numbers of subscriptions were added together: 1) ’98 6th graders; 2) ’97 5th graders; 3) ’96 4th graders; 4) ’95 3rd graders, 5) ’94 2nd graders, 6) ’93 1st graders, 7) ’92 kindergarten children. The resultant total student-years were then divided by MDFCL’s reported 6th grade Fall enrollment for the school year in which the ’98 MSS survey was administered. The end result was ’98 GBS exposure – in average number of years of the GBS program per student.

A similar calculation starting with the number of ’95 6th graders was used to calculate the ’95 GBS exposure. However, ’98 enrollment still had to be used as the divisor, as a result of limitations of data availability. Because the school population was quite stable from ’95 to ’98, use of the ’95 divisor would not have materially changed the calculated ’95 GBS exposure levels.

For those schools using the GBS program, the mean GBS exposure level in 1995 is .918 (SD=1.42). The mean GBS exposure level in 1998 is 4.23 (SD=1.98).

Outcome Variables

Harris and Luxenberg (1995) identified five factors which were used to predict substance use problems in the sample: “self-esteem”, “family—caring”, “others—caring”, “emotional distress”, “antisocial behavior.” The “self-esteem” factor (Cronbach’s alpha=.86) asked seven questions about the student’s perception of his/her self worth on a five point scale. A higher score on this scale indicates higher student self-esteem. The “family—caring” factor (Cronbach’s alpha=.88) consisted of five items on a five point scale about how caring the student perceived his/her family to be towards him/her. A higher score on this scale indicates lower risk to the student. The “other—caring” factor (Cronbach’s alpha=.86) similarly asked three questions about how caring other individuals in the student’s life were toward the student. A higher score on this scale indicates lower risk to the student. Six questions about the student’s “emotional distress” were asked, with different response choices for each question. The Cronbach’s alpha for this factor was .84. A higher score on this scale indicates lower risk to the student. The “anti social behavior” factor (Cronbach’s alpha= .68) asked three questions about the frequency of problem behaviors over the past year. A higher score on this scale indicates more risk to the the student. Scale means and standard deviation values for all scale scores are reported in Table 1.

Using items from the Minnesota Student Surveys, five risk and protective factor domains were created based upon the U.S. Department of Education guidelines: “community”, “school”, “family”, “peer” and “individual.” The community risk and protective factors domain includes eight items about the drug availability and general safety in the student’s neighborhood, and the amount of information about substance use in the community. The school domain asks students twelve questions about the safety of their school and behavior of students and teachers. The family domain includes twelve items about the student’s relationship with parents, health behaviors, and substance abuse and violence in the family. The peer domain asks the student seven questions about the amount of gang activity and substance use at school, the student’s victimization by other youth and involvement in gang activity. The individual domain consists of twelve questions. Students are asked about their feelings about school, their academic success and their weight. This domain also asks about the student’s alcohol use, suicidal ideation and suicide attempts, and sexual abuse. For all five domains higher risk to the student is predicted by a higher score on the scale (See Table 1)

The results are reported by the primary research questions.

Do students exposed to GBS use less health risk behaviors compared to students who are not exposed to GBS?

Table 1 presents the mean scale scores for GBS students and comparison students in 1995 and 1998. Table 2 reports the t-test results for all student outcome measures.

Table 1. Mean Student Outcomes by Group and Year

Students with greater exposure to GBS resources report significantly lower use of alcohol, cigarettes, marijuana, and other substances than comparison students not exposed to the GBS program. They also report fewer violent acts and conduct problems than comparison students.

Do students exposed to GBS experience fewer health risk and more protective factors than students not exposed to GBS?

Table 2. T-Test of Student Outcome Differences by GBS and Comparison Groups

Students exposed to more GBS programming report significantly more family caring, higher self-esteem, lower emotional distress, and less antisocial behavior compared to a comparison group of Minnesota students who have no exposure to GBS and who live in similar communities. GBS students also report significantly less school, family, and peer risk factors than the comparison students.

Do students exposed to GBS make greater gains in healthy behaviors and risk/ protective factors than comparison students?

To answer this question, we calculated the difference in means for GBS students in 6th grade in 1995 and in 1998 and the comparison group in 1995 and in 1998. The difference was calculated by subtracting the mean present in ’95 from the ’98 mean for the respective group. Of the thirteen scales, six had no responses in ’95 and/or ’98 including Community Risk scale, Family Risk scale, Peer Risk scale, Individual Risk scale, Substance Use and Abuse scale and Conduct Problems scale.

Table 3 Changes in Minnesota Student Health Risk Behaviors and Protective Factors from 1995 to 1998 by Exposure to GBS

GBS students have higher difference scores in the Others Caring scale, Antisocial Behavior scale, School Risk scale, and Violent Behavior scale. GBS students improve about the same as comparison students in the Family Caring scale. GBS students have smaller differences in the Self-esteem scale and Emotional Distress scale than comparison students. This finding may result from the initial scores of GBS students who report higher scale scores than the comparison group. So many of the scale items are not completed in 1995 that this finding may also be confounded by missing data.

Table 4. Student Outcomes by Exposure Levels in 1998

Research using data from the MSS in 1995 and 1998 on student health risk behaviors, risk and protective factors, and on MSS constructs supports the positive impact of GBS exposure on student substance use and abuse, violence, and on other student conduct considered important in health education outcomes. This finding is consistent with other literature suggesting that comprehensive health education programs that thoroughly address health topics in developmentally appropriate ways over time while supporting teachers through making high quality materials accessible for individualized application are more likely to produce positive effects. The research design for this study used a large sample of students in Minnesota who completed a standardized instrument with sufficient research on validity and reliability. The study design included a large comparison group of students who were not exposed to GBS programs and who were matched to a large population of GBS exposed students. The selection of comparison students involved controls for proximity to city neighborhoods and economic resources known to be related to the levels of health risk behaviors and other risk and protective factors. While the requirement for anonymity of subjects in the study (and of their schools and districts) prevented more precise matching on control variables, sufficient care was taken to ensure that the comparison and GBS groups were similar on the relevant variables. The results are strongly supportive of a positive GBS effect on student health risk behaviors.

Because of the restrictions imposed on the use of the MSS, we could not match GBS and comparison students on a number of other factors (e.g., ethnicity, family structure, family income levels, and parents’ education), we were nevertheless, able to use Minnesota public information to control for community setting and economic characteristics. While limited to using proximity to St. Paul, Minnesota as an index of urban, suburban and rural status, grade level (all were 6th graders), and the number of free and reduced lunches by school, these variables are known to have strong influences on other related student outcomes. While we believe these are strong control variables, they cannot ensure that the variables identified above may not also help explain the differences we observed. However, the strong positive effects detected, and the size of the sample supports concluding that GBS exposure positively effects student health risk outcomes.