A randomized field trial for the primary prevention of osteoporosis among adolescent females.. August; 1. 9(8): 7. Department of Community Medicine, Faculty of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran. Department of Hematology- Oncology, Faculty of Medicine, Shahrekord University of Medical Sciences, Shahrekord, Iran. Department of Clinical Nutrition, Faculty of Nutrition and Food Science, Isfahan University of Medical Sciences, Isfahan, Iran. Address for correspondence: Dr. Ziba Farajzadegan, Department of Community Medicine, Isfahan Medical Sciences University, Hezarjerib Street, Isfahan, Iran.
E- mail: ri. ca. ium. Received 2. 01. 4 March 1. Revised 2. 01. 4 May 9; Accepted 2.
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August 2. 0. Copyright : . Since the majority of bone mass occurs during adolescence, primary prevention is important. Probably mother's participation in health education interventions leads to promote health behaviors in children. Aims: To assess a lifestyle modification intervention focused on mothers and students has an impact on osteoporosis preventive behaviors in adolescent girls. Materials and Methods: It is a randomized field trial in female high schools.
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Students in groups A and C and mothers in group B were selected Through the sampling frame. Our lifestyle modification was based on group based education in the public girls’ high schools.
Subjects in the intervention groups participated in three educational sessions. Students’ osteoporosis preventive behaviors were measured by using a lifestyle questionnaire consisting of items assessing nutrition, physical activity and sun exposure. Repeated measure ANOVA at baseline, 4 week, 2 months and 6 months and were used to analyze the data. Results: After 1 month, diet and sun exposure scores increased significantly (P < 0. B compared with group A. After 6 months, diet and sun exposure status in the group A approximately decreased to baseline, while in group B, diet components were significantly different compared to baseline (P < 0. There was no change in physical activity.
Conclusion: Osteoporosis prevention intervention of adolescent can be effective when parents or girls participate in training sessions, but education is associated with better outcomes when focused on mothers. Keywords: Community intervention, daughter centered, lifestyle, mother centered, osteoporosis, primary prevention. INTRODUCTIONOsteoporosis, a major public health threat, influences more than 2. Americans. Bone mass density is critical for strong bones.
Since over 4. 0% of bone mass in the adult is established during adolescence thus increasing of it through these years may be an important issue that will prevent osteoporotic fractures during later life. These choices play a significant role in the attainment of picking bone mass. The aim of this study was an assessment of mothers and students focus lifestyle modification intervention on behavior changes in relation to osteoporosis prevention of 1. Isfahan Iran. MATERIALS AND METHODSThis study was a multi- center, randomized field trial to compare the effectiveness of the two methods (Mother centered and Daughter centered) in a 3 week lifestyle modification intervention on improvement of dietary status, physical activity level and the use of sunlight.
The investigation was approved by The Medical Ethics Committee of Isfahan University of Medical Science. This is the second phase of the field trial, which had been carried out in three all- female High Schools between September 2. February 2. 01. 4 in Isfahan, Iran.
The sample size of the trial was estimated 2. I error = 0. 0. 5, standard deviation . Each subject gave informed consent before participating in the intervention.
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Sampling was conducted in three stages. The First one includes a list containing all 1.
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Isfahan province, was prepared by the Department of Training and Education then within the sampling frame of six urban education and training regions, three schools were selected by simple random sampling. To prevent contamination, the groups were selected from different schools the schools were classified into three groups based on randomized allocation.
After coordination with managers, the first school was selected for education of girls (daughter centered = group A), the next selected for education of the mothers (Mother centered = group B) and the last one, was selected as a control group (group C). All three schools have had a health educator. The next step was to select students in both groups A and C. Through the sampling frame 7. The sampling flow was about the official number in each grade. They were asked to take participate at the specified time in the meeting.
Furthermore, in group B 7. They were invited by letter to participate in training sessions that is about healthy lifestyles in order to prevent osteoporosis in their daughters. They got a package including a letter from the head researcher, detailed information about research aims, a timetable, and consent form. Inclusion criteria.
Healthy female students aged between 1. Exclusion criteria. Specific disease or use of medication during the study that may influence the absorption or excretion of calcium, unwillingness to participate in the study, any questionnaire that was not filled > 2.
Questionnaire. The instrument for gathering information was a multicomponent lifestyle questionnaire concerning behaviors that prevent osteoporosis. The questionnaire consisted of two parts and 3. The first part included demographic information and the second part contained different aspects of life related to osteoporosis prevention including: Food frequency, sun exposure and, physical activity the girls indicated the times per day or per week they ate a food or beverage or specified if they did not consume the certain food.
They specified items regarding their sun exposure quality and quantity they were asked about daily and weekly physical activity. The range of lifestyle score based on diet and sun exposure were 0- 1. The diet and 3. 3 points about sun exposure) that categorized to three levels, undesirable: Rating from 0 to 8. More than 1. 45 (between 8. About the exercise, 4. Validity and reliability of the questionnaire was developed by Rahnavard et al. All of the groups were similar in follow- up.
Content of the intervention program. Our lifestyle modification was based on group based education in the public girls’ high schools. We had created an easily understandable educational booklet for adolescents 1. The intervention training package included the following topics: Epidemiology and complications of osteoporosis, risk factors, behavioral choice that prevents osteoporosis, exercise, diet and the benefits of using sunlight.
In addition to written materials a video CD, a documentary movie about osteoporosis prevention, was prepared which was exhibited during the course. It was prepared by the Research Center for Endocrinology and Metabolism of the Tehran University. The intervention program consisted of three meetings each week. Each was approximately 9. Health trainer teachers who worked in these schools were trained about lifestyle modification package by the researcher. They handled the meeting all of the participants groups A and B received one educational package in the second meeting. The content of the meeting of the two groups was similar.
Data analyses. We measured all data 4 times (repeated measure, baseline, 4 weeks after the intervention, 2 months and 6 months). All analyses performed by using SPSS version 2.
Chi- squared analysis used to explore associations between qualitative data. We used t- tests and repeated measures ANOVA analysis. Data analyzed based on intention- to- treat basis, the level of significance established for a two- tailed t- test was 0. RESULTOf the 2. 10 participants, 1.
A, 6. 0 in group B and 6. The response rate was 9. During the intervention all of the subjects responded to all of the questions because of the close investigator's follow- up. Flow of subjects through the trial. There were no statistically significant differences in demographic variables including: Financial status family member numbers Birth rank body mass index father and mother's educational level between three groups. For controlling possible confounders, we entered demographic data in the model (repeated measures analysis), but it wasn’t statistically significant.
Participants’ demographic characteristics. The average consumption of foods (time/day) were assessed by questionnaire.
At baseline regarding the diet In group A, 1. N = 1. 1) of the girls had undesirable and 8. N = 5. 5) had semi desirable lifestyle, while 8. N = 5) were categorized at undesirable and 9.
N = 5. 5) at semi desirable classification in group B. N = 1. 4) had undesirable and 7.
N = 5. 2) did semi desirable lifestyle in control group. No subject had desirable diet condition.
There was no significant difference between three groups’ diet at baseline (P = 0. Table 2 for the mean percentage of desirability of diet (MPDD) and SD in groups for each time point. The group B had significantly high desirable diet condition at 4 week after the intervention (6. Both of them had a significant rise regarding the desirability of diet compared to baseline (P < 0. After 2 months MPDD of group B had significantly decreased about 7% compared to 4 week (P < 0. However, we did not find statistically significant decrease in group A.
The MPDD 2 months after compared to the baseline in this group was significant (P = 0. Six months after the intervention the MPDD in group B (6. There was no significant difference between the last measure and baseline in group A.
Based on repeated measure ANOVA test MPDD from baseline to 6 months follow- up for the control group did not change significantly over the time. Regarding the milk consumption at the 0 time 1. There is statistically significant (P < 0. B. Fifteen participants (7. Mean percentage, SD and P value of desirability of diet (MPDD) in groups for each time point.