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ACCESSION NO: 0187113  SUBFILE: CRIS; HNRIMS 

PROJ NO: IND084062G AGENCY: NIFA IND 
PROJ TYPE: OTHER GRANTS PROJ STATUS: TERMINATED 
CONTRACT/GRANT/AGREEMENT NO: 00-52102-9696 PROPOSAL NO: 2000-04490 
START: 15 SEP 2000 TERM: 30 SEP 2004 FY: 2004 
GRANT AMT: $3,750,000 GRANT YR: 2000
INITIAL AWARD YEAR: 2000

INVESTIGATOR: Savaiano, D. A.; Boushey, C. J.; Weaver, C. M.; McCabe, G. P.

PERFORMING INSTITUTION: 
PURDUE UNIVERSITY 
WEST LAFAYETTE, INDIANA 47907

IMPROVING BONE HEALTH IN ADOLESCENCE THROUGH TARGETED BEHAVIORAL INTERVENTION

NON-TECHNICAL SUMMARY: This proposed targeted behavioral intervention is designed to improve calcium

intakes and bone health among Asian, Caucasian and white Hispanic adolescents, likely reducing their risk for
osteoporosis later in life. Adolescent girls, ages 11-12, will enter into a six site multi-state intervention program. The
effectiveness of an innovative technology-based targeted behavioral intervention will be established, as well as data
on bone accretion and calcium consumption in these populations.

OBJECTIVES: OBJECTIVES: Develop, implement, and evaluate a targeted behavior intervention that will alter
dietary behavior to include adequate calcium (dairy and nondairy food sources) in the diet of Asian, Hispanic and
Caucasian adolescents and to determine if this change in dietary behavior translates to improved bone health.
Establish a technologically driven behavioral intervention program that can be readily expanded to meet the needs of
education professionals, health care providers, and health educators on a national basis. Recruit 900 healthy 11-12
year old females equally divided between Asian, Caucasian, and white Hispanic youth from 6 states for participation
in a two-year behavioral intervention designed to increase calcium intake thereby enhancing the rate of increase in
bone mineral concentration. Determine that lactose maldigestion as an obstacle to adequate calcium consumption
can be overcome by behavioral intervention. To demonstrate by psychological assessment measures, the
advantages of applying predictive schemes for targeted behavioral intervention.

APPROACH: APPROACH: Develop strategies for youth based on data from focus groups. Translate the strategies
into curriculum designed around the digital platform, i.e., a metered delivery format. The resulting DVD/CD-ROM will
be based on several theoretically-derived design concepts: 1) A nutritional assessment of the young user's current
calcium intake patterns, accompanied by immediate feedback; 2) Tailored messages based on the user's readiness
to increase calcium intake (stage of change), and results from his/her nutritional assessment; and 3) Sequential
staging, so that the user may return periodically and move ahead to new information, skills, and strategies designed
to facilitate lasting improvements in calcium intake, and may pursue new goals and challenges. The effectiveness of
this approach will be tested through a randomized intervention among 900 females 11-12 years old (intervention,
n=450; no intervention, n=450). Participants will represent equal numbers of 3 ethnic groups (Asian, Caucasian, and
white Hispanic) equally divided among intervention sites in California, Hawaii, Indiana, New Mexico, Nevada, and
Ohio. Intervention effectiveness will be determined as significant differences between the intervention and control
groups in percent change in bone mineral content. Bone mineral content, vertebral dimensions, total body calcium,
and body composition will be determined by dual-energy x-ray absorptiometry (DXA). These measures will indicate
any differences in bone mass between intervention and control groups. The intervention will last for 24 months. The
interactive computer curriculum will encompass eight 45-minute computer-based sessions in the first phase. The
second phase will continue at half the level of the first phase. Secondary outcome measures will include calcium
intake as determined from a semi-quantitative food frequency, behavior stage using traditional staging questions, and
body composition (i.e., changes in lean body mass). Raven's Standard Progressive Matrices (SPM), Center for
Epidemiologic Studies Depression Scale (CES-D), and a self-regulatory subscale (Bandura) will be used to measure
intellectual ability, depression, locus of control, and self-efficacy. These psychological measures will aid in
determining which individuals are most amenable to intervention. Lactose maldigestion will be determined from
breath samples collected after a challenge of 0.35 g lactose/kg body weight (in 1% milk), as well as any reports of
symptoms. The samples will be analyzed for hydrogen concentrations using the Quintron Model CM2 Hydrogen
Analyzer. If a subject experiences a rise in breath hydrogen of >20 parts per million (ppm) (0.9 mmol hydrogen/L air)
after the challenge dose of lactose, the subject will be classified a lactose maldigester. A delayed intervention, i.e.,
distribution of the DVD to the control group will take place at the end of the intervention, as well as Extension
Program development.

PROGRESS: 2000/09 TO 2004/09
Throughout two years of recruitment, 851 total subjects were recruited to participate in the Bone Health project. Of
the total, 745 subjects met the eligibility requirements. Since the completion of recruitment, each site continues to
carry out midpoint and final measurement visits for each subject. At this point, approximately 425 midpoint
measurement visits and 250 final measurement visits have occurred. Retention of subjects throughout the 18 month
study duration has been excellent and overall, approximately only 4.3 percent of subjects have not achieved full study
participation. The Bone Health project curriculum was implemented in sixth grade school classrooms in six states
across the country. During the 2002-2003 school years 33 schools agreed to participate in the project and during the
2003-2004 school years 40 schools agreed to participate. The total number of students who participated in the Bone
Health project in the classroom totaled 3509 over the two-year period. During the second year of school
implementation, a multiple choice, pre/post survey was introduced. This survey was administered at both intervention
and control schools in two states. Data analysis of the pre/post survey results has shown a statistically significant
change in subject area knowledge between the intervention and control schools. At each intervention session,
students completed worksheets relating to each session. The data entry process for the school worksheets is
currently over 50 percent complete. The extension and distribution phase of the project is currently underway. The
group of Extension Educators who will pilot the Bone Health curriculum has been recruited and trained. A Facilitator's
Guide was developed to assist the educators in piloting the program. Educators will be working with fifth, sixth, and
seventh grade youth and in a variety of settings from schools to after-school care programs and 4H clubs. The
pre/post knowledge survey will be administered to the pilot participants as well as a food behavior questionnaire.
Groups of investigators from the consortium have been formed to work on a variety of manuscripts. Finally, the Bone
Health multi-media curriculum was awarded the Association for Communication Excellence in Agriculture's Gold
Award for the most innovative interactive. Institutional support at the intervention and data analysis sites will allow for
timely completion of this project in 2004-05. All measurements will be completed by 07/07/2005. Manuscripts are in
process and will continue to be submitted in the coming year. A June 2005 NRI grant application is being prepared to
request support to continue to follow these subjects over two additional years.

IMPACT: 2000/09 TO 2004/09
Monitoring and measuring adolescent girls in both intervention and control groups over a period of 18 months will
help determine the ability of a multi-media science curriculum to influence the food behavior, physical activity, and
bone growth of the subject population. The continued piloting of the multi-media curriculum will provide further
evidence to support current findings which show significant increase in knowledge following participation in the
project sessions. Both the growth and knowledge data will support the continued development and usage of multi-
media science and health curriculums.

PUBLICATIONS (not previously reported): 2000/09 TO 2004/09

No publications reported this period