MCH Alert

National Center for Education in Maternal and Child Health

Search past issues of the MCH Alert and other MCH Library resources at

June 25, 2004

1. Web Site Provides Resources for Parents to Help Their Daughters Develop Bone-Healthy Habits
2. Reports Analyze Effects of Mothers' Employment on Children's Nutrition
3. Authors Describe a Social Marketing Campaign to Increase Physical Activity Among Children
4. Study Reveals Inconsistencies in Assessing Mothers' Beliefs or Behaviors Associated with Childhood Obesity
5. Article Compares Adolescent-Violence-Related Behaviors Across Five Countries


LAST CALL: A Quick Reader Feedback Form

Thanks to all who have completed the MCH Alert Reader Feedback Form to date.

This week, we will once again send a request for feedback in a separate e-mail message. This LAST CALL message will be sent to MCH Alert subscribers from the following address:

The Reader Feedback Form will appear in the body of the message. If you have not yet responded, we ask that you take a few moments to complete the questions and submit your comments by e-mail (, fax (202/784-9777), or mail (MCH Library, Georgetown University, Box 571272, Washington, DC  20057-1272).

You will also find the form online at

We sincerely appreciate your time and for helping make the MCH Alert a success.



The Powerful Bones, Powerful Girls campaign promotes optimal bone health in girls ages 9 to 12 in an effort to reduce their risk of developing osteoporosis later in life. The campaign Web site for parents, which is part of the National Bone Health Campaign, offers suggestions on ways parents can integrate healthy behaviors into their daughter's social lifestyles. The Web site provides information on calcium and physical activity, and also includes the Powerful Bones Toolbox. The toolbox contains recipes and shopping lists, explanations of nutritional requirements, examples of weight-bearing physical activities, and question-and-answer sections providing parents with an array of resources. The Web site is available at



Maternal Employment and Children's Nutrition presents findings from a study designed to explore the effects of mothers' work on their children's nutrition. The study, funded by the U.S. Department of Agriculture's (USDA's) Economic Research Service, analyzed differences in nutrition and nutrition-related outcomes among children whose mothers work full time, part time, and not at all. The findings are presented in two volumes. The first volume includes an analysis of the role the USDA's Child and Adult Care Food Program plays in meeting the nutrition needs of participating children, especially those whose mothers work. The second volume includes information on food program participation, children's eating patterns, household food acquisition and sufficiency, and children's physical activity and risk of overweight. The reports are available at



"Success in changing behavior among tweens is more likely to be achieved when the following conditions are met: consumers have an in-depth understanding of the product and price associated with it, they have easy access to appropriate places where they can perform the behavior in everyday life, and product promotion portrays benefits in a positive, appealing fashion and reaches audiences through channels they value," state the authors of an article published in the July 2004 issue of Preventing Chronic Disease. The article describes how the four principles of social marketing (product, price, place, and promotion) were applied to formulate the strategies and tactics of VERB, a multiethnic media campaign to increase and maintain physical activity among children ages 9 to 13 (tweens). The article also provides examples of the multimedia materials that were created for the campaign.

VERB was launched by the Centers for Disease Control and Prevention in June 2002 with a goal of increasing and maintaining physical activity among tweens. Parents (especially mothers) ages 29 to 46 and other individuals who influence tweens are the secondary audiences of the VERB initiative. Before launching the campaign, planners conducted extensive research to gain an understanding of physical-activity-related attitudes, beliefs, and behaviors of tweens and their parents. Campaign planners applied findings from the audience research, along with the four principles of commercial marketing, to develop VERB as a social marketing campaign.

Product -- Product is the desired behavior for the targeted audience. The VERB campaign's product is physical activity. Early VERB advertising stimulated curiosity about the brand and enticed tweens to identify and try the activities that most appealed to them.

Price -- Price represents a balance of product benefits and costs. For physical activity, the costs of changing behavior can be financial, psychological, environmental, or time related. VERB messages are designed to convince tweens and their parents that physical activity has the "right price" -- that benefits outweigh costs.

Place -- Place is where the target audience either performs the behavior or accesses programs or services. Place must be readily available. A VERB place is where tweens can be physically active in a safe environment. Keeping VERB a "cool brand for tweens" is a critically important goal for partners (e.g., parks, schools, youth-serving organizations) as they collaborate on the campaign.

Promotion -- Promotion includes multiple ways to reach the target audience to promote the benefits of the behavior change, including product, price, and place components. Some of the promotion strategies and tactics employed by the VERB campaign include paid media advertising, community-based events, contests and sweepstakes, community and corporate partnerships, and Web sites.

"A lifestyle or behavior change such as increasing physical activity is difficult to achieve and even more difficult to sustain," state the authors. A baseline survey was conducted before the campaign's launch, and two follow-up surveys, one in 2003 and one in 2004, will measure the effectiveness of the campaign in motivating tweens to be more active.

Wong F, Huhman M, Heitzler C, et al. 2004. VERB -- A social marketing campaign to increase physical activity among youth. Preventing Chronic Disease: Public Health Research, Practice, and Policy 1(3):1-7. Available at

Readers: Formative research reports about the VERB campaign are available at

More information about physical activity and children and adolescents is available on the Bright Futures Web site at and from the MCH Library knowledge path, Physical Activity and Children and Adolescents, at



"The interviews found instances where urban, low-income African American mothers of preschool children understood a construct and a question item differently from the investigators," state the authors of an article published in the June 2004 issue of Appetite. The authors developed and employed an instrument called the Preschooler Feeding Questionnaire (PFQ) to assess specific maternal beliefs and practices about child feeding perceived to be associated with the development of obesity in children. However, the results did not reveal consistent associations between the practices assessed and the weight status of preschool-age children. The article describes a study to assess question interpretation and the presence and relevance of particular feeding constructs.

The PFQ assesses eight factors perceived to be related to childhood obesity, including (1) difficulty in child feeding, (2) concern about child overeating or being overweight, (3) pushing the child to eat more, (4) using food to calm the child, (5) concern about the child being underweight, (6) the child's control of feeding interactions, (7) structure during feeding interactions, and (8) age-inappropriate feeding. Although the original questionnaire was pilot-tested and revised before implementation, qualitative or open-ended techniques were not used to assess how respondents understood or interpreted the questions.

Women considered eligible for this study were enrolled in WIC, were African American, and were the biological mothers of children ages 25-59 months at the time of the study (July and August 2001). The women were invited to participate in a 1-hour, audiotaped interview about "how they feed their child." The authors determined whether the women interpreted questions similarly and if their interpretations were well matched with what was intended during item development.

The authors found that three of the eight constructs (difficulty in child feeding, pushing the child to eat more, and using food to calm the child) were consistently misunderstood. For example:

Question: Was he/she a picky eater?
Intention: The term "picky eater" was intended to describe a child that was difficult to feed because he/she either ate less than the mother expected or ate only a few types of foods.
Interpretation: To these mothers, picky eaters were selective about what they ate or the manner in which food was prepared; to them; the term was not associated with how much the children ate and whether mothers thought they were difficult to feed. Furthermore, to these mothers, being a picky eater was not necessarily a negative trait.

Question: Did you ever punish him/her or remove privileges to get him/her to eat more?
Intention: The intention was that the mother would describe what happened if her child did not eat enough at mealtime.
Interpretation: To these mothers, punishment meant spanking (with hand), whooping (hitting with another object), or some action like being given a time-out or being made to stand in the corner. None of the mothers used what they called "punishment" to encourage eating.

Question: When he/she was fussy, was giving him/her something to eat or drink the first thing you would do?
Intention: The intention was to determine whether the mother would readily use feeding as a technique to calm her child's emotional distress.
Interpretation: Mothers easily revealed friends' behaviors, but the tone of the question seemed to make them hesitate to admit their own use of food to calm their child.

The authors suggest that "similar problems in item wording may characterize other feeding questionnaires, and this may contribute to the ambiguous relationship between particular maternal feeding practices and changes in child weight."

Jain A, Sherman SN, Chamberlin LA, et al. 2004. Mothers misunderstand questions on a feeding questionnaire. Appetite 42(3):249-254.

Readers: More information about child and adolescent nutrition is available from the Bright Futures Web site at and from the MCH Library's knowledge path, Child and Adolescent Nutrition, at



"In this cross-national comparison of violence-related behaviors in adolescents, our results show that youth in 5 different countries behaved remarkably similarly with respect to violent behaviors," state the authors of an article published in the June 2004 issue of Archives of Pediatric and Adolescent Medicine. The authors state that violent behavior among adolescents is a significant problem worldwide and that three developed countries, Israel, France, and Norway, now join the United States as nations in which firearms are the second leading mechanism of death among 15- to 24-year-olds. However, the literature on violent behavior among adolescents outside the United States is relatively limited. The study described in this article used information from the World Health Organization-coordinated cross-national Study of Health Behavior in School-Aged Children to derive country-specific distributions of certain violent behaviors and to assess country-specific explanatory factors, which then provided a basis for comparing violence-related behaviors in five developed countries (Ireland, Israel, Portugal, Sweden, and the United States).

The analysis is based on cross-national, school-based surveys conducted during the 1997-1998 school year of students at mean ages of 11.5, 13.5, and 15.5 years. The numbers of participating students, as well as the response rate, for each country are as follows: Ireland: 4,398 (response rate: 74%), Israel: 5,054 (response rate: 75.0%), Portugal: 3,721 (response rate: 94.0%), Sweden: 3,802 (response rate: 91.7%), and United States: 5,168 (response rate: 87.0%). The main outcome measures were frequency of physical fighting, bullying, weapon carrying, and fighting injuries in relation to other risk behaviors and characteristics in home and school settings.

The authors found that

* The frequencies of any fighting, frequent fighting, weapon carrying, and fighting injuries were remarkably similar across countries.

* The frequency of bullying ranged from 14.8% in Sweden to 42.9% in Israel for students who bullied once or more per school term.

* Violence-related behaviors often occurred together in adolescents cross-nationally.

* Fighting was associated with smoking, alcohol use, feeling irritable or bad tempered, having been bullied, and not living with the father.

The authors concluded that "These findings are particularly important to today's climate, in which violent behavior in youth has increased to epidemic proportions and high-publicity school shootings in the United States and recently in Germany have raised public concern about teenage violence even further."

Smith-Khuri E, Iachan R, Scheldt PC. 2004. A cross-national study of violence-related behavior in adolescents. Archives of Pediatric and Adolescent Medicine 158(6):539-344.

Readers: Information about adolescent violence prevention is available from the MCH Library's knowledge path at and the organizations list at


To subscribe to MCH Alert, send an e-mail message to with SUBSCRIBE in the subject line. You do not need to enter any text in the body of the message.

To unsubscribe from MCH Alert, send an e-mail message to with UNSUBSCRIBE in the subject line. You do not need to enter any text in the body of the message.


MCH Alert © 2004 by National Center for Education in Maternal and Child Health and Georgetown University. MCH Alert is produced by MCH Library Services at the National Center for Education in Maternal and Child Health under its cooperative agreement (6U02 MC 00001) with the Maternal and Child Health Bureau, Health Resources and Services Administration, U.S. Department of Health and Human Services. The Maternal and Child Health Bureau reserves a royalty-free, nonexclusive, and irrevocable right to use the work for federal purposes and to authorize others to use the work for federal purposes.
Permission is given to forward MCH Alert to individual colleagues. For all other uses, requests for permission to duplicate and use all or part of the information contained in this publication should be sent to MCH Alert Editor, National Center for Education in Maternal and Child Health, at

The editors welcome your submissions, suggestions, and questions. Please contact us at the address below.

EDITORS: Jolene Bertness, Tracy Lopez

National Center for Education in Maternal and Child Health
Georgetown University
Mailing address: Box 571272, Washington, DC 20057-1272
Street address: 2115 Wisconsin Avenue, N.W., Suite 601, Washington, DC 20007-2292
Phone: (202) 784-9770
Fax: (202) 784-9777
Web site: