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a Aging Research and Education Center
b School of Allied Health
c Division of Geriatrics and Gerontology, Department of Medicine
d Division of Nephrology, Department of Medicine, University of Texas Health Science Center at San Antonio
Correspondence: Michael J. Lichtenstein, MD, MSc, Division of Geriatrics and Gerontology, Department of Medicine, University of Texas Health Science Center at San Antonio, 7703 Floyd Curl Drive, San Antonio, TX 78229-3900. E-mail: lichtenstei{at}uthscsa.edu.
Laurence G. Branch, PhD
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Abstract |
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2 = 13.9, p < .001). In addition, only 20% of the second drawings from the intervention school were more negative than the first drawing compared to 27% from the control school (2 = 11.3, p < .001). Using a generalized logit model, we adjusted for each student's baseline drawing (positive–neutral–negative), grade level, gender, ethnic group, and socioeconomic status. After adjustment, students in the intervention school were more likely to draw positive (odds ratio [OR] 1.48, 95% confidence interval [CI] 1.13, 1.94) or positive and neutral images (OR 1.58, 95% CI 1.21, 2.19) at follow-up compared to the control school. Implications: This controlled study demonstrated that use of the Positively Aging® teaching materials and activities moved middle school students toward a more positive view of elders. Interdisciplinary teaching materials based on geriatrics and gerontology can be successfully developed and tested in public school systems to affect attitudes about aging.
Key Words: Education • Middle school • Controlled trial • Aging
The White House Conference on Aging (U.S. Department of Health, Education and Welfare 1961
) endorsed the need for aging education in public schools 40 years ago; since then there has been a steady increase in the number of efforts to infuse gerontologic content into public school curricula (Lucchino, Ferguson, and Lane 1997; McGuire 1987). Aging is a universal process experienced by everyone: students, parents, teachers, and school systems. Recognizing the impact of lengthening life spans on personal and societal growth and development, a number of teacher organizations (e.g., National Association of Biology Teachers) are adopting content about aging and changes over time into their professional standards.
Two organizations have long been involved in developing and cataloging materials on aging education: the National Academy for Teaching and Learning About Aging (formerly the Center for Understanding Aging) at the University of North Texas, Denton (www.unt.edu/natla), and Generations Together at the University of Pittsburgh, Pennsylvania (www.pitt.edu/~gti). Although aging education materials for public education exist, there continues to be a need to test and evaluate programs designed to change children's attitudes and beliefs on aging.
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Description of the Positively Aging® Teaching Materials |
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In its present form, the Positively Aging® teaching materials consist of 12 integrated interdisciplinary units with 276 activities. The units (with their interdisciplinary lessons and activities) are packaged separately to facilitate dissemination. Each unit has an overarching theme with a set of learning objectives mapped to specific knowledge and skills as defined by the Texas Education Agency 1997. Lessons within units are designed to meet specific learning objectives. Activities in each lesson are classroom exercises designed to stimulate students to actively learn the content and skills necessary to master the material. The Positively Aging® materials specifically incorporate health promotion and disease prevention objectives from Healthy People 2010 (U.S. Department of Health and Human Services 2000). The lessons and activities directly address the two central Healthy People 2010 goals of (a) increasing the quality and years of healthy life, and (b) eliminating health disparities. The rationale, structure, and content of the 12 Positively Aging® units have been previously described in detail (Lichtenstein et al. 1999).
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Challenges to Infusing Aging Education in Public Schools |
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identified five barriers to incorporating aging education into public schools. The Positively Aging® teaching materials address and overcome a number of these obstacles (Lichtenstein et al. 1999). The first barrier is that aging represents a nontraditional topic (i.e., it is not typically part of the school curriculum). Our approach has been to use examples from geriatrics and gerontology to teach established curricular elements. For example, if a student needs to learn the physical concept of density in a science class, the Positively Aging® materials use bone mineral density to teach this. Bone mineral density can then be linked to bone biology and osteoporosis, providing opportunities to teach about nutritional and exercise habits to maintain bone health across the life span. Russell's second barrier was that material and resources are inadequate to effectively teach the subject. Since Russell's 1979 article, multiple bibliographies and lesson plans have been created, one of which now is the Positively Aging® curriculum. The third and fourth barriers to aging education were that many teachers are not interested in aging and lack the training to teach the topic. Through structured training programs that provide opportunities for professional development, a growing number of teachers now receive training in the delivery of aging education content. Once shown that the lessons from the Positively Aging® materials facilitate teaching established curricular elements rather than change what they are required to instruct, teachers are more likely to accept the lessons and activities. Once involved with the lessons, teachers often confront their own biases about aging.
Russell's fifth barrier was that attempts at content integration have been unsuccessful. The Positively Aging® teaching materials are designed to be interdisciplinary so that a team of middle school teachers may coordinate teaching different aspects of a unit simultaneously. Further, the Positively Aging® lessons and activities have been linked to state and national educational standards (American Association for the Advancement of Science 1993; National Research Council 1996; Texas Education Agency 1997).
McGuire 1986, McGuire 1994 noted that when aging education is presented, it frequently focuses on the pathology of aging, rather than on positive aspects. She states that gerontologic content should promote aging as a natural, lifelong process of growth and development. The Positively Aging® materials provide ample opportunity for intergenerational activities, the assessment of elders in society, and changes over the life span. Children can be taught that older people are valuable and contributing members of society. Old and young people can enjoy and learn from each other, comparing their similarities and differences. McGuire 1994 also states that the goal of aging education involves producing a generation of older people who successfully adapt to old age. Jantz, Seefeldt, Galper, and Serock 1976 call for curricula that enable children to assess their perceptions of the aging process and see how it affects them. These curricula should expose children to an unbiased look at the characteristics of elderly people in a variety of roles to discourage formation of stereotypical attitudes. Indeed, intergenerational activities in schools have shown that exposure to vigorous elders can improve children's views of aging (Newman, Faux, and Larimer 1997).
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Assessing Children's Attitudes Toward Elders |
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; Newman et al. 1997) and the Children's Attitude Toward the Elderly (CATE) questionnaire (Jantz et al. 1976, Jantz et al. 1977). Newman and colleagues 1997 note the importance of having children express their opinions of elders without an external framework imposed by adults. They note that when asked in an open-ended way, about one third of elementary school children will have positive views of elders, and one half will describe neutral physical characteristics of aging (e.g., wrinkles).
Human figure drawing has been used in multiple settings to investigate children's intellectual development and attitudes (Harris 1963; Harris and Pinder 1974). Drawings also have been employed in at least three studies to explore children's attitudes about elders (Couper, Donorfio, and Goyer 1995; Falchikov 1990; Seefeldt et al. 1977). Seefeldt and colleagues 1977 had 180 preschool to sixth grade children evaluate four drawings of one man at ages 20, 40, 60, and 80 years through a structured interview. The majority (69%) of the children were able to correctly sequence the drawings, thereby demonstrating an understanding of relative age. The interviews with the children indicated negative attitudes toward the physical characteristics of the image of the eldest man and the children's view of their own aging.
In contrast to the Seefeldt study (1977), Falchikov 1990 asked 28 Scottish children (mean age 11 years) to draw images of an old man, an old woman, a young man, and a young woman. In comparing the drawings, images of elders frequently showed signs of physical deterioration (e.g., the use of a cane, inactivity). The older figures were drawn smaller than the younger figures, and Falchikov felt that the images frequently portrayed stereotypes of aging. This small study illustrates the rich detail of these drawings and contrasts the extremes of youth and old age—it provides a starting framework for other investigators working to describe the content of children's drawings of elders.
Couper and colleagues 1995 had 423 children (ages 6–11 years) draw pictures of an old person and a young person, and then asked them to explain the differences. Children who drew images of someone they knew (e.g., a grandparent) were more likely to portray an older person with positive attributes. Girls tended to draw more positive images of elders than boys, and boys also expressed more negative ideas about aging. On average, older children were more negative about old age than younger children.
We were not able to find a study that directly compares the use of an open-ended qualitative method (such as drawings) with a quantitative close-ended method (e.g., standardized questionnaire). Qualitative open-ended approaches solicit children's views while minimizing the potential for an expectation bias, that is, students responding in a way they think they are being asked to respond—"what the teacher wants." Open-ended methods are more challenging to interpret, given the range and heterogeneity of responses. Standardized questionnaires have the advantage of a uniform metric for assessing attitudes, but may either frame the expected response or miss important content because it is not included as an item on the questionnaire. Questionnaires may also contain open-ended responses (Newman et al. 1997), but these, too, may be challenging to interpret. Without complementary use and analysis of both methods for assessing children's attitudes about aging within a single study, it is difficult to directly compare and contrast the strengths and weaknesses of each approach.
The purpose of the present study was to determine whether the use of the Positively Aging® teaching materials by regular classroom teachers could change children's images of elders as reflected through their drawings of older people. We chose drawings as our measure of children's views of elders because this is an activity that does not completely depend on a student's reading and writing ability. Further, having teachers collect drawings as a classroom activity precludes the need for survey administration by research personnel.
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Methods |
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Drawings are made in a 14.0 x 17.5 cm rectangle. Teachers instruct their students to draw the whole person and to make the very best picture possible. Students place the person in a setting and answer a series of questions describing the picture. The questions include the person's age, activities, feelings, thoughts, possible relation to the student, and how the drawn person's characteristics differ from those of the student.
Our goal was to collect drawings from every student in the two schools at the beginning (September–October 1998) and at the end (April–May 1999) of the school year. Students were not given grades for completion or the quality of the drawings.
Characterization of Positive–Neutral–Negative Drawings
Using a structured coding sheet and standardized instructions, four raters (CLB, LAP, MJL, and CEM) coded the characteristics of the drawings in detail. A large number of features (e.g., use of assisted devices and hunched posture—see Fig. 1) were abstracted from the drawings. In assessing changes over time, we could not realistically examine differences in every drawn feature and chose a global measure instead. As part of this process, the raters classified the drawings and written responses to the questions into three overarching categories: negative, neutral, or positive images of older people. This article focuses solely on the overall rating of the images, not the specific characteristics drawn by the students.
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; Drasgow 1986; Fleiss 1975). The Kappa value was .07 (95% confidence interval [CI] = -.14, .30) and the polychoric correlation was -.01. This low level of agreement indicates that students are not likely to draw a similar image on two separate occasions close together. The test for symmetry statistic (Fleiss 1975) was .93 (3 df, p = .82), indicating that there was no systematic drift toward more negative or more positive images between drawings.
Interrater Agreement
To determine the comparability of coding between the raters, all four independently coded a random sample of 50 drawings as positive, neutral, or negative. The pair-wise interrater Kappa statistics were excellent (Landis and Koch 1977), ranging from .64 to .81. The weighted Kappa for all four raters was also excellent at .73 (95% CI = .67, .80).
Assessment of Rater Bias (Intrarater Agreement)
Raters were not masked to the school of origin when coding the drawings. To test for potential rater coding bias (i.e., knowing which drawings were from the intervention school, did the raters tend to code them more positively?) we selected a random sample of 60 follow-up drawings for each rater for recoding (10 positive, 10 neutral, and 10 negative from each of the two schools). One rater (LAP) only had 44 drawings because she happened to code a smaller number of drawings for one school at follow-up. Thus, the total sample for this test was 224 rather than 240 drawings. These 224 drawings had all school identifiers removed and were recoded a second time by the raters.
The results of the test for potential rater bias are presented in Table 1 . Individual Kappa statistics for the four raters range from .62 to .87. The overall weighted Kappa was .74 (95% CI = .68, .81). The Kappa statistics for the intervention and control school were similar at .78 and .71, respectively. In addition, none of the tests of symmetry were statistically significant, indicating no difference in pattern of coding responses between coding sessions. This means there was no shift toward either a more positive or more negative coding pattern between occasions.
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Study Design and Program Implementation
Selection and Description of the Schools
Northside Independent School District (NISD) is the sixth largest school district (out of 1,110) in Texas. NISD serves more than 61,000 students in 350 square miles of Northwest San Antonio and surrounding Bexar County. All 12 NISD middle schools were potentially eligible for inclusion in the study. During the pilot phase of the research, the middle school principals were surveyed about the schools and their willingness to participate in the project. Two schools agreed to participate, with one school specifically asking to be the control site during the implementation year due to their competing academic programs and school district requirements.
The characteristics of the two schools are compared in Table 2 . The control school had proportionately more Mexican American and economically disadvantaged students than the intervention school. In addition, the mobility rates (the proportion of students who enter or leave the school after the school year has started) were greater in the control school.
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Teacher Training
During June 1998, 13 teachers from the intervention school (approximately 10% of the faculty) participated in an intense 2-week in-service training program (60 contact hours) in the rationale and use of the Positively Aging® teaching materials. We attempted to get representation from as many of the 12 academic interdisciplinary teams at the intervention school as possible. The training program, entitled Stealth GerontologyTM, provided direct experience with sample lessons and activities from all Positively Aging® units. Faculty from the University of Texas Health Science Center led interactive seminars in their respective content areas. None of the teachers from the control school participated in any training.
Suggested Scope and Sequence
Through teacher feedback from pilot-testing the Positively Aging® teaching materials in the classroom, a logical scope and sequence has emerged for presenting the lessons across the middle school grade levels. The suggested sequence is guided by the Texas Essential Knowledge and Skills requirements (Texas Education Agency 1997), identifying knowledge and skill elements that are grade specific, and elements that can be repeated in sixth through eighth grade. The suggested scope and sequence are summarized in Table 3 .
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; Fleiss 1975; Landis and Koch 1977). For test–retest repeatability we used polychoric correlation for strength of association in an ordinal variable (Drasgow 1986) in addition to the Kappa statistic. Tests of symmetry were used to assess for shifts of distributions within contingency tables in either direction (Fleiss 1975).
Chi-square statistics (Armitage 1971) and marginal homogeneity (Stokes, Davis, and Koch 1995) were used to test the differences in positive–neutral–negative distributions of drawings within and between schools from baseline to follow-up. Finally, we used generalized logit modeling (Clogg, Eliason, and Grego 1990) to adjust for the variables associated with the follow-up drawings and the difference in distribution of demographic factors between the two middle schools. We used generalized logit modeling because polytomous regressions indicated that the data did not fit the assumption of equivalent effects at the different levels of the ordinal outcome variable (positive–neutral–negative). For the generalized logit models, some independent variables had to be recoded to bivariate variables. For example, grade level was recoded into two variables, with seventh grade as the reference (sixth vs seventh grade and seventh vs eighth grade). The results from the generalized logit model are presented as odds ratios (OR) and 95% CIs.
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Results |
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Response Rates and Assessment for Response Bias
The response rates for obtaining baseline and follow-up drawings are listed in Table 4 . At the beginning of the school year, baseline drawings were obtained from 79% and 83% of the intervention and control schools, respectively. At follow-up, the end of the school year, drawings were obtained from 69% and 61% of the students in the two schools. The drop-off in obtaining drawings was similar in both schools and attributable to competing educational programs and mandates (e.g., standardized testing). Further, as the school year progressed, schedules necessarily adjusted for unanticipated events that changed the timing of curricular instruction. A number of teachers reported that they simply did not have class time at the end of the school year to get second sets of drawings.
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Within schools, there were no differences between respondents (those students for which we have paired drawings) and nonrespondents with respect to gender, ethnic group, or being economically disadvantaged. For the students for whom we had paired data, the proportions of girls were 52.7% and 48.1% in the intervention and control schools, respectively. The proportion of Mexican Americans was 27.9% and 62.9%, respectively, and the proportion of economically disadvantaged students was 10.0% and 44.5%, respectively. These proportions are similar to those present in both school populations at the beginning of the school year (Table 2 ).
Baseline Versus Follow-up Drawings
The raw data for the distribution of positive, neutral, and negative drawings at baseline and follow-up, stratified by school, are listed in two panels in Table 5 . At baseline, the distribution is similar for both schools: 28.1% positive, 49.0% neutral, and 23.0% negative at the intervention school compared with 32.0% positive, 47.7% neutral, and 20.3% negative at the control school (2 [2 df] = 3.03, p = .22). At follow-up, there was a shift—the proportion of positive drawings increased to 38.0% at the intervention school and decreased to 30.6% at the control school. The proportion of negative drawings decreased to 14.2% at the intervention school and increased to 22.2% at the control school. The difference in distributions between the schools at follow-up is statistically significant (2 [2 df] = 17.64, p < .001). For the control school, testing for marginal homogeneity at baseline and follow-up, there was no difference in the distributions (p = .66). In contrast, comparing the marginal homogeneity for the intervention school, a difference between baseline and follow-up was evident (p = .001).
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2 [1 df] = 13.9, p < .001). The results are similar if restricted to only those persons who were negative or neutral at baseline: 47.8% of the intervention school and 36.8% of the control school were more positive at follow-up.
The proportion of students who drew more negative images is obtained by summing the three numbers in italics in both schools as shown in Table 5 . Students in the control school drew more negative images at follow-up (27.4% ([69 + 30 + 63]/591)) compared to the intervention school (19.7% ([90 + 16 + 48]/782)). This difference in proportions is also statistically significant (2 [1 df] = 11.3, p < .001). The results are similar if restricted to only those persons who were positive or neutral at baseline: 25.6% of the intervention school and 34.4% of the control school were more negative at follow-up.
A post-hoc subgroup analysis was done within the intervention school to determine if classes that used more of the Positively Aging® lessons had greater shifts in the drawings compared to classes that used fewer lessons. There were no demonstrable differences between the two groups of classes in the positive–neutral–negative distribution of drawings at follow-up.
Generalized Logit Modeling
Generalized logit modeling was used to adjust the observed shifts in the follow-up drawings for (a) baseline drawing status, (b) grade level, (c) gender, (d) ethnic group, (e) being socioeconomically disadvantaged, and (f) school. The results are summarized in Table 6 . The first column dichotomizes between negative drawings at follow-up and combined positive and neutral drawings. The second column dichotomizes between positive drawings at follow-up and combined neutral and negative drawings. At both dividing points for the positive–neutral–negative levels, ethnic group and being socioeconomically disadvantaged (i.e., eligible for free and reduced lunches) was not associated with the follow-up drawings. At both dividing points, girls were approximately two to three times more likely to draw positive images of elders than were boys (OR 1.63 and 2.76). The baseline drawing level was associated with level at follow-up: Children drawing positive images at baseline were twice as likely to draw positive images at follow-up (OR 1.87 and 2.00).
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After adjusting for grade level, gender, ethnic group, eligibility for free and reduced lunch, and baseline level of the drawing, students in the intervention school were significantly more likely to draw positive images of elders at follow-up compared to the control school. This observation was true for both levels of the drawing variable in the generalized logit analysis (OR 1.58 and 1.48 for the two levels of the ordinal outcome variable).
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Discussion |
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Our findings confirm the observation that girls are more likely than boys to draw positive images of elders (Couper et al. 1995). We found no difference in drawings based on ethnic group or being socioeconomically disadvantaged (as defined by being eligible for federally subsidized school luncheons). The distribution of positive–neutral–negative images observed in both schools at baseline is similar to the distribution of others in their survey work with elementary school children (Newman et al. 1997). Approximately 25% of students produce positive images on their own. About one half the images are neutral, being primarily physical descriptors without any values, either positive or negative, attached to them.
Comparing the present study and prior reports in the literature, differences in study design must be considered. For example, Newman and colleagues 1997 reported improving fourth- and fifth-grade children's conceptions of elders simply by having older adults participate in classroom activities, whereas our sample is from middle schools (sixth–eighth grade). Work by Couper and associates 1995 indicated that younger children (ages 6–8) have less negative age-associated stereotypes than older children (ages 9–11). Thus age differences in samples could partially account for differences between studies. Newman and colleagues' study used a questionnaire, the CVoA, whereas our study used drawings as the assessment tool. We are unaware of any literature directly comparing the results from questionnaires with results from drawings. Thus, the outcome measures chosen partially explain observed differences between the studies. Finally, the Newman study is based on 71 predominantly African American students from Pennsylvania; there were post-test improvements on the CVoA without a control group, and it is difficult to measure how much of the change was attributable to the intergenerational program per se. In contrast, our study is based on 1,373 predominantly Mexican and European American children in two San Antonio schools with one school serving as a control site. We were able to demonstrate a statistically significant shift in the drawn images in the intervention school with no significant shift in the control school. Although a 10% change may not be "educationally" large, it is what we were able to measure with a one-year intervention. Educators and gerontologists working in school systems must take into account differences in research and evaluation methods prior to adopting a particular program or set of teaching materials.
Limitations of the Study
The results of the study must be interpreted within its limitations. First, we experienced a lower response rate in the number of drawings obtained at follow-up at the end of the school year. This drop-off in responses was due in part to children moving out of the school area. However, the primary reason is that teachers felt they could not take classroom time to collect drawings at the end of the school year. Mandated state testing and other curricular requirements simply took precedent. Nevertheless, the response rates were similar in both schools, and there was no evidence for systematic bias in the decreased response rates. Further, we believe that obtaining paired drawings from more than half the students in two middle schools actually represents a high response rate in this form of educational research.
A second limitation is the variable and relatively low utilization of the Positively Aging® teaching materials in the intervention school. Here again, competing curricular requirements and inertia in adopting new lesson plans on the part of the school faculty played a role in the number of lessons and activities taught. We were able to formally train only about 10% of the intervention school faculty prior to the start of the school year. These are the realities of incorporating a voluntary program into any school and can only be overcome with increased training, support throughout the school year, and a persistent presence over the course of multiple years. Nevertheless, despite the low level of utilization over a one-year period, we were still able to measure a 10% shift to more positive images of elders (although classes in the intervention school that used larger numbers of lessons and activities did not show a greater shift toward more positive images). There may be key lessons (e.g., intergenerational activities) that are more conducive to changing children's views, whereas other lessons may change specific knowledge content. Presumably, utilization of the Positively Aging® materials over longer periods of time could result in greater shifts in children's perceptions of older persons.
A third limitation is the marked differences in ethnic group and socioeconomic status between our schools; they are very different communities of learners, even though they come from one school district. Other investigators are likely to encounter similar differences when working with entire schools and obtaining controlled data. In 1998–1999, these were the only two middle schools in the NISD that were willing to take part in the study. We acknowledge that other unmeasured factors in the school environments may partially account for the observed changes in the drawings. In spite of the differences in student populations, there were no baseline differences in the distribution of the positive–neutral–negative drawing measure. Further, the differences in ethnic group and socioeconomic status between the schools were not associated in any way with changes in drawing status in the generalized logit models (Table 6 ).
A fourth potential limitation is the poor repeatability of the drawing measure. In the pilot middle school, children simply did not draw the same type of image of an older person on two occasions. This suggests that the positive–neutral–negative attribute for elders is not fixed in the minds of middle school students and may be changed with appropriate instruction. The fact that the intervention school showed more of a shift toward positive images than the control school over the course of the school year adds credence to this argument.
A fifth limitation is turnover of students during the school year. We were surprised by the high mobility rates of students moving in and out of the school during the year. This turnover can only dilute the impact of any teaching program and is a reality for any public school system.
Teacher turnover is less of a problem during the school year, but presents a sixth limitation to incorporating new teaching materials into a school. Teachers may move between schools from year to year. An instructional program may be dependent on a single outstanding teacher at a particular school. When that teacher moves to another school, other interests at the first school may replace the program.
In spite of these limitations and barriers, the present controlled study demonstrates that the presence of an interdisciplinary teaching program that uses examples from geriatrics and gerontology to teach required curricular elements can improve middle school students' images of elders.
Recommendations
The challenges we encountered in testing the Positively Aging® teaching materials in the present study are likely to be there for any group interested in improving aging education in America's public school systems. There are at least five components to solutions that will facilitate the incorporation of gerontology content into schools. First, aging education programs must have a persistent year-to-year presence in the schools so that teaching about aging becomes part of the curriculum's structure. Second, opportunities exist for improving teacher training and professional development in gerontology. For example, all the Positively Aging® materials were written by middle school teachers and field tested in their classrooms; the act of creating and testing lessons and activities gave these teachers a sense of ownership and empowered them to use them with their students. Once materials are created and new knowledge becomes available, teachers may continually modify and adapt lessons for their specific classroom needs. These modifications can be incorporated into future revisions of a curriculum and increase its usefulness to others. A third strategy is to be sure that whatever aging education teaching materials are developed, they are linked to national, state, and local curriculum requirements. The Positively Aging® teaching materials are all carefully linked to the Texas Essential Knowledge and Skills (Texas Education Agency 1997). We have also created these materials with linkages to national standards for science education and literacy (American Association for the Advancement of Science 1993; National Research Council 1996). Teachers may be more likely to pick up and use the teaching materials if they meet national and state standards for education. Fourth, creating a presence on the World Wide Web with teaching materials and instruction can overcome many of the barriers of access and support. Finally, advocacy at the state level to place aging education into curricula can create incentives in local school districts to adopt and implement these instructional programs.
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Acknowledgments |
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We thank the administration, teachers, and students of Northside Independent School District in San Antonio, Texas, for their participation in this study. A special thanks to Ms. Lydia Martinez, principal of Anson Jones Middle School, Dr. Debbie Sonnen, principal of Katherine Stinson Middle School, and Mr. Charles Burling, principal of Pat Neff Middle School, for facilitating the project in their schools. Thanks also to Dr. Phil Linerode, program evaluation specialist for Northside Independent School District, for his guidance and counseling in working with the schools. The authors also thank Dr. Helen P. Hazuda, Dr. Linda M. McManus, Ms. Corrine Price, and Dr. Charles L. Slater for their critical review of earlier versions of this article.
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Footnotes |
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Received for publication November 6, 2000. Accepted for publication January 29, 2001.
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