Addictive Behaviors 39 (2014) 757–760
Contents lists available at ScienceDirect
Addictive Behaviors
Short Communication
A web-based, health promotion program for adolescent girls and their
mothers who reside in public housing
Traci M. Schwinn a,⁎, Steven Schinke a, Lin Fang b, Suganthi Kandasamy a
a
b
Columbia University School of Social Work, 1255 Amsterdam Ave, New York, NY 10027, USA
University of Toronto Factor-Inwentash Faculty of Social Work, University of Toronto, 246 Bloor St. West, Toronto, ON M5S 1V4, Canada
H I G H L I G H T S
•
•
•
•
Developed and tested a brief, family- and web-based health promotion program
Designed for adolescent girls and their mothers who reside in public housing
Focused on dietary intake, physical activity, and substance use risks
Findings indicate the potential to improve multiple health behaviors.
a r t i c l e
Keywords:
Gender-specific
Health-promotion
Web-based
Public housing
Family-based
i n f o
a b s t r a c t
This study tested a brief web-based, family-involvement health promotion program aimed at drug use,
physical activity, and nutrition for adolescent girls, aged 10 to 12 years, who reside in public housing.
Separately, girls (n = 67) and their mothers (n = 67) completed baseline measures online. Following
baseline, 36 randomly assigned mother–daughter dyads jointly completed a 3-session, health promotion
program online. Subsequently, all girls and mothers separately completed posttest and 5-month followup measures. Attrition at posttest and 5-month follow-up measures was 3% and 9%, respectively. At posttest, intervention-arm girls, relative to control-arm girls, reported greater mother–daughter communication and parental monitoring. Intervention-arm mothers reported greater mother–daughter
communication and closeness as well as increased vegetable intake and physical activity. At 5-month
follow-up, intervention-arm girls and mothers, relative to those in the control arm, reported greater
levels of parental monitoring. Intervention-arm girls also reported greater mother–daughter communication and closeness, reduced stress, greater refusal skills, and increased fruit intake. Findings indicate
the potential of a brief, web-based program to improve the health of low-income girls and their mothers.
© 2013 Elsevier Ltd. All rights reserved.
1. Introduction
Adolescent girls who live in public housing are at risk for poor
health outcomes owing to their socio-economic status. Low-income
youths have poorer nutritional intake and are less physically active
than their higher socio-economic peers (Regan, Lee, Booth, &
Reese-Smith, 2006). Neighborhood disadvantage may also increase
girls' risks for drug use (Leech, 2012). Because negative health behaviors share common risk factors, health promotion programs
must target multiple outcomes (Flay, 2002). And, because for girls
in particular, a healthy and close parent–child relationship is associated
with positive adolescent development (Chan, Kelly, & Toumbourou,
⁎ Corresponding author. Tel.: +1 212 851 2280; fax: +1 212 854 1530.
E-mail address: tms40@columbia.edu (T.M. Schwinn).
0306-4603/$ – see front matter © 2013 Elsevier Ltd. All rights reserved.
http://dx.doi.org/10.1016/j.addbeh.2013.11.029
2013; Kelly et al., 2011; Lombe, Nebbitt, & Mapson, 2009), health promotion programs should involve parents. Programs should also be engaging, simple to use, and easy to disseminate.
Web-based interventions are ideal for meeting the aforementioned
demands of health promotion programs. They use a delivery platform
familiar to teens and their parents, can be culturally tailored, and require no staff training. Web-based programs also mitigate the logistical
challenges commensurate with family-involvement interventions because parents can receive the intervention at home.
Building off our prior work with computer-based interventions
(Schinke, Fang, & Cole, 2009; Schwinn & Schinke, 2010; Schwinn,
Schinke, & Di Noia, 2010) this pilot study tested a brief, health promotion program for low-income girls and their mothers. The program aimed to enhance the well-being of girls residing in public
housing by improving dietary intake, increasing physical activity,
and reducing drug use risks.
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T.M. Schwinn et al. / Addictive Behaviors 39 (2014) 757–760
2. Materials and methods
2.1. Sample
Participants were from 27 U.S. states and lived in publicly subsidized
housing. Across 4 weeks, we ran recruitment ads on Facebook,
craigslist, and Google AdWords and in public housing development
newspapers. Ads directed mothers to the study's information website.
There, interested mothers requested receipt of the study information
packet (an introductory letter, a list of frequently asked questions, enrollment forms, and a franked return envelope) by providing their
name and mailing address. We mailed out 86 information packets and
received 67 signed youth assent, parent permission, and parent consent
forms.
2.2. Procedures
Mother–daughter dyads were randomly assigned to the intervention or control arm. Girls and mothers completed their respective baseline measures online. Subsequently, intervention-arm dyads completed
the 3-session health promotion program; control-arm dyads received
no intervention materials. All dyads completed posttest and 5-month
follow-up measures. Each girl and mother received $20 for baseline,
$30 for posttest, and $30 for 5-month follow-up. The Columbia University IRB approved our Human Subjects' procedures.
2.3. Health promotion program
After baseline, intervention-arm mothers and daughters were directed to complete the first session of the health promotion program
on a secure website. Working together at the same computer, mothers
and daughters completed each session in roughly 25 min. Dyads completed one session per week for 3 weeks. E-mail reminders and telephone calls prompted participants when they fell behind schedule.
The integrated, 3-session program focused on developing and
maintaining girls' and mothers' healthy relationships, bodies, and
minds. Session 1 focused on active listening, communication, and
the benefits of family meals. In session 2, mothers and daughters
discussed their knowledge about drugs. Mothers learned to set and
enforce rules. Dyads learned strategies to make healthy and economical decisions at the grocery store and how to make healthy dinners.
Session 3 dealt with coping skills. Drawing from a list of stressors
that reflect the hardships of living in public housing, dyads identified
and shared with each other sources of stress. Mothers and daughters
were also exposed to a 5-step problem solving process.
2.4. Fidelity
To assess program completion fidelity, research staff sent mothers
and daughters the link to the study website and assigned each dyad
member a unique code. Neither member of the dyad was provided
with the other member's code. Separately, with their codes, both members of the mother–daughter dyad concurrently logged onto the
website. Only by entering both codes could mother–daughter dyads unlock the health promotion sessions. Session completion was tracked by
a real-time backend database linked to the online program. According to
tracking data, of the 36 mother–daughter dyads assigned to the health
promotion program, 35 completed all three sessions and 1 dyad completed two of the three sessions.
2.5. Measures
2.5.1. Daughter and mother measures
Demographic questions asked girls for their age, grade in school,
ethnic–racial identification, and average letter grade earned in school.
Demographic questions asked mothers for their birthdays, ethnic–racial
identification, highest level of education attained, employment status,
and whether their daughters qualified for free or reduced price lunch.
Mother–daughter closeness was evaluated with 10 items adapted
from the Parental Bonding Instrument (Parker, Tupling, & Brown,
1979). Mothers rated such items as “My daughter likes to talk to me”
and “I care about my daughter” with a 6-point Likert scale (“strongly
agree” = 1 to “strongly disagree” = 6). Parallel questions were posed
to girls. Reliability of the mother and daughter items ranged from
α = .73 to .87; the correlation between mothers' and daughters' scores
across all three time points ranged from r = .65 to .73.
Mother–daughter communication was assessed with six items from
the Barnes and Olson Communication Scale (Barnes & Olson, 1985).
With a 6-point Likert scale (“strongly agree” = 1 to “strongly
disagree” = 6), daughters rated such parameters as “It is easy to discuss
my problems with my mother;” and “My mother sometimes doesn't listen to me.” Parallel questions were asked of mothers but reworded to
assess communication quality. Reliability of the mother and daughter
items ranged from α = .83 to .86; the correlation between mothers'
and daughters' scores across all three time points ranged from r = .45
to .60.
Parental monitoring was assessed with five items from the Parental
Monitoring Scale (Small & Kerns, 1993). With a 5-point Likert scale
(“never” = 1 to “always” = 5), mothers rated such parameters as “I
know where my daughter is after school” and “I know my daughter's
friends.” The same questions were reworded and asked of the daughters. Reliability of the mother and daughter items ranged from
α = .84 to .95; the correlation between mothers' and daughters' scores
across all three time points ranged from r = .43 to .56.
Substance use items were adapted from the CDC's Youth Risk Behavior Survey (YRBS; Centers for Disease Control, Prevention, 2005). Girls
reported past-month and past-week use of alcohol, cigarettes, marijuana, heroin, inhalants, methamphetamines, amphetamines, ecstasy, and
tranquilizers. Mothers reported past-month and past-week alcohol
and cigarette use. Response categories let respondents enter the exact
number of times they used a particular substance. Test–retest reliability
for YRBS items ranges from .82 to .95 (Centers for Disease Control,
Prevention, 2004).
Fruit and vegetable intake was evaluated with 21 items from the
Youth and Adolescent Food Frequency questionnaire (Rockett et al.,
1997). Mothers and daughters reported how often they consumed
certain foods per week (“0 times per week” = 1 to “more than 7
times per week” = 6). The reliability for the fruit items is α = .72
(Speck, Bradley, Harrell, & Belyea, 2001); and reliability for the vegetable items is α = .83 (Speck et al., 2001).
Physical activity was evaluated with 12 items from the Kaiser Physical Activity Survey (Ainsworth, Sternfeld, Richardson, & Jackson, 2000).
Eight of the items evaluated the types of activities girls and mothers typically engaged in each week. These eight items used a 5-point Likert
scale (“0 times per week” = 1 to “more than 7 times per week” = 6).
The other four items assessed the number of hours that girls and
mothers spent on such activities as “watching TV” or “surfing the Internet” (“less than 1,” “1,” “2,” “3,” or “more than 3 h per week”). The Kaiser Physical Activity Survey has intra-class correlation coefficients
ranging from .79 to .91 (Lee, Im, & Chee, 2009).
2.5.2. Daughter-only measures
Perceived stress was reported by girls with six items based on the
Perceived Stress Scale (Cohen, Kamarck, & Mermelstein, 1983). With a
5-point Likert scale, girls rated the degree to which they felt stressed because of such situations as “feeling fat or unattractive” or “feeling pressure from friends” (“all the time” = 1 to “never” = 5). The reliability of
the Perceived Stress Scale is α = .84 (Augustine et al., 2011).
Drug refusal skills were measured with two items that assessed the
ease with which girls felt they could refuse an offer to use drugs from
a best friend (Fearnow-Kenney, Hansen, & McNeal, 2002; Hansen &
McNeal, 2001). An illustrative item is “Pretend your best friend offered
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T.M. Schwinn et al. / Addictive Behaviors 39 (2014) 757–760
you marijuana and you did not want it. How hard would it be for you to
refuse the offer?” Response options ranged from “very easy =” 1 to
“very hard” = 4. Reliability for the scale is α = .84 (Fearnow-Kenney
et al., 2002; Hansen & McNeal, 2001).
2.6. Data analysis
Analysis of covariance assessed program effects at posttest, controlling for baseline scores. General linear model repeated-measures examined the time by intervention interaction effects at 5-month follow-up.
Outcome variables (i.e., mother–daughter closeness, mother–daughter
communication, parental monitoring, refusal skills, perceived stress,
substance use, fruit intake, vegetable intake, and physical activity)
were the within-subject factor and assignment to study arm was the
between-subject factor. When sphericity violations occurred, the
Greenhouse–Geisser corrected epsilon value was applied to adjust subsequent repeated-measures ANOVAs. Overall attrition was 9% (14% in
the intervention arm; 3.2% in the control arm).
3. Results
3.1. Baseline
Sample demographics from baseline data appear in Table 1. Girls
and mothers had a mean age of 11.85 years (SD = 0.88) and
36.24 years (SD = 6.16), respectively. Girls were White (43.3%),
Black (40%), Latina (13.3%) and Asian (3.3%). Most girls qualified
for free (78%) or reduced price (15%) lunch. Intervention- and
control-arm participants did not differ in relation to demographic
or outcome variables and demographic variables were not associated
with outcome variables.
3.2. Posttest and 5-month follow-up
At posttest and relative to the control arm (Table 2), girls and
mothers who received the health promotion program reported
greater mother–daughter communication (p b .01; p b .05, respectively). Intervention-arm girls also reported more parental monitoring (p b .01). Intervention arm mothers, reported greater closeness to
their daughters (p b .05), increased vegetable consumption (p b .05),
and increased physical activity (p b .05). Past-month substance use
rates did not differ between intervention arm and control arm
participants.
At 5-month follow-up (Table 2), time by intervention interaction
results showed that over time, intervention-arm girls demonstrated
greater mother–daughter communication (p b .05), closeness (p b .05),
increased fruit consumption (p b .05), reduced psychosocial stress
(p b .05), and greater drug use refusal skills (p b .05), relative to
control-arm girls. Intervention-arm girls and mothers reported increased parental monitoring (p b .01; p b .05, respectively). Again,
there were no differences in past-month substance use between
the intervention- and control-arm participants.
4. Discussion
Building off our prior work with computer- and Internet-based
studies (Schinke et al., 2009; Schwinn & Schinke, 2010; Schwinn
et al., 2010), these findings are the first of their kind from a health
promotion program expressly aimed at adolescent girls and their
mothers living in public housing. Findings suggest that a brief,
web-based health promotion program for such girls and their
mothers can affect positive and relatively sustained changes in
health behavior and salient risk and protective factors. Girls and
mothers improved their scores on measures of communication,
closeness, and parental monitoring. Girls increased their consumption of fresh fruit, and mothers increased their physical activity and
consumption of vegetables. That girls reported better scores on measures of stress and drug refusal responses 5 months after they
received the health promotion program lends credence to the
program's continuing effects. The modest correlation between
mothers' and daughters' scores on closeness, communication, and
parental monitoring suggests that though mother–daughter scores
are somewhat predictive of each other (R2 = 18% to 53%), mothers'
and daughters' perceptions of their relationship differ.
Limitations include a brief intervention, a short follow-up, and a
small sample. An intervention that imparts a greater constellation of
skills and enhanced levels of interactivity is warranted. Additional
follow-up periods should assess long-term impact. And, the sample,
though coming from over one-half of the states in America, was limited
in size and included mothers with impressive educational attainment—
i.e. 28.4% had a 4-year college degree or higher. Follow-on work should
also monitor participant receipt of other health promotion programs—
Table 1
Demographic characteristics of study participants at pretest (n = 134).
Demographic variable
All
Control
Intervention
Daughters
Age, M (SD)
Ethnicity, % (n)
White
Black
Latina
Asian
Eligible for school lunch program, % (n)
Free
Reduced
Does not qualify
Mothers
Age, M (SD)
Education, % (n)
Some high school of less
Completed high school
Vocational school or 2-year college
4-year college
Graduate school
Employment, % (n)
Full-time
Part-time
Homemaker
Student or unemployed
n = 67
11.85 (0.88)
n = 31
11.87 (0.96)
n = 36
11.83 (0.81)
40.3 (27)
44.8 (30)
11.9 (8)
3.0 (2)
35.5 (11)
45.2 (14)
16.1 (5)
3.2 (1)
44.4 (16)
44.4 (16)
8.3 (3)
2.8 (1)
79.1 (53)
14.9 (10)
6.0 (4)
n = 67
36.24 (6.16)
80.6 (25)
16.1 (5)
3.2 (1)
n = 31
36.03 (5.94)
77.8 (28)
13.9 (5)
8.3 (3)
n = 36
36.43 (6.43)
7.5 (5)
31.3 (21)
32.8 (22)
25.4 (17)
3.0 (2)
3.2 (1)
32.3 (10)
41.9 (13)
16.1 (5)
6.5 (2)
11.1 (4)
30.6 (11)
25.0 (9)
33.3 (12)
0
44.8 (30)
16.4 (11)
11.9 (8)
26.9 (18)
41.9 (13)
16.1 (5)
6.5 (2)
35.5 (11)
47.2 (17)
16.7 (6)
16.7 (6)
19.4 (7)
t or χ2
p
t(65) = 0.17
χ2(3) = 1.19
.86
.76
χ2(2) = .80
.67
t(64) =−0.26
χ2(4) = 7.12
.80
.13
χ2(3) = 3.16
.37
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T.M. Schwinn et al. / Addictive Behaviors 39 (2014) 757–760
Table 2
Pretest, posttest, and 5-month follow-up data for daughters and mothers.
Outcome variable
Control
Intervention
Pretest
(n = 31)
Posttest
(n = 31)
5-month follow-up Pretest
(n = 30)
(n = 36)
Posttest
(n = 35)
5-month follow-up
(n = 31)
Pretest to posttesta Pretest to post-test and
5-month follow-upb
M (SD)
M (SD)
M (SD)
M (SD)
M (SD)
M (SD)
F (1, 58)
F (2, 58)
Daughter measures
Mother–daughter closeness
Mother–daughter communication
Parental monitoring
Perceived stress
Drug refusal skills
30-day substance usec
Fruit intake
Vegetable intake
Physical activity
4.17 (0.85)
4.17 (1.20)
4.76 (0.64)
4.10 (1.18)
3.87 (0.44)
0.37 (0.91)
2.86 (1.66)
2.31 (0.91)
2.29 (0.62)
4.00 (1.25)
3.93 (1.19)
4.31 (0.93)
4.14 (0.92)
3.83 (0.38)
0.17 (0.37)
2.66 (1.47)
2.51 (1.08)
2.41 (0.70)
3.86 (1.33)
4.00 (1.34)
4.62 (0.78)
3.72 (1.41)
3.83 (0.38)
0.10 (0.22)
2.62 (1.24)
2.20 (0.94)
2.25 (0.71)
3.90 (0.98)
4.10 (1.14)
4.48 (0.77)
3.94 (1.26)
3.58 (0.81)
0.53 (2.19)
2.39 (1.17)
2.28 (0.90)
2.17 (0.65)
4.03 (0.80)
4.52 (0.63)
4.61 (0.56)
3.94 (0.93)
3.48 (1.06)
0.11 (0.29)
2.35 (1.14)
2.38 (0.81)
2.19 (0.70)
4.29 (0.82)
4.52 (0.63)
4.68 (0.54)
4.13 (0.72)
3.94 (0.25)
0.12 (0.29)
2.90 (1.11)
2.41 (0.99)
2.12 (0.71)
0.41
8.33⁎⁎
8.89⁎⁎
3.18⁎
4.04⁎
6.53⁎⁎
0.47
1.44
0.78
0.02
0.33
0.58
4.32⁎
3.49⁎
0.28
3.61⁎
2.02
0.21
Mother measures
Mother–daughter closeness
Mother–daughter communication
Parental monitoring
30-day alcohol use
30-day cigarette use
Fruit intake
Vegetable intake
Physical activity
4.80 (0.93)
3.67 (0.80)
4.70 (0.65)
3.66 (5.82)
4.55 (14.46)
3.30 (0.77)
2.00 (1.20)
1.27 (0.52)
4.80 (0.55)
3.68 (1.17)
4.60 (0.86)
2.59 (4.08)
5.00 (14.44)
3.25 (0.65)
2.00 (1.11)
1.10 (0.31)
4.83 (0.75)
3.77 (1.140)
4.47 (1.04)
1.52 (2.63)
3.69 (13.38)
3.31 (0.78)
2.23 (1.14)
1.37 (0.67)
5.00 (0.00)
3.58 (1.06)
4.42 (1.03)
2.74 (5.59)
1.32 (5.53)
3.24 (0.65)
2.16 (1.13)
1.26 (0.77)
5.00 (0.00)
4.06 (0.87)
4.52 (0.85)
2.26 (5.67)
0.32 (0.54)
3.39 (0.71)
2.61 (1.23)
1.39 (1.02)
4.97 (0.18)
3.94 (0.81)
4.77 (0.50)
1.65 (2.63)
0.26 (0.45)
3.40 (0.61)
2.35 (1.25)
1.42 (0.89)
4.34⁎
4.54⁎
0.27
0.05
1.39
1.40
5.11⁎
4.05⁎
0.90
1.63
3.58⁎
0.36
1.18
0.66
1.68
0.99
Note.
a
Analysis of covariance (ANCOVA) results, controlling for pretest outcome variable scores.
b
Time by intervention interaction effect based on repeated-measures general linear modeling results.
c
Index variable for scores on 30-day alcohol, cigarettes, and marijuana.
⁎ p b .05.
⁎⁎ p b .01.
something this study did not do. Beyond these improvements, tailored
health promotion programs should exploit the advantages of computer
programming to build programs adaptable to multiple family relations
(e.g., mothers and sons, fathers and sons). Still, findings point toward
the benefits of focusing on girls' and mothers' overall health by integrating skills related to improving a healthy body, mind, and parent–child
relationship.
Role of funding sources
This study was sponsored by the National Institute on Drug Abuse (NIDA) grant no.
R21DA24618. NIDA had no role in the study design, data collection or analyses, the writing
of the report, or the decision to submit the manuscript for publication.
Contributors
Steven Schinke and Traci Schwinn designed the study and wrote the protocol.
Suganthi Kandasamy conducted literature searches and provided summaries of previous
research studies. Lin Fang conducted the statistical analysis. Traci Schwinn wrote the
first draft of the manuscript and all authors contributed to and have approved the final
manuscript.
Conflict of interest
There are no real or perceived conflicts of interest by any of the authors.
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