McHale S M, Tershakovec A M, Corneal D A, Tournier B A, Shannon B M
College of Health and Human Development, Pennsylvania State University, University Park 16802, USA.
Ann Behav Med. 1998 Summer;20(3):233-40. doi: 10.1007/BF02884966.
The goals were to assess psychosocial effects of labeling children as hypercholesterolemic and to measure changes in child well-being as a function of participation in nutrition education interventions. Older (6-10 years old) and younger (4-6 years old) children with (> 4.55 mmol/l; > 176 mg/dL) and without elevated total cholesterol levels were identified by cholesterol screening. Psychosocial functioning (self-esteem, perceived dietary competence, health beliefs, parental control of eating) was assessed and at-risk children were randomized into a home-based, self-contained nutrition education program (the Parent-Child Autotutorial, or PCAT program), dietary counseling with a registered dietician, or an at-risk control group. At three, six, and twelve months following baseline, children's psychosocial functioning again was assessed; parents also provided data at baseline, three months, and twelve months. Analyses of data from 189 at-risk and 74 not-at-risk children revealed that: (a) Older hypercholesterolemic children reported poorer health beliefs than non-labeled children; (b) Older girls in nutrition education programs reported lower self-esteem than control group girls; (c) Older children's feelings of efficacy at choosing a healthful diet were positively related to their health beliefs and self-esteem; (d) Younger children's reports of parents' dietary control were negatively related to children's feelings of acceptance; and (e) Parents of older children in the PCAT program reported increases over time in children's ability to choose a healthful diet. The quasi-experimental design means that conclusions about negative labeling effects should be drawn cautiously, but the evidence suggests that education interventions can have an impact on child efficacy and potentially child adjustment. Factors associated with adverse reactions to labeling (parental control or feelings of efficacy) should be taken into account in the development of intervention programs for children.
研究目的是评估给儿童贴上高胆固醇血症标签的心理社会影响，并衡量参与营养教育干预措施对儿童幸福感的变化。通过胆固醇筛查确定了年龄较大（6 - 10岁）和年龄较小（4 - 6岁）、总胆固醇水平升高（> 4.55 mmol/l；> 176 mg/dL）和未升高的儿童。评估了心理社会功能（自尊、感知到的饮食能力、健康信念、父母对饮食的控制），并将有风险的儿童随机分为家庭式独立营养教育项目（亲子自学教程，即PCAT项目）、由注册营养师提供饮食咨询或风险对照组。在基线后的三个月、六个月和十二个月，再次评估儿童的心理社会功能；父母也在基线、三个月和十二个月提供数据。对189名有风险儿童和74名无风险儿童的数据进行分析后发现：（a）年龄较大的高胆固醇血症儿童报告的健康信念比未贴标签的儿童差；（b）参与营养教育项目的年龄较大女孩报告的自尊低于对照组女孩；（c）年龄较大儿童在选择健康饮食方面的效能感与他们的健康信念和自尊呈正相关；（d）年龄较小儿童报告的父母饮食控制与儿童的被接纳感呈负相关；（e）PCAT项目中年龄较大儿童的父母报告，随着时间推移，儿童选择健康饮食的能力有所提高。准实验设计意味着关于负面标签效应的结论应谨慎得出，但证据表明教育干预措施可以对儿童效能感以及潜在的儿童适应产生影响。在为儿童制定干预项目时，应考虑与标签不良反应相关的因素（父母控制或效能感）。
