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Program Profile: Michigan Model for Health

Evidence Rating: Promising - One study Promising - One study

Date: This profile was posted on July 25, 2013

Program Summary

A health education curriculum that targets K–12 students and includes age-appropriate lessons that focus on the most serious health challenges facing school-aged children. The program is rated Promising. The intervention group had a decline in aggressive behavior; improved social and emotional health, interpersonal and drug refusal skills; and better odds for avoiding drug use. There was no significant intervention effect found for prosocial behavior.

This program’s rating is based on evidence that includes at least one high-quality randomized controlled trial.

Program Description

Program Goals
The Michigan Model for Health® (MMH) (formerly the Michigan Model for Comprehensive School Health Education) is a comprehensive health education curriculum that targets K–12 students utilizing a skills-based approach. Age-appropriate and sequential lessons focus on the most serious health challenges school-aged children face: (1) social and emotional health; (2) nutrition and physical activity; (3) alcohol, tobacco, and other drugs; (4) personal health and wellness; (5) safety (unintentional injuries and violence); and (6) HIV. The goal of the curriculum is to teach students the knowledge and skills they need to build and maintain healthy behaviors and lifestyles.

MMH facilitates skills-based learning through lessons that incorporate a variety of teaching and learning techniques. Lessons emphasize active student participation, especially in developing and practicing skills and role-playing strategies for using those skills. The program is designed for implementation as part of the core school curriculum, and skills can be integrated into various disciplines, such as language arts, science, and social studies.

Program Theory
The MMH is based on the Adapted Health Belief Model that incorporates elements from several behavior change theories, such as Social Cognitive Theory and Social Influence Theory (Rosenstock, Strecher, and Becker 1988). The Adapted Health Belief Model merges four important cognitive, attitudinal, and socio-emotional factors in order to enhance health-promoting behavior. These four factors are knowledge, skills, self-efficacy, and environmental support. It is believed that behavior change is more likely to happen if these four factors are included in a health education program (Educational Materials Center 2006).

Program Components
The comprehensive health education curriculum focuses on skills and knowledge in six content areas (mentioned above) identified by the Centers for Disease Control and Prevention (CDC). Each lesson is designed to be implemented by a classroom teacher and lasts 20 to 50 minutes, depending on grade level. The educational materials include lessons designed to increase knowledge and develop healthy attitudes and behaviors through skills-based instruction and social and emotional learning. The MMH’s comprehensive health approach is a building-block format that introduces, fully develops, and then reinforces skill development and key health promotion and prevention messages over a period of years. Parent and family involvement pieces are also included as part of student instruction in key content areas.

The fourth-grade curriculum consists of 25 lessons on social and emotional health; alcohol, tobacco, and other drugs; safety; and nutrition and physical activity. The fifth-grade curriculum consists of 28 lessons on the same health topics as well as personal health and wellness.

Evaluation Outcomes

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Study 1
Aggressive Behavior
O’Neill, Clark, and Jones (2011) found the intervention effect for aggressive behavior was statistically significant. Although the control group appeared to have some decline in the level of aggressive behavior, there was a greater decrease over time for the Michigan Model for Health® (MMH) intervention group.

Prosocial Behavior
No significant intervention effect was found for prosocial behavior. Students in both the intervention and control groups improved in prosocial behavior over time.

Interpersonal Skills
The intervention effect for interpersonal skills was statistically significant. Interpersonal communication remained stable over time for students in the control group, but increased for students in the intervention group.

Social and Emotional Health
The intervention effect for social and emotional health was statistically significant. There was a greater increase among intervention group students’ scores for social and emotional health compared with control group students.

Drug Refusal Skills
The intervention effect for drug refusal skills was also statistically significant. Similar to the result for social and emotional health, there was a greater increase among intervention group students’ scores for drug refusal skills compared with control group students.

Drug Use Behavior
The treatment condition was a statistically significant predictor of all measures of drug use. Students in the intervention group showed greater improvement in the odds of avoiding drug use compared with the control group. Intervention students reported significantly less alcohol use and cigarette smoking in the past 30 days compared with control students.
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Evaluation Methodology

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Study 1
O’Neill, Clark, and Jones (2011) evaluated the effects of the Michigan Model for Health® (MMH) using a pretest/posttest control group design. Fifty-eight schools (42 from Michigan and 16 from Indiana) were randomly assigned to a group that implemented the MMH (the intervention group) or a group that did not implement the MMH (the control group). The schools were characterized as urban (28 percent), rural (31 percent), and suburban (41 percent). Although schools were the unit of randomization, data about program effects was collected and analyzed at the student level. The final evaluation sample consisted of 2,512 students (1,345 in the intervention schools and 1,167 in the control schools). The sample consisted of 54 percent boys with an average age of 9.56 years. The racial/ethnic composition was 54 percent white, 38 percent African American, and 8 percent other or mixed ethnicity. There were no significant differences between the intervention and control groups on gender, race/ethnicity, and all outcome variables.

The MMH intervention was implemented in classrooms over a 12-week period in grade 4 during the 2006–07 school year, and a 14-week period in grade 5 during the 2007–08 school year. Pretests were administered one week prior to the implementation of the intervention, and posttests were administered 5 to 6 weeks after the conclusion of the intervention.

A self-report questionnaire was developed to assess knowledge, skills, intentions, and behaviors related to the MMH. Health-promoting skills were measured using selected-response items developed from the State Collaborative on Assessment and Student Standards-Health Education Assessment Project. Aggressive behavior and drug use were measured using items from the Youth Risk Behavior Survey. Drug use intentions and prosocial behavior were measured using items from previous research (Hansen and McNeal 1997; Bosworth and Espelage 1995).

Statistical tests examining the effectiveness of the MMH involved two different analytic techniques, depending on the type of dependent variable. Analysis of continuous variables involved using a mixed model approach. The models took the general form of the measures nested within student and school with the four factors (treatment condition, gender, time, and ethnicity) having main effects and interactions, and with time as a repeated measure. Analysis of the four drug use outcomes (lifetime and recent alcohol and tobacco use) involved a different approach. The scores on these variables were converted to dichotomous measures (presence or absence of use) and used as the dependent variables in a binary logistic regression.

One limitation to the study is attrition. A number of students pretested in the fourth grade were not available for study in the fifth grade (n=919) and were excluded from the study. Fourth-grade pretest demographic and outcomes scores for this group were compared to those who completed all fourth- and fifth-grade tests (n=749). Attrition was not significantly associated with treatment and age, but was associated with gender and ethnicity (attrition rates were lower for girls compared with boys, and lower for African Americans and other minorities compared with Caucasians). There were also significant differences on the outcome variables. Students not retained through the fifth-grade intervention reported higher levels of lifetime and recent use of alcohol and tobacco, and exhibited lower social-emotional skills, interpersonal communication skills, and drug refusals skills than students who were retained.
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Current pricing information for the Michigan Model for Health® is available on the Educational Materials Center Web site:
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Implementation Information

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Central Michigan University’s Educational Materials Center (EMC) is the official publisher and distribution center for the Michigan Model for Health®. Please see the EMC Web site for more information on the curriculum and support materials.
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Evidence-Base (Studies Reviewed)

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These sources were used in the development of the program profile:

Study 1
O’Neill, James M., Jeffrey K. Clark, and James A. Jones. 2011. “Promoting Mental Health and Preventing Substance Abuse and Violence in Elementary Students: A Randomized Control Study of the Michigan Model for Health.” Journal of School Health 81(6):320–30.
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Additional References

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These sources were used in the development of the program profile:

Bosworth, K., and D. Espelage. 1995. Teen Conflict Survey. Bloomington, Ind: Indiana University, Center for Adolescent Studies.

Educational Materials Center. 2006. Overview of the Michigan Model for Health. Mt. Pleasant, Mich: Central Michigan University, Educational Materials Center.

Educational Materials Center. 2011. Michigan Model for Health. Mt. Pleasant, Mich: Central Michigan University, Educational Materials Center. Accessed June 24, 2013.

Fahlman, Mariane M., Joseph A. Dake, Nate McCaughtry, and Jeffrey Martin. 2008. “A Pilot Study to Examine the Effects of a Nutrition Intervention on Nutrition Knowledge, Behaviors, and Efficacy Expectations in Middle School Children.” The Journal of School Health 78(4):216–22.

Hansen, William B., and Ralph B. McNeal. 1997. “How D.A.R.E. Works: An Examination of Program Effects on Mediating Variables.” Health Education Behavior 24(2):165–76.

Rosenstock, Irwin M., Victor J. Strecher, and Marshall H. Becker. 1988. “Social Learning Theory and the Health Belief Model.” Health Education Quarterly 15(2):175–83.

Shope, Jean T., Laurel A. Copeland, B.C. Marcoux, and Mary E. Kamp. 1996. “Effectiveness of a School-Based Substance Abuse Prevention Program.” Journal of Drug Education 26:323–37.

Shope, Jean T., Laurel A. Copeland, Mary E. Kamp, and Sylvia W. Lang. 1998. “Twelfth Grade Follow-Up of the Effectiveness of a Middle School–Based Substance Abuse Prevention Program.” Journal of Drug Education 28:185–97. (This study was reviewed but did not meet Crime Solutions' criteria for inclusion in the overall program rating.)

Shope, Jean T., B.C. Marcoux, and J. Thompson. 1990. Summary of Results of an Evaluation of the Substance Abuse Lessons in the Michigan Model. Mount Pleasant, Mich.: Central Michigan University.

Shope, Jean T., Laurel A. Copeland, and T.E. Dielman. 1994. “Measurement of Alcohol Use and Misuse in a Cohort of Students Followed from Grade 6 Through Grade 12.” Alcoholism: Clinical and Experimental Research 18(3):726–33.
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Program Snapshot

Age: 9 - 11

Gender: Both

Race/Ethnicity: Black, White, Other

Geography: Rural, Suburban, Urban

Setting (Delivery): School

Program Type: Classroom Curricula, Conflict Resolution/Interpersonal Skills, Alcohol and Drug Prevention

Current Program Status: Active

Listed by Other Directories: Model Programs Guide, National Registry of Evidence-based Programs and Practices

Program Developer:
Sophia Hines
Program Consultant
Michigan Department of Community Health
109 W. Michigan Avenue, 4th Floor, PO Box 30195
Lansing MI 48909
Phone: 517.335.6965
Fax: 517.335.8294

Program Developer:
Jessica Shaffer
Program Consultant
School Health Education Consultant, Michigan Department of Community Health
109 W. Michigan Avenue, 4th Floor, PO Box 30195
Lansing MI 48909
Phone: 517.241.0270
Fax: 517.335.8294

James O’Neill
Department of Psychology, Madonna University
36600 Schoolcraft Road
Livonia MI 48150
Phone: 734.432.5734

Training and TA Provider:
Paula Parise
Educational Materials Center, Central Michigan University Global Campus
802 Industrial Drive
Mt. Pleasant MI 48858
Phone: 800.214.8961