by David DuBois
I had occasion a few years ago to consult with a statewide mentoring organization around issues of program evaluation and outcome measurement. The outcome survey that I developed for the organization’s consideration proved to be too long for practical use. So, a session was convened in which program leaders had the opportunity to essentially vote on which portions of the measure were most and least essential. A set of items I had included about exercise and healthy eating was a nearly consensus pick to be eliminated, with some of the program representatives explaining that these simply were not outcomes with much, if any, chance of being impacted by their programs. Not surprisingly for a professor whose home is in a school of public health, I had the distinct urge to plead my case, perhaps noting for example that obesity is widely regarded as the most significant and costly threat to our nation’s health. Yet, I held my peace. I did so, in part, because I realized that I was aware of little hard evidence to support my belief that mentoring programs could indeed make a positive difference in young people’s physical health.
What a difference a few years can make. Without even doing a systematic search of the literature, I can now point to a small, but impressive collection of studies that point toward mentoring’s potential to foster positive health among developing youth. A sampling of results from these investigations is illustrative:
*In a follow-up assessment of 1,037 participants in the Dunedin Multidisciplinary Health and Development Study when they were 32 years of age, social isolation during childhood was found to predict elevated age-related-disease risks in adulthood (these risks included a clustering of metabolic risk biomarkers such as overweight, high blood pressure, and high total cholesterol). Remarkably, for those experiencing very high levels of social isolation, the association with disease risk persisted even when controlling statistically for other adverse childhood experiences (low socioeconomic status, maltreatment) and a range of other risk factors (e.g., childhood body mass index, family history of cardiovascular disease, and measures of socioeconomic status, physical activity, and diet during adulthood).
*A randomized assignment design was used recently to evaluate a program that provided 1-to-1 mentoring to African-American youth from low-income communities with a focus on promoting physical activity and healthy diet (Black et al., 2010). As described by the authors, “The 12-session intervention was implemented in adolescents’ homes with college students (or recent graduates) as mentors, who accompanied the adolescents to neighborhood convenience stores and playgrounds to promote healthy dietary choices and PA [physical activity]. By using the principles of social cognitive theory and motivational interviewing, the mentors helped the adolescents identify personal challenges and goals related to diet and PA (p. 286). Findings were encouraging. For example, at a 2-year follow-up, it was found that the intervention had reduced the percentage of overweight/obese youth in the program group relative to the control group. Other results suggested that the program had the most pronounced effects on youth who were obese/overweight at baseline.
*Another randomized assignment study tested the impact of incorporating a multicomponent intervention called “Partners of all Ages Reading About Diet and Exercise” (PARADE) into school-based mentoring programs such as Big Brothers Big Sister (Haire-Joshu et al., 2010). As described by the authors, “PARADE mentors delivered eight lesson plans addressing key concepts related to diet and activity; eight child-focused computer-tailored storybooks with messages targeting that child’s diet and activity patterns and eight parent action support newsletters” (p. S76). Control group children also participated in the mentoring programs but without the PARADE content being delivered to them by their mentors. At the conclusion of the program, children receiving PARADE (compared to those in the control group) were significantly more knowledgeable about diet and activity guidelines, reported challenging themselves significantly more on a daily basis to eat five fruits and vegetables and be active at least one hour, and were significantly more likely to report that they would ask for a fruit or vegetable for a snack. Based on reports from parents, there also was evidence that PARADE reduced the intake of calories from high fat foods among overweight/obese children.
*Chen and colleagues (in press), in a study of 163 youth ages 13–16, found that among youth from lower socioeconomic status (SES) backgrounds, those reporting a supportive role model had lower levels of interleukin-6, an inflammatory marker that is an established risk factor for cardiovascular disease. Interestingly, a similar association was not found among higher SES youth, thus suggesting that role model support served to buffer the negative effects of SES that were evident on the same risk factor.
Not all findings have been positive. Illustratively, I co-authored a study (Ahrens et al., 2008) looking at outcomes associated with natural mentoring relationships for foster care youth, using data from a national longitudinal study called Add Health, in which a report of having had a mentor during adolescence was not linked to either level of physical activity or body mass index in young adulthood.*
Yet, the weight of the evidence seems clear in pointing to the promise of further exploring – both in research and practice — the potential of mentoring relationships to foster better physical health among youth. Intentional approaches to mentoring that are focused on improving physical activity and diet show noteworthy promise. The available evidence, however, also speaks to the salutary effects that simple companionship may have on young people’s health. The potential health benefits of social support for older adults – including longer life expectancy – are well-recognized. I believe that we would be remiss as a field to not begin to pay much more careful attention to the health implications that mentoring — as one key source of interpersonal support for developing young persons — also may have at the front end of the life course. I hope you share my enthusiasm for seeing mentoring research and practice “get physical”. As always, I look forward to hearing about your views and work pertaining to this topic.
*Mentored youth in this study did, however, report significantly more favorable overall health and were also significantly less likely to report having had a sexually transmitted infection in the past year.
Ahrens, K. R., DuBois, D. L., Richardson, L. P., Fan, M., & Lozano, P. (2008). Youth in foster care with adult mentors during adolescence have improved adult outcomes. Pediatrics, 121, e246-e252.
Black, M. M., Hager, E. R., Le, K., Anliker, J., Arteaga, S., DiClemente, C., & Wang, Y. (2010). Challenge! Health promotion/obesity prevention mentorship model among urban, Black adolescents. Pediatrics, 126, 280–288. doi:10.1542/peds.2009-1832
Chen, E., Lee, W. K., Cavey, L., & Ho, A. (in press). Role models and the psychological characteristics that buffer low-socioeconomic-status youth from cardiovascular risk. Child Development.
Danese, A., Moffitt T. E., Harrington H., Milne B. J., Polanczyk, G., Pariante, C. M., Poulton, R., & Caspi A. (2009). Adverse childhood experiences and adult risk factors for age-related disease: depression, inflammation, and clustering of metabolic risk markers. Archives of Pediatric Adolescent Medicine, 163, 1135-1143.
Haire-Joshu, D., Nanney, M. S., Elliott, M., Davey, C., Caito, N., Loman, D., Brownson, R. C., & Kreuter, M. W. (2010). The use of mentoring programs to improve energy balance behaviors in high-risk children. Obesity, 18(Supp. 1), S75-S83.