The Calcium Connection: Healthy Bones from One Generation to Another

Methodology and Results

As with all of Dairy Council's nutrition programs, this Calcium Connection program uses a behavior change model to help instill positive lifestyle changes. However, this program is unique in that it targets women throughout their lives with information that applies to their specific life stage and age. In addition, a woman could use this information for themselves and/or their own mother or daughter. We wanted to find out if this approach is useful to women and if it serves to increase concern for building bones in girls and young women.

Evaluation of Physicians

Over 3,500 physicians in family practice or OB/GYN were sent a sample Calcium Connection booklet along with a survey. Over 250 (7%) were returned. The respondents were fairly evenly split between the family practice physicians and those who practiced OB/GYN. Overall, the physicians gave the Calcium Connection program high marks and indicated a strong endorsement of the booklet as an education tool. Most physicians felt that patients would understand and be able to use the information in the booklet. A majority (97%) of physicians felt the booklet would help inform female patients about bone health. More physicians felt a concern about bone health for women over 50 (83%) than for the 11-24 year old women (52%).

Evaluation of Health Professionals

Over 2,000 health professionals (registered dietitians, nutritionists, nurses, health educators and others) were sent a sample Calcium Connection booklet along with a survey. After four weeks, 301 (15%) were returned. A majority (58%) of respondents were registered dietitians/ nutritionists. Overall, health professionals responded favorably to the Calcium Connection and especially liked the emphasis on bone health versus disease and the program's ability to address calcium needs across all age groups. They also liked that the booklet allowed consumers to assess and plan their own calcium intake.

Most health professionals felt that clients would understand the information in the booklet and would find it very useful. A majority (94%) of health professionals felt the booklet would help inform female patients about bone health. More health professionals felt a concern for the 11-24 (67%) and 25-49 (71%) year olds to build and maintain bone health than for the over 50 year old to maintain bone health (56%). Health professionals also noted that they liked the easy-to-read format of the booklet itself. 

Here is what Health Professionals said about the Calcium Connection program:

• "The whole booklet is a nice resource for me."
• "The emphasis that bone health related to calcium is a lifelong project".
• "Stresses the need for prevention now.the message that bone health is essential for women of all ages and can be worked on".

Evaluation of Women

Surveys and Calcium Connection booklets were mailed out via several physicians and health professionals to 365 of their women patients/ clients. Thirty-one women completed the survey, 70% being college graduates. Nearly 70% of the women were over 46 years of age and the majority (74%) were Caucasian.

The majority of women (71%) did not know how many calcium servings were needed for someone their own age before reading the booklet. After completing the booklet and checking their food choices, only half felt they got enough calcium from the foods they ate.

The Calcium Connection program enables people to identify and make personal choices that will impact their calcium intake and bone health. The following changes were identified by survey participants as things they would do to get more calcium and to protect their bones:

• Over 50% said they would try to drink or eat at least one or more additional servings of high calcium foods from the milk and milk products group each day.
• A majority (70%) said they would consume additional servings from the medium calcium foods each day.

Two out of three women said that they were likely to pass the information found in this booklet to others. Here are a few additional comments that the women had about the Calcium Connection:

• "Supplements are less beneficial than obtaining calcium from foods."
• "The best time for high peak bone mass was the teenage and young adult years."
• "Walking is a good bone exercise."
• "How necessary dairy products are in obtaining need calcium levels."

Evaluation of Girls

Surveys and Calcium Connection booklets were mailed out through a Women's Clinic to girls at three private schools in Menlo Park, California. Responses from 151 schoolgirls between the ages of 11 and 18 were collected. The majority (60%) were Caucasian.

The majority of girls (78%) did not know how many calcium servings were needed for someone their own age before reading the booklet and most were uncertain of calcium levels in foods. After completing the booklet and checking their food choices, only half felt they got enough calcium from the foods they ate.

The Calcium Connection program enables people to identify and make personal choices that will impact their calcium intake and bone health. The following changes were identified by girls in the survey as things they would do to get more calcium and to protect their bones:

• Nearly a third of girls (31%) said they would try to reduce their intake of soft drinks. A majority (72%) indicated they already do this or plan to make this change.
• Over half were interested in consuming calcium rich foods lower in fat.

One out of three girls said that they were likely to pass the information found in this booklet to others. Here are a few additional comments that the girls had about the Calcium Connection:

• "Milk has the most calcium."
• "The idea that at my age (17) it is so important to 'fill my bones' with calcium. Later in life I will not have such a chance to prevent osteoporosis."
• "Substitute sodas with milk."
• "Thank you for caring about us."

Discussion

This survey indicated that physicians have increased their concern for building bones in the 11-24 year old group which is when over half of total lifetime bone calcium is formed. This represents a positive shift from earlier Dairy Council of California surveys that indicated that physicians saw bone disease or osteoporosis as a health issue primarily for post-menopausal women and focused few prevention efforts on this younger age group.

Interestingly, more health professionals concerned themselves with building and maintaining bone health in younger women versus maintaining bone health in the older women. However, this is not to say that health professionals were not also concerned with the bone health of older women. This does, however, reflect the knowledge that over half of total lifetime bone mass is laid down during the teen and young adult years and that a window of opportunity exists for these young women.

Women & Girls

Before completing the booklet, both girls and women said they didn't know exactly how much calcium was needed for someone their age. With all the information out there, only one in four knows how much calcium they need! This program helped over 70% discover how much dietary calcium they need and whether they get enough based on what they eat.

Conclusion

Both this field-testing and the developmental testing that came before, indicated that the Calcium Connection is helpful. Younger women and their physicians are now more aware that getting adequate calcium is also essential for girls and young women age 11-24 years old. Most importantly, both women and girls identified health behavior changes that they intended to make as a result of completing The Calcium Connection: Healthy Bones from One Generation to Another.

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