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Michigan Model for Health

The Michigan Model for Health is a comprehensive and sequential health education curriculum that aims to give students aged 5-19 years (grades K-12) the knowledge and skills needed to practice and maintain healthy behaviors and lifestyles. The intervention provides age-appropriate lessons that address issues commonly faced by students, including use of alcohol, tobacco, and other drugs; prevention of HIV/AIDS; proper nutrition; physical activity; and other wellness and safety concerns. These 20- to 45-minute lessons are designed to be implemented by the classroom teacher, and they include extension ideas for core subjects such as language arts and social studies, as well as ways to use the intervention outside of the classroom. The intervention also provides information for parents regarding the content that students are learning in the classroom and suggestions for related activities that can be done at home.

The Michigan Model for Health is based on the Adapted Health Belief Model, which merges several behavior change theories and maintains the principle that a health education program is more likely to impact behavior change if it incorporates knowledge, skills, self-efficacy, and environmental support. The intervention, which can be implemented in public, private, or alternative schools, facilitates learning and skill development through a variety of interactive teaching and learning techniques, including demonstration and guided practice. Materials are packaged for each grade from kindergarten through 6th grade, for 7th and 8th grade, and for 9th through 12th grade. Teacher training, which is required in Michigan and recommended for implementers in other States, provides grade-specific information, including an understanding of the curriculum and the application of skills-based instruction.

The studies reviewed for this summary focused on 4th- and 6th-grade students, who participated in the intervention for 2 consecutive years.

Descriptive Information

Areas of Interest Mental health promotion
Substance abuse prevention
Outcomes Review Date: April 2011
1: Alcohol use
2: Tobacco use
3: Intention to use alcohol and cigarettes
4: Aggression
5: Judgment on healthy behaviors
Outcome Categories Alcohol
Tobacco
Violence
Ages 6-12 (Childhood)
13-17 (Adolescent)
Genders Male
Female
Races/Ethnicities Black or African American
White
Race/ethnicity unspecified
Settings Home
School
Geographic Locations Urban
Suburban
Rural and/or frontier
Implementation History The Michigan Model for Health was first implemented in 1985 when multiple Michigan State agencies collaborated to create a coordinated program providing school-aged children with information and skills related to health promotion and disease prevention. According to the results of a 2008 survey of schools, approximately 80% of Michigan schools implement the Michigan Model for Health, and 72% of all Michigan students (1.2 million) receive the lessons annually. Michigan has a network of regional school health coordinators who conduct required teacher trainings on the intervention and provide ongoing technical assistance in their respective school districts. Including Michigan, the Michigan Model for Health has been implemented in 40 States.
NIH Funding/CER Studies Partially/fully funded by National Institutes of Health: No
Evaluated in comparative effectiveness research studies: No
Adaptations No population- or culture-specific adaptations of the intervention were identified by the developer.
Adverse Effects No adverse effects, concerns, or unintended consequences were identified by the developer.
IOM Prevention Categories Universal

Quality of Research
Review Date: April 2011

Documents Reviewed

The documents below were reviewed for Quality of Research. The research point of contact can provide information regarding the studies reviewed and the availability of additional materials, including those from more recent studies that may have been conducted.

Study 1

Shope, J. T., Copeland, L. A., Marcoux, B. C., & Kamp, M. E. (1996). Effectiveness of a school-based substance abuse prevention program. Journal of Drug Education, 26(4), 323-337.  Pub Med icon

Study 2

O'Neill, J. M., Clark, J. K., & Jones, J. A. (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), 320-330.  Pub Med icon

Supplementary Materials

Shope, J. T., Copeland, L. A., & Dielman, T. E. (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), 726-733.  Pub Med icon

Outcomes

Outcome 1: Alcohol use
Description of Measures In one study, alcohol use was assessed using 2 self-report items from the Substance Use Survey measuring the frequency and quantity of beer, wine, and liquor use in the past 2 months. An alcohol frequency/quantity index was created by multiplying frequency by quantity for each of the three substances, summing the amounts, then dividing to reflect the total number of drinks per week. Higher mean scores indicated greater alcohol use.

In another study, alcohol use was assessed using 2 self-report items from the Youth Risk Behavior Survey (YRBS) measuring lifetime alcohol use, with response categories ranging from "never used" to "12 years or older," and 30-day alcohol use, with response categories ranging from "0 days" to "five or more days."
Key Findings Participants in one 2-year study were randomly assigned to an intervention group or a wait-list control group. Students in the intervention group received the Michigan Model for Health in both the 6th and 7th grades. Data were collected with Substance Use Survey items at the beginning of the study (pretest) and after the intervention was implemented, both at the end of the first school year (first posttest) and at the end of the second school year (second posttest). Study results indicated a statistically significant difference in alcohol use between groups from pretest to the two posttests (p < .05): Although mean alcohol use scores increased among students in both groups, the increase among students in the intervention group (from 0.44 to 0.60 and 0.71, respectively) was less over time compared with students in the control group (from 0.42 to 0.56 and 1.33, respectively).

In another 2-year study, participating schools were randomized into intervention and wait-list control conditions. Students from the intervention schools received the Michigan Model for Health in both the 4th and 5th grades. Data were collected with YRBS items within 1 week before (pretest) and after (posttest) the intervention, as well as 6 weeks after the intervention (follow-up); this data collection schedule was followed in both years of the study. Data were then analyzed to predict avoidance of lifetime and 30-day alcohol use. Alcohol use by 4th-grade students in the intervention and control schools was equivalent at baseline. From the 5th-grade pretest to follow-up, students in the intervention schools had greater improvement in the odds of avoiding lifetime alcohol use (p = .008) and 30-day alcohol use (p = .013) compared with students in the control schools. Both results had small effect sizes (odds ratios of 1.51 and 1.73, respectively).
Studies Measuring Outcome Study 1, Study 2
Study Designs Experimental, Quasi-experimental
Quality of Research Rating 2.8 (0.0-4.0 scale)
Outcome 2: Tobacco use
Description of Measures In one study, tobacco use was assessed using a single self-report item from the Substance Use Survey measuring the frequency of tobacco use in the past 30 days. Higher mean scores indicated greater tobacco use.

In another study, tobacco use was assessed using 2 self-report items from the YRBS measuring lifetime tobacco use, with response categories ranging from "never used" to "12 years or older," and 30-day tobacco use, with response categories ranging from "0 days" to "five or more days."
Key Findings Participants in one 2-year study were randomly assigned to an intervention group or a wait-list control group. Students in the intervention group received the Michigan Model for Health in both the 6th and 7th grades. Data were collected with a Substance Use Survey item at the beginning of the study (pretest) and after the intervention was implemented, both at the end of the first school year (first posttest) and at the end of the second school year (second posttest). Study results indicated a statistically significant difference in tobacco use between groups from pretest to the two posttests (p < .05): Among students in the intervention group, mean tobacco use scores remained low (from 0.12 to 0.27 and 0.26, respectively), whereas students in the control group had a sizable increase in mean tobacco use scores (from 0.12 to 0.14 and 0.91, respectively).

In another 2-year study, participating schools were randomized into intervention and wait-list control conditions. Students from the intervention schools received the Michigan Model for Health in both the 4th and 5th grades. Data were collected with YRBS items within 1 week before (pretest) and after (posttest) the intervention, as well as 6 weeks after the intervention (follow-up); this data collection schedule was followed in both years of the study. Data were then analyzed to predict avoidance of lifetime and 30-day tobacco use. Tobacco use by 4th-grade students in the intervention and control schools was equivalent at baseline. From the 5th-grade pretest to follow-up, students in the intervention schools had greater improvement in the odds of avoiding lifetime tobacco use (p = .029) and 30-day tobacco use (p < .001) compared with students in the control schools. The effect sizes for these results were small (odds ratio = 1.54) and medium (odds ratio = 3.17), respectively.
Studies Measuring Outcome Study 1, Study 2
Study Designs Experimental, Quasi-experimental
Quality of Research Rating 2.6 (0.0-4.0 scale)
Outcome 3: Intention to use alcohol and cigarettes
Description of Measures Intention to use alcohol and cigarettes was assessed using 4 self-report items from the Intentions To Use Substances Survey. Participants responded to each item (e.g., "Do you think you will smoke cigarettes during the next year [12 months]?") using a 4-point scale (1 = no, 2 = maybe not, 3 = maybe, and 4 = yes). Higher scores indicated greater intention to use alcohol and cigarettes.
Key Findings In a 2-year study, participating schools were randomized into intervention and wait-list control conditions. Students in the intervention schools received the Michigan Model for Health in both the 4th and 5th grades. Data were collected with Intentions To Use Substances Survey items within 1 week before (pretest) and after (posttest) the intervention, as well as 6 weeks after the intervention (follow-up); this data collection schedule was followed in both years of the study. Across time, students in the intervention schools had a decrease in scores for intention to use alcohol and cigarettes compared with students in the control schools, whose scores increased (p < .01 for intention to use alcohol and p < .001 for intention to use cigarettes).
Studies Measuring Outcome Study 2
Study Designs Experimental
Quality of Research Rating 3.1 (0.0-4.0 scale)
Outcome 4: Aggression
Description of Measures Aggression was assessed using 3 self-report items from the YRBS. Participants responded to each item (e.g., "In the past month [30 days], how many times did you hit or punch someone when you were mad?") using a scale that ranged from 1 (0 times) to 6 (5 or more times). Higher scores indicated greater aggression.
Key Findings In a 2-year study, participating schools were randomized into intervention and wait-list control conditions. Students in the intervention schools received the Michigan Model for Health in both the 4th and 5th grades. Data were collected with YRBS items within 1 week before (pretest) and after (posttest) the intervention, as well as 6 weeks after the intervention (follow-up); this data collection schedule was followed in both years of the study. Across time, students in the intervention and control schools had a decrease in aggression scores; however, students in the intervention schools had a greater decrease compared with students in the control schools (p < .05).
Studies Measuring Outcome Study 2
Study Designs Experimental
Quality of Research Rating 3.2 (0.0-4.0 scale)
Outcome 5: Judgment on healthy behaviors
Description of Measures Judgment on healthy behaviors was assessed using 30 self-report items developed from the State Collaborative on Assessment and Student Standards-Health Education Assessment Project (SCASS-HEAP):

  • 8 items measured social and emotional health skills (e.g., "We often have disagreements with others. Which of these choices is the most positive way to solve a disagreement?").
  • 8 items measured self-management skills (e.g., "You are so angry, you could hit something. Which of the following is the most healthful way for you to deal with this emotion?").
  • 10 items measured interpersonal communication (e.g., "Keisha's friend wants to copy your homework. Which of the following refusals demonstrates the clearest 'no'?").
  • 4 items measured drug refusal skills (e.g., "Which of the following is the best response you could give, using a respectful, clear 'no' statement, to someone who offers you a beer?").
Participants responded to each item by choosing an answer from four response categories, and a score was determined on the basis of the number of correct answers. In each category of healthy behaviors, higher scores indicated better judgment.
Key Findings In a 2-year study, participating schools were randomized into intervention and wait-list control conditions. Students in the intervention schools received the Michigan Model for Health in both the 4th and 5th grades. Data were collected with SCASS-HEAP items within 1 week before (pretest) and after (posttest) the intervention, as well as 6 weeks after the intervention (follow-up); this data collection schedule was followed in both years of the 2-year study. Across time:

  • Students in the intervention and control schools had an increase in social and emotional health skills scores; however, students in the intervention schools had a greater increase compared with students in the control schools (p < .001).
  • Students in the intervention and control schools had an increase in self-management skills scores with no statistically significant difference found between the groups.
  • Students in the intervention schools had an increase in interpersonal communication scores compared with students in the control schools, whose scores remained the same (p < .001).
  • Students in the intervention and control schools had an increase in drug refusal skills scores; however, students in the intervention schools had a greater increase compared with students in the control schools (p < .001).
Studies Measuring Outcome Study 2
Study Designs Experimental
Quality of Research Rating 3.2 (0.0-4.0 scale)

Study Populations

The following populations were identified in the studies reviewed for Quality of Research.

Study Age Gender Race/Ethnicity
Study 1 6-12 (Childhood)
13-17 (Adolescent) 		50.5% Male
49.5% Female 		Data not reported/available
Study 2 6-12 (Childhood) 54% Male
46% Female 		54% White
38% Black or African American
8% Race/ethnicity unspecified

Quality of Research Ratings by Criteria (0.0-4.0 scale)

External reviewers independently evaluate the Quality of Research for an intervention's reported results using six criteria:

For more information about these criteria and the meaning of the ratings, see Quality of Research.

Outcome Reliability
of Measures 		Validity
of Measures 		Fidelity Missing
Data/Attrition 		Confounding
Variables 		Data
Analysis 		Overall
Rating
1: Alcohol use 3.0 3.5 2.5 2.0 2.3 3.5 2.8
2: Tobacco use 2.5 3.0 2.5 2.0 2.3 3.5 2.6
3: Intention to use alcohol and cigarettes 4.0 3.0 3.0 2.0 2.5 4.0 3.1
4: Aggression 3.5 4.0 3.0 2.0 2.5 4.0 3.2
5: Judgment on healthy behaviors 3.5 4.0 3.0 2.0 2.5 4.0 3.2

Study Strengths

Most of the measures have acceptable or strong reliability and validity and have been used in other research studies. Both studies used random assignment to intervention or control condition and longitudinal follow-up with multiple assessments. The mixed-model approach to analyses used in both studies was appropriate for multilevel designs.

Study Weaknesses

Teacher self-report was the only indicator of intervention fidelity in both studies. Methods used in one study to control for differences between completers and noncompleters were unclear. The other study did not assess differential attrition at the school or student level. Both studies had potential confounding variables, including differential exposure to the curriculum for the intervention and control groups, as well as baseline differences between groups for students retained through study completion.
Readiness for Dissemination
Review Date: April 2011

Materials Reviewed

The materials below were reviewed for Readiness for Dissemination. The implementation point of contact can provide information regarding implementation of the intervention and the availability of additional, updated, or new materials.

Educational Materials Center. (2000). Protect a friend--Share your skills: Alcohol, tobacco, and other drug prevention. A module for grades 7-8. Michigan Model for Comprehensive School Health Education. Mt. Pleasant: Central Michigan University.

Educational Materials Center. (2004). The two "R's" for stopping assault and preventing violence: A module for grades 7-8. Michigan Model for Comprehensive School Health Education. Mt. Pleasant: Central Michigan University.

Educational Materials Center. (2006). Internet language--Safety grade 4 [Set of 38 cards plus title card and teacher key]. Mt. Pleasant: Central Michigan University.

Educational Materials Center. (2006). Michigan Model for Health grade 4 curriculum: The model for healthy kids! Teacher's manual. Mt. Pleasant: Central Michigan University.

Educational Materials Center. (2006). Michigan Model for Health grade 4 HIV/AIDS education. Mt. Pleasant: Central Michigan University.

Educational Materials Center. (2006). Michigan Model for Health grade 5 HIV/AIDS education. Mt. Pleasant: Central Michigan University.

Educational Materials Center. (2006). Nutrition facts: Food labels for grade 5. Mt. Pleasant: Central Michigan University.

Educational Materials Center. (2008). Burn hazards. Grade 4--Safety [Set of 24 cards]. Mt. Pleasant: Central Michigan University.

Educational Materials Center. (2009). A winning team. Healthy eating and physical activity: A module for grades 7-8. Michigan Model for Health. Mt. Pleasant: Central Michigan University.

Educational Materials Center. (2009). A winning team: Healthy eating and physical activity: Grades 7-8 teacher resources CD. Michigan Model for Health. Mt. Pleasant: Central Michigan University.

Educational Materials Center. (2009). Grade 4 student workbook: Student worksheets, handouts, and family resource fact sheets for the Michigan Model for Health curriculum. Mt. Pleasant: Central Michigan University.

Educational Materials Center. (2009). Grade 5 student workbook: Student worksheets, handouts, and family resource fact sheets for the Michigan Model for Health curriculum. Mt. Pleasant: Central Michigan University.

Educational Materials Center. (2009). Michigan Model for Health grade 4 teacher resources CD. Mt. Pleasant: Central Michigan University.

Educational Materials Center. (2009). Michigan Model for Health grade 5 curriculum: The model for healthy kids! Teacher's manual. Mt. Pleasant: Central Michigan University.

Educational Materials Center. (2009). Michigan Model for Health grade 5 teacher resources CD. Mt. Pleasant: Central Michigan University.

Educational Materials Center. (2010). Growing up and staying healthy: Understanding HIV and other STIs. A module for grades 7-8. Michigan Model for Health. Mt. Pleasant: Central Michigan University.

Educational Materials Center. (2010). Growing up and staying healthy: Understanding HIV and other STIs. Grades 7-8 teacher resources CD. Michigan Model for Health. Mt. Pleasant: Central Michigan University.

Educational Materials Center. (2010). The power is yours to be tobacco free: A module for grades 7-8. Michigan Model for Health. Mt. Pleasant: Central Michigan University.

Educational Materials Center. (2010). The power is yours to be tobacco free: Grades 7-8 teacher resources CD. Michigan Model for Health. Mt. Pleasant: Central Michigan University.

National Dairy Council. (2005). Arianna's nutrition expedition: Arianna's interactive nutrition games. Rosemont, IL: Author.

National Dairy Council. (2005). Food models [Cards 1-55]. Rosemont, IL: Author.

Program Web sites:

  • http://www.emc.cmich.edu/mm
  • http://www.emc.cmich.edu/mm/implementation/default.htm
  • http://www.michiganmodel.org

Readiness for Dissemination Ratings by Criteria (0.0-4.0 scale)

External reviewers independently evaluate the intervention's Readiness for Dissemination using three criteria:

  1. Availability of implementation materials
  2. Availability of training and support resources
  3. Availability of quality assurance procedures

For more information about these criteria and the meaning of the ratings, see Readiness for Dissemination.

Implementation
Materials 		Training and Support
Resources 		Quality Assurance
Procedures 		Overall
Rating
4.0 4.0 4.0 4.0

Dissemination Strengths

The implementation materials, which are organized by grade, are comprehensive and easy to understand. Although the program is based on State of Michigan policies regarding health education, it appears to be adaptable to the policies of other States. A variety of formats are represented in the implementation materials, including CDs, posters, cards, and workbooks. The training steps for effective implementation are comprehensive and clear. Training materials are available either in hard copy or online, making them easily accessible. Consultation is available, as are updates regarding revisions to the program. Methods for quality assurance are integrated throughout the materials, and the clarity in their presentation makes it likely that they will be understood and followed. Fidelity tools include feedback forms, checklists, and pre- and posttests.

Dissemination Weaknesses

No weaknesses were identified by reviewers.
Costs

The cost information below was provided by the developer. Although this cost information may have been updated by the developer since the time of review, it may not reflect the current costs or availability of items (including newly developed or discontinued items). The implementation point of contact can provide current information and discuss implementation requirements.

Item Description Cost Required by Developer
Teacher's manual and program materials for each grade, K-6 (includes introductory sessions, lessons, student worksheets, handouts, family resource fact sheets, slide masters, Teacher Resources CD, and curriculum framework)
  • Grade K: $600 ($535 for Michigan residents)
  • Grade 1: $570 ($525 for Michigan residents)
  • Grade 2: $365 ($325 for Michigan residents)
  • Grade 3: $290 ($255 for Michigan residents)
  • Grade 4: $460 ($410 for Michigan residents)
  • Grade 5: $565 ($515 for Michigan residents)
  • Grade 6: $1,100 ($1,000 for Michigan residents)
 		Yes
Modules and program materials for grades 7-8 and 9-12 (includes introductory sessions, lessons, student worksheets, handouts, family resource fact sheets, slide masters, Teacher Resources CD, and curriculum framework)
  • Grades 7-8: $1,040 ($850 for Michigan residents)
  • Grades 9-12: $1,190 ($1,020 for Michigan residents)
 		Yes
Student workbooks (each grade, K-6) $0.90-$3.75 each, depending on grade level and State of residence No
3-day national training of trainers in Michigan, with online component (includes teacher's manuals and training materials) $950 per participant No
3-day, on-site training of trainers, with online component (does not include teacher's manuals and training materials) $1,700–$2,000 per day for up to 35 participants, depending on customization needed, plus travel expenses No
On-site teacher training (does not include teacher's manuals and training materials) $1,700-$2,000 per day for up to 35 participants, depending on customization needed, plus travel expenses No
On-site consultation $1,500 per day plus travel expenses No
Phone or email consultation Free No

Additional Information

All teacher's manuals, modules, and program materials also can be purchased separately. In addition, program materials can be purchased as a grade-level kit for use with the corresponding manual for each grade, K-6, or as a kit for use with the grades 7-8 nutrition and physical activity module. Other modules have too few materials to warrant kits, but special packaging of materials is available by request.
Replications
Contact Information

To learn more about implementation, contact:
Paula Nettleton
(800) 214-8961
emc@cmich.edu

To learn more about research, contact:
James O'Neill, Ph.D.
(734) 432-5734
joneill@madonna.edu

Consider these Questions to Ask (PDF, 54KB) as you explore the possible use of this intervention.

Web Site(s):