Factors Influencing the Implementation and Receptivity of a Physical Activity Intervention in Three Middle Schools

Introduction: Recent trials with adolescents have intervened to increase physical activity levels. Primary results report on the outcome (change in physical activity) with less focus on the evaluation of the intervention strategies and activities. This dissertation project presents an in-depth analysis of the extent to which Trial of Activity of Adolescent Girls (TAAG), a physical activity intervention targeting middle school girls, was implemented and received in three Maryland schools. Individual, social, and environmental factors were explored. Methods: Responses from select quantitative process evaluation data were used to assess dose, fidelity, and reach for each TAAG component. Information was integrated with data from nine focus groups with girls and 24 in-depth interviews with school staff, community partners, and TAAG university staff, who were key participants of the intervention activities. The focus group and interview data were analyzed using thematic methodology to identify key concepts, categories, and themes. Results: Implementation of the intervention varied by school and by intervention component. Qualitative interviews suggested that school differences could be attributed to school staff buy-in, administrative and faculty/staff support, and student behavior. Study staff implemented the intervention to teachers with higher levels of dose, fidelity, and reach than what teachers delivered to students. Notably, fidelity for physical education (PE) concepts and health education with activity challenges (HEAC) lessons was lower. Class observations indicated that PE objectives were observed 6% to 93% of the time, and 38% to 82% of HEAC lesson components were fully completed. Reasons reported by teachers for low fidelity were lack of time, administrative barriers, and limited space for activities. Reach for most components were high. Participation in after school programs ranged from approximately 9-22 girls. Girls reported lack of transportation, cost of programs, lack of interest, and time conflict as reasons for not joining programs. Conclusion: To maximize intervention efforts, it is important for researchers to decrease factors that negatively influence how well physical activity initiatives are executed as planned. Different data sources can provide information to better understand factors influencing program implementation

Socio-Cultural and Environmental Factors that Influence Weight-Related Behaviors: Focus Group Results from African-American Girls and Their Mothers

African-American girls experience higher rates of obesity than other youth and are more likely to live in environments that may inhibit healthy lifestyles. Focus groups with African-American girls (14.2 ± 2.36 years) and their mothers were conducted to explore socio-cultural and physical factors within the home, neighborhood, and school environments that influence physical activity (PA) and food choices (i.e., availability and accessibility). Being active at home was dependent on availability of unstructured PA, possibility of activity with family/friends/pet, structured sports in the community, and perceived safety of neighborhood. Girls reported unhealthy foods and excessive snacking as issues at home while citing choice of school meals vs. vending machine items and easy accessibility to fast food restaurants as concerns at school. Learning more about the PA and food environments is a fundamental step to develop effective and innovative, environmental strategies to address unhealthy weight-related behaviors in this population

Does television viewing predict dietary intake five years later in high school students and young adults?

<p>Abstract</p> <p>Background</p> <p>Prior research has found that television viewing is associated with poor diet quality, though little is known about its long-term impact on diet, particularly during adolescence. This study examined the associations between television viewing behavior with dietary intake five years later.</p> <p>Methods</p> <p>Survey data, which included television viewing time and food frequency questionnaires, were analyzed for 564 middle school students (younger cohort) and 1366 high school students (older cohort) who had complete data available at Time 1 (1998–1999) and five years later at Time 2 (mean age at Time 2, 17.2 ± 0.6 and 20.5 ± 0.8 years, respectively). Regression models examined longitudinal associations between Time 1 television viewing behavior and Time 2 dietary intake adjusting for sociodemographic characteristics, Time 1 dietary intake, and Time 2 total daily energy intake.</p> <p>Results</p> <p>Respondents were categorized as limited television users (<it><</it>2 hours/daily), moderately high television viewers (2–5 hours/daily), and heavy television viewers (≥5 hours/daily). Among the younger cohort, Time 1 heavy television viewers reported lower fruit intake and higher sugar-sweetened beverage consumption than the other two groups. Among the older cohort, watching five or more hours of television per day at Time 1, predicted lower intakes of fruits, vegetables, whole grain and calcium-rich foods, and higher intakes of trans fat, fried foods, fast food menu items, snack products, and sugar-sweetened beverages (products commonly advertised on television) five years later.</p> <p>Conclusion</p> <p>Television viewing in middle and high school predicted poorer dietary intake five years later. Adolescents are primary targets of advertising for fast food restaurants, snack foods, and sugar-sweetened beverages, which may influence their food choices. Television viewing, especially during high school, may have long-term effects on eating choices and contribute to poor eating habits in young adulthood.</p

Culturally-appropriate, family- and community-based physical activity and healthy eating Intervention for african-american middle school-aged girls: A feasibility pilot

This study tested the feasibility and acceptability of a physical activity, healthy eating, and social support intervention. Twelve African-American daughter-mother dyads (BMI percentile: daughters=92.6±12.79; BMI: mothers=38.8±5.81 kg/m2) met weekly during the 8-week Intensive Phase; throughout the 6-month Maintenance Phase, participants received monthly newsletters for 3 months and attended monthly face-to-face sessions for 3 months. Daughters and mothers reported positive feedback about intervention activities and educational curriculum. Post-intervention daughter survey results revealed positive trends towards increasing PA; increasing breakfast, water, and fruit/vegetable intake; and reducing sugar sweetened drink consumption. Mothers reported similar behavioral changes. This unique intervention was highly enjoyed by participants and utilized feasible, family-involved strategies to address obesity-related behaviors among African-American females

The relative influence of demographic, individual, social, and environmental factors on physical activity among boys and girls

<p>Abstract</p> <p>Background</p> <p>This study aimed to evaluate the associations of selected demographic, individual, social, and environmental factors with moderate-to-vigorous physical activity (MVPA) in a sample of children and adolescents.</p> <p>Methods</p> <p>MVPA was assessed among youth (n = 294) 10-17-years-old using the ActiGraph accelerometer. Youth completed measures of demographic and individual variables related to physical activity (PA), perceived social support by parents and peers, and perceived neighborhood characteristics. Parents completed the long-form of the International Physical Activity Questionnaire. The Physical Activity and Media Inventory was used to measure the home environment and Geographical Information Systems software was used to measure the physical neighborhood environment. Bivariate correlations and hierarchical multiple regression were conducted stratified by gender.</p> <p>Results</p> <p>Boys participated in significantly more MVPA than girls. In hierarchical analyses, peer support, home PA equipment, and temperature were significantly associated with MVPA among boys whereas distance to the school they attended was associated with MVPA among girls. The final models accounted for 25% and 15% of the variance in MVPA among boys and girls, respectively.</p> <p>Conclusions</p> <p>Important differences exist among the individual, social, and environmental factors related to MVPA between boys and girls. Boys' levels of activity appear to be influenced by factors closely linked to unstructured and social types of activities whereas girls' activities relate to internal and external barriers as well as their proximity to their schools. The prospective contribution of these important individual, social, and environmental factors to changes in MVPA among children and adolescents remains to be determined.</p

The relative influence of demographic, individual, social, and environmental factors on physical activity among boys and girls

Background: This study aimed to evaluate the associations of selected demographic, individual, social, and environmental factors with moderate-to-vigorous physical activity (MVPA) in a sample of children and adolescents. Methods: MVPA was assessed among youth (n = 294) 10-17-years-old using the ActiGraph accelerometer. Youth completed measures of demographic and individual variables related to physical activity (PA), perceived social support by parents and peers, and perceived neighborhood characteristics. Parents completed the long-form of the International Physical Activity Questionnaire. The Physical Activity and Media Inventory was used to measure the home environment and Geographical Information Systems software was used to measure the physical neighborhood environment. Bivariate correlations and hierarchical multiple regression were conducted stratified by gender. Results: Boys participated in significantly more MVPA than girls. In hierarchical analyses, peer support, home PA equipment, and temperature were significantly associated with MVPA among boys whereas distance to the school they attended was associated with MVPA among girls. The final models accounted for 25% and 15% of the variance in MVPA among boys and girls, respectively. Conclusions: Important differences exist among the individual, social, and environmental factors related to MVPA between boys and girls. Boys\u27 levels of activity appear to be influenced by factors closely linked to unstructured and social types of activities whereas girls\u27 activities relate to internal and external barriers as well as their proximity to their schools. The prospective contribution of these important individual, social, and environmental factors to changes in MVPA among children and adolescents remains to be determined

A School-Based, Peer Leadership Physical Activity Intervention for 6th Graders: Feasibility and Results of a Pilot Study

Background: The aim of this study was to promote physical activity in 6th graders by developing and testing the feasibility of an enhanced Presidential Active Lifestyle Award (PALA) program comprised of a peer leadership component and innovative exercise resource toolkit including DVDs. Methods: A racially/ethnically diverse sample of students received the standard PALA program (2 control schools, n = 61) or enhanced PALA+Peers program (2 intervention schools, n = 87) during 2006-2007 academic year. Results: Compared with the control condition, the intervention was successful in increasing moderate physical activity in all students (P = .02) and moderate and hard physical activity among girls (P = .03 and P = .04, respectively). Teachers and students reported a high level of satisfaction and receptivity with the intervention. All teachers thought the DVDs were well-received, and 87% of students reported that they would recommend the enhanced program to peers. Conclusion: Coupling peer leadership with DVDs that promote physical activity may be an effective way to increase youth physical activity

Parental Report Versus Child Perception of Familial Support: Which Is More Associated With Child Physical Activity and Television Use?

Background: Parent-report and child perception of familial support for weight-related behaviors may not be congruent. This research explores whether parent-report or child perception is more strongly associated with child-reported physical activity and television (TV) use. Methods: Elementary school children (n = 73) participating in Ready. Set. ACTION!, a theater-based obesity prevention pilot program in Saint Paul, MN, and their parents completed surveys assessing familial support for physical activity and limitations on TV use in fall 2006. Paired t tests examined congruency between parent-report and child perception. Linear regression models adjusted for sociodemographics explored the associations between familial support and child-reported behavior. Results: Levels of agreement between parent-report and child perception for support for physical activity and limitations on TV use were approximately 70%. Compared with parent-report for physical activity support, child perception was more strongly associated with child physical activity (β = .17, P = .02). Neither parent-report nor child perception for support for limitations on TV use was associated with child TV use. Discussion: Although parent-report and child perception of familial support for physical activity and to limit TV use were similar, child perception was more strongly associated with child physical activity behavior. More research, probably qualitative, is needed to examine how parents and children define and perceive parental support

Associations of American Indian Children\u27s Screen-Time Behavior With Parental Television Behavior, Parental Perceptions of Children\u27s Screen Time, and Media-Related Resources in the Home

Introduction: American Indian children have high rates of overweight and obesity, which may be partially attributable to screen-time behavior. Young children\u27s screen-time behavior is strongly influenced by their environment and their parents\u27 behavior. We explored whether parental television watching time, parental perceptions of children\u27s screen time, and media-related resources in the home are related to scree time (ie, television, DVD/video, video game, and computer use) among Oglala Lakota youth residing on or near the Pine Ridge Reservation in South Dakota. Methods: We collected baseline data from 431 child and parent/caregiver pairs who participated in Bright Start, a group-randomized, controlled, school-based obesity prevention trial to reduce excess weight gain. Controlling for demographic characteristics, we used linear regression analysis to assess associations between children\u27s screen time and parental television watching time, parental perceptions of children\u27s screen time, and availability of media-related household resources. Results: The most parsimonious model for explaining children screen time included the children\u27s sex, parental body mass index, parental television watching time, how often the child watched television after school or in the evening, parental perception that the child spent too much time playing video games, how often the parent limited the child\u27s television time, and the presence of a VCR/DVD player or video game player in the home (F7,367 = 14.67; P \u3c .001; adjusted R2 = .37). The presence of a television in the bedroom did not contribute significantly to the model. Conclusion: Changes in parental television watching time, parental influence over children\u27s screen-time behavior, and availability of media-related resources in the home could decrease screen time and may be used as a strategy for reducing overweight and obesity in American Indian children