Knowledge, Attitudes and Beliefs That May Influence Infant Feeding Practices in American Indian Mothers

The promotion of healthy infant feeding is increasingly recognized as an important obesity prevention strategy. This is relevant for American Indian (AI) populations, who exhibit high levels of obesity and low compliance with infant feeding guidelines. The literature examining the knowledge, attitudes and beliefs (KAB) surrounding infant feeding within the AI population is sparse and focuses primarily on breastfeeding, with limited information on the introduction of solid foods and related practices that may be important in an obesity prevention context. This research presents descriptive findings from a baseline KAB questionnaire on infant feeding and related behaviors, administered to mothers (n=438) from five Northwest AI tribes that participated in the Prevention of Toddler Overweight and Teeth Health Study (PTOTS). Enrollment occurred during pregnancy or up to 6 months postpartum. The KAB questionnaire focused on themes of Breastfeeding/Formula Feeding and Introducing Solid Foods, with supplemental questions on Physical Activity. Knowledge questions were multiple-choice or true/false. Attitudes and beliefs were assessed on Likert scales. Descriptive statistics included frequencies and percents, and means and standard deviations. Most women knew basic breastfeeding recommendations and facts, but fewer recognized the broader health benefits of breastfeeding (e.g., reducing diabetes risk), or knew when to introduce solid foods. Women believed breastfeeding to be healthy and perceived their social networks to agree. Attitudes and beliefs about formula feeding and social support were more ambivalent. This work suggests opportunities to increase the perceived value of breastfeeding to include broader health benefits, increase knowledge about solid foods, and strengthen social support

Listening to Girls and Boys Talk About Girls’ Physical Activity Behaviors

As part of the formative assessment for the Trial of Activity for Adolescent Girls (TAAG), a multicenter study to reduce the decline of physical activity in adolescent girls, girls and boys with diverse ethnicity from six states participated in focus groups and semistructured interviews. Data from 13 girls’ focus groups (N = 100), 11 boys’ focus groups (N = 77), and 80 semistructured interviews with girls are examined to identify perceptions of girls’ physical activity behaviors to help develop TAAG interventions. Both girls and boys talk about physically active girls as being “tomboys” or “too aggressive.” Girls are more likely to characterize active girls as “in shape,” whereas boys say they are “too athletic.” Girls report boys to be influential barriers and motivators in shaping their beliefs about physical activity. Given the strong influence of peers, developing successful interventions for girls should include verbal persuasion, modeling, and social support from both girls and boys

Physical and Social Contexts of Physical Activities Among Adolescent Girls

Background: With limited opportunities for physical activity during school hours, it is important to understand the contexts of physical activities done outside of school time. Given the importance of physical and social aspects of environments, the purpose of this study was to describe where and with whom girls participate in physical activities outside of school. Methods: Participants were 1925 sixth-grade girls in the Trial of Activity for Adolescent Girls (TAAG). At baseline, they completed a 3-day physical activity recall (3DPAR), reporting the main activity performed during 30-minute intervals and the physical and social contexts of physical activities. Results: The most frequently reported physical activities done outside of school time were house chores, walking (for transportation or exercise), dance, basketball, playing with younger children, and running or jogging. The most common location for these activities was at home or in the neighborhood. With the exception of household chores, these activities were typically done with at least one other person. Conclusions: Interventions that promote physical activities that can be done at or around home or developing supportive social networks for physical activity would be consistent with the current physical activity contexts of adolescent girls

Correlates of Physical Activity in Black, Hispanic, and White Middle School Girls

Background: A need exists to better understand multilevel influences on physical activity among diverse samples of girls. This study examined correlates of moderate-to-vigorous physical activity (MVPA) among adolescent girls from different racial/ethnic backgrounds. Methods: 1,180 6th grade girls (24.5% black, 15.7% Hispanic, and 59.8% white) completed a supervised self-administered questionnaire that measured hypothesized correlates of PA. MVPA data were collected for 6 days using the ActiGraph accelerometer. Hierarchical regression analysis was used to examine correlates of PA in each racial/ethnic group. Results: Hispanic girls (n=185) engaged in 21.7 minutes of MVPA per day, black girls (n=289) engaged in 19.5 minutes of MVPA per day, and white girls (n=706) engaged in 22.8 minutes of MVPA per day. Perceived transportation barriers (+; P=.010) were significantly and positively related to MVPA for Hispanic girls. For black girls, Body Mass Index (BMI) (-; P\u3c.005) and social support from friends (+; P=.006) were significant correlates of MVPA. For white girls, BMI (-; P\u3c.001), barriers (-; P=.012), social support from friends (+; P=.010), participation in school sports (+; P=.009), and community sports (+; P=.025) were significant correlates of MVPA. Explained variance ranged from 30% to 35%. Conclusions: Correlates of MVPA varied by racial/ethnic groups. Effective interventions in ethnically diverse populations may require culturally tailored strategies

The Role of Peer Social Network Factors and Physical Activity in Adolescent Girls

Objective: To study the relationship between peer-related physical activity (PA) social networks and the PA of adolescent girls. Methods: Cross-sectional, convenience sample of adolescent girls. Mixed-model linear regression analyses to identify significant correlates of self-reported PA while accounting for correlation of girls in the same school. Results: Younger girls were more active than older girls. Most activity-related peer social network items were related to PA levels. More PA with friends was significantly related to self-reported PA in multivariate analyses. Conclusions: Frequency of PA with friends was an important correlate of PA among the peer network variables for adolescent girls

A Community-Based Intervention to Prevent Obesity Beginning at Birth among American Indian Children: Study Design and Rationale for the PTOTS study

Eating and physical activity behaviors associated with adult obesity have early antecedents, yet few studies have focused on obesity prevention interventions targeting very young children. Efforts to prevent obesity beginning at birth seem particularly important in populations at risk for early-onset obesity. National estimates indicate that American Indian (AI) children have higher rates of overweight and obesity than children of other races/ethnicities. The Prevention of Toddler Obesity and Teeth Health Study (PTOTS) is a community-partnered randomized controlled trial designed to prevent obesity beginning at birth in AI children. PTOTS was developed to test the effectiveness of a multi-component intervention designed to: promote breastfeeding, reduce sugar-sweetened beverage consumption, appropriately time the introduction of healthy solid foods, and counsel parents to reduce sedentary lifestyles in their children. A birth cohort of 577 children from five AI tribes is randomized by tribe to either the intervention (three tribes) or the comparison condition (two tribes). The strengths and weaknesses of PTOTS include a focus on a critical growth phase, placement in the community, and intervention at many levels, using a variety of approaches

Self-Management Strategies Mediate Self-Efficacy and Physical Activity

Self-efficacy theory proposes that girls who have confidence in their capability to be physically active will perceive fewer barriers to physical activity or be less influenced by them, be more likely to pursue perceived benefits of being physically active, and be more likely to enjoy physical activity. Self-efficacy is theorized also to influence physical activity through self-management strategies (e.g., thoughts, goals, plans, and acts) that support physical activity, but this idea has not been empirically tested

Promoting Physical Activity in Middle School Girls: Trial of Activity for Adolescent Girls

Background - Physical activity is important for weight control and good health; however, activity levels decline in the adolescent years, particularly in girls. Design - Group randomized controlled trial. Setting/participants - Middle school girls with English-speaking skills and no conditions to prevent participation in physical activity in 36 schools in six geographically diverse areas of the United States. Random, cross-sectional samples were drawn within schools: 6th graders in 2003 (n=1721) and 8th graders in 2005 (n=3504) and 2006 (n=3502). Intervention - A 2-year study-directed intervention (fall 2003 to spring 2005) targeted schools, community agencies, and girls to increase opportunities, support, and incentives for increased physical activity. Components included programs linking schools and community agencies, physical education, health education, and social marketing. A third-year intervention used school and community personnel to direct intervention activities. Main outcome measures - The primary outcome, daily MET-weighted minutes of moderate-to-vigorous physical activity (MET-weighted MVPA), was assessed using accelerometry. Percent body fat was assessed using anthropometry. Results - After the staff-directed intervention (pre-stated primary outcome), there were no differences (mean=-0.4, 95% CI=-8.2 to 7.4) in adjusted MET-weighted MVPA between 8th-grade girls in schools assigned to intervention or control. Following the Program Champion-directed intervention, girls in intervention schools were more physically active than girls in control schools (mean difference 10.9 MET-weighted minutes of MVPA, 95% CI=0.52-21.2). This difference is about 1.6 minutes of daily MVPA or 80 kcal per week. There were no differences in fitness or percent body fat at either 8th-grade timepoint. Conclusion - A school-based, community-linked intervention modestly improved physical activity in girls

The Effect of a Physical Activity Intervention on Bias in Self-Reported Activity

A positive outcome in self-reported behavior could be detected erroneously if an intervention caused over-reporting of the targeted behavior. Data collected from a multi-site randomized trial were examined to determine if adolescent girls who received a physical activity intervention over-reported their activity more than girls who received no intervention