E. Lisako J. McKyer

Perceived barriers to children’s active commuting to school: a systematic review of empirical, methodological and theoretical evidence

Active commuting to school (ACS) may increase children’s daily physical activity and help them maintain a healthy weight. Previous studies have identified various perceived barriers related to children’s ACS. However, it is not clear whether and how these studies were methodologically sound and theoretically grounded. The purpose of this review was to critically assess the current literature on perceived barriers to children’s ACS and provide recommendations for future studies. Empirically based literature on perceived barriers to ACS was systematically searched from six databases. A methodological quality scale (MQS) and a theory utilization quality scale (TQS) were created based on previously established instruments and tailored for the current review. Among the 39 studies that met the inclusion criteria, 19 (48.7%) reported statistically significant perceived barriers to child’s ACS. The methodological and theory utilization qualities of reviewed studies varied, with MQS scores ranging between 7 and 20 (Mean =12.95, SD =2.95) and TQS scores from 1 to 7 (Mean =3.62, SD =1.74). A detailed appraisal of the literature suggests several empirical, methodological, and theoretical recommendations for future studies on perceived barriers to ACS. Empirically, increasing the diversity of study regions and samples should be a high priority, particularly in Asian and European countries, and among rural residents; more prospective and interventions studies are needed to determine the causal mechanism liking the perceived factors and ACS; future researchers should include policy-related barriers into their inquiries. Methodologically, the conceptualization of ACS should be standardized or at least well rationalized in future studies to ensure the comparability of results; researchers’ awareness need to be increased for improving the methodological rigor of studies, especially in regard to appropriate statistical analysis techniques, control variable estimation, multicollinearity testing, and reliability and validity reporting. Theoretically, future researchers need to first ground their investigations in theoretical foundations; efforts should be devoted to make sure theories are used thoroughly and correctly; important theoretical constructs, in particular, need to be conceptualized and operationalized appropriately to ensure accurate measurement. By reviewing what has been achieved, this review offered insights for more sophisticated ACS studies in the future.

Children’s active commuting to school: an interplay of self-efficacy, social economic disadvantage, and environmental characteristics

BackgroundActive commuting to school (ACS) can promote children’s physical activity and may help prevent childhood obesity. Previous researchers in various disciplines, e.g., health, urban planning, and transportation, have identified various predictors of ACS. However, little research has been carried out into investigating the effect of self-efficacy on ACS. The purpose of this study is to investigate the roles of children’s and parents’ self-efficacy in children’s ACS, controlling for sociodemographic and objective environmental characteristics.MethodsThis study is part of the Texas Childhood Obesity Prevention Policy Evaluation (T-COPPE) project, which includes data from 857 parent/child pairs from 74 schools who lived within two miles of school in Texas. Measures included children’s usual modes of commuting to school, participants’ sociodemographics, perceived self-efficacy toward ACS, sources of children’s self-efficacy, school settings, and objective environmental constraints. Multilevel structural equation modeling (SEM) was employed to test the hypothesized pathways using Mplus 7.0.ResultsAround 18% of the children were active commuters. Two sources of children’s self-efficacy were identified, i.e., emotional states (βu2009=u20090.36, pu2009<u20090.001) and social modeling (βu2009=u20090.28, pu2009<u20090.01). Compared with children’s self-efficacy (βu2009=u20090.16, pu2009<u20090.001), parents’ self-efficacy (βu2009=u20090.63, pu2009<u20090.001) had a stronger influence on children’s ACS. Participants’ social economic disadvantage (βu2009=u20090.40, pu2009<u20090.001), environmental constraints (βu2009=u2009−0.49, pu2009<u20090.001), and school setting (βu2009=u2009−0.17, pu2009=u20090.029) all had statistically significant direct effects on children’s ACS.ConclusionsFuture initiatives should consider both parents’ and children’s self-efficacy in developing strategies for promoting children’s ACS. Social disadvantage and environmental constraints also need to be addressed for effective interventions. The work reported here provides support for the continuing exploration of the role of self-efficacy in children’s ACS.

Assessment of school wellness policies implementation by benchmarking against diffusion of innovation framework.

BACKGROUNDnThe School Wellness Policy (SWP) mandate marks one of the first innovative and extensive efforts of the US government to address the child obesity epidemic and the influence of the school environment on child health. However, no systematic review has been conducted to examine the implementation of the mandate. The study examines the literature on SWP implementation by using the Diffusion of Innovations Theory as a framework.nnnMETHODSnEmpirically based literature on SWP was systematically searched and analyzed. A theory-driven approach was used to categorize the articles by 4 diffusion stages: restructuring/redefining, clarifying, routinizing, and multiple stages.nnnRESULTSnTwenty-one studies were identified, and 3 key characteristics of the reviewed literature were captured: (1) uniformity in methodology, (2) role of context in analyzing policy implementation, and (3) lack of information related to policy clarification. Over half of the studies were published by duplicate set of authors, and only 1 study employed a pure qualitative methodology. Only 2 articles include an explicit theoretical framework to study theory-driven constructs related to SWP implementation.nnnCONCLUSIONSnPolicy implementation research can inform the policy process. Therefore, it is essential that policy implementation is measured accurately. Failing to clearly define implementation constructs may result in misguided conclusion.

Risk Factors for Childhood Obesity among Asian Americans: A Systematic Review of Literature and Recommendations for Health Care Research

Childhood obesity has become an epidemic across all racial/ethnic groups in the U.S., including Asian Americans. With different cultures, beliefs, and lifestyles, Asian Americans may face unique sets of risk factors for childhood obesity. This review critically assesses and summarizes the literature on risk factors for childhood obesity among Asian Americans. Among the 14 studies identified, five (35.7%) used national or state-level data, seven (50%) targeted Chinese Americans, and two (14.3%) focused on Hmong Americans. Multiple risk factors for childhood obesity among Asian Americans were reported, including acculturation, generational status, and family functioning. Limitations of the literature included use of small samples, scarcity of ethnically specific data for Asian American subgroups, shortage of qualitative studies, and lack of theoretical foundation. More disaggregated studies are needed to examine the important variability that may exist in risk factors for childhood obesity among Asian American subgroups.

Food-shopping environment disparities in Texas WIC vendors: a pilot study.

OBJECTIVEnTo identify differences in food-shopping environments of Texas WIC vendors using a culturally adapted instrument.nnnMETHODSnA survey tool was developed for measuring food availability, accessibility, and affordability in 111 WIC vendors in Texas. Two-tailed t-tests and Mann-Whitney tests were used for rural/urban and Texas-Mexico border/non-border area comparisons.nnnRESULTSnPrices were higher in rural areas than in urban areas for 2 key foods, fruits (p = .024) and milk (p = .007); non-border vendors had overall better food availability than border vendors; non-border vendors had better accessibility for fruits (p = .007) than border vendors.nnnCONCLUSIONnIn Texas, disparities in food-shopping environments are evident and can be assessed using a culturally adapted survey tool.

Influence of the Home Food Environment on Children’s Fruit and Vegetable Consumption A Study of Rural Low-Income Families

Background. This investigation sought to identify micro-level built and sociocultural characteristics of a home food environment that have been theoretically linked with fruit and vegetable (F&V) consumption. Method. We examined rural families (n = 298) from the southeastern United States. Hierarchical multiple regression analyses determined the association between the outcome variable (F&V consumption) and micro-level built and sociocultural characteristics of a home food environment. Results. Demographic characteristics were entered at Step 1, explaining 14% of variance in vegetable consumption and 9% in fruit consumption. After entry of sociocultural factors in the home food environment, such as parenting styles and so on, in Block 2, the total variance explained increased by 25% for vegetable consumption and 12% for fruit consumption. Micro-level built environmental factors such as the availability of F&V in the home was entered at Block 3, total variance explained by the model for vegetable consumption was 67%, F(17, 111) = 13.5, p < .001, and for fruit consumption was 57%, F(17, 160) = 12.5, p < .001. Conclusion. F&V availability was the most important variable influencing a child’s consumption of F&V. There are modifiable factors within the rural low-income home that could serve as priorities for intervention to improve F&V consumption.

Understanding the essence and lived experience of self-care management among African-American men living with type 2 diabetes

Purpose: To explore, understand and describe the lived experience of African-American men (AA men) living with type 2 diabetes, with emphasis on capturing perceptions of challenges, facilitators and perceived barriers associated with self-care management. Materials and Methods: Participants (n = 19) were AA men ages 35-69 years, who were diagnosed with type 2 diabetes. Participants were recruited via community outreach efforts, including barbershops and churches located in predominantly African-American communities in southeast US. Upon consent, individual interviews were conducted, audio-recorded and subsequently transcribed. Transcripts were analyzed using a phenomenological approach, and focused on identifying common themes among the descriptions of AA men′s experiences specific to type 2 diabetes. Results: AA men perceived their experience of managing type 2 diabetes as tedious, complicated, demanding, and frustrating. Common themes included the perception of family histories and personal behaviors as causes or contributors to the development of diabetes, albeit there was lack of clarity regarding biological versus behavioral familial contributions. Other theses included fears related to long-term complications of type 2 diabetes, and the critical role of social support as a factor assisting with self-care management. Limb amputation, insulin injections and vision changes were fears related to having type 2 diabetes. Commensurately, important referent others (e.g., family and close friends) provided critical encouragement and support toward managing their diabetes. Conclusions: Future diabetes research and education should give attention to how masculinity may have a powerful influence on diabetes management behavior among African-American men′s as well as utilizing preventive health services.

Psychosocial Correlates of Smokeless Tobacco Use Among Indiana Adolescents

Adolescent tobacco use is influenced by intrapersonal (e.g., impulse control) and external factors, such as behaviors of friends and peers. The relationships of these factors to smokeless tobacco (ST) use are not yet fully understood. This is especially true as it pertains to the simultaneous examination of psychological and normative perceptions. Using constructs of the Biopsychosocial Model, this study investigates factors associated with lifetime ST use among middle and high school students. Data were analyzed from 938 Indiana middle and high school students. Binary sequential logistic regression was performed to examine the relationship of personal characteristics and psychosocial measures to adolescent lifetime ST use. Approximately 9xa0% reported having ever used ST, among which 78.6xa0% were male. Females and younger students were less likely to have used ST in their lifetime, whereas participants with a sibling smoker and those who compared their life to the lives of others were more likely to report lifetime ST usage. In the presence of psychological and normative variables, sex, age, and comparing one’s life to others remained significant. Additionally, participants who perceived higher friend approval of substance use were significantly more likely to report lifetime ST use. Understanding the normative perceptions of adolescents may lend insight into the drivers of ST use adolescent subgroups and, which may enable community and school officials to tailor interventions to prevent ST initiation and promote cessation.

A Comparative Study of Smoking in American and Japanese Adolescents: Self, Social Influences, and Health Beliefs

Adolescent health-endangering behaviors are often explained in relation to psychosocial factors. The present study examined how differing psychosocial factors affect smoking by comparing American and Japanese adolescents. Participants in this study were 844 American (374 boys, 401 girls, and 69 undefined) and 734 Japanese (426 boys, 297 girls, and 11 undefined) students from the 7th to 12th grade. The average age of the American sample was 15.24xa0years old (SDu2009=u20092.05); the average age of the Japanese sample was 15.78 (SDu2009=u20091.16). Multiple regression analysis with a moderation analysis was conducted to examine the effects of culture on smoking status. A significant moderation effect of culture was found for the perceived prevalence of smoking among peers—perceived prevalence predicted smoking in the past month for Japanese adolescents but not for Americans. The results suggest that Japanese adolescents’ smoking behavior is influenced by the collectivistic nature of their culture.

African-American Fathers' Perspectives on Their Children's Health Education: A Qualitative, Exploratory Study.

Purpose: To investigate African-American fathers’ (AAF) perceptions regarding the applicability and need for their involvement as a health connection for their children and describe how participating fathers’ behavior was affected by their attitudes, knowledge, and perceptions of their influence on their children’s health. Methods: This exploratory study gathered data via semi-structured focus groups (nu2009=u20093) and thematically analyzed it utilizing a grounded theory approach. Participants included AAF (nu2009=u200920) with a mean age of 37u2009years (SD 11.79), with at least one child between 6 and 18u2009years old. Results: Four major themes were revealed: (1) appropriate health education for participants’ children (should first and foremost be delivered by parents); (2) participants’ paternal health-related guidance approach (reactive, rather than proactive); (3) participants’ perceived influences on health-related communication with their children (gender roles, efficacy constraints); and (4) paternal definitions of health (most often associated with diet). Conclusion: Understanding AAFs’ perceived and desired role in their children’s health edification can inform initiatives that actively engage these men, and nurture their level of involvement, to promote positive health behaviors among their children; this is necessary to realize their potential to actively improve the health of their children, families, and communities.