Karly S. Geller

Physical Activity and Healthy Eating in the After-School Environment.

BACKGROUND No research to date has extensively described moderate and vigorous physical activity (MVPA) and healthful eating (HE) opportunities in the after-school environment. The current study described the quality of the after-school environment for its impact on childrens MVPA and HE. METHODS An alliance of 7 elementary schools and Boys and Girls Clubs who worked with the Cooperative Extension Service in Lawrence, KS, was selected to participate in a larger intervention study. After-school settings were observed for information regarding session type, session context, leader behavior, physical activity, and snack quality using validated instruments such as the System for Observing Fitness Instruction Time. Data presented are baseline measures for all sites. RESULTS Participating children (n = 144) were primarily non-Hispanic white (60%) and in fourth grade (69%). After-school sites offered 4 different sessions per day (active recreation, academic time, nonactive recreation, and enrichment activities). Children were provided with a daily snack. On 36% of the days observed, this snack included fruit, fruit juice, or vegetables. There was significantly more time spent in MVPA during free play sessions (69%) compared to organized adult-led sessions (51%). There was also significantly more discouragement of physical activity during organized adult-led sessions (29%) as compared to the free play sessions (6%). CONCLUSIONS The quality of after-school programs can be improved by providing fruits and vegetables as snacks; offering more free play activities; training the after-school staff in simple, structured games for use in a variety of indoor and outdoor settings; and training after-school staff to promote and model MVPA and HE in and out of the after-school setting.

Longitudinal and cross-sectional influences on youth fruit and vegetable consumption

Both cross-sectional and longitudinal research depict a decline in the fruit and vegetable consumption (FVC) of children and youths with age, but identifying developmental changes and their influences with regard to FVC cannot be fully explained with application of only one of these research designs. Reviewed here are results from longitudinal and cross-sectional research, and a proposal is presented for a lifespan development methodology that uses a sequential design strategy to illuminate the multilevel processes that determine FVC. Conclusions from the review were similar for both cross-sectional and longitudinal research, with fruit and vegetable (FV) preferences and FV accessibility/availability being the most consistent influences on FVC. Furthermore, this review illuminates several methodological issues, offering suggestions to strengthen comparisons between studies. Research designs that incorporate longitudinal, cross-sectional, and time-lag data are warranted.

The preventable proportion of type 2 diabetes by ethnicity: the multiethnic cohort.

PURPOSE To estimate the population-attributable risk (PAR) associated with modifiable risk factors for diabetes among Caucasians, Native Hawaiians, and Japanese Americans in the Hawaii component of the Multiethnic Cohort. METHODS This analysis is based on 74,970 cohort participants ages 45-75 years who completed a questionnaire on demographics, diet, and lifestyle factors in 1993-1996. After a mean follow-up time of 12.1 (0.01-14.4) years, 8,559 diabetes cases were identified by self-report, a medication questionnaire, and through health plan linkages. Hazard ratios for diabetes and partial PARs for single and different combinations of modifiable risk factors were estimated. RESULTS Overweight, physical inactivity, high meat intake, no alcohol consumption, and smoking were positively associated with diabetes risk in all ethnic groups. The estimated PARs suggested that among men, 78%, and among women, 83%, of new diabetes cases could have been avoided if all individuals had been in the low risk category for all of the modifiable risk factors. The slightly lower PARs in Japanese Americans were not significantly different from those in Caucasian and Native Hawaiian subjects. CONCLUSIONS Although PARs varied slightly over ethnicity, our findings do not support ethnic-specific prevention strategies; interventions targeted at multiple behaviors are needed in all ethnic groups.

Measuring Children’s Self-Efficacy and Proxy Efficacy Related to Fruit and Vegetable Consumption

BACKGROUND Social cognitive theory describes self-efficacy and proxy efficacy as influences on fruit and vegetable consumption (FVC). Proxy efficacy was defined as a childs confidence in his or her skills and abilities to get others to act in ones interests to provide fruit and vegetable (FV) opportunities. The purpose of this study was to develop a scale assessing childrens self-efficacy and proxy efficacy for FVC at after-school programs and at home. METHODS Elementary-aged children (n = 184) attending 7 after-school programs completed a self-efficacy questionnaire relevant to FVC. Questionnaire validity was investigated with exploratory factor analysis and mixed-model analysis of covariance. Internal consistency reliability and readability were also assessed. RESULTS The questionnaire assessed 4 constructs: self-efficacy expectations for fruit consumption, self-efficacy expectations for vegetable consumption, proxy efficacy to influence parents to make FV available, and proxy efficacy to influence after-school staff to make FV available. Children perceiving FV opportunities in after-school had greater self-efficacy expectations for FVC and greater proxy efficacy to influence after-school staff compared to students who did not perceive FV opportunities. Children attending schools of higher socioeconomic status (SES) and less diversity were more confident they could influence their parents to make FV available than students attending lower SES and less diverse schools. Adequate internal consistency and test-retest reliabilities were established. CONCLUSIONS Self-efficacy is a multicomponent construct that can be assessed in children using the reliable and valid instrument evaluated by the current study.

Future directions of multiple behavior change research.

Non-communicable diseases (i.e., chronic diseases including cardiovascular disease, cancer, chronic respiratory disease, diabetes and obesity) result in 36 million deaths each year. Individuals’ habitual participation in a single health-risk behaviors substantially contribute to morbidity and mortality (e.g., tobacco use, daily fast food intake, etc.); however, more concerning is the impact of typically co-occurring or clustering of multiple health-risk behaviors. This burden can be minimized through successful cessation of health-risk behaviors and adoption of healthy behaviors; namely healthy lifestyle adoption or multiple health behavior change (MHBC). MHBC is a developing field and future research recommendations are provided to advance MHBC research. A valid measure of MHBC (i.e., lifestyle) is warranted to provide the needed basis for MHBC investigations and evaluations. MHBC is thought to occur through shared co-variation of underlying motivating mechanisms, but how these relationships influence behavior remains unclear. A better understanding of the relationship between behaviors and the related motivating mechanisms (and potential cross-relationship of influences) is needed. Future research should also aim to improve lifestyles through understanding how to change multiple health behaviors. Finally, MHBC research should target the development of sustainable interventions which result in lasting effects (e.g., capacity, systems, policy and environmental changes), with dissemination considered during development. Focusing MHBC research in these areas will increase our understanding and maximize the impact on the health of populations.

Examining Elementary School—Aged Children’s Self-Efficacy and Proxy Efficacy for Fruit and Vegetable Consumption

Children’s self-efficacy for fruit and vegetable consumption (FVC) and proxy efficacy to influence others to make fruit and vegetables (FV) available may influence their FVC. A previous investigation has demonstrated that self-efficacy for fruit consumption, self-efficacy for vegetable consumption, proxy efficacy to influence parents to make FV available, and proxy efficacy to influence after-school staff to make FV available can be measured with four independent but related scales. The purpose of the present investigation is to confirm this factor structure and determine if the scales were invariant across gender, ethnicity, and socioeconomic status (SES) subgroups of children attending after-school programs. Results provide further validity evidence for the four correlated scales. In addition, results confirm measurement invariance across gender, SES, and ethnicity, confirming the unbiased generalizability of the current measure to these demographic groups. Lastly, tests of population heterogeneity reveal no meaningful differences in self- and proxy efficacy among gender, SES, and ethnicity subgroups.

Youth proxy efficacy for fruit and vegetable availability varies by gender and socio-economic status

OBJECTIVE The current study examined proxy efficacy, which was defined as youths confidence to influence their parents to provide fruits and vegetables. The overall objective was to examine change in middle-school youths proxy efficacy over time, and to determine if changes were moderated by gender and socio-economic status. DESIGN Longitudinal cohort nested within schools. SETTING Eight middle schools located in urban, suburban and rural areas of a mid-western US state. SUBJECTS Seven hundred and twelve youth followed across their 6th, 7th and 8th grade years. The sample was 51.8 % female, 30.5 % low socio-economic status and 89.5 % Caucasian, non-Hispanic. RESULTS Males and lower socio-economic status youth were significantly lower in proxy efficacy at each assessment year compared with females and high socio-economic youth, respectively. CONCLUSIONS Proxy efficacy to influence parents to provide fruits and vegetables may be an important construct to target in future interventions.

Access to environmental resources and physical activity levels of adults in Hawaii

Purpose. Examine associations between physical activity (PA) and spatial accessibility to environmental PA resources in Hawaii. Methods. Metabolic equivalents (METs) of mild, moderate, and strenuous PA were compared for accessibility with environmental PA resources within a population-based sample of Hawaiian adults (n = 381). Multiple linear regression estimated differences in PA levels for residing further from a PA resource or residing in an area with a greater number of resources. Results. No associations were found in the total sample. Analyses within subsamples stratified by ethnicity revealed that greater spatial accessibility to a PA resource was positively associated with strenuous PA among Caucasians (P = .04) but negatively associated with moderate PA among Native Hawaiians (P = .00). Conclusion. The lack of association in the total sample may be a consequence of Hawaii’s unique environment. Results of stratified sample analyses are unique, providing groundwork for future examinations within parallel environments and among similar ethnic groups.

Intrinsic and Extrinsic Motives Support Adults’ Regular Physical Activity Maintenance

Motives for physical activity were compared between adults who either successfully or unsuccessfully maintained regular physical activity over the last 10 years. Adults age 28–45 (N=721) completed an online survey, reporting their current physical activity levels and self-determination theory (SDT) motives, as well as their physical activity levels at least 10 years prior. With participants’ current and retrospective reports of their physical activity, four sample subgroups were created, including maintainers, improvers, decliners, and sedentary. ANOVA analyses were used to examine differences in motives between physical activity maintenance groups. Those who successfully maintained regular physical activity (maintainers) reported higher intrinsic and extrinsic motives compared to those who were not regularly active ( P <0.05). Interestingly, maintainers reported similar physical activity motives compared to those who reported increased physical activity over time. Among the current sample and consistent with theory, motives for physical activity significantly influenced participants’ long-term maintenance of regular physical activity. Future interventions should consider these constructs to promote sustained physical activity.

Validity and reliability of measures assessing social-cognitive determinants of physical activity in low-active Australian adults

ABSTRACT This cross-sectional study of 504 community-dwelling Australian adults (328 females, 176 males, mean age 50.8 ± 13.0 years) sought to examine the reliability and validity of measurement scales for physical activity (PA) self-efficacy and outcome expectations. Participants completed demographic and anthropometric measurements, and a 23-item psychosocial questionnaire pertinent to an intervention target of 10,000 steps per day. Exploratory (n = 252) and confirmatory (n = 252) factor analyses were conducted to determine psychometric properties of the measures. Based on theory and goodness-of-fit indices, six factors were extracted from the questionnaire: PA self-efficacy; PA barriers self-efficacy (including general, personal, and conflict); and physical and mental outcome expectations. From confirmatory factor analysis, the model demonstrated good data fit in four out of five indices: CFI = 0.99; TLI = 0.99; SRMR = 0.03; RMSEA = 0.03, 90%CI = 0.01–0.05, χ2 = 113.14 (88), p = 0.04; including good fit by sex, age, weight status, education, and birth country. PA interventions can employ our psychometrically sound social cognitive measures.