Margaret Schneider

Media use and obesity in adolescent females

Objective: In the context of growing public health concern with the obesity rates among children and adolescents, much attention has focused on the role of television as a contributor to the problem. Less attention has been devoted to interactive media (internet surfing and video games), despite the fact that these forms of entertainment are fast gaining in popularity among youth. This study investigated the relative associations of TV viewing and interactive media use with body fat and BMI, controlling for both physical activity participation and cardiovascular fitness.

HEALTHY study rationale, design and methods: moderating risk of type 2 diabetes in multi-ethnic middle school students.

The HEALTHY primary prevention trial was designed and implemented in response to the growing numbers of children and adolescents being diagnosed with type 2 diabetes. The objective was to moderate risk factors for type 2 diabetes. Modifiable risk factors measured were indicators of adiposity and glycemic dysregulation: body mass index ⩾85th percentile, fasting glucose ⩾5.55 mmol l−1 (100 mg per 100 ml) and fasting insulin ⩾180 pmol l−1 (30 μU ml−1). A series of pilot studies established the feasibility of performing data collection procedures and tested the development of an intervention consisting of four integrated components: (1) changes in the quantity and nutritional quality of food and beverage offerings throughout the total school food environment; (2) physical education class lesson plans and accompanying equipment to increase both participation and number of minutes spent in moderate-to-vigorous physical activity; (3) brief classroom activities and family outreach vehicles to increase knowledge, enhance decision-making skills and support and reinforce youth in accomplishing goals; and (4) communications and social marketing strategies to enhance and promote changes through messages, images, events and activities. Expert study staff provided training, assistance, materials and guidance for school faculty and staff to implement the intervention components. A cohort of students were enrolled in sixth grade and followed to end of eighth grade. They attended a health screening data collection at baseline and end of study that involved measurement of height, weight, blood pressure, waist circumference and a fasting blood draw. Height and weight were also collected at the end of the seventh grade. The study was conducted in 42 middle schools, six at each of seven locations across the country, with 21 schools randomized to receive the intervention and 21 to act as controls (data collection activities only). Middle school was the unit of sample size and power computation, randomization, intervention and primary analysis.

Rationale, design and methods for process evaluation in the HEALTHY study.

The HEALTHY study was a multi-site randomized trial designed to determine whether a 3-year school-based intervention targeting nutrition and physical activity behaviors could effectively reduce risk factors associated with type 2 diabetes in middle school children. Pilot and formative studies were conducted to inform the development of the intervention components and the process evaluation methods for the main trial. During the main trial, both qualitative and quantitative assessments monitored the fidelity of the intervention and motivated modifications to improve intervention delivery. Structured observations of physical education classes, total school food environments, classroom-based educational modules, and communications and promotional campaigns provided verification that the intervention was delivered as intended. Interviews and focus groups yielded a multidimensional assessment of how the intervention was delivered and received, as well as identifying the barriers to and facilitators of the intervention across and within participating schools. Interim summaries of process evaluation data were presented to the study group as a means of ensuring standardization and quality of the intervention across the seven participating centers. Process evaluation methods and procedures documented the fidelity with which the HEALTHY study was implemented across 21 intervention schools and identified ways in which the intervention delivery might be enhanced throughout the study.

Rationale, design and methods of the HEALTHY study behavior intervention component

HEALTHY was a multi-center primary prevention trial designed to reduce risk factors for type 2 diabetes in adolescents. Seven centers each recruited six middle schools that were randomized to either intervention or control. The HEALTHY intervention integrated multiple components in nutrition, physical education, behavior change and communications and promotion. The conceptual rationale as well as the design and development of the behavior intervention component are described. Pilot study data informed the development of the behavior intervention component. Principles of social learning and health-related behavior change were incorporated. One element of the behavior intervention component was a sequence of peer-led, teacher-facilitated learning activities known as FLASH (Fun Learning Activities for Student Health). Five FLASH modules were implemented over five semesters of the HEALTHY study, with the first module delivered in the second semester of the sixth grade and the last module in the second semester of the eighth grade. Each module contained sessions that were designed to be delivered on a weekly basis to foster self-awareness, knowledge, decision-making skills and peer involvement for health behavior change. FLASH behavioral practice incorporated individual and group self-monitoring challenges for eating and activity. Another element of the behavior intervention component was the family outreach strategy for extending changes in physical activity and healthy eating beyond the school day and for supporting the students lifestyle change choices. Family outreach strategies included the delivery of newsletters and supplemental packages with materials to promote healthy behavior in the home environment during school summer and winter holiday breaks. In conclusion, the HEALTHY behavior intervention component, when integrated with total school food and physical education environmental changes enhanced by communications and promotional campaigns, is a feasible and acceptable mechanism for delivering age-appropriate social learning for healthy eating and physical activity among an ethnically diverse group of middle school students across the United States.

Testing the Health Belief Model in a Field Study to Promote Bicycle Safety Helmets

Calls for communitywide interventions to promote bicycle safety helmet usage among children abound, yet little is known about the factors that cause parents to purchase helmets and consistently insist on their usage. The health belief model proposes that cues to action are important influences on self-protective behaviors. A communitywide field study was conducted to test the effectiveness of six different kinds of cues to action. Parents of children between the ages of 5 and 18 were selected via random-digit-dialing techniques for participation in the study. The results indicated that cues to action affected perceptions of threat but were unrelated to attitudes, intentions, or behaviors. However, perceptions of threat were found to be important influences on bicycle helmet attitudes, intentions, and behaviors.

An investigation of psychosocial factors related to changes in physical activity and fitness among female adolescents

Research examined the effects of a supervised physical activity program on potential psychosocial mediators and determined whether changes in these psychosocial variables predicted changes in physical activity and fitness. Sedentary adolescent females were assigned to an intervention (n = 79) or comparison (n = 67) group. Cardiovascular fitness (cycle ergometer), physical activity (3-Day Physical Activity Recall), and psychosocial variables related to physical activity (i.e., self-efficacy, perceived barriers, social support, enjoyment) were assessed at three time points over the 9-month study. An intention-to-treat analysis showed that the intervention did not impact any of the psychosocial variables, with the exception of perceived barriers, which increased in the intervention group. Longitudinal analyses showed that improvements in fitness were associated with positive changes in global self-efficacy and exercise enjoyment. Psychosocial variables did not mediate the programs effects on fitness or activity. However, individual level changes in psychosocial variables were related to changes in cardiovascular fitness.

Social marketing-based communications to integrate and support the HEALTHY study intervention

The HEALTHY study was a randomized, controlled, multicenter, middle school-based, multifaceted intervention designed to reduce risk factors for the development of type 2 diabetes. The study randomized 42 middle schools to intervention or control, and followed students from the sixth to the eighth grades. Participants were a racially, ethnically and geographically diverse cohort from across the United States. Here, we describe the conceptual underpinnings and design of the social marketing-based communications component of the HEALTHY study intervention that combined changes in the school nutrition and physical education (PE) environment with behavior change initiatives. The communications intervention component coordinated multiple elements to deliver campaigns that served to integrate and support all aspects of the HEALTHY intervention. The campaigns unfolded across five semesters of middle school, each targeting a specific theme related to the HEALTHY objectives. Communications campaigns comprised (1) core elements such as branding, posters, banners and visual and verbal messaging, (2) student events supporting the nutrition, PE and behavior intervention components through the application of social marketing and communications strategies, including the incorporation of student-generated media and (3) distribution of premiums and theme enhancers to extend the visibility of the study beyond the intervention environment. Formative research conducted with students, parents and school administrators was used to refine the communications strategy. Student peer communicators selected from the student body were involved to influence the normative student environment. Marketing and creative design experts developed a brand, logo, activities and materials. In the latter half of the study, student-generated messages and media were used to reflect local interests and culture and enhance peer influence. The HEALTHY intervention delivery and impact were strengthened by the communications strategies. The HEALTHY experience provides practical considerations for systematically incorporating a social marketing-based communications approach within future school-based health behavior interventions.

Personality, physical fitness, and affective response to exercise among adolescents.

PURPOSE Evidence shows that aspects of personality are associated with participation in physical activity. We hypothesized that, among adolescents, behavioral activation (BAS) and behavioral inhibition (BIS) systems would be associated with physical fitness (cardiovascular fitness and percent body fat), enjoyment of exercise, tolerance of and persistence in high-intensity exercise, and affective response to an acute exercise bout. METHODS One hundred and forty-six healthy adolescents completed a cardiovascular fitness test, percent body fat assessment (dual-energy x-ray absorptiometer), and two 30-min cycle ergometer exercise tasks at moderate and hard intensities. Questionnaires evaluated BIS/BAS, enjoyment of exercise, and preference and tolerance for high-intensity activity. Affect in response to exercise was assessed using the Feeling Scale (FS) and the Activation Deactivation Adjective Check List (AD ACL). RESULTS BIS was negatively correlated with cardiovascular fitness and tolerance for high-intensity exercise, and adolescents with high BIS scores reported more negative FS in response to exercise at both moderate and hard intensities. BAS was positively correlated with enjoyment of exercise, and adolescents with high BAS scores reported having more positive FS and higher energetic arousal on the AD ACL in response to moderate-intensity exercise. The association between BAS and affect was attenuated for the hard-intensity exercise task. CONCLUSION These findings suggest that both the drive to avoid punishing stimuli (BIS) and the drive to approach rewarding stimuli (BAS) are related to the affective response to exercise. The BIS may be more strongly associated with fitness-related exercise behavior among adolescents than the BAS, whereas the BAS may play a relatively greater role in terms of subjective exercise enjoyment.

Role of Control and Social Support in Explaining the Stress of Hassles and Crowding

In a previous study, social hassles in the home, such as arguments and lack of privacy, were associated with greater psychological distress only in people living in crowded homes. Hassles were not related to distress in people in uncrowded homes. The current study undertakes a secondary analysis of these data to understand why household crowding potentiates the negative effects of social hassles on psychological well-being. The aim is to evaluate how two psychosocial variables—perceived control over the residential environment and social support from housemates—might explain the interactive effects of hassles and crowding on psychological distress. The results suggest that decreased perceived control among those who experience both crowding and hassles in the home explains why this subgroup has greater psychological distress. The authors argue that hassles in crowded homes lead to lower perceived control because household crowding constrains ones ability to avoid or escape from the hassles. Perceived social support from roommates does not account for the interactive effects of hassles and crowding.

Enjoyment of exercise moderates the impact of a school-based physical activity intervention

BackgroundA school-based physical activity intervention designed to encourage adolescent girls to be more active was more effective for some participants than for others. We examined whether baseline enjoyment of exercise moderated response to the intervention.MethodsAdolescent girls with a low level of baseline activity who participated in a controlled trial of an intervention to promote increased physical activity participation (n = 122) self-reported their enjoyment of exercise and physical activity participation at baseline, mid-way through the intervention, and at the end of the 9-month intervention period. At all three time points, participants also underwent assessments of cardiovascular fitness (VO2peak) and body composition (percent body fat). Repeated measures analysis of variance examined the relationship of baseline enjoyment to change in physical activity, cardiovascular fitness, body composition and enjoyment of exercise.ResultsA significant three-way interaction between time, baseline enjoyment, and group assignment (p < .01) showed that baseline enjoyment moderated the effect of the intervention on vigorous activity. Within the intervention group, girls with low enjoyment of exercise at baseline increased vigorous activity from pre-to post-intervention, and girls with high baseline enjoyment of exercise showed no pre-post change in vigorous activity. No differences emerged in the comparison group between low-and high-enjoyment girls.ConclusionAdolescent girls responded differently to a physical activity promotion intervention depending on their baseline levels of exercise enjoyment. Girls with low enjoyment of exercise may benefit most from a physical-education based intervention to increase physical activity that targets identified barriers to physical activity among low-active adolescent girls.