Tandalayo Kidd

The Effects of Young Adults Eating and Active for Health (YEAH): A Theory-Based Web-Delivered Intervention

OBJECTIVE To assess the effectiveness of a tailored theory-based, Web-delivered intervention (Young Adults Eating and Active for Health) developed using community-based participatory research process. DESIGN A 15-month (10-week intensive intervention with a 12-month follow-up) randomized, controlled trial delivered via Internet and e-mail. SETTING Thirteen college campuses. PARTICIPANTS A total of 1,639 college students. INTERVENTION Twenty-one mini-educational lessons and e-mail messages (called nudges) developed with the non-diet approach and focusing on eating behavior, physical activity, stress management, and healthy weight management. Nudges were short, frequent, entertaining, and stage-tailored to each behavior, and reinforced lesson content. MAIN OUTCOME MEASURE All participants were assessed at baseline, postintervention (3 months from baseline), and follow-up (15 months from baseline) for primary outcomes of weight, body mass index (BMI), fruit and vegetable intake (FVI), physical activity (PA), and perceived stress; and secondary outcomes of waist circumference, percent dietary fat, energy from sugar-sweetened beverages, servings of whole grains, self-instruction and regulation for mealtime behavior, hours of sleep, and stage of readiness for change for consuming 5 cups of FVI, completing 150 minutes of PA/wk, and managing stress on most days of the week. Demographics were collected at baseline. ANALYSIS Chi-square analysis and mixed-models repeated measures analysis were performed to determine differences between experimental and control outcomes. RESULTS There were no differences between experimental and control participants in BMI, weight, and waist circumference. There were small improvements in FVI (P = .001), vigorous PA in females (P = .05), fat intake (P = .002), self-instruction (P = .001), and regulation (P = .004) for mealtime behavior, and hours of sleep (P = .05) at postintervention, but improvements were not maintained at follow-up. At postintervention, a greater proportion of experimental participants were in the action/maintenance stages for FVI (P = .019) and PA (P = .002) than control. CONCLUSIONS AND IMPLICATIONS Young Adults Eating and Active for Health is one of the first studies to use the community-based participatory research process of PRECEDE-PROCEED to develop a non-diet approach intervention. Although there were no differences between experimental and control participants in weight change or BMI, the intervention supported positive change in behaviors that may mediate excessive weight gain, such as increasing FVI and more healthful self-regulation mealtime behaviors immediately postintervention. Additional strategies to maintain the behavior changes need to be explored.

Sweet and salty. An assessment of the snacks and beverages sold in vending machines on US post-secondary institution campuses.

This study assessed the nutritional quality of snacks and beverages sold in vending machines. The contents of snack and beverage vending machines in 78 buildings on 11 US post-secondary education campuses were surveyed. Of the 2607 snack machine slots surveyed, the most common snacks vended were salty snacks (e.g., chips, pretzels) and sweets (i.e., candy and candy bars). The 1650 beverage machine slots assessed contained twice as many sugar-sweetened beverages as non-calorie-containing beverages. Only two institutions sold both milk and 100% juice in vending machines. The portion of snacks and beverages sold averaged more than 200 cal. Neither snacks nor beverages were nutrient dense. The majority of snacks were low in fiber and high in calories and fat and almost half were high in sugar. Most beverages were high in calories and sugar. This studys findings suggest that vending machines provide limited healthful choices. Findings from benchmark assessments of components of the food environment, like the vending options reported here, can provide valuable input to campus administrators, health services, food service, and students who want to establish campus policies to promote healthful eating.

Development of Young Adults Eating and Active for Health (YEAH) Internet-Based Intervention via a Community-Based Participatory Research Model

OBJECTIVE To develop a tailored, theory-based, Web-delivered intervention to prevent excessive weight gain in young adults using a Community-Based Participatory Research model. DESIGN Investigators from 14 universities developed the intervention and supporting administrative portal using the 4 phases of the PRECEDE model. Steering committees were composed of the target audience (aged 19-24 years) and key health/wellness personnel were formed at each institution and provided information during each phase that was used to guide development of the intervention, Project YEAH (Young Adults Eating and Active for Health). Piloting results were used to refine the curriculum and identify and avoid barriers to delivery. RESULTS Qualitative and quantitative data collected at each phase informed Project YEAH development. In Phase 1, factors of highest priority to young adults were identified. In Phase 2, environmental supports for healthful lifestyles were elucidated. In Phase 3, behavior and environmental changes considered important and changeable were identified. In Phase 4, the 10-week, theory-based, stage-tailored, interactive-learning intervention with a 10-month reinforcement period was developed. CONCLUSIONS AND IMPLICATIONS Applying the PRECEDE model with fidelity during development of Project YEAH resulted in an intervention that pilot participants found relevant and useful, gained attention, instilled confidence in the ability to apply the information, and provided a sense of satisfaction.

Relationships of Sleep Duration With Weight-Related Behaviors of U.S. College Students

This study describes sleep behaviors of U.S. college students (N = 1,252; 18–24 years old; 59% female) and examines associations of sleep duration with weight-related behaviors. More than one quarter of participants slept < 7 hr/night and had mean Pittsburgh Sleep Quality Index (PSQI) scores indicating poor sleep quality. There were significant differences for all PSQI scales among sleep duration categories, < 7 hr (n = 344), 7–8 hr (n = 449), ≥ 8 hr (n = 459) sleep/night. Compared to those who slept ≥ 8 hr, those who slept < 8 hr had significantly more negative eating attitudes (2% higher), poorer internal regulation of food (4% lower), and greater binge eating (4% higher) scores. Findings advocate for health care professionals to evaluate sleep behaviors of college students during office visits and promote good sleep behaviors.

Recruitment lessons learned from a tailored web-based health intervention project Y.E.A.H. (young adults eating and Active for health)

Purpose – Recruiting college students for research studies can be challenging. The purpose of this paper is to describe the lessons learned in the various recruitment strategies used for enrolling college students in a theory-based, tailored, and web-delivered health intervention at 13 US universities. Design/methodology/approach – The community-based participatory research (CBPR) model was used to develop a staged-tailored, web-based, randomized control trial, focussing on eating behavior, physical activity, and stress management. Participant feedback during baseline assessments was used to evaluate recruitment strategies. Findings – Findings from this feedback suggest that traditional recruitment strategies, such as newspaper ads and flyers, may not be the best approach for recruiting college students; instead, web-based efforts proved to be a better recruitment strategy. Research limitations/implications – This project included results from 13 US universities and thus may not be generalizable: more res...

Path Analysis of Campus Walkability/Bikeability and College Students’ Physical Activity Attitudes, Behaviors, and Body Mass Index:

Purpose: The purpose of this study was to assess the relationship between the walkability/bikeability of college campuses and students’ body mass index (BMI) with student physical activity (PA) attitudes and behaviors as potential mediators. Design: Cross-sectional. Setting: Thirteen university campuses. Participants: A total of 1384 student participants. Measures: Walkability/bikeability environmental score (ES): 12-item audit assessed an average of 44 path segments per campus. Students were measured for height and weight and completed online surveys. Physical activity stage of change/behavior intentions were assessed using the transtheoretical model. The Cognitive Behavioral Physical Activity Questionnaire assessed outcome expectations, self-regulation, and personal barriers. International Physical Activity Questionnaire assessed walking-, moderate-, and vigorous-intensity PA. Analysis: Descriptive statistics, zero-order correlations, and path analysis with maximum likelihood estimation. Results: The overall model fit was good with χ2 of 171.388 (df = 18), P < .001, comparative fit index value of .95, and a root mean square of approximation of .079. After controlling for gender, there was a direct negative association between walkability/bikeability ES and BMI (β = −.085) and positive association between personal barriers and BMI (β = .134). Walkability/bikeability ES was positively associated with walking-intensity PA (β = .010). Self-regulation was positively associated with moderate-intensity PA (β = .213), which, in turn, was negatively associated with BMI (β = −.057). Conclusions: The ease of walking and biking on a campus was related to college students’ walking behavior and their BMI. Students’ PA behavioral intentions were associated with moderate PA and lower BMI. These results provide evidence to focus on policies and structural supports for walkable/bikeable environments to supplement and enhance interventions encouraging individual behavior change for PA and weight management.

Identifying barriers, perceptions and motivations related to healthy eating and physical activity among 6th to 8th grade, rural, limited-resource adolescents

Purpose – The purpose of this paper is to enable community members to discuss their perceptions of eating habits and physical activity in relation to sixth, seventh, and eighth graders, and reveal facilitators and barriers to healthy eating behavior and physical activity engagement. Design/methodology/approach – Nine focus groups, which included six groups from sixth, seventh, and eighth graders, two parents’ groups, and one teachers’ group, were conducted in a middle school in southwest Kansas. Individual influences, social influences, and larger contextual influences on early adolescent health were assessed by discussing behaviors, personal characteristics, and environmental factors, based on the Socio-Ecological Model (SEM). Findings – Adolescent participants’ knowledge regarding healthful foods was limited. Taste and appearance were the two leading factors that contributed to food choices. Responses from adolescents, parents, and teachers all indicated difficulties when introducing new and healthful f...

An Examination of Factors Associated With Self-Efficacy for Food Choice and Healthy Eating among Low-Income Adolescents in Three U.S. States

Background: Self-efficacy is a crucial component in effective health communication and health promotion interventions and serves as a moderator for behavior change. Although awareness and risk perception are important in the behavior change process, self-efficacy gives people the necessary confidence in their ability to engage in advocated health behaviors. In addressing childhood obesity, self-efficacy plays a crucial role in dietary decisions. Informed by the social cognitive theory, this study examines the behavioral and environmental factors that determine self-efficacy for healthy food choices and healthy eating among adolescents in low income communities. Method: A survey was administered among adolescents in 6th to 8th grades from three U.S. States -- Kansas, Ohio and South Dakota (N=410). Results: Results show a correlation between efficacy for healthy food choice and the adolescent’s perceptions of behavioral control or sense of empowerment. Attitudes towards overall health predict efficacy for healthy eating and for healthy food choice. Other predictors for healthy eating include perceptions of peers’ health concerns and perceptions on healthy food availability whereas perceived control influences efficacy for healthy food choice. Gender played a significant role in adolescents’ perceptions of peers’ health concerns whereas geographical location (state played a role in their in adolescents’ attitudes toward health. Ethnicity was a more significant factor in their perceived barriers for healthy eating, perceptions for healthy food availability and in attitudes towards health. Conclusion: The study suggests ethnic-specific nutrition education that focuses on attitudes towards health as well as community partnerships that would support a healthy food environment to enhance self-efficacy and healthy dietary behaviors among adolescents.

The development and preliminary validation of the behavior, environment, and changeability survey (BECS).

OBJECTIVE To develop and test the validity of the Behavior, Environment, and Changeability Survey (BECS) for identifying the importance and changeability of nutrition, exercise, and stress management behavior and related aspects of the environment. DESIGN A cross-sectional, online survey of the BECS and selected validated instruments. SETTING Ten state universities. PARTICIPANTS A convenience sample of college students (n = 1,283), ages 18-24 years. ANALYSIS Principal component analysis was used to confirm a 6-component structure of the BECS in 2 independent samples for the purpose of cross-validation. Internal consistency was measured and construct and criterion-related analyses were conducted to test the reliability and validity of the BECS subscales. RESULTS Six components representing 34 BECS items were revealed from the original 69 items and explained 64% of the total variance. Six scales were retained, and internal consistency of each ranged from α = .82 to .93. BECS Nutrition Behavior and Nutrition Changeability scale scores were highest for participants in action/maintenance Stages of Change for fruit and vegetable intake. CONCLUSIONS AND IMPLICATIONS There is strong support for the use of the BECS when planning health programs to gain insight into behavior that young adults are willing to improve, specifically related to nutrition, exercise, and sleep.

Using the Community-Based Participatory Research (CBPR) Approach in Childhood Obesity Prevention

Childhood and adolescent obesity has increased drastically in the past 30 years. While this is troubling, there is also evidence of large disparities among certain ethnic groups such as African American and Hispanic children and adolescents. The Community-Based Participatory Research (CBPR) Model emphasizes a collaborative, co-learning, mutually beneficial, and community-partnered approach to research. Unique aspects of this model include viewing community members as equal partners in non-hierarchical teams, working together in a strengths-based, action oriented research process. This review consists of an investigation of the CBPR approach, its important tenets, and why such an approach may be more effective for childhood and adolescent obesity intervention program development, especially in stratified communities.