Black, Hispanic, and white girls' perceptions of environmental and social support and enjoyment of physical activity

A multiple technology-based physical activity intervention for Latina adolescents in the USA: randomized controlled trial study protocol for Chicas Fuertes

Background

Latina adolescents in the USA report some of the lowest rates of physical activity of any demographic subgroup; this is paralleled by a markedly higher lifetime risk of obesity, type 2 diabetes, and other conditions related to inactivity. Despite this, to date, no fully powered clinical trials have tested physical activity interventions specifically for this population. High use of mobile technologies (including text messages, smartphone apps, and social media) suggests this could be an appropriate intervention channel, while also having potential for broad reach. This paper describes the protocol for Chicas Fuertes, a fully powered randomized trial of a mobile technology-based physical activity intervention for Latina adolescents.

Methods

We plan to recruit 200 Latina teens (age 13–18) in San Diego, CA, currently engaging in ≤ 150 min/week of moderate-to-vigorous physical activity (MVPA) to be assigned 1:1 to the intervention or control groups. Those randomly assigned to the intervention group receive a one-on-one goal setting session followed by 6 months of mobile technology-based intervention, including a personalized website, Fitbit activity tracker and app, individually tailored text messages based on Fitbit data, and daily intervention content on Instagram. Those randomized to the control group receive only a Fitbit activity tracker. The main outcome is change in weekly minutes of MVPA from baseline to 6 months, measured both objectively (ActiGraph accelerometers and Fitbit Inspire HR) and subjectively (7-Day Physical Activity Recall Interview). Additional outcomes are maintenance of activity change at 12 months and changes in psychosocial constructs, including social support and self-efficacy, engagement with mobile technology channels, and costs of intervention delivery. We are also examining the potential mediators and moderators of the intervention. The efficacy of the intervention is analyzed using a mixed effects regression model, adjusting for any potential confounders not balanced by randomization. All analyses of accelerometer measured MVPA are also adjusted for wear time.

Discussion

The Chicas Fuertes trial uses widely available mobile technologies to target critical health behavior, physical activity, in Latina teens, a population with a high lifetime risk of lifestyle-related diseases. The results will speak to the efficacy and acceptability of the intervention, which has the potential for broad dissemination.

Trial registration

ClinicalTrials.govNCT04190225. Registered on November 20, 2019

Perceptions of Family-Level Social Factors That Influence Health Behaviors in Latinx Adolescents and Young Adults at High Risk for Type 2 Diabetes

Given that health behaviors occur within the context of familial social relationships, a deeper understanding of social factors that influence health behaviors in Latinx families is needed to develop more effective diabetes prevention programming. This qualitative study identified perceived family-level social factors that influence health behaviors in Latinx adolescents (12-16 years; N = 16) and young adults (18-24 years; N = 15) with obesity and explored differences in perceptions across sex and age. Participants completed an in-depth interview that was recorded, transcribed, and coded using thematic content analysis. Emergent themes central to health behaviors included: perceived parental roles and responsibilities, perceived family social support for health behaviors, and familial social relationships. Mom's role as primary caregiver and dad's role as a hard worker were seen as barriers to engaging in health behaviors among adolescent females and young adults, males and females. Adolescents perceived receiving more support compared to young adults and males perceived receiving more support compared to females. Health behaviors in both age groups were shaped through early familial social interactions around physical activity. These insights suggest that traditional gender roles, social support, and social interaction around health behaviors are critical components for family-based diabetes prevention programs in high-risk Latinx youth and young adults.

The role of physical activity enjoyment in the pathways from the social and physical environments to physical activity of early adolescent girls

Most girls experience a notable decline in physical activity (PA) in early adolescence, increasing their risk for harmful health outcomes. Enjoyment for PA (i.e., positive feelings toward PA) is a determinant of PA among girls during adolescence and sustained PA throughout adulthood. Previous studies recommended increasing girls' PA enjoyment in order to increase their PA, but did not include environmental-level strategies for how families, schools, or communities do this. To gain insight on such strategies, this study examines the role of PA enjoyment as a mediator of social and physical environments to moderate-to-vigorous intensity PA of early adolescent girls. Cross-sectional, secondary analyses, using structural equation modeling, were conducted on a U.S. national dataset of 1721 sixth grade girls from the Trial of Activity for Adolescent Girls in 2003. Mediation model fit parameters included χ2 (292, N = 1721) = 947.73 p < 0.001, CFI = 0.95, RMSEA = 0.04 (90% CI = 0.03, 0.04), and SRMR = 0.037 suggesting overall good fit. There were no indirect effects on PA through PA enjoyment from the social or physical environmental factors. To PA, there were significant direct effects only from social support from friends (β = 0.15, CI = 0.09, 0.22). To PA enjoyment, there were significant direct effects from social support from family (β = 0.15, CI = 0.08, 0.23), school climate (teachers β = 0.15, CI = 0.10, 0.21 and boys β = 0.15, CI = 0.09, 0.20), and neighborhood environment (β = 0.10, CI = 0.04, 0.17). The findings of this study identified several direct effects of the social and physical environment on PA enjoyment that can begin to inform environmental-level strategies for increasing PA enjoyment among early adolescent girls.

Correlates of Social Support and its Association With Physical Activity Among Young Adolescents

BACKGROUND

A substantial proportion of adolescents, particularly girls and minority youth, fail to meet daily physical activity (PA) recommendations. Social support contributes to adolescent PA, but studies examining this relationship have yielded inconsistent results and rarely focus on diverse, urban populations.

AIMS

This study examines the correlates of support for PA from family and friends and its relationship with PA outcomes among young adolescents.

METHODS

Data were collected in a cross-sectional survey of 4,773 middle school students. Social support from family and friends was separately measured using the Sallis Support for Exercise Scales. Hierarchical logistic regression models were used to assess correlates of high support and the relationship between support and self-reported PA.

RESULTS

Approximately one quarter of students reported being active for at least an hour each day. 31.7% of students reported high family support for PA, while 17.8% reported high friend support. Differences in perceptions of support by gender, ethnicity, and language emerged. Support from family and friends were both consistently strong predictors of all three PA outcomes measured.

DISCUSSION

Findings highlight the need for multilevel interventions targeting both psychosocial influences on behavior in addition to addressing the physical environment. Given low rates of friend support for PA, there appears to be an opportunity to increase PA levels through promotion of supportive behaviors among peers.

CONCLUSION

Support for PA from family and friends is a key contributor to increased PA among adolescents. Further research is needed to further understand the mechanisms by which these factors influence PA.

Culturally-grounded diabetes prevention program for obese Latino youth: Rationale, design, and methods

BACKGROUND

Type 2 diabetes (T2D) disproportionately impacts Latino youth yet few diabetes prevention programs address this important source of health disparities.

OBJECTIVES

To address this knowledge gap, we describe the rationale, design, and methodology underpinning a culturally-grounded T2D prevention program for obese Latino youth. The study aims to: 1) to test the efficacy of the intervention for reducing T2D risk, 2) explore potential mediators and moderators of changes in health behaviors and health outcomes and, 3) examine the incremental cost-effectiveness for reducing T2D risk. Latino adolescents (N=160, age 14-16) will be randomized to either a 3-month intensive lifestyle intervention or a control condition. The intervention consists of weekly health education delivered by bilingual/bicultural promotores and 3 moderate-to-vigorous physical activity (PA) sessions/week. Control youth receive health information and results from their laboratory testing. Insulin sensitivity, glucose tolerance, and weight-specific quality of life are assessed at baseline, 3-months, 6-months, and 12-months. We will explore whether enhanced self-efficacy and/or social support mediate improvements in nutrition/PA behaviors and T2D outcomes. We will also explore whether effects are moderated by sex and/or acculturation. Cost-effectiveness from the health system perspective will be estimated by the incremental cost-effectiveness ratio using changes in insulin sensitivity at 12-months.

CONCLUSIONS

The results of this study will provide much needed information on how T2D prevention interventions for obese Latino youth are developed, implemented and evaluated. This innovative approach is an essential step in the development of scalable, cost-effective, solution oriented programs to prevent T2D in this and other high-risk populations.

Diabetes Prevention for Latino Youth: Unraveling the Intervention "Black Box"

The translation of research findings into sustainable health promotion and disease prevention programs in community settings remains a challenge. This report describes the process of substantiating a community-developed diabetes prevention program for Latino youth through research. Included are design considerations, measurement strategies, and the context through which the project is culturally grounded for relevance and fit within a local community. The process included (1) refining the program to include salient, stakeholder-identified behavioral components; (2) refining the collaborative effort to embrace the capacity for facilitating relevant behavior change on targeted health-related outcomes to enhance intervention effectiveness; and (3) including the accurate assessment of intervention efficacy via precise assessment of diabetes-related health outcomes. We explain the process of collaborating with community partners to enhance the cultural relevance and sustainability of intervention effects on both individuals and communities. We discuss the rationale for empirical support for academic-community collaborations that function in both a "top-down" and a "bottom-up" manner to advance the science and practice of sustainable and efficacious community health promotion.

Physical and social environmental characteristics of physical activity for Mexican-origin children: examining differences between school year and summer perceptions

BACKGROUND

Colonias are substandard residential areas along the U.S.-Mexico border. Families of Mexican-origin living in colonias face health burdens characterized by environmental and socioeconomic hardships. Mexican Americans and low-income families, including colonias children, do not frequently participate in physical activity despite the known link to disease risk reduction. For colonias children, schools are the most commonly reported location for physical activity. School closures and extreme temperatures during summer months create a need to explore seasonal differences in environmental supports and barriers in this population. The purpose of this study was to examine the effect of seasonality on perceived environmental barriers, opportunities, and social support for physical activity among colonias children. As a secondary aim, mother-child discordance for each factor was analyzed.

METHODS

Promotora-researchers recruited mother-child dyads (n=101 dyads, n=202 participants) from colonias in Hidalgo County, Texas. Mothers and children were separately administered surveys at two time points to capture perceived barriers, opportunities, and social support for physical activity (school-year: February-May; summertime: July-August). Summative scores for each outcome were calculated and three multilevel longitudinal models for continuous outcomes were examined; children were nested within households. Mother-child discordance was measured using Cohen's Kappa statistic.

RESULTS

Physical activity barriers and environmental opportunities (household and neighborhood) increased from school-year to summer by 1.16 and 2.83 points respectively (p≤0.01), after adjusting for covariates. Significant predictors of increased barriers included household income of >$900/month and having more household members. Children of mothers with significant others who were employed part-time or full-time saw significant decreases in barriers. Mother-child agreement of barriers, environmental opportunities, and social support across seasons was slight to fair (range: median κ=0.047 to κ=0.262).

CONCLUSIONS

These results suggest a complex relationship between dimensions of economic hardship (employment status, household income, etc…) and perceived opportunities and barriers of children's physical activity engagement during the school-year and summer. In this study, both barriers and opportunities increased from school-year to summer, further demonstrating that interactions among these characteristics need to be better understood and addressed when considering physical activity initiatives for colonias and other Mexican-American children, specifically during summer when school-based physical activity resources are unavailable.

The association of self-efficacy and parent social support on physical activity in male and female adolescents

OBJECTIVE

Previous research has shown that cognitive factors may account for the relationship between interpersonal factors and health behaviors. Given these findings, the current study sought to further explore the direct and indirect relationship between parental social support and adolescent physical activity (PA).

METHOD

Data were collected from 1,421 sixth graders (73% Black, 54% females, 71% on free or reduced lunch) in South Carolina. Measures for emotional social support, instrumental social support, and adolescent self-efficacy (SE) were assessed and PA was assessed via accelerometry.

RESULTS

Parent instrumental social support was directly related to girls' PA and parent emotional social support was inversely related to girls' PA. Parent instrumental social support was indirectly related to boys' PA through boys' SE. The covaried association of SE with PA was significant for boys and marginal for girls.

CONCLUSIONS

SE for overcoming barriers may be an important construct for understanding the relationship between parent instrumental social support and boys' PA in underserved populations. The mechanisms for engaging in PA may be different for adolescent girls and boys.

Predicting physical activity and fruit and vegetable intake in adolescents: a test of the information, motivation, behavioral skills model

Most adolescents do not meet national recommendations regarding physical activity and/or the intake of fruits and vegetables. The purpose of this study was to explore whether variables in the information, motivation, behavioral skills (IMB) model of health promotion predicted physical activity and fruit and vegetable intake in 404 adolescents from 2 high schools in the Southwest United States using structural equation modeling (SEM). The SEM models included theoretical constructs, contextual variables, and moderators. The theoretical relationships in the IMB model were confirmed and were moderated by gender and race. Interventions that incorporate cognitive-behavioral skills building may be a key factor for promoting physical activity as well as fruit and vegetable intake in adolescents.

Treatment fidelity of motivational interviewing delivered by a school nurse to increase girls' physical activity

Motivational interviewing, which involves the use of person-centered, directive counseling techniques, shows promise for changing adolescent behaviors. The purpose of this article was to describe the methodology and findings related to the treatment fidelity of three face-to-face motivational interviewing sessions involving middle school girls and a school nurse to help the girls increase their moderate-to-vigorous physical activity. The following four areas related to treatment fidelity were addressed: (a) study design, (b) training of interventionists, (c) intervention delivery, and (d) intervention receipt. Findings showed that 34 of 37 (91.9%) girls completed all three sessions. An initial motivational interviewing training workshop followed by evaluation of audiotaped sessions with constructive feedback can result in successful and consistent delivery by a school nurse.

Parental Influences on Physical Activity Behavior in Children and Adolescents: A Brief Review

Understanding the social and environmental factors that influence physical activity is important in the development of effective interventions to increase physical activity behavior in children and adolescents. One factor that has received considerable research attention is the influence of parenting practices and behaviors on child physical activity. This review evaluated 103 studies that examined the influence of parental physical activity, parental support for child physical activity, parenting style, and family cohesion on child and adolescent activity behavior. Results showed that parental support was consistently positively and significantly associated with child activity. With respect to the association between parent and child physical activity, there was little evidence of association. Although the evidence linking parenting style and family cohesion with child physical activity was nonsupportive, too few studies have examined these relationships to draw firm conclusions. Priorities for future research and implications for health care professionals are discussed.

Physical Inactivity of Black Adolescent Girls: Is It All About Attitude?

Physical activity is an essential component for a healthy life and has implications for the prevention of chronic diseases and obesity. Physical inactivity is an independent risk factor for many chronic diseases and is associated with increased morbidity and mortality. Attitudes of Black adolescent girls toward physical activity were identified as an important predictor for engaging in physical activity among Black adolescent girls. Understanding and addressing attitudes of Black adolescent toward physical activity could help increase physical activity levels of Black adolescent girls. Physical activity programs that are enjoyable and culturally relevant are discussed as effective strategies that can increase physical activity levels of this target group, that is, Black adolescent girls. To reverse this growing trend of physical inactivity noted in Black adolescent girls, more intervention programs directed at Black adolescent girls are needed.

Parental social support and the physical activity-related behaviors of youth: a review

Social support from parents serves as one of the primary influences of youth physical activity-related behaviors. A systematic review was conducted on the relationship of parental social support to the physical activity-related behaviors of youth. Four categories of social support were identified, falling under two distinct mechanisms-tangible and intangible. Tangible social support is divided into two categories: instrumental-purchasing equipment/payment of fees and transportation-and conditional-doing activity with and watching/supervision. Intangible social support is divided into the two categories of motivational- encouragement and praise-and informational-discussing benefits of. The majority of studies demonstrated positive associations among selected measures of parental tangible and intangible social support and youth activity. Overall, parental social support demonstrated positive effects. Many studies, however, combine social support categories and/or respondents into composite measures, making it difficult to disentangle the specific effects of parents and the type of support provided.